EastKentCoastCCGs …...41/19 Next Governing Body Meetings: 1.45pm - 4.00pm Tuesday 5 March 2019...

East Kent Coast CCGsThanet CCG Governing Body Meeting - Part 1

Council Chamber, 3rd floor Thanet District Council Offices, Cecil Street, Margate, CT9 1XZ8 January 2019 13:45 - 8 January 2019 16:00

Overall of 184

AGENDA

# Description Owner Time

0.19 Agenda

Thanet Agenda - PART 1 - 8 January 2019v11.doc 7

13.19 Introduction and Apologies Chair

14.19 Feedback and Pre-submitted questions Chair

15.19 Quorum Chair

16.19 Declarations of Interest

16-19 - Thanet GB declaration of interest register.p... 11

Chair

17.19 Draft minutes and Action Log of meeting held on Tuesday 6November 2018

17-19 - 181106 Draft Formal Governing Body minut... 13

17-19 - East Kent CCGs Governing Body Action Lo... 21

Chair

18.19 Managing Director’s Report

18-19 - SBAR Board Report - Managing Director R... 23

Caroline Selkirk,

Managing Director

19.19 Communications, engagement and Public Affairs Update

19-19 - SBAR Board Report comms and engagem... 25

Clive Hart, PPE Lay Member

20.19 Assurance Framework

20-19 - SBAR Board Report - Assurance Framewor... 33

20-19 - Appendix 1 - Assurance Framework Dashb... 35

Anthony May,Acting

Company Secretary

21.19 Local Care Progress Report (including Improved Access)

21-19 - SBAR Board Report - Local Care Update -... 37

Oena Windibank,

Director, Local Care

Quality

22.19 Quality Report

22-19 - SBAR Board Report East Kent Quality Rep... 49

22-19 - East Kent Quality Report for GB 01 19 final... 51

Sarah Vaux, Chief Nurse

Overall of 184


23.19 Wheelchair Service update

23-19 - SBAR based Board Report Jan Wheelchair... 57

Ailsa Ogilvie, Director of

Partnerships and

Membership Engagement

24.19 Children’s Mental Health update

24-19 - SBAR Board Report - Childrens Mental Hea... 65


Partnerships and


25.19 Continuing Healthcare (CHC) Service Update

25-19 - SBAR Board Report dec18 - Quality - CHC... 75

Sarah Vaux, Chief Nurse

26.19 Clinical Assurance and Strategy Committee Summary

26-19 - SBAR Board Report - Summary for Governi... 79

Lorraine Goodsell, Deputy

Managing Director

Finance, Performance, QIPP and Contracting

27.19 Finance Report (month 8)

27-19 - SBAR Board Report - Financial Position at... 83

27-19 - Financial Position - NHSE local Run rate sli... 87

David Meikle,Turnaround

Director

28.19 QIPP Programme Update David Meikle,Turnaround

Director

29.19 Performance Report

29-19 - SBAR East Kent Integrated Performance R... 93

Karen Benbow,

Director of Commissioni

ng

30.19 Transforming Care: Investment in Community Infrastructurefor Learning Disability and Autism

30-19 - SBAR Board Report Transforming Care Co... 115


Partnerships and

Membership Engagement and Emma

Emery, Interim Chief

Finance Officer

31.19 Planning Guidance Mark Needham, Director of Contracting

32.19 Contracting, Finance and Performance Committee Summary

32-19 - SBAR Board Report - Contracting Finance... 139

David Meikle,Turnaround

Director

33.19 Audit, Governance and Risk Committee Summary David Lewis, Audit Chair

Local Care and Primary Care

Overall of 184


34.19 Primary Care Commissioning Committee (PCCC) Summary(Part 1)

34-19 - SBAR EK PCCC Thanet part 1 summary FI... 143

Bill Millar, Director of

Primary Care

Corporate Business

35.19 Terms of reference – East Kent Joint Committee

35-19 - SBAR Board Report - Joint Committee.doc 147

JC Terms of reference unapproved v1.6.doc 151

JC Agreement document unapproved v1.6.doc 163

Anthony May,Acting

Company Secretary

36.19 Strategic Commissioner Progress Report Caroline Selkirk,

Managing Director

37.19 East Kent Executive Meeting Summary

37-19 - SBAR Summaries of Joint Exec Oct and No... 181


Managing Director

38.19 Forward Plan Chair

Any Other Business

39.19 Any Other Business

40.19 Invitations for questions from members of the public on the current agenda

41.19 Date of next meeting - 5 March 2019

42.19 Closure of Part 1

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INDEX

Thanet Agenda - PART 1 - 8 January 2019v11.doc.......................................................................7

16-19 - Thanet GB declaration of interest register.pdf...................................................................11

17-19 - 181106 Draft Formal Governing Body minutes Part 1.docx...............................................13

17-19 - East Kent CCGs Governing Body Action Log - Part 1 - Dec updated - T..........................21

18-19 - SBAR Board Report - Managing Director Report.doc........................................................23

19-19 - SBAR Board Report comms and engagement - Thanet January_TS (00........................25

20-19 - SBAR Board Report - Assurance Framework.doc..............................................................33

20-19 - Appendix 1 - Assurance Framework Dashboard.pdf..........................................................35

21-19 - SBAR Board Report - Local Care Update - January 2019.doc..........................................37

22-19 - SBAR Board Report East Kent Quality Report.doc............................................................49

22-19 - East Kent Quality Report for GB 01 19 final version.docx.................................................51

23-19 - SBAR based Board Report Jan Wheelchairs draft v3 Thanet CCG.doc.............................57

24-19 - SBAR Board Report - Childrens Mental Health Update.doc..............................................65

25-19 - SBAR Board Report dec18 - Quality - CHC Placements - overspend ad..........................75

26-19 - SBAR Board Report - Summary for Governing Body from CASC Meetin.........................79

27-19 - SBAR Board Report - Financial Position at M8.doc...........................................................83

27-19 - Financial Position - NHSE local Run rate slides M8 v1.pptx..............................................87

29-19 - SBAR East Kent Integrated Performance Report (December 18).docx.............................93

30-19 - SBAR Board Report Transforming Care Comunity Infrastructure FINAL..........................115

32-19 - SBAR Board Report - Contracting Finance and Performance Committee.........................139

34-19 - SBAR EK PCCC Thanet part 1 summary FINAL.docx......................................................143

35-19 - SBAR Board Report - Joint Committee.doc.......................................................................147

JC Terms of reference unapproved v1.6.doc.................................................................................151

JC Agreement document unapproved v1.6.doc.............................................................................163

37-19 - SBAR Summaries of Joint Exec Oct and Nov 18.doc........................................................181

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NHS Thanet CCGGOVERNING BODY MEETING – Part 1

Tuesday 8 January 20191.45pm to 4.00pm

Council Chamber, 3rd floor, Thanet District Council, Cecil Street, Margate, CT9 1XZ

AGENDAItems with * for information only

Paper Lead Purpose Time 13/19 Introduction and Apologies Verbal Chair14/19 Feedback and Pre-submitted

questionsVerbal Chair

15/19 Quorum Verbal Chair16/19 Declarations of Interest Chair17/19 Draft minutes and Action Log

of meeting held on Tuesday6 November 2018

All

18/19 Managing Director’s Report Caroline Selkirk,Managing Director

Assurance

19/19 Communications, engagement and Public Affairs Update

Clive Hart,PPE Lay Member

20/19 Assurance framework Anthony May, Acting Company

Secretary

15 mins

21/19 Local Care Progress Report(including Improved Access)

Oena Windibank,

Director, Local Care

Assurance

30 mins

Quality22/19 Quality Report Sarah Vaux

Chief NurseAssurance

23/19 Wheelchair Service update Ailsa OgilvieDirector of

Partnerships and


Assurance

24/19 Children’s Mental Health update

Ailsa OgilvieDirector of

Partnerships and

Membership Engagement/

Assurance

45 mins

Thanet Agenda - PART 1 - 8 January 2019v11.docOverall of 184

Jane O’RourkeHead of EK Children’s

Commissioning Support Team

25/19 Continuing Healthcare (CHC) Service update

Sarah VauxChief Nurse

Assurance

26/19 *Clinical Assurance and Strategy Committee Summary

Lorraine Goodsell,Deputy

Managing Director

To note

Finance, Performance, QIPP and Contracting27/19 Finance report (month 8) David Meikle

Turnaround Director

Assurance

28/19 QIPP programme update Verbal David MeikleTurnaround

Director

Assurance

29/19 Performance Report Karen BenbowDirector of

Commissioning

Assurance

30/19 Transforming Care: Investment in Community Infrastructure for Learning Disability and Autism

Ailsa OgilvieDirector of

Partnerships and

Membership Engagement/Emma EmeryActing Chief

Finance Officer, Thanet CCG

Decision

31/19 Planning Guidance Verbal Mark Needham,Director, Contracts

Assurance

32/19 *Contracting, Finance and Performance Committee Summary

David MeikleTurnaround

Director

To note

33/19 *Audit, Governance and Risk Committee Summary

Verbal David Lewis, Audit Chair

To Note

40 mins

Local Care and Primary Care34/19 *Primary Care

Commissioning Committee (PCCC) Summary (Part 1)

Bill Millar, Director Primary

Care

To Note

10 mins

Corporate Business35/19 Terms of reference – East

Kent Joint CommitteeAnthony May,

Acting Company Approval


Secretary36/19 Strategic Commissioner

Progress ReportVerbal Caroline Selkirk,

Managing Director

37/19 *East Kent Executive meeting Summary


Managing Director

To note

38/19 Forward Plan Chair

10 mins

Any Other Business39/19 Any Other Business

40/19 Invitations for questions from members of the public on the current agenda

10 mins

NEXT GOVERNING BODY MEETING

41/19 Next Governing Body Meetings:1.45pm - 4.00pm Tuesday 5 March 2019 Council Chamber, 3rd floor, Thanet District Council, Cecil Street, Margate, CT9 1XZ

42/19 CLOSURE OF PART 1

Conduct of meetings in relation to attendance by members of the public: Members of the public are asked to note that the Governing Body meetings are meetings of a Committee held in public. They are not ‘public meetings’ where members of the public can speak at any point. Agendas identify when the Chair will receive questions and comments from the public. For all other agenda items speaking rights are reserved to Governing Body members and agreed representatives sitting at the table; members of the public should not speak or intervene in proceedings unless invited to do so. In all matters the Chair’s decision is final.

Written questions from the public: Any questions relating to Governing Body meeting papers which are received in writing three or more days in advance of the meeting will receive a verbal response at the meeting, and the response will be appended to the minutes of the meeting.

Please send your question, along with a contact telephone number or e-mail address, to:

NHS Thanet CCGGoverning Body Clinical Chair


Thanet District Council OfficesCecil StreetMargateKentCT9 1XZOr via email: [email protected]


mailto:[email protected]

Fin

anci

al In

tere

st

No

n-F

inan

cial

Pro

fess

ion

al in

tere

st

No

n-F

inan

cial

Per

son

al In

tere

st

From To

East Cliff Practice - GP Practice✔

Direct Partner in practice providing Enhanced Services


Direct Provider of private consulting and Meeting Rooms.


Direct Active Doctor for Out Of Hours service.

St. Lukes Primary Care Centre - Healthcare✔

Direct Member of St. Lukes PCC

Emma Simmons Trust - CharityIndirect

Trustee of Emma Simmons Trust

East Kent Family Practitioners - Healthcare✔

Direct Director of EKFP Ltd, formed by federation of three

local GP practices.

Romania International Children's Foundation -

Charity ✔Direct Chair of trustees

Fundatia Internationala Pentru Copii, Romania -

Charity✔

Direct President of Governing Body

The Grange Practice - Primary CareDirect GP Partner providing Enhanced Services

Dr Jihad Malasi Clinical ChairMember of British Medical Association ✔

Direct

GP Partner at Bethesda Medical Centre ✔Direct

Thanet CIC Director ✔Direct

Dr Markus Maiden-Tilsen Governing Body MemberThanet Health CIC - Community Health

Direct Director of organisation

Oxney Residentials Ltd - Real Estate✔

Direct Director and Principal Shareholder

Medway CCG - Healthcare Commissioning✔

Direct Lay Member for Governance

Clive Hart Lay Member for Patient Participation

and Engagement

Nil

Sue Martin Lay Member - Primary CareGiving Company Secretary advice to Channel Health

Alliance✔

Direct 25/01/2018 31/03/2018

Ailsa Ogilvie Chief Operating Officer Nil

Date of Interest

Dr John Neden Governing Body Member

Name Current position(s) held in the CCG i.e.

Governing Body member; Committee

member; Member practice; CCG

employee or other

Declared Interest (Name of the organisation and

nature of business)

Type of Interest Is the interest

direct or

indirect?

Nature of Interest

Dr Suzie Marsden Governing Body Member

Dr Muhammad Sohail Governing Body Member

David Lewis Lay Member for Governance

16-19 - Thanet GB declaration of interest register.pdfOverall of 184

Overall of 184

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GOVERNING BODY MEETINGCouncil Chamber

Thanet District Council, Cecil Street, Margate, Kent, CT9 1XZTuesday 6 November 2018, 13:45 – 16:00

PART 1 MINUTES

Members: Dr Jihad Malasi TM Clinical Chair (Chair)Jonathan Bates JB Chief Finance OfficerDr Gauri Jha GJ Governing Body GPClive Hart CH Lay Member, Patient and Public EngagementDavid Lewis DL Lay Member, Governance & RiskDr Marcus Maiden-Tilsen MMT Governing Body GPSue Martin SM Lay Member for Primary Care CommissioningDavid Meikle DM Turnaround DirectorCaroline Selkirk CS Managing Director, East KentSarah Vaux SV Chief Nurse, East Kent

In Attendance: Matt Capper MC Company Secretary, East KentSarah Forster SF Business Support Officer (minutes)Mike Gilbert MG Director of Corporate Affairs, Kent and Medway

Strategic CommissioningAilsa Ogilvie AO Chief Operating Officer, Thanet CCGMia Powell MP Business Support ApprenticeOena Windibank OW Director of Local Care

Item1 Introduction and Apologies

Dr Jihad Malasi welcomed everyone to the meeting. He took the opportunity to thank Jonathan Bates for having served in the NHS with distinction for the last 24 years, the last six of which were as Chief Finance Officer for Thanet and South Kent Coast CCGs. Jonathan retires on 9 November 2018.

Apologies were received from Maria Jackson, Radhi Mangam, Suzie Marsden, John Neden.

2 Feedback and Pre-submitted Questions

No questions were received.

3 Quorum

The meeting was confirmed as quorate.

Dr Jihad Malasi reported that he would need to leave the meeting at 3pm and that Dr Markus Maiden-Tilsen would then deputise as Chair.

4 Declarations of Interest

No additional interests were declared.

5 Draft minutes and action log of the meeting held on 11 September 201817-19 - 181106 Draft Formal Governing Body minutes Part 1.docx

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The minutes were agreed as an accurate record of the meeting held on 11 September 2018.

Performance Report including Cancer and Maternity National Assessments actionAilsa Ogilvie highlighted that the latest update on this action had not been reflected in the papers. She noted that it was not currently possible to access practice level data on patients waiting over 104 days for treatment.

GP representation at PCCCMatt Capper reported that he was exploring a number of options to cover Dr Suzie Marsden at PCCC while she was on maternity leave. Sue Martin highlighted that there were now no GP representatives on the membership of the East Kent Primary Care Co-commissioning Committee and that the nominated representative for the Thanet Primary Care Operational Group (PCOG) had not attended to date.

Action: Matt Capper to explore short term cover arrangements for GP representation at Thanet PCOG from existing GP complement.

6 East Kent CCGs Managing Director Report

The Governing Body noted the East Kent CCGs Managing Director Report.

Caroline Selkirk noted that the outline business case for Kent and Medway Care Record (KMCR) now needed to go to CCG boards, seeking agreement to commit to one interoperative solution and the capital funding to implement and run the solution. However because of the timing of the East Kent CCG Governing Body meetings and the procurement timetable Caroline Selkirk requested the Governing Body delegate authority for approval to the four East Kent Clinical Chairs so as not to delay the process.

The Governing Body agreed to delegate authority to the East Kent Clinical Chairs for the KMCR proposal.

Caroline Selkirk highlighted the public listening events on the reconfiguration of urgent, emergency and acute medical services which were taking place across East Kent, and in Thanet on 13 and 20 November 2018. She noted that the CCG was not in consultation about proposals, but emphasised that the events were a very important way to engage with the public and hear their concerns. She reported that the feedback on the format of the listening events held to date had been positive, with the Health and Scrutiny Oversight Committee commending the format which had also been used at a previous engagement event at the Spitfire Ground. Caroline Selkirk reported that an email with from Save Our NHS Kent had been received and she had responded with details of how the events had been arranged.

7 Communications, Engagement and Public Affairs Update

The Governing Body noted the Communications, Engagement and Public Affairs Update.

Clive Hart reported that the Thanet Health Reference Group were very much looking forward to meeting with Jihad Malasi and with Caroline Selkirk in the near future. He highlighted that a recent event to discuss plans for the development of a new extended facility (hub) at Bethesda was well attended.

Clive Hart noted that a number of recent Thanet Health and Wellbeing Board meetings had been cancelled and emphasised the importance of engaging with partners to affect change.

Action: Caroline Selkirk to discuss with the Chairs how to be more proactive through the pre-agenda setting meeting for Thanet Health and Wellbeing Boards going forward to ensure appropriate agenda items are agreed from all parties.

17-19 - 181106 Draft Formal Governing Body minutes Part 1.docxOverall of 184

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DECISION/APPROVAL

8 Draft Agreement and Terms of Reference for the Joint Committee of Kent and Medway Clinical Commissioning Groups (including Cancer Services)

Mike Gilbert reported that the agreement and terms of reference proposed were very similar to the other established joint committee arrangements (for example the Joint Stroke Committee) however rather than developing new joint committees for each service area, a single joint committee would be established to consider strategic elements of commissioning and services for consideration would be opted in subject to unanimous agreement from all Kent and Medway CCG Governing Bodies. He noted that the eight CCGs were moving towards working in greater alignment across the county while the individual CCGs remained responsible for their geographic services. He highlighted that the proposal included core members who would serve on the joint committee regardless of service area discussed, and non-core members who would only attend meetings relevant to their specialty. He noted that the percentage for quoracy and passing votes had been set very high to build trust among all member organisations, and stated that this could be reviewed at a later date if required. Several Thanet Governing Body members noted that they were assured by this high threshold.

The lack of non-executive member on the proposal to provide challenge and hold others to account was queried. Mike Gilbert reported that this had been considered and discussed with the lay members for governance for all the Kent and Medway CCGs however it was felt that this would increase the membership numbers too extensively. He noted that a governance oversight group had been established to look at the governance of the STP and the development of the strategic commissioner, and that there were non-executive representatives on all CCG sub-committees to provide sufficient challenge.

The lack of a nursing and quality member was queried. Mike Gilbert agreed that this was an oversight and that he would take a proposal for a nursing and quality representative both in terms of a core member and appropriate specialty non-core member to the other seven Kent and Medway CCGs for agreement (as Thanet was the first Governing Body to consider the proposal).

Action: Matt Capper to feedback from other Kent and Medway CCGs on the proposal for including nursing and quality representation on the membership of the proposed Joint Committee.

The need for meeting venues to rotate, and not always be central, to ensure that clinical representatives from Thanet could attend was noted.

The Governing Body approved the Draft Agreement and Terms of Reference for the Joint Committee of Kent and Medway Clinical Commissioning Groups (including Cancer Services) and agreed to delegate authority to the Company Secretary and Clinical Chair for minor amendments to be made if required.

9 Constitution including Standing Orders and Standing Financial Instructions

Matt Capper reported that the Department of Health had recently launched a revised model constitution and as the four East Kent CCGs were working in much closer alignment with a new joint executive team it was agreed that the constitution should be updated. The opportunity had also been taken to harmonise the schemes of delegated authority and the standing financial instructions. He reported that the draft had been reviewed by the East Kent CCGs Audit Committee and following feedback the sections of the constitution which had been revised were not highlighted for easier identification. He noted that as the CCGs had adopted the handbook it was possible to make minor amendments without seeking NHS England approval. He also noted that some of the links within the document had been knocked out due to automatic updating and these would be corrected.


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The Governing Body approved the amended constitution subject to the following amendments:

Explicit statement regarding acting in the best interests of patients Consistent use of either Company Secretary or Director of Corporate Affairs Independent Registered Nurse to be included under item 5.5.2/3

10 Risk Management Strategy

Matt Capper reported that the risk management strategies across the four East Kent CCGs have been reviewed and updated to describe an East Kent CCGs approach to risk management. The document had been previously presented to Governing Body but the latest draft reflected comments from the Audit Committee. He noted that the internal auditors required Governing Body approval of the document. In addition appetite for risk required Governing Body agreement. A Governing Body development session in January 2019 would be dedicated to this.

It was noted that the section around Accountable Officer responsibilities did not accurately reflect the delegated responsibilities of the East Kent Managing Director and it was agreed that this should be updated.

The Governing Body agreed to delegate authority to approve the risk management strategy and risk appetite to the East Kent Clinical Chairs or Audit Chairs.

11 Delegation of the management of Excess Treatment Costs

Jonathan Bates reported that CCGs were responsible for the cost of treatment within research studies in non-commercial research projects. He noted that very little research was undertaken in East Kent and therefore the costs involved were small.

The Governing Body approved the delegation of the management of excess treatment costs.

Matt Capper reported that a research strategy was being developed with some East Kent GPs in collaboration with the University of Kent and Canterbury. A portfolio and clinical trial research programmes were being developed in preparation for the establishment of the new medical school at Canterbury and these would be brought to Governing Body in due course for consideration. He noted that these would also feed into the pipeline for QIPP plans for 2019/20.

DISCUSSION/ASSURANCE

12 Winter Planning Update

Ailsa Ogilvie noted that the winter planning was advancing well and was being progressed through the A&E Delivery Board. Oena Windibank reported that the current draft had been through external independent review and been discussed by both NHS England and NHS Improvement.

One of the metrics to be used to ensure effective system flow during the winter period was attaining 185 discharges a day from EKHUFT over a seven day week. Oena Windibank reported that 185 discharges were currently being achieved during Monday-Friday, with 150 per day at the weekends. She noted that the senior leadership group were meeting fortnightly with telecoms between meetings. Dr Gauri Jha queried whether there was evidence that patients were being discharged inappropriately and bouncing back within 48 hours. Oena Windibank reported that once patients could be tracked electronically this would be reviewed; in the meantime spot check audits were being undertaken to ensure this was not occurring.

Social services capacity was noted as a historic stumbling block for winter planning. Oena Windibank noted that there was social services involvement in the senior leadership group and a


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social care element of the rapid transfer service. She noted that the access issue was evidenced anecdotally and that the acute task force team were looking at long stay patients and the reasons behind their long stays to address them. She noted that social care had been awarded additional winter monies and the A&E Delivery Board would hold them to account.

Dr Markus Maiden-Tilsen queried how primary care was involved and requested that the term ‘transfer of care’ was used instead of ‘discharge’. Oena Windibank confirmed that the discharge policy was being updated to reflect the term ‘transfer of care’ but noted that the reporting systems still used the term ‘discharge’. She reported that simple discharges should not affect primary care and that work was underway with enhanced primary care networks to gather information on simple discharges. Complex patients would be managed by the rapid transfer team.

Dr Gauri Jha queried whether A&E patients would still be discharged with only two days of medication and told to see their GP for repeat prescriptions. Oena Windibank reported that she, Karen Benbow (Chief Operating Officer for South Kent Coast CCG and EKHUFT contract lead) and Bill Millar (Director of Urgent Care) had met with EKHUFT to monitor the contract arrangements.

13 EPRR Assurance Plan

Matt Capper reported that NHS England launched a new Emergency Preparedness, Resilience and Response (EPRR) Assurance Toolkit in July 2018. All four East Kent CCGs have assessed themselves as being ‘substantially compliant’ with the 2018 toolkit. He noted that in the assurance process last year the four CCGs were assessed as being ‘fully compliant’ however there were two sections that could not be completed in advance of the submission date. There was push back nationally around how these sections could be scored.

Sue Martin noted that the CCG had a responsibility for ensuring providers were compliant and noted that this was challenging. Matt Capper reported that EKHUFT had buddied up with MTW to share learning and improve acute level resilience and had been assessed as fully compliant. KMPT had also made progress and had been assessed as fully compliant this year. A new template for business continuity planning and emergency preparedness for primary care was being rolled out shortly and NHS England were keen to use East Kent as an exemplar and share with the wider primary care community.

14 Local Care Progress Report

Oena Windibank noted that the Thanet focus for the report was not currently clear enough and would be adjusted for future Governing Body meetings. She noted that the fortnightly multi-disciplinary team meetings had been rolled out in all Thanet primary care homes and the feedback had been very positive to date. Wound and continence clinics were also now in place. The patient tracker list would be rolled out in the next six weeks. Work was under way with all Thanet GP practices to identify priorities for local care investment. Submissions were not currently aligned and therefore consensus would be sought around whether to support rolling out the acute care team or setting up a home visiting service. The work undertaken on Westbrook House last year was paying dividends and a new model of care had been established in June 2018. The number of patients going through Westbrook House had increased and the number of hospital admissions had been reduced. GPs have direct access to Westbrook House as it piggybacks the ART model.

Dr Markus Maiden-Tilsen highlighted that the positive impact of the local care initiatives was being seen in primary care.

15 Strategic Commissioner Progress Report

The Governing Body noted the Strategic Commissioner Progress Report.

16 QIPP Programme


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David Meikle reported that the figures contained within the report pertain to Month 6. There was an adverse variance of £780k on the plan in the year to date, however work was ongoing to validate savings which would be reconciled at Month 7 through the vigorous PMO assurance processes. Oena Windibank confirmed that a lot of work had been done on local care QIPP and this would be a lot closer to plan in Month 7.

Sue Martin queried how the Joint Executive Team were planning to address the risk. Caroline Selkirk confirmed that key plans which would deliver big savings were being very vigorously project managed and the Joint Executive Team were identifying what could be done to help support delivery of these.

17 East Kent CCGs – Revised Committee Terms of Reference

Matt Capper reported that the revised terms of reference for all the East Kent CCGs committees had been presented at the East Kent Governing Body development session on 27 September 2018 and comments made had been included in the revised versions.

The Governing Body ratified the terms of reference and the decisions made by the committees to date.

18 Wheel Chair Service Update

The Governing Body noted the Wheel Chair Service Update.

19 Governing Body Assurance Framework

Matt Capper reported that the presented framework represented the first iteration of the East Kent CCG’s Governing Body Assurance Framework, following recent discussions at the Audit Governance and Risk Committees. It was noted that the format was very different to the previous board assurance framework template. Matt Capper confirmed that all four East Kent CCG Governing Bodies would receive training on the new version at a future Governing Body development session.

20 Finance Report

David Meikle presented the East Kent CCGs position at Month 6. He noted that in addition to planned QIPP there were areas of overspend which needed to be addressed including £11m on acute overperformance, £4m on Continuing Healthcare (CHC) and placements and £2m in the independent sector. He reported that the CCGs were working closely with EKHUFT, testing the trust’s ability to deliver planned activity to bring costs closer to the £419m in the CCG plan. There is a scrutiny programme for CHC; however an unintended consequence of this work was that cases were being brought forward for consideration. Jonathan Bates and Mark Needham (Director of Contracting) had held discussions with the six main independent healthcare providers in East Kent so overspend was expected to reduce. However a caveat to this was the statutory RTT requirement that no more patients were waiting at the end of the year than the beginning.

Jonathan Bates presented the Thanet CCG position at Month 6 and reported that the deficit was at £5.6m. The majority related to the acute trust. He also reported that there was £1.6m adverse variance with Spencer Wing and work was underway to drive down the trajectory of activity by £1m by year end. He noted that CHC was £700k above plan and that the number of new patients requiring assessment or funding was outweighing the work being undertaken to reduce spend. It was noted that if patients were assessed too early or whilst in hospital then they were more likely to meet the CHC eligibility criteria. GP drugs were underspend by £1/3m but pharmacist vacancies were an issue to be addressed.


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David Meikle confirmed that there were twice weekly meetings between the CCG and the trust to maintain momentum.

21 NHS England and NHS Improvement Planning Update Letter

David Meikle highlighted that it was explicit in the planning guidance that the CCGs and EKHUFT were expected to work together. He noted the key submission date in the timeline – 14 January 2019 – when the 2019/20 initial plan must be submitted.

22 Commissioning Intentions

The final version of the public information leaflet was noted by the Governing Body.

23 Performance Report

Ailsa Ogilvie highlighted that the number of cancer patients waiting over 104 days had decreased to eight. She noted that there was a new Chief Operating Officer at EKHUFT who was keen to turn performance around and was focused on patients waiting between 45 and 62 days for treatment to identify actions required. EKHUFT had suggested compliance to target by December 2018, however the CCG currently had limited assurance around this.

Ailsa Ogilvie reported that A&E performance had begun strongly this year and had improved over the first five months, however this had decreased over the last three months and there was a risk it could worsen with winter pressures. Ambulance handovers had maintained positive reduction and therefore if flow was maintained combined with a strong winter plan and focus on stranded patients then improvement in A&E performance may still be possible.

24 Chief Nurse Report – Safeguarding Annual Report

Sarah Vaux noted that EKHUFT had recently been inspected by the CQC and was awaiting the written report. There have been improvements in mixed sex accommodation figures which hinted at improvement in patient flow. KMPT had also had a CQC inspection and concerns remain about staffing levels. She noted that the Governing Bodies would undertake their mandatory safeguarding training during the development session in December 2018.

TO NOTE25 Primary Care Commissioning Committee (PCCC) Summary (Part 1)

The Governing Body noted the Primary Care Commissioning Committee report.

26 Clinical Assurance and Strategy Committee Summary

The Governing Body noted the Clinical Assurance and Strategy Committee report.

27 Audit Governance and Risk Committee Summary (Part 1)

The Governing Body noted the Audit Governance and Risk Committee report.

28 Forward Plan

This item was carried forward as Jihad Malasi was not present.

FOR INFORMATION29 Kent and Medway Medical School Update

The Governing Body noted the update.


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30 CCG Annual Report 2017/18

The Governing Body noted the CCG Annual Report 2017/18.

ANY OTHER BUSINESS31 Invitations for questions from members of the public on the current agenda

No questions were received.

NEXT GOVERNING BODY MEETING8 January 2019

CLOSURE OF PART 1


East Kent CCGs Governing Body Action Log - Part 1

Relevant CCG Date of Meeting Item No. Action no. Action Assigned To Update Status

All 12/09/201811/09/201806/09/2018

09/18/05016191/18

GB1-07145

Governing Body Assurance FrameworkMatthew Capper to circulate an updated frameworkbefore the next Governing Body meeting

Matthew Capper Single assurance framework for all CCGs reviewed by AuditGovernance and Risk Committee in December 2018.Assurance Framework Dashboard on Governing BodyJanuary 2019 Agenda.

Complete

Thanet 06/11/2018 5 5.1 Draft minutes and action log of the meeting held on 11September 2018Matt Capper to explore short term cover arrangementsfor GP representation at Thanet PCOG from existing GPcomplement.

Matthew Capper In Progress

Thanet 06/11/2018 7 7.1 Communications, Engagement and Public AffairsUpdateCaroline Selkirk to discuss with the Chairs how to bemore proactive through the pre-agenda setting meetingfor Thanet Health and Wellbeing Boards going forwardto ensure appropriate agenda items are agreed from allparties.

Caroline Selkirk In Progress

Thanet 06/11/2018 8 8.1 Draft Agreement and Terms of Reference for the JointCommittee of Kent and Medway Clinical CommissioningGroups (including Cancers Services)Matt Capper to feedback from other Kent and MedwayCCGs on the proposal for including nursing and qualityrepresentation on the membership of the proposed JointCommittee

Matthew Capper All CCGs agreed to the proposal to include a nursing andquality representation on the membership of the jointcommittee.

Complete

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Thanet 11/09/2018 19 6 Primary Care Commissioning CommitteeMatthew Capper to take forward GP representation atPCCC while SLM was currently on maternity leave.

Matthew Capper No expression of interest was received. SLM returningMarch 2019.

In Progress

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East Kent Clinical Commissioning Groups

Meeting Title: Thanet CCG Governing Body Agenda Item: 18/19

Date of Meeting: 8 January 2019

Title of Report: Managing Director’s Report

Author: Caroline Selkirk, Managing Director, East Kent CCGs

Executive/ Lay Sponsor: Caroline Selkirk, Managing Director, East Kent CCGs

Finance sign-off Not required

Approval Decision Assurance InformationThis paper is for:(please X as applicable) X

Are any members of the meeting conflicted?

Y/N None identified: members to declare conflicts as necessary.

No YesIs circulation restricted?(please X as applicable) X

Report summary/purpose:

This report provides an update on key items not covered elsewhere on the Governing Body agenda.

Changes to the Executive Team

We have continued to make changes to the joint Executive Team across the four east Kent CCGs to overcome our challenges and ensure that we work as a single, efficient team. To this end, we have replaced the two Chief Operating Officer roles, with a Director of Commissioning - Karen Benbow - and a Director of Partnerships and Membership Engagement - Ailsa Ogilvie.

The Director of Commissioning will look after the major contracts with EKHUFT, KCHFT, KMPT, GP federations and the commissioning of planned care, urgent care and cancer services. The Director of Partnerships and Membership Engagement will be responsible for local patient and public engagement, as well as the commissioning of children’s maternity services, children and young people’s targeted and specialist mental health services, the wheelchairs contract and supporting the GP membership.

The Director of Corporate Services and Governance – Matthew Capper - has been seconded to the Kent and Medway STP where he will be working to ensure the health and care systems in Kent and Medway are as prepared as possible for all possible Brexit scenarios. Whilst Matthew is on secondment, the Head of Corporate Services – Anthony May - will be Acting Company Secretary.

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Following an external recruitment process for a new Chief Finance Officer for the CCGs in east Kent, the interviewing panel met with three shortlisted candidates on Monday 10 December and unanimously selected Ivor Duffy as the successful candidate. Ivor demonstrated knowledge and understanding of East Kent and put forward the best approach to our financial situation.

Ivor is currently working with NHS England as Director of Assurance and Delivery and will be returning to East Kent, where he was the Chief Finance Officer with Ashford & Canterbury and Coastal CCGs until 2015.

We look forward to Ivor joining the Executive Team early in 2019.

All staff event

We held a successful all staff event on 17 December 2018, where we reflected on and celebrated the achievements we have made over the last eleven months, since the four CCGs commenced working more closely under a single Managing Director, whilst also recognising the challenges ahead. Bringing the four CCGs together has been an evolutionary process but we are now getting the right people in the right roles and that puts us into a good position for the journey ahead.

At the event we agreed to establish a staff engagement forum to provide a space for discussing what matters to staff and how we can work collectively as we go forward.

Recommendation:

The Governing Body is asked to note the report.

Combined impact assessments Has the report/recommendation/proposal been impact assessed

Yes

No (state reason)

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Meeting Title: NHS Thanet CCG Governing Body

Agenda Item: 19/19


Title of Report: Communications, engagement and public affairs update

Author: David Muir, Head of Communications, NEL Commissioning Support Unit

Executive/ Lay Sponsor: Clive Hart, PPE Lay Member

Finance sign-off N/A



N None identified: members to declare conflicts as necessary



This paper gives an on update on communications and public and patient engagement activities to the end of December 2018.

Recommendation:

That the governing body note this report.


Yes

No (state reason)

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SBAR Report

Communications, engagement and public affairs update

Situation:

This report highlights activities undertaken since the last governing body meeting.

1. Patient and Public Engagement

1.1 Lay Rep’s UpdateThanet Health Reference Group (HRG) met twice. 0n 13 November they met with Dr Jihad Malasi, our Thanet CCG Chair and on 5 December with our East Kent Director, Caroline Selkirk.

Both meetings lasted two hours and covered a very wide range of patient-raised concerns. Chaired by our Lay Member for Patient and Public Engagement, the group continues to provide valuable support and positive challenge (as a critical friend) to NHS Thanet Clinical Commissioning Group (CCG) on local health service provision.

Thanet Health Network consists of patients, the public, and representatives of local voluntary organisations and community groups. Our Lay Member keeps the Health Network updated on the CCG’s work with a monthly e-bulletin. This month’s bulletin provided feedback from recent discussions concerning the Margate Hub project. We also communicate and engage with the network on a broad range of topics concerning NHS service provision in Thanet.

Our lay member (Public Champion) also promotes the work of the CCG in relation to engagement, healthy and active lifestyles and positive causes to 1,100+ followers using social media platforms.

At a meeting of Thanet Adult Strategic Partnership (TASP) on 28th November, our lay member heard concerns from the voluntary sector concerning communication with CCG staff on specific work stream issues. It appeared that some CCG personnel had changed roles and third sector organisations were having difficulty gaining and maintaining contact. A new contact sheet for the East Kent Executive Team, provided by the CCG, was presented to the meeting and went some way to helping this situation.

TASP members also called for a stronger Thanet Health and Wellbeing Board as it is the only public forum at which they could more meaningfully engage with Thanet District Council, Kent County Council, and the NHS.

Our lay member supported the Ageless Thanet 50+ Festival held at St George’s School in Broadstairs on Sunday 4 November and the national annual Ageing Better Conference held at Turner Contemporary on 8/9 November, also hosted by our local Ageless Thanet team. Both events were excellent showcases for examples of best practice taking place locally and nationally in the fight against ageism, social isolation and loneliness.

Our lay member attended both the recent public (pre-consultation) NHS East Kent listening events in Ramsgate on 13 November and in Margate on 20 November. The listening events were part of wider pre-consultation engagement on potential changes to local care and hospital services. Both events were well attended and our lay member would like to thank everyone who supported this latest round of discussions.



1.2 Thanet Health Network Thanet Health Network consists of patients, the public, and representatives of local voluntary organisations and community groups. We also communicate and engage with them on questions about services across Thanet.

A recruitment plan has been developed to increase the number of members on Thanet Health Network. This will be done in various ways such as, face to face with sign up cards by targeting existing groups and seldom heard groups, online through the use of the CCG website and promotion through advertising on social media sites which include Facebook, Instagram and Twitter.

1.3 Margate engagement on development of services for new Bethesda facility To make sure that the new Margate hub meets the needs of the patients already registered at Bethesda Medical Practice, patients registered at Northdown Surgery, and the local Margate population, the ideas and plans were shared and tested with Margate residents, with four specific questions:

1. What services should be in the hub and why? Which of these are essential and which desirable? What have we missed?

2. Are there any other factors you would like us to consider in terms of the community hub helping to keep the Margate population well?

3. What should we consider to make sure the hub is easily accessible and can serve our population?

4. This centre and the additional services will be at the Bethesda Medical Practice, but the extended facility is available to patients across Margate, so what should we call it? Suggestions include: community hub, integrated community services, Margate health centre, Margate healthy community hub. What would make sense to people?

The answers to all of these questions showed consistent concern from people about the possibility of Northdown Surgery merging with Bethesda Medical Practice. There will be separate engagement with local people about this.

Other main themes were:

Support for social prescribing – working in partnership with voluntary and community organisations to run projects for people who are socially isolated or have mental health issues.

A need for good access – this focused mostly on adequate car parking and good access to the building for people who are disabled, but also touched upon the challenges people may face trying to get there on time for an appointment.

Transport/travel – this is a real concern for people, especially those living in the Dane Valley and Northdown area of Margate. There will be a need for people to catch two, if not three, buses to get to the building one way and the cost may also become prohibitive for some residents.

Concerns about the appointment system – if the number of patients increases, will people be able to get an appointment? This is already a struggle.

The need for more appointments – This focused on appointments being available for working adults after 5pm and before 8am on a weekday and more availability at weekends: this fits with the CCG’s recent introduction of more appointments to improve access to GP services.



Improving information for local people – providing health and wellbeing information and service information more readily available in places people go.

Recommendations Engagement and communication to continue throughout this project.

Assess the needs of the community to develop a sustainable transport/ travel plan, co-designing this with local people.

Look at different ways of working within the community to support local people, not necessarily from the Bethesda Medical Centre.

An engagement report was written to support the full business case which was submitted to NHSE at the end of November.

1.4 East Kent TransformationTen public listening events were held between 30 October and 12 December 2018 across east Kent. More than 600 members of the public attended across the ten sessions. The programme for each event included a mixture of presentations (on the case for change and options being developed), whole group question and answers, and facilitated table discussions. Each event ran for three hours. On two occasions (Hythe and Ramsgate) the whole group discussion continued for an extended period so there were no table discussions. Engage Kent attended all sessions as observers and will produce a report on the events.

1.4.1 Key themes from listening eventsFrom the communications and engagement group’s perspective, some key themes from the listening events are listed below. In each case, the comments highlight the need to provide more compelling evidence and to further clarify current challenges and future plans as part of preparing the Pre-consultation Business Case (PCBC) and materials for a public consultation.

Case for change support – good levels of general support for the objectives of improving care by providing more local services and bringing specialist services together. However, clear expectation of more evidence being made available to support statements about the challenges facing local services.

Workforce – concerns were raised about current workforce shortages in primary care, community and hospital services and the impact this will have on the ability to deliver the proposed improvements. A particular focus of comments was on general practice with current workforce constraints already making it difficult to access services and concerns about how general practice could take on more.

Travel times – concerns were raised about the potential distance people would need to travel for A&E, maternity and specialist services. Concerns covered both travel in ambulances and by private car or public transport. At several events people questioned the assumptions we are making about travel times from various parts of east Kent. Feedback from areas such as Romney Marsh and Hythe was that existing hospital services were already a long way.

Developer’s offer – concerns were raised about the potential risk of the developer’s offer falling through and what impact that would have. Comments about whether the NHS should accept such offers were raised.



1.4.2 Public SurveyAn online and hardcopy survey ran until 9 December 2018. A total of 774 responses were received. Most responses have been from members of the public with a smaller number coming from NHS staff in east Kent.

The survey asked similar questions to the discussion topics at the listening events e.g. how well people feel the case for change has been made, whether the proposals will improve patient experience and quality of care; and what additional information people would expect to see supporting a public consultation.

An independent report on the results is being produced to support the stakeholder engagement section of the PCBC and preparation for consultation.

1.4.3 Engage Kent undertake Outreach engagement for east Kent transformationEngage Kent has been commissioned to carry out research with seldom heard groups. They have used a mixture of street surveys and group discussions to gather feedback. and have spoken with over 400 people.

Groups they have attended include: Homeless & migrant Mental health Nepalese Slovak & Roma mums Parents with disabled children.

Street surveys have focused on geographical areas with multiple indices of deprivation and rural isolation, including: Cliftonville (CT9), Victoria Park (TN23), Shepway (CT20), Northgate (CT1), Minster (CT12), Tenterden (TN30) and Hawkinge (CT18). Surveys were also carried out with students on the Canterbury campus. Further meetings and street surveys continued in December, with additional visits to areas where we were not able to run public listening events including Romney Marsh, Whitstable, and Deal.

1.4.4 Out of area patient and public engagement

The East Kent Hospitals University NHS Foundation Trust (EKHUFT) runs a number of specialist services with a catchment area beyond east Kent. These services include haemophilia outpatients, Primary Percutaneous Coronary Intervention (PpCI) and renal inpatients. The number of patients from outside east Kent using these services (and the percentage of EKHUFTs activity for each service) is relatively low; however a programme of targeted engagement with patients will be taking place in January.

1.4.5 East Kent transformation next stepsA full report from the Oct-Dec 2018 pre-consultation engagement activities will be prepared for the East Kent Transformation Delivery Board and will be used to support the next stage of evaluation of the current options. It will also be included as part of the stakeholder engagement content for the PCBC. The communications and engagement group are currently developing a plan for ongoing stakeholder engagement between now and the public consultation to ensure we continue to gather feedback and provide progress updates to stakeholders and inform the plans for public consultation. An initial discussion with the Patient and Public Advisory Group about consultation planning is being held in January.

1.5. Kent and Medway Patient and Public Advisory GroupThe Public and Patient Advisory Group (PPAG) continue to meet each month. We have successfully recruited new members and are currently inducting them and seeing which of



the Kent and Medway Sustainability and Transformation Partnership (STP) work streams they would be interested in joining. PPAG members are now each involved in at least one of the STP work streams, making sure a patient/lay perspective at a more detailed level across the programme. We have shared the co-production approach across all work streams and we are encouraged to hear that several are intending to use it: local care and the development of the carer’s app, mental health has identified several opportunities and prevention also wants to use it.

In November we had positive updates on: the clinical vision captured on a single page shows the influence of patient’s

perspectives

the prospective medical school has appointed a Foundation Dean, Professor Chris Holland. He has assumed leadership of the school. 100 places were approved in spring 2018 and the two partner universities immediately began the multiple, inter-related pieces of work required to gain the necessary accreditations

the changing governance arrangements for local care

the Kent and Medway Care Record, having finalised its outline business case, is ready to proceed to procurement.

2. Spreading the word through the media and other communications

2.1 News releasesWe have sent out five news releases across all four CCGs since the last governing body meeting. These announced the additional east Kent listening events, the third award in a year for the Mind and Body programme, reminded residents to take up their flu vaccination and promoted Self Care Week.

2.2 Web articlesWe published an update on the Kent and Medway wheelchair service, promoted free suicide prevention training offered by Kent County Council and the east Kent winter patient newsletter.

Top 5 pages1. Prescribing Recommendations2. About Us3. Governing Body4. Contact Us5. Who we are

Web Updates Web banner and news article for Suicide Prevention Training A number of news articles General admin support Adding new categories Adding new Intranet users

The NHS Thanet CCG website has been viewed 4,440 times in the past two months.



2.3 Social mediaSince the last governing body meeting, we have sent out an average of 80 tweets from each CCG account. These included promoting the east Kent listening events, details of governing body meetings and all news releases. We supported national campaigns such as Flu, Stoptober, Improved GP access plus awareness campaigns including self-care, alcohol awareness and diabetes. We also supported provider messaging for East Kent Hospitals University NHS Foundation Trust, Kent and Medway NHS and Social Care Partnership Trust and Kent Community Health NHS Foundation Trust. In addition, we promoted stay well in winter messaging (aligned to the national campaign Help Us Help You) including pharmacy, minor injury units, GP, NHS 111 and Health Help Now plus social prescribing such as parkrun and Active10. All four accounts have seen an increase in engagement and new users in this period.

NHS Thanet CCG Twitter account now reaches 14,700 people.

2.4 Urgent care communicationsThe Kent Health Help Now web app, which launched in December 2013, has now been used 374,269 times by people using 314,910 devices (such as smartphones, tablets or computers). Users stay on for just over one minute on average.

Forty per cent of users are aged 18 to 34, 24 per cent are 35 to 44, 17 per cent 45 to 54, 11 per cent 55 to 64, and eight per cent 65 plus. Just over 70 per cent of usage is by women.The downloadable app, which launched in December 2014, had been used 93,400 times by 38,136 visitors. People typically stay on for five minutes and look at 13 screens.

3. Public affairs

3.1 Health overview and scrutinyAt the Health Overview and Scrutiny Committee (HOSC) meeting on 23 November, briefings were presented on:

Kent and Medway Strategic Commissioner South East Coast Ambulance Service NHS Foundation Trust (SECAmb) CCGs Annual Assessment 2017/18 (Written Update) Kent and Medway Integrated Urgent Care Service Procurement Kent and Medway Non-Emergency Patient Transport Service Performance.

The next HOSC meeting is on Friday 25 January 2019.

The meeting schedule for 2019/20 has been published.

Following the April 2019 meeting the dates move away from traditionally being held on a Friday.

The dates are as follows: Friday 25 January 2019 Friday 1 March 2019 Friday 26 April 2019 Thursday 6 June 2019 – newly published from this point onwards Tuesday 23 July 2019 Thursday 19 September 2019 Tuesday 26 November 2019 Wednesday 29 January 2020



Thursday 5 March 2020 Wednesday 29 April 2020.

3.2 Stakeholder briefings A briefing note was prepared for members of the Medway Health and Adult Social Care Committee (HASC) on the Kent and Medway wheelchair service.

Briefings were prepared in response to a letter to the Secretary of State from Craig MacKinlay MP on the Kent Stroke Services reconfiguration and a letter from Kevin Hollinrake MP on behalf of a constituent who was in need of an A&E whilst visiting east Kent, and who raised some concerns about provision in the area.

Background:We recognise that listening to, and acting on, what matters to local people is important to the delivery of our commissioning intentions and plans. The more actively we engage and communicate with patients and local people in jointly designing and commissioning services, the more active and powerful a resource they will become and this will help us gain a much better return on the money we invest in local services.

Assessment:The CCG has a statutory duty to involve patients and the public in their work in a meaningful way.

It is important that the CCG involves people in commissioning to improve health and care services and that it meets its legal duties to do so under the National Health Service Act 2006 under sections 14Z2 and 13Q respectively.

The actions described in this report are part of an ongoing programme of activity to involve patients and the public in commissioning in a meaningful way and one which enables them to make informed decisions about their health care and to give the Governing Body assurance that it is meeting its legal duties.

Recommendation:That the governing body note this report.





Title of Report: Governing Body Assurance Framework Dashboard

Author: Anthony May, Acting Company Secretary

Executive/ Lay Sponsor: Anthony May, Acting Company Secretary







This report updates the Governing Body on the introduction of a Governing Body Assurance Framework Dashboard following review of risk management reports by the Audit Governance and Risk Committee.

The Governing Body Assurance Framework Dashboard links the CCGs’ strategic priorities to the strategic objectives and describes the link between these and the items on the Governing Body agenda.

A copy of the Dashboard is provided in appendix 1.

Recommendation:

1. The Governing Body should note the introduction of the Assurance Framework Dashboard, and the detail contained within.


Yes

X No (state reason) – not required

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Situation:

The Governing Body Assurance Framework Dashboard links the CCGs’ strategic priorities to the strategic objectives and describes the link between these and the items on the Governing Body agenda.

Background:

An effective Assurance Framework and associated risk management process drive the agenda of the committees and Governing Bodies it reports to. To reinforce this, the agenda template for the Governing Body has been redesigned around key work areas and an Assurance Framework Dashboard has been developed to cross reference the strategic objectives, priorities and the various sections or reports on the Governing Body agenda. Both the Dashboard and the Assurance Framework were reviewed by the Audit Governance and Risk Committee in December 2018.

Assessment:

The Dashboard sits above the more detailed Assurance Framework, and includes a RAG (Red/Amber/Green) rating for each objective based on the number and significance of the risks identified against its achievement. The Dashboard will be updated prior to the agenda setting meeting of each Governing Body meeting, and will be a standing item at each formal meeting to provide assurance that the agenda covers the key risk areas.

The full detail of the Assurance Framework will be reported to the Governing Body on a bi-annual basis, with the detailed review of this taking place at each meeting of the Audit Governance and Risk Committee who oversee the risk management process.

Recommendation:

The Governing Body should note the introduction of the Assurance Framework Dashboard, and the detail contained within

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Aim / Strategic

ObjectiveRAG

Brief Description (and link to strategic priorities as

appropriate) - colours are used to highlight a strategic priority

that is common to more than one objective

Governing Body agenda

section/item

Additional

sources of

assurance

1aCCG to recover £49m deficit position (before Commissioning

Support Funding)

"Finance, Performance, QIPP and

Contracting" section

2a Improve delivery of constitutional standards "Performance Report"

2b Ensuring all patients receive the care they need at the right time, in

the right place and that east Kent meets, as a minimum, the

national average for all types of care.

"Performance Report"

3a Improve delivery of constitutional standards "Performance Report"

3b Ensuring all patients receive the care they need at the right time, in

the right place and that east Kent meets, as a minimum, the

national average for all types of care.

"Local care and Primary Care" section

3c Prioritise the submission of the Pre Consultation Business Case

(PCBC) and accelerate our tier two local care programme.

"Corporate Business" section,

"Strategic Commissioner Progress"

report

3d Working with all our patients to design new and improved hospital

services

"Communications, engagement and

Public Affairs Update" report

3eTransforming GP practices to increase the type of care and

services available outside of a main (acute) hospital

"Local Care and Primary Care"

section

4aImplement the actions outlined in the Governance, Capability and

Capacity review

"Audit, Governance and Risk

Committee Summary" report

4bImproving the tools we have (such as IT and buildings) to deliver

care and ensure that we have the right staff in place.

5a Transforming GP practices to increase the type of care and

services available outside of a main (acute) hospital

"Local Care and Primary Care"

section

5b Prioritise the submission of the Pre Consultation Business Case

(PCBC) and accelerate our tier two local care programme.

"Corporate Business" section,

"Strategic Commissioner Progress"

report

5c Making sure the NHS is working together with social care and

voluntary services so patient get better, joined-up care

5d Working with all our patients to design new and improved hospital

services

"Communications, engagement and

Public Affairs Update" report

5e Making sure we commission the right services, in the right way,

with the right type of contracts so they can be responsive to current

and future needs

"Quality" and "Finance, Performance,

QIPP and Contracting" sections

Formula

Green - All green

Amber/Green - One to three amber, remainder green

Amber/Red - One to three red, remainder amber or green

Red - More than three red

2. To improve the quality

and equality of services

and reduce waste harm

and variation

3. To improve patient

experience and access

to the appropriate care

at the right time.

1. To ensure there is a

sustainable, affordable

healthcare system in

East Kent.

Minutes from:

Contracting, Finance and

Performance Committee

QIPP PMO

Transformation Boards

(opeariotnal / strategic)

Appendix 1: East Kent CCG Governing Bodies Assurance Framework - Dashboard

This dashboard links the CCG's strategic priorities, defined within the 2019-20 commissioning intentions, to the strategic objectives and describes the link between

these and the items on the Governing Body agenda. Each strategic objective is given a Red/Amber/Green (RAG) rating depdendent on the status of the principle

risks linked to its achieement. A key explaining the RAG status is provided at the bottom of the page. The dashboard also provides a signpost to additional

sources of assurance.

4. Organisational

development to ensure

East Kent CCG's meet

organisational health

and capability

requirements.

5.Implementation of

healthcare system

transformation in line

with the Kent and

Medway Sustainability

and Transformation Plan

Minutes from:

Audit, Governance and

Risk Committee

NHS England Assurance

letter

CCG ratings

Minutes from:

Primary Care

Commissioning

Committee

Sustainable Acute

Medical Care in East

Kent Joint Committee

Clinical Assurance and

Strategy Committee

Quality Committee

Ernst and Young

preconsultation business

case (PCBC) readiness

assessment

Minutes from:



Quality Committee

Provider performance

meetings

Minutes from:



Quality Committee

Provider performance

meetings

Sustainable Acute

Medical Care in East

Kent Joint Committee

Primary Care

Commissioning

Committee

Clinical Assurance and

Strategy Committee

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The four clinical commissioning groups (CCGs) in east Kent are working together to improve healthcare across their communities.

NHS Ashford CCG - NHS Canterbury and Coastal CCG - NHS South Kent Coast CCG - NHS Thanet CCG



Title of Report: Local Care Update

Author:

Lisa Barclay, Head of Local Care, Ashford CCGClare Thomas, Head of Local Care, Canterbury and Coastal CCGTim Wilson, Senior Project Manager, Canterbury and coastal Local Care Team

Executive/ Lay Sponsor: Oena Windibank, Local Care Director

Approval Decision Assurance InformationThis paper is for:(please X as applicable) x



Is circulation restricted? No X Yes

Report summary/purpose:This report updates Governing Body on the development and delivery of the local care model across the four CCGs. This is being led by CCG local care teams working with GP Federations and provider partners.

The priorities in the Local Care Plan have been aligned to the East Kent CCGs QIPP Transformation programme. Local care hub level dashboards are being produced to support review of performance against both the delivery plan and QIPP transformation at a local level. The report is for both

information and assurance that progress against the Local Care Delivery Plan is on track and

to highlight areas where there is a lack of progress on delivery to identify actions to resolve.

Recommendation:Governing Body is asked to note the report and following key risks to delivery of the Local Care Delivery Plan:

Identification of appropriate patients for the MDT/ ICM model requires all partners to use available tools to identify appropriate patients for support.

The community workforce capacity represents a significant risk to achieving all elements of the delivery plan with particular emphasis on the ability to increase numbers entering ICM, ensuring capacity to implement care plans alongside ongoing pressures in general practice to continue to meet core GMS requirements alongside the growing Local Care agenda.


Yes

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No (state reason)Impact Assessment for delivery being reviewed under QIPP programme.

Local Care UpdateSituation:

This report updates Governing Body on the development and delivery of the local care model across the four CCGs. This is being led by CCG local care teams working with GP Federations and provider partners. The priorities in the Local Care Plan have been aligned to the East Kent CCGs Quality, Innovation, Productivity and Prevention (QIPP) Transformation programme. Local care hub level dashboards are being developed to support review of performance against both the delivery plan and QIPP transformation at a local level. The report is for both

information and assurance that progress against the Local Care Delivery Plan is on track and

to highlight areas where there is a lack of progress on delivery to identify actions to resolve.

Background:

A detailed Local Care Delivery Plan for each locality has been developed and agreed across the four CCGs in East Kent that identifies priorities areas as follows:

1. Frailty/ At Risk2. GP at Scale3. Pathway redesign – unplanned care4. Pathway redesign – planned care (in co-ordination with the Planned Care Team). 5. Prevention

Investment to support delivery is provided via the GP Forward View allocation and additional local investment. The local care model is based on a core provision of Integrated Case management (ICM) delivered in Extended Primary Care Networks (EPCNs) and supported by planned care pathways. When required, rapid access services are available based on the Acute Response Team (ART model and unplanned care pathways as represented in Figure 1.




Figure 1: Local Care Delivery Model

Assessment:

1. Frailty/ At Risk

Delivery of the frailty model is primarily an ICM model via the EPCNs and their Multidisciplinary (MDT) teams.

Elements of the model established in all hubs are as follows: Regular MDT meetings, held either weekly or fortnightly. These are at different

stages of maturity and have some variety in membership as outlined per locality below.

Access to integrated catheter clinics (Canterbury locality and limited access in Ashford) Plan to roll out to South Kent Coast (SKC) and Thanet during 19/20.

Access to social prescribing (includes Red Zebra, Age UK Personal Independence Programme and other voluntary sector)

Access to Primary Care Mental Health Specialist Workers Access to dementia support workers (Canterbury locality only). Plan to roll out to

Ashford Quarter 4 2018/19.

The Local Care Delivery Plan for frailty in 2018/19 is premised on an increase in activity via the Local Care MDTs so that a greater proportion of at risk patients are supported in the community. The target is that by 2021, 3.5% of the patient population, those who are severely frail, will be supported by this model of care. The plan for each CCG area is listed in Table 1.

Table 1: Planned trajectory, population coverage and patient numbers for implementation of ICM model in 2018/19.CCG % coverage Patients

Ashford 1.0% 1,324




C&C 1.4% 3,136

SKC * 0.2% 305

Thanet * 0.6% 834

EK total 1.1% 5,599

*Thanet trajectory from October 2018, South Kent Coast January 2019

Detailed trajectories per CCG are based on the frail population (measured against the Electronic Frailty Index (eFI) and risk stratification tools. Planned vs actual activity for MDTs is monitored against trajectory, by locality. Detail of each locality is given in the locality updates at the end of this report.

The key risks against delivery are: Use of appropriate tools to identify the target patient cohort Workforce availability to deliver patient support required. Assurance that the patients most at risk of emergency admission are being included

within ICM Further means of undertaking ICM in addition to the weekly MDT meeting as they

reach capacity

A number of key data flows have been identified to support identification of patients who may benefit from MDT support. These data flows should be seen as a tool kit of options to be used to suit the local care hub population. To date work has focussed on patients being identified by Primary care, however there is a need to work with all partners to use data available to the MDT to support patient identification.

The Patient Tracking List is being rolled out and will be available in all localities by the end of December. This allows dedicated members of the MDT to track patients. Development work with EKHUFT is in progress to maximise the information available on the A&E attendance section.

East Kent CCGs Local Care Teams are working with the STP Local Care Team to develop quality standards and shared protocols across Kent and Medway to ensure patients coming into ICM are those most at risk of emergency admission. This work will also address concerns that increase in activity will impact negatively on quality but agreeing core standards for all MDTs and reviewing the MDT TOR to reflect this.

The savings impact of ICM is identified in the QIPP Highlight Report.

Rapid Home Visiting Access to rapid home visiting services is available in 3 out of the 4 localities. SKC this is via the home visiting service commissioned through the Federation, Thanet this element is delivered through the ART Canterbury via the Encompass and Herne Bay Rapid Home Visiting Specification. In Ashford plans are being developed utilising local care investment monies for

Quarters 3 & 4.

The savings impact of Rapid Home Visiting is identified in the QIPP Highlight Report.

Care Home Support




The east Kent CCGs are continuing to scope and implement the plan to provide enhanced clinical support to care homes in order to reduce unnecessary hospital attendances and admissions. A telephone advice line is currently being piloted to support care homes to access

advice in addition to local support. To date this line has not received high call volumes and is being reviewed alongside the IC24 Professionals line.

The roll out of the red bag scheme started on 10 December 2018. Work is commencing to align with existing frailty service and the Thanet ART

Rapid Access Building on the outputs of the Local Care Clinical Models Group supporting the PCBC development, the Local Care Team and clinical and operational representatives from East Kent Hospitals University Foundation Trust (EKHUFT), Kent Community Health Foundation Trust (KCHFT) and Kent County Council (KCC) are working to develop the whole-system pathway that will support the effective management of frail people requiring urgent care in both the community and/or acute setting. A draft pathway has been circulated to the Clinical Reference Group for comment.

This builds on the ICM model and existing good practice and ensures the ability to respond quickly to patients whose condition is deteriorating or whose support network is struggling. This is currently being developed through the rapid transfer service commissioned through KCHFT




2. GP at Scale

Each CCG area has established primary care networks (PCN) at 30-50,000 population, developing an integrated working approach.

The comprehensive Improved Access to General Practice (IAGP) in line with the General Practice Forward View (GPFV) was implemented across all localities by 1 October 2018. In all localities there is a service accessible to all patients weekday evenings to 8.00pm, weekends and bank holidays. Detailed activity information is provided in the IPR. In October 2018 63% of available appointments were booked with a utilisation rate of 95%. Improvement of utilisation is being supported via increased advertising. Detailed utilisation rates and advertising information per CCG is given in the locality updates below.

To further implement the GPFV Local Care Teams are enabling practices to implement the 10 High Impact Actions within ‘Time to Care’. A full summary of these actions is reported to the PCCC but all localities are working in defined Extended Primary Care Networks (EPCNs) and have implemented active signposting training, text messaging services, workflow optimisation training and mobile tablets.

3. Pathway redesign – unplanned care

A number of the pathways already referred to above contribute to a review of urgent care response in the community, including the wound and catheter pathways and rapid frailty assessments in both the community and at the front door of the acute hospital. In addition, there are a number of key urgent care work streams within the Local Care Delivery Plan as follows:

Primary Care treatment stream at Queen Elizabeth Queen Mother (QEQM) William Harvey Hospital (WHH) and Kent and Canterbury (KCH): The primary care treatment streams at QEQM and WHH are being aligned to operate on the Urgent Care Centre model (standardised triage, more integrated workforce) this will help to inform and deliver the Urgent Treatment Centre Strategy.

Review of minor injuries and urgent treatment centres: The East Kent CCGs are currently reviewing the need for UTCs and the number of centres required to meet population demand. This review will take the form of a feasibility study to identify how many UTCs are required and the feasibility of using the different available sites. A UTC commissioning strategy will be produced to indicate the number of units required and how these units will work in a network with other primary and secondary urgent care services.

Rapid Transfer of Care Service: Following the review of discharge pathways from the hospital, the Integrated Discharge Team resource has been redesigned to support rapid turn-around of patients (admission avoidance) at the front door and discharge planning for complex patients. The Local Care Teams have worked with partners in EKHUFT and KCHFT to agree the detailed specification for this service to ensure that the learning from the Thanet ART model is incorporated and that the service co-ordinates with the wider frailty local care model.

Out of hospital Beds Review: A partnership task and finish group has been established to take forward the review of all out of hospital beds. This will include community hospitals, Integrated care facilities, health and social care village beds and the new spot purchase arrangements. This will also align the oversight and management of frail patients within the ICM approach to ensure patients are stepped




up into support as opposed to admitted in to secondary care. Recommendations are due end of Marc h 2019.

DVT: The work that has previously been undertaken by individual CCGs to develop a community pathway is being refreshed to support delivery across East Kent from Quarter 4. The east Kent pathway will be presented at CASC meeting in January 2019 with phased roll out immediately after, if supported. EKHUFT have been notified via contracting intentions that the CCGs will support DVT screening and treatment in a community setting.

Pneumonia: Communication has been sent, via Clinical Chairs, to all GPs across east Kent with guidance on COPD and Pneumonia. The Pneumonia Development Group has been re-established with the next meeting to be held on 20 December. Providers have been asked to ensure appropriate representation. Discussion is ongoing with SECAmb on Point of Care testing as this remains a barrier to SECAmb utilising alternatives to A&E.

UTI/CAUTI: The Pathway was developed and agreed in spring 2018. Public Health England were developing new guidelines and publication was awaited before a go live date could be agreed. Those guidelines were published in late October 2018 and these are now being incorporated into the policy and pathway. A meeting has been arranged with KCHFT in December 2018 to discuss its ability to support pathway delivery – this is due to the recent implementation of the Rapid Transfer Service and re-introduction of the Pneumonia Pathway. All three initiatives require significant resource from KCHFT Enhanced Intermediate Care/Rapid Response so prioritisation for delivery may be required.

4. Pathway redesign – planned care (in co-ordination with the Planned Care Team).

As part of the QIPP programme, a dedicated team is reviewing the planned care schemes with support from local care as required. Progress to these schemes is reported to the Governing Body in a separate Planned Care Report. As part of the PCBC and national drive to address the outpatient model work has commenced on out patient transformation in east Kent.Ashford Local Care Team is implementing a pilot scheme within Cardiology which is feeding into the planned care programme.

5. PreventionThere are a number of prevention elements to the clinical pathway approach described above. Social prescribing is a key prevention/self-management tool and health trainer elements of the hub level MDTs support the prevention agenda. The roll out of the Fire and rescue Service frailty assessment programme is underway across east Kent aligning to the ICM modelThere is a need to map the prevention services across the wider east Kent geography, commissioned in collaboration with Public Health to identify where the significant gaps are and to develop an east Kent local action plan




Locality Updates:

Ashford: 1. Frailty/ At Risk

2018/19 YTD delivery of ICM model

Care Homes: Ashford has an established Care Home Local Enhanced Service and the CCG is working with the practices and federation to identify opportunities to implement some of the principles of the enhanced support to care home model and specification using the LES.

2. GP at ScaleAs per the East Kent update, practices are working in three EPCNs. Improved Access is delivered via Ashford Clinical Providers on a hub or Ashford wide basis. In October 2018 73% of appointments were booked with utilisation rate of 90%. 100% of Ashford practices are advertising in waiting rooms and on websites. All practices have reception staff trained to offer appointments and therefore it is anticipated that for the next refresh of the IPR report these booked appointment and utilisation rates will have improved.

3. Pathway redesign – unplanned careAs per the East Kent update, the GP treatment stream at William Harvey Hospital is established provided by Invicta Health Care CIC. There have been ongoing concerns about the productivity and value for money of this service discussed at Governing Bodies. The current plans to transition to an Urgent Care Centre model will ensure workforce is used efficiently and the most appropriate clinician is identified via triage. There are ongoing data entry challenges at WHH that the CCG and providers are working to resolve.

4. Pathway redesign – planned care (in co-ordination with the Planned Care Team). As noted, Ashford are running a Cardiology pilot as an element of this programme.

5. PreventionAs per the East Kent Update.

Highlight Issues: There are high levels of vacancies in the rapid response team in Ashford that the CCG is working with KCHFT to resolve.




Canterbury and Coastal:

1. Frailty/ At Risk2018/19 YTD delivery of ICM model YTD delivery of Rapid Home Visiting:

Care Homes: The Herne Bay pilot of a primary care led clinical support service for care homes is now being rolled out across Canterbury. The CCG is working with Encompass GP Partnership Ltd and Herne Bay Health care Ltd to finalise the specification, mobilisation plan and financial schedule that will facilitate roll out in 18/19 and 19/20. This has been agreed at CASC and FPCC.

2. GP at ScaleAs per the East Kent update, practices are working in six EPCNs. Improved Access is delivered via Encompass GP Partnership Ltd and Herne Bay Healthcare Ltd. In October 2018 89% of appointments were booked with utilisation rate of 95%. 100% of Canterbury practices are advertising in waiting rooms and on websites. All practices have reception staff trained to offer appointments and therefore it is anticipated that for the next refresh of the IPR report these booked appointment and utilisation rates will have improved.

In addition to the East Kent actions noted above towards achieving the GPFV high impact actions, Canterbury and Coastal have also completed a number of avoidable appointments audits to inform development of skill mix within practices with support from the National team.

3. Pathway redesign – unplanned careAs per the East Kent Update, the requirement and potential resources for UTCs are being reviewed. There is a pilot UTC at Estuary View Medical Centre and the evaluation of this pilot is informing the UTC strategy.

4. Pathway redesign – planned care (in co-ordination with the Planned Care Team). As per the East Kent Update

5. PreventionAs per the East Kent Update. In Canterbury one GP Federation has also supported an initiative to introduce the Daily Mile project in local schools and developed an enhanced Lifestyle Advisor Service in partnership with the KCHFT provided One You service.

Highlight Issues: The CCG Local Care Team are working with hubs to develop more frequent MDT input to ICM than the weekly MDT meeting with the eventual aim of a daily virtual ward round. The key risk to developing this is again workforce availability for all providers, particularly Community Nursing teams.




South Kent Coast:

1. Frailty/ At RiskYTD Delivery of Rapid Home Visiting:

The Clinical Assurance and Strategy Committee have approved continuation of the Home visiting service but to align to the integrated case management approach and deliver a collaborative model. This is under development with recommendations due in Q1

Care Homes:The SKC Local Care Team is working with KCHFT to explore potential use of telecare in care homes. The team is also exploring how the hubs can be used to support a model of enhanced care to care homes model and specification.

2. GP at ScaleAs per the East Kent update, practices are working in EPCNs. Work is underway to develop a number of GP estate solutions, this includes the development of the integrated hub facility on Romney Marsh in partnership with KCC and local practices.

Improved Access is delivered via Channel Health Alliance. In October 2018 46% of appointments were booked with utilisation rate of 95%. A formal audit of advertising in practices is due to be undertaken to ensure that all steps are being taken to increase utilisation of available appointments.

3. Pathway redesign – unplanned careAs per the East Kent Update, the requirement and potential resources for UTCs are being reviewed. There are currently a number of urgent minor illness hubs and minor injuries units across the locality and this current provision will be considered as part of the development of the UTC strategy.


5. PreventionAs per the East Kent Update.




Thanet:

1. Frailty/ At RiskYTD delivery of ICM model (PCN MDTs only):

The graph only shows those patients that have gone through a wider primary care network MDT for support from September 2018. The frailty LES has supported practices to identify their frail population and care plan with health and social care partners to support complex care at home. The Thanet GPs are all on one clinical system, which allows the Acute Response Service (ART) to have access to care plans.

Care Homes: The team is exploring how the existing frailty LES can be used with additional investment to support the enhanced care to care homes model and specification.

2. GP at ScaleAs per the East Kent update, practices are working in EPCNs. Improved Access is delivered via Thanet Community Interest Company. In October 2018 60%% of appointments were booked with utilisation rate of 95%. 100% of Thanet practices are advertising in waiting rooms and have staff trained to offer appointments. A trajectory was agreed to ensure all practices were advertising on website by the end of December 2018.

In addition to the East Kent actions noted above towards achieving the GPFV high impact actions, 10 Thanet practices have also completed the Quick start programme with support from the National Team.

3. Pathway redesign – unplanned careAs per the East Kent update, the GP treatment stream at QRQM is established provided by Thanet CIC. The service is valued by the Emergency Department and the lessons from this pathways are contributing to current plans to transition to an Urgent Care Centre model on both main sites.


5. PreventionAs per the east Kent Update.

Highlight Issues: The 4 Thanet Primary Care Homes have developed proposals for the utilisation of this recurrent investment. The proposals will be finalised w/b 21st January. All of the proposals will enhance primary care resilience across each of the PCHs. For example, by increasing access to the Primary Care Visitor role, and increasing clinical staffing in already established Acute Care Teams. PCH leads are working with BI colleagues to develop measurable outcomes which will demonstrate the impact of the schemes on patients, primary care and the wider health and social care system.




Recommendation:

Governing Body is asked to note the following key risks to delivery of the Local Care Delivery Plan:

Identification of appropriate patients for the MDT/ ICM model requires all partners to use available tools to identify appropriate patients for support.

The community workforce capacity represents a significant risk to achieving all elements of the delivery plan with particular emphasis on the ability to increase numbers entering ICM, ensuring capacity to implement care plans alongside ongoing pressures in general practice to continue to meet core GMS requirements alongside the growing Local Care agenda.



Meeting Title: Governing Body Agenda Item: 22/19

Date of Meeting: January 2019

Title of Report: Quality, Safety and Safeguarding Report

Author: Maria Reynolds, Deputy Chief Nurse, East Kent CCG

Executive/ Lay Sponsor: Chief Nursing Officer: Sarah Vaux

Approval Decision Assurance InformationThis paper is for:(please X as applicable) x x


N

NoIs circulation restricted?(please X as applicable)

Report summary/purpose:This paper provides the Governing Body with an assurance report across the Chief Nurse’s Quality executive portfolio relating to key statutory duties of the CCG Quality of commissioned services, to include;

Safeguarding Infection Prevention and Control (IPC) Looked after Children (LAC)

The issues set out to governing body were presented to East Kent CCG’s Quality Committee on December 12th 2018. The committee were asked to approve and support further work in relation to;

Primary Care Quality Assurance Framework and IPC Primary Care Strategy and associated work plan

The committee noted the additional assurances around Safeguarding that were presented to NHS England.

Commissioned ServicesThe Governing Body is requested to note the existing challenges across all of our commissioned providers which are impacting on quality of services and our ability to make significant and sustained quality improvementsEast Kent Hospitals University Foundation Trust (EKHUFT)

IPC - Following a number of Serious Incidents (SI’s) and a recent outbreak of pseudomonas work is planned to undertake an IPC stocktake.

Never Even - A wrong site surgery was reported 22/11/18 within Gynaecological surgery at William Harvey Hospital. The event is under investigation. Duty of Candour was fully completed.

CQC inspection - rating remains requires improvement following visit in May and June 2018. Action plan monitored at monthly EKHUFT Clinical Quality Review Group (CQRG)

22-19 - SBAR Board Report East Kent Quality Report.docOverall of 184


Ophthalmology a further SI was reported in September 2018.

NELFT Attention Hyperactive Disorder (ADHD) /Autism Spectrum Disorder (ASD) .The

numbers of children and young people requiring repeat medication for ADHD/ASD is having a significant impact on NELFT’s ability to deliver services to Tier 2 and Tier 3 children within receipt or waiting for services.

Millbrook CCG colleagues and Service Users progressing work with Millbrook to improve

and support improvements where identified including Complaints.

Recommendation:

Governing Body are asked to note the contents of the report and to consider impact on East Kent CCG’s residents in relation to the challenges experienced by our commissioned providers.To review the risks escalated to Governing bodies and raise any additional issues for discussion and suggested actions.To note learning in relation to Safeguarding review for Child G and consider if there is any additional learning for East Kent CCGs and Governing Body members.


Yes

No (state reason)

22-19 - SBAR Board Report East Kent Quality Report.docOverall of 184

East Kent CCGs Joint Quality, Safety and Safeguarding ReportFor presentation at Governing Body

January 2019

22-19 - East Kent Quality Report for GB 01 19 final version.docxOverall of 184

CCG Statutory Requirements

Looked After Children (LAC)The Designated Consultant Nurse for LAC continues to work with Providers to achieve the CCG statutory targets for assessment. Over the past year, there has been a significant improvement in compliance and an increased drive to work collaboratively to achieve improved outcomes for this vulnerable group. Currently Kent Community Health Foundation Trust (KCHFT) are achieving 100% against target for Initial Health Assessments and East Kent Hospitals University Foundation Trust (EKHUFT) 73%. The compliance for Review Health Assessments has reached 94% for under 5’s and 97% for over 5’s. There are several issues regarding EKHUFT clinical practice, (particularly with regards to the adoption pathway) and performance which are being monitored robustly and escalated via Kent and Medway (K&M) Quality Surveillance Group (QSG).

We have successfully recruited a dedicated LAC project lead (starting Jan 19) and a Deputy Designated Nurse (starting Feb 19), however still fall below the national guidelines for numbers of designated professionals across the Kent & Medway footprint. We have been unable to recruit to the Designated Doctor role and are considering how to address this gap –there is a National shortage of Designated professionals in this very specialist area. We currently have an interim post holder who is due to leave the role on 31st March 2019.

We are also considering the impact of Brexit on the numbers of Unaccompanied Asylum Seeking children entering the Kent system and a report has been shared with the QSG.

Infection Prevention and Control (IPC)IPC Specialists are working closely with commissioned providers and Primary Care to ensure IPC is embedded within organisations and where improvements are identified that they are delivered.The East Kent Quality Committee has eceived an IPC strategy for Primary Care and work plan to support delivery of improvements within Primary Care.

SafeguardingUpdate on Serious Case Reviews (SCR)Child G was a child in the South Kent Coast area who died in 2017 and the case has been the subject of a SCR. A report has now been completed and published on the Kent Safeguarding Children Board (KSCB) Website.

Child G was two months old when she died while in the care of her parents. Her father admitted manslaughter and was convicted and received a custodial sentence in June 2018. Child G died from injuries consistent with being shaken. Her parents were young parents and mother had significant mental health issues as a teenager and was transitioning to adult mental health services during the period of the review.

Key learning from the Child G Serious Case Review:• The need to assess and provide support and services to both parents, regardless of gender. • When a parent is vulnerable, professionals may struggle to identify that they are not

meaningfully engaging with services. • The importance of supervision and clear processes for professionals to follow if they are not

receiving supervision as required. • The need for on-going communication and information sharing around, and following, transitions

between services. • The need for a timely response to any decline in a family’s situation, particularly bearing in mind

the vulnerability of very young babies.


https://www.kscb.org.uk/__data/assets/pdf_file/0008/88109/20181004-SCR-report-Child-G-Final.pdfThere have been 3 previous SCRs published in East Kent in the past 2 years, the most recent being Child C who died following ingestion of mother’s methadone. In addition, there are currently 8 SCRs in progress in Kent and 2 of these are also East Kent cases. It should be noted that the cases in the North and West may also be applicable to East Kent as many of the providers are shared and learning will be jointly reviewed. The Child G review and other SCRs have highlighted learning and themes for all agencies. As some of the learning is seen in a number of local reviews, there is a need to consider what the issues and risks are across the system. For example, can providers demonstrate that front line staff are trained to undertake their safeguarding role and whether they are using a “think family” approach. There is also a need to consider how the learning from SCRs is disseminated to front line staff in provider organisations and embedded in practice.

The associated action plans which address the learning from health providers including Primary Care are monitored by the Designated Professionals through the KSCB.

NHSE Safeguarding Assurance returnNHSE have asked for further assurance and an improvement plan in relation to Safeguarding. NHSE undertook a review of safeguarding across Kent and Medway in 2018 and all CCGs were asked to provide additional evidence. NHSE requested further evidence in relation to safeguarding arrangements. This was in particular related to vacancies that existed at the time and how the CCGs were developing a plan to address safeguarding in line with the new safeguarding partnership arrangements for children and the STP.

The team have reviewed the feedback from NHSE and significant progress has been made since the original self- assessment. For example the safeguarding team is now fully staffed and progress has been made with recruitment for LAC. The improvement plan will address the remaining areas.

Primary Care Primary Care Quality VisitsEast Kent CCGs are continuing to offer support to practices to implement improvements identified as a result of CQC inspections.

Further iteration of Primary Care quality assurance and improvement framework received by Quality Committee describes the approach to monitoring and assuring quality and supporting improvement in Primary Care services for the 4 east Kent CCGs. Once agreed, implementation of the quality framework will determine a risk based forward schedule of practice visits aligned with available resources.

Primary Care Workforce Development LeadsThe 4 East Kent CCGs have a total of 3 Primary Care Workforce Development Leads (PCWDLs), one for Thanet CCH, one for South Kent Coast CCG and one for Ashford and Canterbury and Coastal CCGs. The PCWDLs are working together to align work streams and processes following the restructure of the Nursing and Quality Team. Opportunities for the PCWDLs to expand their roles to further support practices with the wider quality agenda are being explored.


https://www.kscb.org.uk/__data/assets/pdf_file/0008/88109/20181004-SCR-report-Child-G-Final.pdf

https://www.kscb.org.uk/__data/assets/pdf_file/0008/88109/20181004-SCR-report-Child-G-Final.pdf

EAST KENT HOSPITALS NHS FOUNDATION TRUST (EKHUFT)EKHUFT: SummaryInfection Prevention Control IPCFollowing a number of Serious Incidents (SIs) and a recent outbreak of pseudomonas work is planned to undertake an IPC stocktake.

Never EventA wrong site surgery was reported 22/11/18 within Gynaecological surgery at William Harvey Hospital. The event is under investigation. Duty of Candour was fully completed.

Care Quality Commission (CQC)The CQC rating for EKHUFT remains at Requires Improvement, following the recent inspection May and June 2018. The Improvement Plan was submitted to the CQC on 8 October 2018. The Trust’s risk management system 4Action is being updated with all the actions, of which these will be assigned to Care Group representatives and other leads across the organisation. Action leads will be required to maintain progress against their actions, and updates will be received through the agreed governance process. A two year improvement journey is being developed to ensure a rating of ‘good’ at the next inspection. The Trust undertook a Routine Quality Review on 5 October 2018. Feedback was shared at a Trust-wide collaboration session held in the afternoon of the visit.

There remains a challenge to maintaining clinical safety and quality within the emergency departments during periods of high pressure, highlighted within the recent CQC report. Actions to address this include focussing on improving patient flow, assuring the appropriate staffing in terms of numbers and skill mix and embedding monitoring and assurance systems such as the Bristol Safety checklist.

Report from CQC unannounced visit to children’s services is awaited. The improvement plan will be updated following awaited report.

ComplaintsThe management of the complaints process remains a challenge for EKHUFT. This month EKHUFT have reported a decline in performance for complaints responded to within timescales achieving only 75.5% within agreed timescales. Work is ongoing to address the backlog position and seeking resolution with clients whose complaints have been open beyond the agreed date. Actions to address these challenges include monthly meetings with Care Groups, reducing the backlog, a peer review by a local Trust and recruiting into the corporate team.

Duty of CandourThe Clinical Risk Team (CRT) at EKHUFT monitors the Duty of Candour (DoC) compliance of SIs. Of the 11 SIs reported in September 2018 only 5 (45%) were fully compliant with Duty of Candour. Care groups are now providing an updated report of Duty of Candour on a weekly basis. Training is provided by CRT and additional work is progressing to support improvement in the Duty of Candour process such as a checklist for staff and improved template letters.

OphthalmologyA further Ophthalmology SI was reported in September 2018. The Ophthalmology service has developed long term plans to address the underperformance through improved theatre booking efficiencies.

DiabetesThe management of diabetic patients and the prescribing of insulin has theme in incidents this year.


In October 2018 there were 8 SIs involving Insulin. EKHUFT have established a steering group with inpatient staff and diabetes nurses to lead the improvements to reduce harm in diabetes.

KENT COMMUNITY HEALTH NHS FOUNDATION TRUST (KCHFT)KCHFT: SummaryWorkforceWorkforce issues are a risk to the Trust. KCHFT are drafting a workforce strategy to present to the CCG at the Clinical Quality Review Group (CQRG) meeting.

Community Information System (CIS)KCHFT Assistant Director for Patient Safety and Experience, provided assurances around CIS. Incidents reported on to the CIS are now being reported on Datix.

KENT AND MEDWAY NHS AND SOCIAL CARE PARTNERSHIP TRUST (KMPT)KMPT: SummaryCare Quality Commission (CQC)A series of inspections have been undertaken, formal feedback is awaited.

Female Psychiatric Intensive Care Unit (PICU)KMPT do not have access to a female PICU. A key area for constant review is the number of women placed out of area who require a PICU bed. The actual numbers of women out of area at any one time are small (between 4 and 8 women). The CCGs have requested a service response from KMPT to give assurances that they are correctly managing the split in female/male beds and monitoring women who go out of area for treatment.

SOUTH EAST COAST AMBULANCE SERVICE (SECAMB)SECAMB: SummarySerious Incident SECAmb have reported one incident that has met SI related to rhythm recognition in a cardiac arrest. SECAmb Action: An initial debrief was held with the team by the Operational Team Leader. Investigation is underway.

INTEGRATED CARE LTD (IC24) IC24: Summary

NORTH EAST LONDON NHS FOUNDATION (NELFT)NELFT: SummaryComplaintsIn Kent it has been noted that there has been an increased number of formal and MP complaints


with 21 in September 2018 and 25 in October 2018 compared to 14 in previous months. Neuro-Development (ND) service concerns are reflected as a theme in the complaints received.

Management of Repeat Medication for Children and Young People with Attention Deficit Hyperactive Disorder (ADHD) /Autism Spectrum Disorder (ASD) There are currently 1,437 children and young people on NELFT caseloads who are stable but require repeat prescriptions. The numbers of children and young people requiring repeat medication for ADHD/ASD is having a significant impact on NELFT’s ability to deliver services to Tier 2 and Tier 3 children within receipt or waiting for services. NELFT are also reporting that there is inconsistency around blood taking, and physical health checks within primary care. The NELFT county wide Clinical Quality Review Group are working with commissioners and Clinical Leads to support the NELFT clinical and quality issues that are being identified to support discussions and drive improvements.

WorkforceThere are significant risks around workforce which is impacting the provider’s capacity to meet demand. Vacancy rates reduced slightly in October 2018 to 27.4% from 29.4% in September 2018. However, it is noted that sickness levels have been on an increasing trend in August and September 2018. Recruitment remains ongoing with newly appointed staff due to start between November 2018 and January 2019 and there are a number of interviews to be held in November 2018. Managers have also recruited bank and agency staff to prioritise waiting lists.

Recruitment remains ongoing with newly appointed staff due to start between November 2018 and January 2019. Where a 30% vacancy rate has been reported this would trigger a Director of Nursing Trigger Visit within 5 days to provide a review of services and identify areas for improvement and ensure no quality or safety risks. Where there is immediate elevation of risk to patient or staff safety, mitigating actions are taken. The Trigger Visits are in addition to the planned (unannounced CQC style) programme of inspections which NELFT undertake.

KENT AND MEDWAY WHEELCHAIR SERVICE – MILLBROOK HEALTHCAREMILLBROOK: SummaryComplaintsThe CCG are seeking assurance around the number of complaints being received from Millbrook Wheelchair Service, service users, or their carers. The routes for complaint appear complex and there are gaps in understanding how the information is triangulated to support improvements. CCG colleagues and Service users are working with Millbrook to improve reporting and support improvements where identified.



1



Title of Report: Wheelchair Service Update

Author: Tamsin Flint, Commissioning Manager

Executive/ Lay Sponsor: Ailsa Ogilvie, Director of Partnerships and Membership Engagement




N None identified: members to declare conflicts as necessary.



This paper is to update the Governing Body about Kent and Medway Wheelchair Service performance and actions the CCGs and Millbrook Healthcare are taking to deliver the Service Improvement Plan.

Recommendation:

On the basis of Millbrook’s continued performance improvement, Thanet CCG Governing Body is asked to agree to release the final tranche of additional funding associated with a higher complexity case mix during 2018/19.


X Yes

No (state reason)

23-19 - SBAR based Board Report Jan Wheelchairs draft v3 Thanet CCG.docOverall of 184


2

SBAR Report

Kent and Medway Wheelchair Service Update

Situation:

The Kent and Medway wheelchair service is showing early signs of improvement in service performance as the waiting lists for equipment and repairs continue to reduce.

Since September 2018, when the first tranche of additional funding for the Kent and Medway Wheelchair Service was released, Millbrook Healthcare has placed additional equipment orders to drive waiting list clearance.

Governing Bodies of the eight Kent and Medway CCGs have given Thanet CCG, as the lead commissioner for this contract, delegated responsibility to agree release of the next tranche of investment funding subject to evidence of continuing service performance improvement; this is due for release in January 2019.

The CCG continues to engage with service users on a regular basis through monthly meetings and information bulletins between meetings. From January 2019 a Service Improvement Board (SIB) will replace the initial Service User Improvement Group that had been set up in September 2018. The SIB model has been tried and tested elsewhere by Millbrook Healthcare and service users agree this is the right framework to provide advice and scrutinise delivery of the Service Improvement Action Plan (SIAP). Millbrook Healthcare is also seeking to recruit a Lived Experience Advisor to work alongside their staff teams to offer advice and support.

Background:

Millbrook Healthcare took over the NHS-funded wheelchair contract for Kent and Medway on 1st April 2017. This contract is managed by Thanet CCG on behalf of the eight Kent and Medway CCGs.

During the early months following contract mobilisation, Millbrook Healthcare raised concerns about a larger than expected inherited caseload comprising a high complexity case mix which was impacting on their ability to deliver the contract. Further data was provided by Millbrook Healthcare but this identified discrepancies which needed to be understood and resolved prior to agreeing next steps. Consequently NHS Thanet CCG commissioned TIAA Ltd to undertake an independent audit to clarify the impact of the inherited backlog and identify whether there may be risks relating to business as usual.

The initial findings of the independent audit were reported in June 2018 and identified a number of issues which had put additional pressures on the service and caused the performance issues patients are experiencing:

- Millbrook Healthcare inherited a backlog of long waiters with a high complexity case mix.

- Overall referrals into the service since April 2017 are lower than expected, but demand for specialist wheelchairs and equipment is significantly higher than data available during the procurement had indicated.

- Additional funds are needed to resolve the backlog of people who have been waiting longer than 18 weeks and to deliver an ongoing and sustainable service for patients.



3

In response to the independent audit findings and with input from service users, a service improvement plan, trajectory and work programme have been agreed between Thanet CCG and Millbrook Healthcare to clear the inherited long waiting lists, to rebalance the case mix and to deliver key improvements to the service.

During September, to support delivery of the improvement plan all eight Kent and Medway Governing Bodies approved additional funding to cover the cost pressures above the agreed contract value experienced by Millbrook Healthcare. A summary of the funding plan which was approved by Governing Bodies in September is set out below:

Phase 1: Funding unexpected cost pressures from the Inherited Caseload A first tranche of additional funding to alleviate pressure on Millbrook associated with the inherited backlog was released following Governing Body meetings during September at which this was agreed. Phase 2: Cash Advance for Stock Purchased. This is not an addition to the contract value and is an advance that will be repaid at the end of the contract term.

Phase 3: Cost Pressure from Change in Caseload Complexity This final tranche of additional funding is to cover the unexpected cost pressure

associated with an increased complexity case mix of in-year referrals during 2018/19. Decision to release this funding has been delegated to Thanet CCG subject to performance improvement.

The CCGs will not release and/or will seek to recoup funding if the improvement plan is not delivered

NHS Thanet CCG will be reviewing estimated cost pressures over the final quarter of 2018/19 using more up to date information about actual spend and demand. This may lead to a proposal for a revised contract value for the final three years of the contract. Any proposal for amendment to contract value will be brought back to Kent and Medway CCG Governing Bodies for their consideration in March 2019.

Assessment:

Latest data up to the end of October 2018 shows continued signs of improvement in the Kent and Medway wheelchair service.

Since the start of the contract the waiting list for assessment and equipment provision grew to 3,369 at the end of August. By the end of September the waiting list started to reduce to 3,313 and by the end of October it had dropped further to 3,037 and is in line with the improvement plan trajectory. This includes new referrals and shows that for the first time since the start of the contract there have been three consecutive months net reduction in the waiting list. Between the end of August to the end of October 1,261 referrals have been closed.

Of the 3,037 still on the waiting list 55.7 per cent have had their appointment and a further 23.2 per cent have their appointments booked.

Reduction in the size of the waiting list, which has included a higher complexity case mix, is beginning to re-balance the remaining case mix; the proportion of low/medium complexity has increased from 66 per cent in March 2018 to 76.2 per cent in October.



4

There have been significant improvements in the repairs waiting list, which has reduced from 461 in mid-August to 229 by end of September and by the end of October this has reduced significantly further to 91. However, of those people still waiting for repairs, there continues to be a high percentage (90 per cent) who have been waiting for more than 10 days and hence there is further improvement to be achieved.

Following a review of the complaints received by Millbrook Healthcare about the Kent and Medway Wheelchair Service a number of key themes have been identified and action taken.

Communication: It has been identified that the current local processes do not support a proactive communication culture. Repairs and timely progression of service user referrals are key areas of concern. As part of a root cause analysis Millbrook have implemented a number of changes around service user referral progression, a dedicated Customer Service Repair Team and training and recruitment of a Customer Experience Co-ordinator to enable proactive communication and response to complaints.

Incorrect information on the system: Due to the quality of the initial data transfer at the start of the contract it has transpired that some service user records are missing, incomplete or inaccurate. This has significantly impacted Millbrook’s ability to accurately manage service user pathways and wheelchair servicing requirements. It has also caused frustration with service users when accessing Millbrook Healthcare for the first time following the transfer. Millbrook have implemented a number of measures in order to mitigate any associated risk and to ensure data integrity.

Outstanding repairs: It was apparent that the first fix rate and service user experience in regards to the repair element of the contract needed to be reviewed and improved. The action plan includes training and development programme for all staff, reviewing stock held in vans and a review of areas and routes to ensure that there is ongoing and consistent coverage for repairs across Kent and Medway and to provide the ability to offer am/pm and ‘first job’ appointments.

There are a number of workstreams within the work programme for which work is already underway, with the following workstreams have been prioritised with input from service users:

Complaints Review: This is to look at improvements in the handling of complaints in the wheelchair service ensuring agreed deadlines are met and that soft intelligence is gathered so that it may be triangulated with complaints and concerns being raised through other channels to give a full picture of the presenting issues and themes. The CCG and Millbrook Healthcare are taking a joint and collaborative approach to streamline processes for more effective complaints handling for service users and to derive organisation lessons which will help drive operational improvements.

KPI Review: This is to review KPI’s and other contract related documentation to develop a bespoke KPI performance monitoring tool with appropriate data in which to accurately monitor the contract performance and demonstrate quality. A second meeting has been held with service user representatives, Millbrook Healthcare and the CCG to finalise a KPI set for immediate contract management and to develop plans for implementing outcome based metrics.



5

Eligibility Criteria Review: This is to ensure the guidelines support consistent application by Kent and Medway therapists and is written in a clear and concise format to aid service user and external partners' understanding. The CCG has conducted a scoping exercise of eligibility criteria for other NHS wheelchair services across the country and has had discussions with other CCG commissioning colleagues to gather information and any lessons learned elsewhere. This knowledge will be used as a platform to develop refined eligibility criteria with input from service users, other external partners and Millbrook Healthcare staff.

Personal Wheelchair Budgets: This is to deliver a personal wheelchair budget

scheme that meets the health and wellbeing needs of service users. The CCG is conducting a scoping exercise to gather and review information from other areas that are further ahead in delivering personal wheelchair budgets for service users. This work will enable the CCG to respond to questions and comments raised by service users in an initial workstream meeting. Once the scoping has been completed service users will be involved to discuss proposals for a way forward.

Disability Equality Training: This is to be implemented for commissioners and Millbrook Healthcare staff to create a better understanding of service user challenges. Discussions with a potential trainer have been held and the CCG is awaiting the proposal.

These early signs of performance improvement are positive, but there is considerable further work to be done to deliver the improvement plan. There is continued involvement of service users who are working collaboratively and constructively with the CCGs and Millbrook Healthcare to monitor delivery of Kent and Medway’s Wheelchair Service Improvement Plan and the work programme.

Recommendation:

On the basis of Millbrook’s continued performance improvement, Thanet CCG Governing Body is asked to agree to release the final tranche of additional funding associated with a higher complexity case mix during 2018/19.



6

Appendix I: Kent and Medway’s Wheelchair Service Improvement Plan Performance Summary

Waiting List Size

The graph below shows the increase in the waiting list size since the start of the contract and then the reduction in September and October. These figures include new referrals and show that for the first time since the start of the contract there has been three consecutive months net reduction in the waiting list.

Waiting Times

The average length of waiting time for open referrals across Kent and Medway has increased from 29.4 weeks in September to 30.8 weeks in October, whilst for children this has decreased from 30.2 weeks in September to 28.7 weeks in October. We continue to monitor and review waiting times.

Equipment Provision:

Overall open episodes of care are now ahead of projection thanks to the increase in spend that has allowed completion of referrals partially through their pathway, both adults and children are now ahead of projection.

Repairs and maintenance

Millbrook Healthcare continue to exceed the plan for outstanding repairs, however clearing a large quantity of repairs that exceed 10 working days has as expected caused the percentage of standard repairs to stay well below the target, we will continue to see this percentage at low levels until all aged repairs are concluded over the next 1-2 months.


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Title of Report: Children’s Mental Health update

Author: Jane O’Rourke, Head of East Kent Children’s Commissioning Support Team



Approval Decision Assurance InformationThis paper is for:(please X as applicable) x


Y/N None identified: members to declare conflicts as necessary



This paper updates on the current waiting list position and progress of the new children’s mental health service (formerly CAMHS). It describes the ongoing challenges faced by the system and some of the key achievements made in east Kent in meeting the ambition of a sustained transformation for children and young people, to meet the increased demand for services.

Recommendation:

This briefing was requested as an update therefore no recommendations have been made.


Yes

No (state reason) not deemed necessary as this report is for information.

24-19 - SBAR Board Report - Childrens Mental Health Update.docOverall of 184


SBAR Report

Children’s Mental Health Overview

Situation:

This briefing updates on the progress to date of the children and young people’s emotional wellbeing and mental health service delivered by North East London Foundation Trust. (NELFT) It highlights some of the current issues facing the delivery of the contract and articulates how east Kent commissioners own the problem and are working to resolve them. The paper also describes some of the key achievements of the children’s Local Transformation Plan in delivering sustainable transformation to children’s mental health services across the system. The Kent plan has been led by the east Kent Children’s commissioning team. It has been highly commended by NHS England as an example of best practice and is being used as a National standard (The plan is available on the CCG websites).

The estimated number of 5-19 year olds in east Kent with any mental health disorder is:

Canterbury & Coastal 5,050 SKC 4,407 Thanet 3,214 Ashford 3,187

Background:

Kent County Council and the Kent Clinical Commissioning Groups have been working together since early 2014 to deliver a new whole system of wellbeing and mental health support that extend beyond the traditional reach of commissioned services. The model, which was developed alongside the principles and approaches articulated within the Department of Health’s 2015 Future in Mind publication, sets out a whole system approach to emotional wellbeing and mental health for which there is a Single Point of Access and clear, seamless pathways to support, ranging from Universal ‘Early Help’ through to highly specialist care with better transition between services.

The new model represents a significant shift in the way that support and services are provided to children and young people across the Kent system setting a clear direction to ensure that young people and their families have easy access to high quality mental health services when they are needed.

As with all systemic and fundamental change across a complex county like Kent, the transformation of services requires a focused, holistic and partnership approach.

There are significant challenges nationally facing children and young people’s (CYP) mental health services, with increased levels of demand and lack of resources and we are seeing the same picture reflected across Kent. .

The new service went live in September 2017 followed by a period of mobilisation, staff consultation and service reconfiguration and transformation.

The contract is led by West Kent CCG as coordinating commissioner.



Assessment:

In east Kent, there had been significant issues with the previous service provided by Sussex Partnership Foundation Trust (SPFT), resulting in long waits for patients and their families, commissioning gaps, cost pressures and reputational risk; there were a large volume of complaints and significant media interest and scrutiny from MP’s. Therefore, when services transferred to NELFT, there was an emerging picture of significantly large caseloads and referrals.

Below is the current activity data provided by NELFT

Caseload, Referral and Discharge Data-provided by NELFT

It is important to note that in east Kent, the entire pathway for Neurodevelopment conditions (ADHD/ASC) is delivered by NELFT for 0-18 year olds but in West Kent, it is for 11-18 and under 11s are excluded from these numbers as they are seen within KCHFT. Caseload figures are also higher for east Kent due to historic commissioning gaps and long waiting lists accumulated by previous providers that have been extremely challenging to resolve. Prevalence data also suggests that we would expect to see higher numbers in east Kent due to levels of deprivation.

Teams Current Caseload

No of Referrals 2018 No of Discharges 2018

Neurodevelopmental and Learning Disabilities (NLD)

April May June July Apr-Jul Apr-Jul

East Kent

West Kent

5,123

1,197

259

74

280

85

320

125

291

134

1,050

418

397

Total 6,320 327 345 445 365 1,468 397

East Kent Locality Teams (excluding NLD)

April May June July April-Jul Apr-Jul

South Kent Coast

Ashford

Canterbury

Thanet

705

403

729

735

223

140

153

147

216

154

191

194

432

173

206

251

229

152

178

194

1,100

619

728

786

693

472

534

582

Total 2,572 663 755 1,062 753 3,233 2,281



Following the establishment of the new locality teams on the 1 April 2018 NELFT created local evidence based pathways to ensure that children and young people receive high quality care. The current caseload of children and young people (across Kent) is approximately 11,500 including all teams. The waiting times are variable per team but in summary:

Waiting Times data

Between 6 and 12 months East Kent - 1404

West Kent - 390

Greater than 12 months East Kent - 646

West Kent - 64

Action to address the waiting list issues:

Kent commissioners have invested Transformation Funding into the contract to enable additional recruitment/resource to tackle the backlog and to bring all waiting lists back in line with the National Referral To Treatment (RTT) timescales. NELFT were asked to submit a proposal to evidence how they would use the investment, with clear, detailed trajectories. Progress against this investment is monitored under the contract Governance structure, with regular reports scrutinised at the Technical and Clinical Quality Review Group (CQRG) meetings. East Kent commissioners review the trajectories and performance data immediately it is received from NELFT and have set up a robust process for raising and escalating queries. We remain in continuous dialogue with NELFT staff. There is also additional oversight at STP level via the Mental Health work stream, the Kent Transformation Board and the 0-25 Health & Wellbeing Board. Each CCG also has to provide assurance to NHS England, who are kept fully informed by east Kent East and who regularly attend strategic meetings. Kent commissioners attend all contract meetings and have oversight of all data; however, it has been an ongoing challenge to get the east Kent position fully understood, appreciated and tackled effectively by the lead commissioner.

During procurement it was estimated that the contract would support a total caseload of approx. 7,000 children and young people, however currently there are nearer to 13,000. The impact of these increasing numbers is also being escalated to strategic level.

NELFT are currently recruiting to teams where additional resources are needed to deliver against the 18 week target in the next 6 months. Each team’s referral time to treatment (RTT) trajectory is routinely monitored to ensure compliance. The intention is that if the referral rate remains consistent month on month, and once the 18 week RTT target is achieved, NELFT will retain the additional staff to deliver a reduction in waiting times across the Board.

Initially, all referrals are triaged by a clinician via the single point of access (SPA). The purpose of the triage is to seek clarity on current needs, complete a risk assessment, to agree next steps including determining if crisis/urgent/planned intervention is required and to agree a safety plan as needed.



The planned referral to treatment waiting times trajectories from 1st October are shown below. However, there was a delay in finalising the CV and getting the finance agreed so recruitment was delayed.

Kent wide

The Kent NDLD team has a very high caseload - 6,320, which includes historical waits and referrals received since September 2017. This new service is still in its development stage and has an action plan that is monitored weekly to ensure key areas of challenge are improving including:

Additional temporary and permanent staffing Screening and assessment process for ADHD and ASD Reviews for children receiving medication Repeat prescription processes

NELFT have reviewed and adapted this pathway in response to dialogue with commissioners and specific pressures within east Kent, including high numbers of children currently receiving medication.

Due to the delay in finalising the CV, we are anticipating that the trajectories will show achievement of targets by the end of March 19, which will be evidenced by a significant decrease in waiting times and higher numbers of patients having been discharged. It is proposed that an update is brought back to the four east Kent Governing Bodies in April to outline the position at that stage, with further options tabled if appropriate.



Local Transformation Plan (LTP)

Sitting alongside the NELFT contract, the children’s mental health Transformation program has funded various initiatives (see Appendix 1) across east Kent with the aim of providing additional resource and support in areas of the system not traditionally offered by Health. Decisions about how this funding was allocated were made in collaboration with stakeholders and signed off by the Kent Transformation Board and the east Kent Transformation Funding Executive Board. Services implemented were evidenced to have a significant impact in improving outcomes for children and young people and in helping east Kent achieve the National target for the Transformation program.

The figures below show Kent and Medway’s predicted performance against the access standard for 2018/19, based on data from the MHSDS (Mental Health standard data set) for April to August 2018. They are sourced from NHS Digital and our target is 32%.

This table demonstrates that targeted investment has enabled east Kent to overachieve against the standard. This is particularly impressive given the high levels of deprivation and numbers of vulnerable children in our locality.

Recommendation:

This paper is for information.



Appendix 1

Examples of transformation projects (not an exhaustive list).

Highlight

EK Lead for

Kent

Good Mental Health Matters

Kent CCGs developed and commissioned Good Mental Health Matters campaign which went to every household in Kent (year 1). In Year 2 a website, free resources, lesson plans, vlogs for primary and secondary schools (Year 6 to Year 13 pupils). Between June - October 2018 over 5,573 website hits and 491 lesson plans downloaded across 251 schools. In 2019 - 2021 every primary school will be offered the opportunity to be visited by the GMHM 'dome' and focussed lesson promoting the Good Mental Health Matters message. Currently we are in discussions with Kent and Medway Scouts who want to develop their own GMHM badge for their 17,000 members. In addition NHS England is interested in rolling programme in other areas.

KCHFT - Targeted Emotional Health Service

Commissioned in parallel with Children and Young People's Service and will work with adolescents that need additional targeted support. KCHFT and NELFT run the new single point of access in partnership. In 2017/18 over 618 packages of care commenced across Kent.

EK Lead for Kent

Mind and Body Piloted in Canterbury (with the support of Dr. Grice) this risk reduction intervention focussing on self-harm in schools and communities has been rolled out across Kent.

In 2017/18 academic year 40 schools took part (13-17 year olds), 6,601 children and young people received info and advice, 565 children and young people completed the programme. Of these, 85% reported a reduction in number of days they thought about self-harming, 92% reported a reduction in number of days they acted on self-harming thoughts and 76% reported an overall improvement in their mental wellbeing following participation in the programme.

In 2018, Addaction won 3 prestigious national awards for the programme. NHS England is interested in rolling this out in other areas.

EK Lead for Kent

The Be You Project Delivered by Porchlight across East Kent CCGs. The Be You Project is a new LGBTQ support service with a website and youth groups set up for children and young people in the LGBTQ community. Between June - October 2018, there have been over 1,345 page views, 27 young people have started to attend the groups, 271 new users of the website.



Children and Young People's Mental Health Service

North East London Foundation Trust (NELFT) was awarded the Children and Young People's Mental Health Service contract across Kent in September 2017. The specification was developed in line with the transformation agenda and included requirement for the provider to deliver new/different services, including: - Single Point of Access- A 0-18 neurodevelopment pathway (east Kent only)- Strategic Improvement Partner function- Conduct Disorder pathway- Post sexual abuse and harmful sexual behaviour pathway

There is currently a Kent-wide caseload of 13,000 children and young people, additional investment of £2.1m has been invested into NELFT to achieve an 18 week referral to treatment target by spring 2019.

EK Lead for Kent

PAWS (Thanet) Porchlight and NELFT CYPMHS are working in partnership to deliver PAWS which is an innovative and creative service to young people aged 13 years+ and their families/carers in Thanet. PAWS provides specialist support for young people with a particular focus on mental and physical health, emotional wellbeing, resilience, offending behaviours and substance misuse. Support is available to improve family communication, support teenage girls, and help parents cope with challenging behaviours.

EK Lead for Kent

Unaccompanied Asylum Seeking Children

Two national conferences were held in May and June 2018 and were led by three young men who had been UASC. The conferences attracted an incredibly high calibre of speakers and received very positive feedback, with over 96% of attendees finding them ‘excellent’ or ‘very good’.

Workforce Strategy The EK CCGs have developed an Outline Workforce Strategy in collaboration with commissioners and providers across Kent, Medway, Sussex and Surrey, and with the aim of addressing both capacity and capability workforce challenges.

We have commissioned our own bespoke CYP audit tool called the 'CYP Matrix' with help from 16 local Champions (clinical and non-clinical staff and managers) across the South East, working with a software developer to ensure the bespoke tool meets the needs of our very complex CYP emotional wellbeing and mental health provider landscape. This has created national interest as no other region has successfully developed a robust audit tool for children's services.



Increasing access Thanet is in top five of CCGs for Children’s Mental Health: Increased prevalence of mental disorders amongst children, and particularly young women, has been in the news [https://www.bbc.co.uk/news/health-46295719] recently. Anne Longfield, the Children’s Commissioner, has also produced a briefing on children’s mental health [https://www.childrenscommissioner.gov.uk/wp-content/uploads/2018/12/childrens-mental-health-briefing-nov-2018.pdf] that analysed CCG provision of Child and Adolescent Mental Health Services (CAMHS). After looking at CCG performance she called for additional funding and ambitious leadership to tackle children’s mental health to be in the NHS’ forthcoming 10 year plan. The briefing used five indicators to compare CCG performance and Thanet was the only CCG outside the North East of England in the top 5 performers. This is important recognition of all of the hard work by our staff who strive to make sure that there is treatment in place to help the children of Thanet and east Kent. Of course, with increasing prevalence of mental disorders amongst children and young people no one knows better than them that there is still more to do but sometimes it is good to pause, accept the recognition and reflect on your achievements. Well done to all those involved in providing and supporting this top performing service.


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Title of Report: NHS Continuing Health Care and Placements report

Author: Angie Glew, Interim Head of Placements

Executive/ Lay Sponsor: Sarah Vaux, Chief Nurse






Report summary/purpose:This provides a report on East Kent CCG’s statutory functions for commissioning bespoke packages of care for patients with complex healthcare needs where they meet the eligibility criteria for NHS Continuing health care (both adults and children). It also covers other health funding of physical and/or mental healthcare, including Learning Disabilities, which is not commissioned through universal arrangements.

CHC over spending (£5.2m) – The in-year over-spend with CHC is assumed to continue for the rest of the year. This forecast outturn has increased from £4m at month 6, due to the month 7 spend increase. A deep dive into this area of spend has happened in recent weeks and will be followed up in early January. From the initial deep- dive, actions which could reduce the in-year spend by £2m were identified (invoice validation, consistency reviews and standard reviews etc). Therefore, actions are underway to mitigate this in year cost pressure.

Recommendation:

For information only.Approval of the Kent and Medway wide allocation tool for children CHC

Combined impact assessments QIPP programme has had combined impact assessments

Yes

No (state reason)

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SBAR Report

Placements and Continuing Health Care (CHC)

Situation:

This provides a report on East Kent CCG’s statutory functions for commissioning bespoke packages of care for patients with complex healthcare needs where they meet the eligibility criteria for NHS CHC (both adults and children). It also covers other health funding of physical and/or mental healthcare, including Learning Disabilities, which is not commissioned through universal arrangements.

Background:

The CCG has statutory accountabilities to arrange and fund bespoke packages of care (healthcare funded placements) where the assessed need of a child or adult meets the specific nationally directed eligibility criteria for NHS CHC. In addition, where expert clinical assessment of a patient’s needs, at the Out of Area Treatment Placements (OATS) Panel identifies they require specialist assessment and/or treatment for mental health and/or learning disability needs this is funded by the CCG.

The CCG has some tri-partite and joint funding requirements with the Local Authority for children’s and mental health funding of aftercare following someone being subject to being sectioned under the Mental Health care Trust.

The CCG’s also has some children/young people placed in residential settings where they jointly fund with the Local Authority.

The CCG commissions an integrated placements service from North East London Commissioning Support Unit (NEL CSU) including referral management, assessments, care packages, placements, reviews, provider checks, contracting, market management and the associated finance requirements. This does not include children’s continuing care assessments which are commissioned from Kent Community Health Foundation Trust (KCHFT). Joint Resources Allocation Placements (JRAP) are being undertaken by the interim Head of Placements.

Previously Unassessed Periods Of Care (PuPOC) – at present this work is being undertaken on a case by case basis by NEL on behalf of EK CCG’s.

Assessment:

Key issues:

NHS CHC – General update and Key points Fast Track (end of life patient) numbers remain year to year static, although certain

months (August and January are usually high). The CHC framework has been revised and implementation commenced October 18.

Whilst it has not changed the eligibility test, it clearly identifies that consideration for NHS CHC should not be done in the acute setting, that reviews should be about quality of the care package etc and not about changing eligibility unless there is a clear indication of improvement in the individual.



Discharge to access DH direction is that no more that 15% of NHS CHC assessments for eligibly for CHC

via and Decision Support Tool (DST) to be done in the acute trust. This is based on evidence that by moving patients out into a more suitable environment and allowing them a length of time to improve, improves the quality of their lives and the number of patients being eligible declines. This target is not being achieved although this varies month on month. At present EK CCGs manage between 60 – 80 % (November figures) - although this figure can be effected by individual CCG low numbers. There are negotiations with NHS E to view East Kent as a system in this regard.

The Placements team have been working with both the acute and the community trust to develop a pathway, which started in November. The new Rapid Response team will have the ability to identify patients for Discharge to Assess and spot purchase a nursing home bed for patients.

NEL has agreed that they will complete a DST within 7 days once a Checklist has been received.

QiPPCHC and Placements are part of the CCGs QiPP programme. The key arears covered so far are; review of 1 to 1 patients, review of care homes, review of packages.

Going forward the next cohort of work will centre on; early review of fast track (end of life) patients, working with the acute trust to identify fast track patients who can go on the help to home scheme, on-going home spot checks which will include looking at patients receiving Funded Nursing Care, minimising waits for personal health budgets, developing a market management strategy with specific work targeting the higher cost care homes.

Children services The national framework for NHS children’s continuing care is under review with a

proposed released date of February 19. Across Kent and Medway a core offer has been developed to ensure equality in

provision.

Personal Health Budget From April 1st 2019, the default position is that all domically patients receiving CHC

will be offered the opportunity of having a PHB.

Ongoing arrangements of provision of NHS CHC and Placements team. Discussions are ongoing with West Kent and North Kent CCG’s (including Medway)

around developing a proposal to create a Kent and Medway CHC and Placements team.

Recommendation:

The Governing Body are asked to note the above.


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1



Title of Report: East Kent Clinical Assurance and Strategy Committee

Author: Dr Navin Kumta, Clinical Chair – Ashford CCG

Executive/ Lay Sponsor: Lorraine Goodsell, Deputy Managing Director, East Kent CCGs







To provide governing body members with a summary of items discussed at the October meeting of the Clinical Strategy and Assurance Committee. Key areas of focus:

Freestyle Libre (FSL)National guidance is changing in relation to the use of FSL The Committee agreed that a further paper that includes the detail of the national guidance will be required to be submitted to the Committee in January 2019.

Health Policy Recommendations – Summary

PR 2018–11 Tattoo Removal The Committee approved all recommendations within the paper.

PR 2018-12 Cryopreservation and ICSI following SSRPaper was presented providing a summary of the policy recommendations. The recommendation has been made following the change in commissioning arrangements which required clarification for Urology services.The Committee approved all recommendations within this paper.

PR 2018-10 Heavy Menstrual BleedingA paper summarising the updated policy is in line with the new NICE Guidelines. NICE recommends hysterectomy as first line treatment if deemed in the best interest of the patient. The previous policy requires the patient to have trialled hormone methods or alternative treatments prior to offering hysterectomy.

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2

Committee approved all recommendations within this paper.

PRGC – Policy 2PR 2018-07 SAFO for foot-drop. A paper was presented, outlining the recommendations relating to funding for silicone ankle foot orthosis. Currently there was not enough research/information/evidence to suggest that Kent and Medway CCGs should fund this. The Policy suggests that we do not fund this. Policy states that there are alternative orthoses available to patients with foot-drop.Committee approved recommendations not to fund.

PR2018-09 LabiaplastyA paper was presented with recommendations that the background section has been updated to increase awareness of variations to the Policy FGM. Currently the procedure is not routinely funded by Kent and Medway CCGs.Committee approved the recommendation to not fund.

East Kent Prescribing Group – Summary of Recommendations

Diabetic Safety Needles – It was recommended that KCHFT supply safety needles directly rather than through the GP practice on FP10.The Committee approved this recommendation.

Proshield Plus –v- Medi Derma-Pro Skin Protectant Ointment Proshield Foam & Spray skin cleanser –v- Medi Derma-Pro FoamA comparison of the Proshield products vs the above MediDerm products was presented at the EKPG. Although the MediDerm products are a lower cost, the Tissue Viability team have confirmed that they believe the Proshield range are more effective but have not formally submitted their evaluation to demonstrate this decision. A rebate is available for the Prosheild products that would make these products a similar cost to MediDerm. The EKPG recommend that we adopt the KCHFT recommendation. The Committee approved this recommendation.

Thickener Reference SheetThickener reference sheet is reviewed due to the publication of guidance from the International Dysphagia Diet Standardisation Initiative (IDDSI). There is one product only which is reviewed by Speech and Language Team (SaLT) which meets requirements. This is Resource Thicken-Up Clear. The Committee approved this recommendation.

Diabetes Treatment Pathway for Adults – Type 1This recommendation had been brought to the Committee as the guidance had been updated to include high strength insulin Glargine in the same part of the pathway as Insulin Degludec.The committee approved this recommendation.

Enoxaparin for Lower limb immobilisation PGDThe East Kent Prescribing Group (EKPG) had approved the PGD pending some amendments to supporting information. These recommendations were approved by the committee.


3

AirFluSal MDIEKPG recommended the removal of AirFluSal MDI from formulary following significant stock issues. Sirdupla is recommended as a direct replacement. Committee approved this recommendation.

FerracruThe recommendation had been delayed while information was clarified on blood test request i.e. whether haematinics were required or iron levels only. Confirmation received that only iron and haemoglobin were required. Request to add to formulary as specialist initiation.Committee approved this recommendation

EK Prescribing Group – Unconfirmed Minutes – 17.10.18Sodium Valproate alert – GP and pharmacy information is in place. There are outstanding issues regarding patients being seen and reviewed annually. Advice was sought as to how to escalate this as although having discussed this issue at the EK Prescribing Group, advice is sought in order to move forwards. Paper to be drafted to present at Policy Recommendations and Guidance Committee (PRGC) and in turn bring to the committee meeting in January (17.1.2019)

NHS Right Care and GIRFT (Getting it right first time)It has been agreed with East Kent Hospitals University Foundation Trust (EKHUFT) that the two programmes will be aligned to provide a framework for addressing variation as a health economy. Some actions that have been identified under GIRFT are out of date and similarly RightCare uses data from 2016/17. The programme will seek to review the original opportunities and agree joint project plans for the pathways.

A process has been agreed with the Trust and all GIRFT action plans will be shared once signed off by the Medical Director. There is potential to reduce 30% of ‘outpatient new’ and 60% of ‘outpatient follow-up’ appointments as part of a longer term plan. This will include implementing ‘virtual clinics’ and the possibility of ‘skyping’ with patients. The prioritisation of development of new policies is also being reviewed to ensure that higher volume procedures are prioritised sooner and in line with NICE guidance.

The Committee were informed that OPTUM provide a benchmarking tool which will help to review the previous areas identified by RightCare. Some of the areas will not change including a focus on MSK and implementing the national low back pain pathway.

East Kent IT Strategy Group It was noted that a number of the pathway improvements described above need an effective IT Strategy underpinning them. An update will be provided to the December meeting of the committee. Kent Care Record – Approval of Outline Business Case (OBC) to include:1. Design and marketing. 2. Procurement and 3. Mobilisation.

The Committee was asked to review the outline business case for KMCR, approve the final draft specification and give authority to proceed to procurement on the basis of the rationale set out in the OBC and the draft specification.


4

In addition the Committee were requested to support a Kent and Medway Memorandum of Understanding which commits all to the process.

The OBC was approved by the committee

QIPP Transformation Programme: Dermatology GIRFT and Right Care RaTC – Policy Recommendations

In relation to Dermatology, work is under way to map out an advanced community model. There is an opportunity for dermatology advice and guidance to go live next year.

In relation to Musculoskeletal triage integrated services a review of data is underway which includes a multitude of services across CCGs.

Urgent Treatment Centres (UTC)There are currently discussions with NHS England who are keen for us to move forward with the development of the UTC programme. A paper outlining a proposed approach will be ready for discussion in January 2019.

Award of Contracts Independent sector hospitals - Kent and Medway FrameworkMembers were informed that the VEAT Notice submitted against the Independent Sector contracts did not have any additional providers expressing an interest in a contract.Therefore contracts will be issued for 2019/2020 for a 3 year period. The contracts will have activity and finance plans and will be subject to annual reviews to include quality.Memo of Understanding was agreed by committee and can proceed to procurement across West Kent/North Kent and Medway CCGs.

Any Other BusinessMental Health to be added as a regular item to CASC meetings.

Recommendation:

The Governing Body note the content of this report.


Yes

No (state reason)





Title of Report: Finance Report as at November 2018 (month 8)

Author: Zoe Chidwick, Acting Chief Finance Officer

Executive/ Lay Sponsor: David Meikle, Turnaround Director

Finance sign-off David Meikle, Turnaround Director



Y/N None Identified

No YesIs circulation restricted?(please X as applicable)

No restriction


To update the Governing Body on the financial position as at November 2018

Recommendation:

The Committee is asked to note:

the current financial position as at month 8 and the forecast outturn;

that the projected in year over-performance at EKHUFT has stabilised at £11m, with discussions on-going with the provider in order to minimise the impact on the CCGs;

the deterioration from month 6 to month 7 has continued into month 8 in the other risks of CHC over-spend and Independent Sector over-performance; and

the QiPP performance year to date and the increase in the risk assessed forecast outturn which is still below the required.

A summary slide pack is attached for consideration. A detailed Finance Report will be forwarded before the Governing Body meeting.

Combined impact assessments Has the report/recommendation/proposal been impact assessed?

Yes

No: To be completed as part of mobilisation and planning in Q4.

27-19 - SBAR Board Report - Financial Position at M8.docOverall of 184


SBAR Report of the Financial Position as at November 2018

Situation:The month 8 reported position reflects this increasing risk position, with the year to date deficit at £38.4m.

The main drivers of this in year deficit are:

the over-performance in the local acute providers the over-performance in the independent sector (acute providers) Impact of losing 2017/18 expert determination is fully reflected in the year to date. over-spending in CHC under-performance in the QiPP programme

The forecast deficit is still in line with the Financial Recovery Plan, with the outturn forecast at £38.14m (including banked Q1 CSF support at £2.3m). Unmitigated risk for East Kent remains at £8.5m, which means that the likely outturn is £46.54m, as Q1 CSF was achieved

Background:The east Kent CCGs produced a plan for 2018/19 that generated a £24m deficit, assuming a £19.5m QiPP programme. The deficit was matched by £24m Commissioning Support Funding of £24m, resulting in a control total of break-even. However, the plan also identified unmitigated risk of £16m.

A revised Financial Plan was submitted to NHSE that moved the planned deficit for 2018/19 from £24m to £49m, before Commissioning Support Funding. This plan has not been fully accepted by NHSE, with the current position is that the revised plan is £40.5m, with unmitigated risks of £8.5m

Assessment:Key issues impacting on the financial plan and Forecast Outturn at October ‘18 are:

EKHUFT over performance (£11m) – weekly meetings are on-going between the CCGs and EKHUFT to bring the activity assumptions into alignment for the remaining part of the financial year. The FRP requires the CCGs spend with EKHUFT to be at £419m. However, the Trust is forecasting income from the CCGs at £430m. The main difference in the assumptions is that the level of planned activity is greater than forecast by the CCGs and the level of non-elective activity is also greater than planned through the opening of additional beds (two wards). Recent analysis has indicated that EKHUFT’s income forecast has now reduced to £427.2m, however, discussions are on-going.

CHC over spending (£5.2m) – The in-year over-spend with CHC is assumed to continue for the rest of the year. This forecast outturn has increased from £4m at month 6, due to the month 7 spend increase. A deep dive into this area of spend has happened in recent weeks and will be followed up in early January. From the initial deep- dive, actions which could reduce the in-year spend by £2m were identified (invoice validation, consistency reviews and standard reviews etc). Therefore, actions are underway to mitigate this in year cost pressure.



IS over performance (£7.3m) – The in-year over-performance with the acute providers in the Independent Sector is assumed to continue for the rest of the year. Director level meetings have been held with these providers and plans have been agreed that would result in an activity reduction in Q4. However, as there is no contractual basis for these plans, we will continue to work with the providers in order to mitigate this position.

QiPP slippage (£2.3m YTD) - Year to date QIPP delivery of £9.1m has been achieved representing 47% of the original £19.5m plan and 28% of the £33m stretch target. The current QIPP profile shows that delivery is forecast to deliver most impact in quarters three and four. There is an adverse variance of £2.3m YTD mainly due to the Local Care Programme plan slippage which is being addressed during 2019/20 planning.

The current QiPP plan is £28m (PYE) before risk assessment. QIPP delivery is on track to achieve the original plan of £19.5m. However, the current risk assessment is £18.5m which is consistent with last month. The priority is to maximise the benefits within the current plan in order to increase the risk assessed forecast whilst developing further pipeline opportunities in order to close the gap.

Recommendation:The Governing Body is asked to note:

the current financial position as at month 8 and the forecast outturn;

that the projected in year over-performance at EKHUFT has stabilised at £11m, with discussions on-going with the provider in order to minimise the impact on the CCGs;

the deterioration from last month in the emerging risks of CHC over-spend and Independent Sector over-performance; and

the QiPP performance year to date and the increase in the risk assessed forecast outturn which is still below the required.

David MeikleTurnaround DirectorEast Kent CCGs

27th December 2018


Overall of 184

Financial Position as at Month 8• A revised Financial Plan was submitted to NHSE that

moved the planned deficit for 2018/19 from £24m to £49m, before Commissioning Support Funding.

• In line with last month, M8 agreed that FOT would reflect a deficit of £40.5m (less banked CSF) and unmitigated risk of £8.5m

• YTD cost pressures are CHC and IS, although work is underway to minimise impact.

Financial Recovery Plan as at Month 8• QIPP delivery – on track to achieve original plan of £19.5.

Current risk assessment is £18.5m.

• FOT remains on plan adding taking into account Medicines managing growth.

• QiPP delivered at M8 is £9.07m which is below revised plan of £11.39.

• Key issues to FRP and FOT are:

• QiPP slippage

• EKHUFT over performance

• In year cost pressures emerging:

• CHC over spending

• IS over performance

Finance update: month 8Month 8 reported position, reflects this increasing risk position:• Forecast £38.14m (including banked Q1 CSF support at

£2.3m).

• Unmitigated risk for East Kent remains at £8.5m

• Likely outturn is £46.54m, as Q1 CSF was achieved

• Although actual QiPP delivered increased by £1.5m from M7 to M8, QIPP delivery continues to be below plan to date

• Deep dive in to current risk position scheduled for Month 9, but if the EKHUFT over-performance cannot be mitigated, the likely FOT deficit will increase accordingly.

27-19 - Financial Position - NHSE local Run rate slides M8 v1.pptxOverall of 184

Finance update: month 8Information by CCG

(as at Month 8)

Ashford Canterbury SKC Thanet

YTD Actual 9,987,805 12,303,015 12,533,445 3,621,785

Actual FOT 9,964,000 13,369,000 9,943,915 4,862,000

% Contingency 100% 100% 100% 100%

Net Risk 3.162 1.240 2.225 1.820

Month 7(for comparison)

Ashford Canterbury SKC Thanet

YTD Actual 9,692,292 11,927,008 10,988,171 4,339,252

Actual FOT 9,964,000 13,369,000 9,943,915 4,862,000

% Contingency 100% 100% 100% 100%

Net Risk 3.162 1.240 2.225 1.820


Finance update: month 8


CCGs’ FOT and EKHUFT income scenarios

Most Worst

Best case Likely Case

£m £m £m

EKHUFT Income Note 1) 419.00 424.00 430.00

CCGs QiPP delivered 19.50 19.50 19.50

CCGs FOT deficit 49.00 54.00 60.00

Note 1: Information from latest discussions between CCGs and EKHUFT on 10th December 2018


Risk (to delivering £49m deficit (FOT))

Value (£m) Mitigation

Value (£m)

Additional unmitigated net risk (£m)

EKHUFT over - performance 11.00 See separate slide (6.00) 5.00

QiPP slippage 1.00QiPP deliver and assurance process (1.00) 0.00

In year cost pressure: CHC cost over-run 2.00

CHC deep -dive with in year actions (2.00) 0.00

In year cost pressure: IS over performance 5.00

IS demand and capacity review (5.00) 0.00

Total

19.00 (10.50) 5.00




EKHUFT income projections (WIP 10/12/18)

Value (£m)

Potential mitigation discussed / agreed

Value (£m)

Additional mitigations to be discussed / agreed

Value (£m)

Forecast outturn based at month 5 421.70Projections agreed 0.00No further mitigations 0.00

Additional elective activity 7.60Demand adj. for out-pats (4.40)Planned care QiPP - Rightcare actions (0.50)

Demand and capacity review on-going (2.70)

Additional non elective activity 1.60Two wards not opened (1.60)Local care QiPP impact on the NEL activity (0.80)ED verbally agreed with a gain of £1m to CCGs from the complete downside position. (1.00)

430.90 (6.00) (5.00)


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Meeting Title: Thanet CCG Governing Body

Agenda Item: 29/19


Title of Report: East Kent Integrated Performance Report

Author:Clara Wessinger, Head of Planning, Performance and Information

Executive/ Lay Sponsor: Karen Benbow, Director of Commissioning

This paper is for: Approval Decision Assurance Information


N None identified: members to declare conflicts as necessary.

Is circulation restricted? No Yes


This report informs the governing body of the CCG’s position against national targets and highlights where areas of performance are of concern. The CCG continues to work with partners across the system to improve performance, meet national standards and ensure patient care is provided with the best possible outcomes.The current position on key constitution and performance standards includes; A&E Waiting Times, NHS111, Referral To Treatment, Cancer Waiting Times, Ambulance Response Times, Dementia, Mental Health Services and Wheelchairs.

Key Performance Headlines:target Aug 18 Sep 18 Oct 18

Cancer 62 days EK CCGs 85% 65.3% 68.3% 75.3% ▲Ashford 85% 69.8% 56.8% 70.6% ▲

Canterbury 85% 62% 71.0% 74.0% ▲SKC 85% 62.5% 68.1% 75.5% ▲

Thanet 85% 71.4% 76.7% 79.35 ▲

target Sep 18 Oct 18 Nov 18 (unvalidated)

A&E 4 hr wait 95% 77.1% 80.9% 81.8% ▲Target

by mth 12(based on 50% reduction

from March 2018)

Sep 18All Providers

(EKHUFT)

Oct 18All Providers

(EKHUFT)

EKHUFT Latest (14 Nov)

RTT 52 week waits 102 149 (125) 128 (115) 129 ▼Ashford 16.5 15 (12) 20 (19) 11 ▲

Canterbury 22.5 36 (30) 27 (25) 29 ▼SKC 40 59 (47) 44 (36) 42 ▼

Thanet 23 39 (36) 37 (35) 45 ▼

Recommendation:The governing body is asked to note the report and the actions and risks in relation to addressing the highlighted areas of under-performance.

Combined impact assessments: Has the report/recommendation/proposal been impact assessed?

Yes – see appendix 2 for links to risk register

29-19 - SBAR East Kent Integrated Performance Report (December 18).docxOverall of 184

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Appendix 1 - East Kent Integrated Quality and Performance Report

Urgent Care

A&E 4 hour SituationBased on month (Oct 2018)National target: 95%In month improvement trajectory target: 86% (95% target to be met by March 2021)Actual position: 80.9%BackgroundThe trust experienced a dip in performance in September with the rollout of PAS. October has seen improvement, and initial data for November indicates ongoing improvement. However, the trust is below their internal trajectory by 5% each month.

Actions completed Whole system action plan has been agreed between providers, CCGs and NHSE/I Primary care networks: Each CCG area has established primary care networks (PCN) at 30-50,000 Integrated Case management (ICM) being rolled out across EK:

o Canterbury; fully mobilised moving to weekly MDTs and exploring daily interface in two hubs where workforce available.

o Ashford; fully mobilised fortnightly MDTs in place, moving to weekly during October o Thanet fully mobilized: a combination of monthly and fortnightly MDTs

Social prescribing frameworks in place in each Locality Care Homes Implementation of the gold standard, Dedicated Care home support via frailty

team/ART/Home visiting service in 3 out of 4 CCG areas GP streaming in place at QEQM and WHH; aligned to the Luton and Dunstable model Integrating with

the acute Trust MIU/minor illness teams delivering Urgent Care centre approachAssessmentThe CCGs are not assured that the trajectory will be met, being under plan by 5% with winter pressure likely to impact performance in the next few months. However, significant progress has been made with discharge of stranded patients. Ambulance handovers have maintained the positive reduction levels seen at the start of the year (see Ambulance Response section below). To maintain the improvements seen in year, a focus on ensuring delivery of the winter plan is critical. RecommendationActions to be taken

Integrated Case management (ICM) SKC to be fully mobilised in Q4 Capital investment into Margate, New Romney and Canterbury developing integrated care services

with primary care at the centre Wound Care pathways: developed and being rolled out in each locality Winter Planning

o Implementation of improved access - Octo Patient Tracker List (PTL) being fully rolled out across EK to support the ICM. - Octo Review CHC pathway - Octo Rapid response in ED (IDT) - Oct o Care homes: Roll out of Red bag scheme to all CCGs - Novo Rapid transfer service: Core, community IV, dementia and palliative care – Nov.o Development of hot frailty – Nov.o Pneumonia pathway proactive response – Nov.o Red Cross in acute - Nov


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Supporting Data

Local Care

Improved Access TargetSituationTargets:

From 1st October 2018 Commission weekday provision of access to pre-bookable and same day appointments to general practice

services in evenings (after 6:30pm) – to provide an additional 1.5 hours a day, Commission weekend provision of access to pre-bookable and same day appointments on both Saturdays

and Sundays to meet local population needs, Commission a minimum additional 30 minutes consultation capacity per 1000 population, rising to 45

minutes per 1000 population (timing to be confirmed by future national planning guidance).

BackgroundThe four CCGs are meeting improved access targets

Actions Taken: Contracting with Providers to provide Service based on targets above Supporting Providers to mobilise Service including ensuring that practice receptionists will be offering

Improved Access appointments alongside core hours appointmentso Advertising and Communication Campaign to ensure public awareness of Service including:

Production of Posters for use in practices, A&Es, UTCs, MIUs, other public places Production of digital materials for practices to use on their websites and waiting room

screens Press Release to local media CCG websites and social media

Commenced development of direct booking from NHS111 to support wider access to Service particularly access to weekend slots after 6.30pm on Fridays.


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Assessment

October 2018 Performance

CCG

Target AshfordCanterbury & Coastal

South Kent Coastal Thanet EAST KENT

1Weekday Service 6.30-8.00pm In place In place In place In place In place

2 Weekend Service In place In place In place In place In place

3

Minimum Additional 30 mins per 1000 population consultation capacity In place In place In place In place In place

a Appointments Offered 1221 4276 7323 526 13346b Appointments Booked 889 3787 3376 315 8367

c%age of Offered Appointments Booked 73% 89% 46% 60% 63%

d Appointments Utilised 800 3616 3215 301 7932

e%age of Booked Appointments Utilised 90% 95% 95% 96% 95%

All CCGs are meeting the Improved Access to General Practice core provision targets The total number of appointments offered in South Kent Coastal includes all appointments provided by

the Primary Care Access Hubs. Improved Access is currently not provided between 8.00am-6.30pm Monday-Friday in the other three CCGs.

The total number of appointments offered in Thanet is an incomplete total as not all practices have submitted their October data. In future Thanet CIC will be collating the data on behalf of all the Practices.

The Service has the potential for greater impact if there is higher take up of offered appointments – the range across CCGs is 46-89%.

Recommendation

The GB/Committee is requested to note the following actions being undertaken to ensure continued provision of the Service to the core standards and increasing utilisation of offered appointments to meet the overarching objectives of the Service of increasing general practice capacity to reduce pressure on core general practice services and to provide an additional alternative for patients who choose to attend A&E/UTC/MIUs for conditions which could be treated in routine general practice:

Establish effective contract and performance management of Service Work with Providers to identify reasons for current utilisation rates and then agree plans to address them Assessment of current advertising on practice websites and in surgeries Continued development and mobilisation of direct booking from NHS111

Ambulance Response Times SituationBased on month (Sep 18)National targets:Category 1 – Life-threatening: Average response 7 mins/90% 15 minsCategory 2 – Emergency: Average response 18 mins/90% 40 minsCategory 3 – Urgent: 90% 120 mins


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Category 4 – Non urgent: 90% 180 mins

Actual position:Cat 1 90th centile target has been met in Thanet CCG, is met variably but close to target in Ashford and is below target in Canterbury and SKC. Category 2, which represents the majority of activity, is meeting the 90th centile target in all CCGs and the mean target in Ashford and Thanet. Category 3 and 4 targets have been underperforming in all CCGs, across the provider and nationally.

BackgroundNew national targets were launched in November 2017. Actions completed

External review of demand and capacity commissioned jointly between CCGs and provider has been issued. Additional funding will be required for trust to meet demand within target. Funding requested will meet targets at provider level, but will leave some EK CCGs below target based on modelled trajectories. Discussion underway between CCGs to agree if funding contributions should be based on projected target compliance, increase in target performance, or contract volume.

AssessmentAssurance that trajectory will be met: Not assured. External demand and capacity modelling trajectories do not project compliance in all EK CCGs. RecommendationActions to be taken

EK CCGs to contribute to discussions with East Sussex CCG (contract lead) regarding contributions to additional funding

Supporting DataThe following table shows the breakdown of performance by standard and CCG:

Cat 1 performance is high in regions with a local hospital.Cat 1 - 15 mins Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18EK CCGs 88% 89% 91% 90% 90% 89% 89% 91%Ashford 89% 95% 88% 90% 90% 90% 91% 84%Canterbury 85% 86% 89% 87% 90% 88% 84% 92%South Kent Coast 82% 81% 86% 82% 83% 81% 83% 85%Thanet 98% 98% 100% 100% 98% 98% 99% 100%

In the remaining targets there is little variation between EK CCGs:Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18

Cat 2 - 40 mins 95% 91% 95% 95% 95% 92% 93% 92%Cat 3 - 2 hrs 87% 73% 84% 84% 85% 69% 75% 77%Cat 4 - 3 hrs 80% 76% 86% 79% 74% 74% 83% 83%

Handover waiting times have reduced in WHH and QEQM compare to the same period in the previous year


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East Kent Clinical Commissioning Groups29-19 - SBAR East Kent Integrated Performance Report (December 18).docx

Overall of 184

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Planned Care

RTTSituationBased on month (Nov 18)Incomplete 18 week target:National target: 92%In month improvement trajectory target: 81% (92% target to be met by March 2021)Actual position: 79.5%52 week waiters:National target: 0improvement trajectory target: 50% reduction by March 2019 (204 breaches reported in March 2018 – must achieve 102 by April 19) Actual position: 128 (all providers October), 129 (EKHUFT 14 Nov update)

BackgroundPerformance continues to decline and backlog is growing. 52 weeks performance has fallen away from trajectory with growth in October and November.

Speciality level concerns: MSK - ERS enabling GPs to bypass the community triage service and book directly into EKHUFT – solution

being worked through with NHSD. Gynaecology - Consultant job planning. Skills gaps at sub-specialty level. Theatre capacity not being

utilised to maximum effect. Ophthalmology - Demand and capacity review underway.

Actions completed: PAS rollout implementation plan – training, overtime, targeted fixes Waiting list validation, focus on ‘cashing up’ of clinics. Improved pre-admission/assessment – pilot in Urology Gynaecology speciality level improvement plan.

o Increased activity to IS. o New external general manager to implement improvement actions. o Focus on theatre productivity and improved job planning.

Outpatients transformation agenda – virtual clinic pilots (fracture and spine) ERS paper switch-off began 1 October. Significant improvement seen in all EK CCGs. Tier 2 Rheumatology: 900 patients have transferred as of the beginning of October

Assessment Trajectory not assured.RecommendationActions to be taken

Right Care and Getting it right the first time (GIRFT) programmes in CCGs and Trust, respectively, are aligning priorities with initial plans to focus on Gastro, Urology (Genito) and MSK.

Development of RaTC implementation - Optum updating the RATC flags on the system and review of policy underway

Outpatients transformation initiated between CCGs and EKHUFT with a focus on digital systems providing alternatives to face to face consultant acute follow-up.

Dermatology model focused on reducing demand on secondary care (supported by Consultant) and using Telederm and A&G as a more cost effective model

Ophthalmology, Gynaecology and Neurology service reviews underway


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Supporting Data


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ERSSituation

GPs using the e-Referral System (e-RS) are able to choose from any provider on the system (including Independent Sector providers) anywhere in the country. Providers should not accept referrals outside of e-RS for consultant-led first outpatient appointments, therefore in order to facilitate patient choice and patient pathways, GPs should be referring through ERS.

Background

The national paper switch off for consultant-led first outpatient referrals was the 1st October 2018.From 1 October 2018, providers should only be paid for activity resulting from these referrals made through e-RS (the e-Referral System).

Providers should provide adequate capacity on the e-Referral System so that patients can choose an appropriate venue and time for their appointment.

An e-RS Board is in place for key stakeholders (Trust, CCG representatives, and colleagues from NHS Digital and NHS England), which meets regularly to discuss management of the system, such as procedures for non-e-RS referrals, etc. Part of the discussion is around utilisation of Ee-S which can be broken down by CCG and practice.

Assessment

All four East Kent CCGs are over 90% usage of e-RS (EKHUFT only data). Technically some practices (and therefore CCGs overall) may not reach 100% utilisation, as Cancer two week wait non e-RS referrals will not rejected (but if any non e-RS 2 week wait suspected cancer referrals are received the Trust is expected to notify the appropriate CCG for them to take further action with the referring practice) . Such referrals will be processed after 24 hours if the practice has not re-submitted but payment processed.

Recommendation

Keep monitoring use of e-RSto ensure there is no decline in utilisation.

Appointment slot issues should also be actioned by providers to ensure there is capacity on Ee-RS.

e-RS provider destinations should be monitored to ensure that triage systems in place are being adhered to.


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Diagnostics

SituationBased on month (October 18)National target: 99%In month improvement trajectory target:Actual position: 99.19%BackgroundTarget was breached between June – August 2018. Compliance now recoveredAssessmentEKHUFT confirmed the breach occurred due to the timing of slots available through ERS being set outside of the diagnostics target times. This setting has been changed and diagnostics are now being booked in the correct timeframe. Recommendation

Continue monitoring

Cancer

62 day referral to treatmentSituationBased on month (September)National target: 85%In month improvement trajectory target: u/a (awaiting final trajectory)Actual position: 68.3%Background

The current 62 day performance for cancer remains non-compliant at below 85% compliance. September performance was 68.3%. Live data for October indicates performance over 75%, however this is from live EKHUFT only unvalidated data. This is showing signs of a steady improvement in waiting times each month. The main tumour sites struggling with performance are Urology, Gynaecology and Colorectal.

Under the new Chief Operating Officer, East Kent Hospitals are updating their cancer improvement plan and trajectory. This has been shared within the most recent CPN meeting, and will be updated and scrutinised on a monthly basis. The


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current trajectory indicates compliance will be achieved in January (so will be shown in March’s release when data will be validated).

The trajectory will focus reducing the number of patients waiting passed day 62. The Trust is currently interrogating the Patient Tracking List (PTL) on a daily basis. Every single patient between 45 and 62 days is being scrutinised and actions taken as required. Efforts made to lower the number of 104+ day waiters is also showing signs of success with the level at 12 patients on 12th November (much lower than seen in previous months where the number was over 30).

Specific actions the Trust is taking include reviewing patients waiting 70 days onwards each morning with senior leadership overseeing actions from the PTL. The access policy is in its final ratification. Clinical MDT lead meetings have taken place and the outcomes of workshops are now reflected in the improvement plan with clinical oversight and monitoring. The trust is also conducting training around MDT meetings.

Current Issues Three unexpected staff absences in colorectal team having an effect on capacity for 2WW and treatments. The

trust is currently working hard to mitigate any risks to the patient pathway. ‘Allscripts’ (the new IT system at the Trust) implementation has had a negative effect on the 2WW pathway.

The trust is working hard to mitigate and ensure that all uploaded data is validated.Actions completed

A GP education day took place in November with a key focus around earlier diagnosis, screening uptake and key priorities around cancer.

The Macmillan GPs haven undertaken an audit of Urgent Suspected Cancer Forms and will write a summary of key findings.

Two extra Urology Clinical Nurse Specialists have been employed to run clinics supporting patients at the front end of the pathway.

Transformational money available for the Trust for care navigators (lung) and straight to test pathways (colorectal).

Further money has been made available through the national support fund for the prostate pathway Macmillan GPs have been completing practice visits to educate GPs and practice staff about NG12, urgent

suspected cancer referrals and the use of direct access and straight to test pathways. AssessmentAssurance that trajectory will be met: The live EKHUFT dashboard is being monitored on a weekly basis to ensure that compliance is on track. Although performance is currently not compliant, commissioners are feeling more assured by the new leadership within the trust and slow improvement is now evident. RecommendationActions to be taken

2WW audit findings to be circulated and used to guide future GP training opportunities CCGs to monitor implementation of transformational funding to support pathway improvement, particularly

prostate. Patient choice/cancellation is a frequent reason seen for two week wait breaches. This puts strain on the latter

part of the pathway to remain 31/ 62 day compliant. The Kent and Medway commissioners are looking to implement a patient information card to be used at the point a GP refers a patient. The card would be given to the patient and would stress the importance of attending all appointments.

Supporting Data

The table below shows the 62 compliance for all trusts for EK patients in September.The key tumour site hindering compliance remains urology, albeit very few tumour sites are compliant


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Please note that September data is not validated and only relates to EKHUFT activityTwo Week Wait: National Standard = 93% Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18EK traj. EK actual 96.4% 96.3% 95.8% 97.1% 91.5% 89.0% 93.7% 94.1% 94.9% 93.5% 91.0% 83.5%Ashford traj. 93.1% 93.5% 93.1% 93.1% 93.2% Ashford actual 96.3% 96.9% 97.4% 98.1% 92.4% 89.7% 95.0% 95.4% 94.9% 92.5% 88.8% 87.4%C&C traj. 93.1% 93.1% 93.1% 93.1% 93.1% C&C actual 97.1% 96.3% 96.1% 97.1% 90.4% 90.9% 92.0% 93.4% 94.4% 92.8% 90.2% 83.1%SKC traj. 93.0% 93.0% 94.0% 93.0% 95.0% SKC actual 97.1% 96.6% 95.9% 96.2% 93.7% 88.6% 95.7% 96.4% 96.2% 94.2% 93.1% 84.5%Thanet traj. 94.7% 93.8% 94.7% 94.1% 94.4% Thanet actual 94.2% 95.6% 93.8% 97.2% 89.5% 85.8% 92.5% 90.8% 93.9% 94.7% 91.1% 79.2%

31 Day Diagnosis to Treatment: National standard = 96%

Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18EK traj. EK actual 96.2% 94.9% 93.5% 97.2% 95.3% 95.6% 96.1% 95.8% 95.5% 95.3% 97.5% 97.1%Ashford traj. 96.4% 97.9% 96.4% 96.0% 96.2% Ashford actual 98.4% 98.3% 94.2% 96.2% 97.8% 98.0% 96.4% 98.1% 98.6% 94.3% 94.9% 97.5%C&C traj. 96.9% 96.4% 96.9% 96.6% 96.7% C&C actual 96.8% 92.9% 93.3% 100.0% 95.6% 96.8% 93.5% 97.2% 91.1% 96.2% 97.3% 98.9%SKC traj. 98.0% 96.0% 96.0% 96.0% 99.0% SKC actual 93.6% 94.1% 95.4% 95.2% 93.0% 96.5% 98.0% 96.3% 97.8% 96.0% 97.5% 96.4%Thanet traj. 97.3% 96.8% 97.3% 97.0% 97.1% Thanet actual 97.4% 95.9% 90.0% 96.7% 96.4% 90.9% 97.2% 92.3% 96.5% 93.3% 100% 96.2%

62 Day Standard Referral to Treatment: National standard = 85%

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

EKHUFT traj. EKHUFT actual 71.7% 73.0% 73.0% 71.0% 70.2% 67.2% 63.6% 64.4% 65.7% 65.3% 68.3% 75.3%Ashford traj. 85.7% 87.1% 85.7% 87.5% 85.3% Ashford actual 70.0% 88.5% 82.1% 73.1% 75.0% 67.7% 61.5% 75.8% 66.0% 69.8% 56.8% 70.6%C&C traj. 86.2% 86.0% 86.2% 86.8% 85.7% C&C actual 75.4% 67.6% 73.7% 75.5% 70.5% 62.1% 60.8% 61.9% 58.7% 62.0% 71.0% 74.0%SKC traj. 86.0% 85.0% 85.0% 88.0% 87.0% SKC actual 69.5% 67.2% 75.0% 68.1% 66.1% 70.2% 70.0% 56.5% 73.6% 62.5% 68.1% 75.5%Thanet traj. 86.8% 87.9% 86.8% 85.3% 86.1% Thanet actual 71.1% 79.6% 60.0% 66.7% 73.0% 70.0% 61.5% 70.2% 64.3% 71.4% 76.7% 79.3%


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Mental Health

Mental Health Waiting Times (provided by KMPT)SituationBased on month (Oct 18)National target: Not set nationally as service is not consultant led. Local aim to achieve 95% complianceIn month improvement trajectory target:Actual position: See chart by CCG below.BackgroundSummary of issue and historical progressActions completed

Data cleansing Implementation of central recording process Implementation of CAPA Caseload review Management of long term sickness and recruitment of new management to SKC team

AssessmentKMPT have provided a trajectory based on a reviewed demand and capacity model and have shown significant improvement. CCGs are assured that waiting times will improve by May 19RecommendationActions to be taken

Ongoing monitoring of waiting times and workforce progressSupporting Data


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Other KMPT targets:EIP targets are consistently met. Dedicated consultant recruitment is underway however first round of recruitment was unsuccessful. Although waiting times are on track the full ranges of NICE guidance interventions are not yet being delivered as all staff yet to be trained. A plan is in place to achieve compliance against NICE Treatment interventions during 2018. KMPT have shared revised a training plan for staff in the service and also latest NHSE Matrix shows improvements in treatment compliance across east Kent. Investment per patient has been noted by NHSE as having increased across east Kent however still short of the expected investment by NHSE.

OOA targets - PICU Bed UseExternal bed use for psychiatric intensive care units in East Kent has increased in year. In April and May this has followed a corresponding decrease in internal PICU bed use. However, the past month has seen a significant increase in PICU activity overall. The trust has reviewed the activity and has assured CCGs the increase was a temporary spike and has returned to previous levels in September.

IAPT (provided by multiple AQP IAPT providers)SituationBased on month (October 18)National target: See tables belowActual position: EK CCGs are achieving the 18 week wait and access rate target. Thanet and SKC are missing the 75% six week wait from referral to treatment target.BackgroundThe East Kent MH Commissioning Team continue to meet regularly with the IAPT providers to discuss performance, the Long Term Conditions pilot, referrals/not appropriate referrals into the service, communications with CMHT and other services.

LTC IAPT : East Kent CCGs have already appointed 20 staff through six IAPT providers to long term integrated IAPT services as part of wave 2 Long term condition integrated IAPT programme. All providers have had a contract variation to ensure that they are submitting to the Long term condition integrated IAPT data base via HSCIC . Three of our providers have attended Long term condition integrated IAPT workshops. AssessmentSix week wait from referral to treatment target is not likely to improve this financial year as we have just lost a key provider in SKC and Thanet, Think Action, due to their inability to deliver the service within the current contract finance arrangements. Think Action had lost staff within Thanet and Dover to other providers , their renewed focus on Ashford will enable them to focus on improving


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recovery rates which have dipped in Ashford. Insight healthcare and Dover Counselling have been tasked with working closely together to improve capacity management and close the gap left by Think Action. Dover Counselling have been failing to deliver the 6 week wait standard in Thanet for 8 months, so there is concern that performance may dip even further. East Kent Mental Health team are monitoring this closely.

The current contract comes to an end in March 2020 and procurement will start early in 2019. Assurance that trajectory will be met – 6 week target likely to not be met. Recovery target likely to be met at quarterly level. RecommendationActions to be taken

Regular performance meetings are held with all providers. An evaluation of IAPT services will be conducted during the next six months and a business case to procure a new service from March 2020 will be presented to cabinets in spring

Supporting Data

Percentage of patients who completed treatment in the month who entered treatment within a maximum of 6 weeks from referral: National Target = 75%

Nov-

17Dec-17

Jan-18

Feb-18

Mar-18

Apr-18

May-18

Jun-18

Jul-18Aug-18

Sep-18

Oct-18

SKC 74.1%

80.2%

85.0% 79.5%

79.9% 83.7% 81.3% 77.3%

78.7% 64.4% 74.8% 68.8%Thanet 100.0

%100.0

%68.8% 69.5

%62.2% 63.4% 53.0% 57.1

%62.1% 67.0% 66.2% 68.2

%Ashford 82.8%

81.5%

83.3% 91.2%

86.6% 91.3% 88.4% 83.2%

84.9% 87.7% 88.3% 87.3%Canterbur

y87.4

%88.1

%83.4% 81.0

%81.9% 81.7% 79.1% 76.0

%80.8% 81.8% 81.8% 79.7

%

Access Target = 19.0%

Jun-18 Jul-18 Aug-18 Sept-18 Oct-18

SKC 21.5% 23.5% 19.5% 26.5% 23.7%

Thanet 24.0% 25.1% 20.8% 21.8% 22.8%

Ashford 19.7% 25.7% 19.2% 17.8% 21.6%

Canterbury 20.8% 24.6% 20.3% 22.2% 24.4%

Percentage of patients moving to Recovery: Target = 50%

Nov-

17Dec-17

Jan-18Feb-18

Mar-18

Apr-18

May-18

Jun-18

Jul-18

Aug-18

Sep-18

Oct-18

SKC 50.3% 46.4% 53.9% 54.5% 50.0% 54.3%

52.6% 53.0%

53.2%

54.1%

53.4%

56.9%Thanet 49.4% 44.3% 51.8% 51.5% 51.5% 58.0

%56.7% 54.4

%49.0

%49.2

%52.5

%50.5

%Ashford 50.0% 56.8% 54.1% 51.8% 45.7% 51.6%

51.4% 49.0%

50.7%

47.4%

55.3%

58.3%Canterbu

ry53.3% 51.4% 55.5% 54.1% 53.0% 53.1

%58.2% 55.6

%56.0

%57.4

%60.8

%57.0

%

CYP access targets (provided by NHS Digital / CCG CYP MH)SituationBased on data for April to July 2018, released in November 2018.National target: To enable 32% of CYP with a diagnosable MH condition to access evidence based MH treatment in 2018/19Actual position: East Kent CCGs predicted to be above access target BackgroundThrough the Transformation fund, CCGs have been asked to increase access to evidence based MH treatment for people aged under 18 to enable 32% of CYP with a diagnosable MH condition to


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access treatment. NHS England hold CCGs to account regarding their performance against this target.

AssessmentCurrently, all four East Kent CCGs are predicted to meet and exceed the 2018/19 access target of 32%. At the moment, only NELFT and KMPT activity is contributing towards performance against the access target across all Kent CCGs. Steps are being taken to ensure data from all providers contributes, as outlined in the recommendations below.

NHS Digital have announced that they will be changing the submission process for the MHSDS from April 2019.There is a possibility that there will be another one-off data collection this year, as there was in 2017/18, which would mean that all activity across all Kent providers contributes towards the access target. Any data submitted cannot be back dated. RecommendationActions:

KCHFT (second largest provider of EWB / ND services in Kent) – due to make their first submission in November, so activity data should be captured from October

Addaction (Kent wide) – have been submitting since January; however, NHS Digital’s methodology for calculating access figures means their activity isn’t counting. NHSD have assured us they will change their methodology, but we are still waiting for this (since approx. May).

Xenzone will be making their first submission to the MHSDS in November, so activity should be captured from October. While this service is Local Authority funded, activity will count towards the access target.

Following the mobilisation of NELFT as our children’s mental health provider, a backlog of patients is waiting is being addressed. A trajectory for clearing the backlog has been proposed which will increase flow through NELFT

KMPT – CCGs are validating the access figures reported by KMPT to conclude whether they are approximately reflective of recorded / expected activity or not

To understand the changes NHS Digital are making and be prepared for themSupporting Data

CCG

Actual number of

CYP receiving

treatment (YTD)

Total number of CYP with a

diagnosable mental health

condition

Percentage access rate (forecast for

2018/19)*highlighted if

< 32%

NHS Ashford CCG 445 2583 34.5%NHS Canterbury and Coastal CCG 645 3492 37.0%NHS Dartford, Gravesham and Swanley CCG 705 5397 26.1%NHS Medway CCG 715 6067 23.6%NHS South Kent Coast CCG 700 3887 36.0%NHS Swale CCG 330 2530 26.1%NHS Thanet CCG 600 2964 40.5%NHS West Kent CCG 990 8936 22.2%

Kent and Medway 5,130 35856 28.6%South East 19,160 152411 25.2%England 141,919 1046246 27.1%

Source: NHS Digital *Access target for 18/19 is predicted based on MHSDS data for April to July 2018 and adjusted for seasonal variation


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Dementia Diagnosis rates (provided by joint working between GPs and MH provider)SituationBased on month (Oct 18)National target: 66.7%Actual position: see table below by CCGBackgroundNational target based on annually revised estimated prevalence by CCG. CCGs have worked with mental health services, GP practices and care homes to improve dementia diagnosis, recording, and care planning and support. CCGs have shown progress with this target in previous years. Rates have dropped in 2018/19 in most CCG areas.AssessmentNational datasets are not always complete due to variable data inputting at practice level. Work with individual practices is underway to improve data accuracy.Assurance that trajectory will be met: Limited AssuranceRecommendationActions to be taken

Memory Assessment serviceo Memory assessment service to provide more detailed data on diagnosiso Evaluation of current memory assessment service and review of alternative models

Patients reluctant to undergo diagnosiso Provide dementia training to protected leaning sessions to all practice staffo Engage with secondary care to provide support to practices

Data – suite of GP data and local data availableo Diagnosis rates by GPo Care home/GP prevalenceo GP level report on population / prevalenceo GP peer support with local care o Practice level prevalence rates to be reviewed in Thanet CCG to help support specific

practices with lower diagnosis rates.Supporting Data

Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sept-18 Oct-18Target 66.7% 66.7% 66.7% 66.7% 66.7% 66.7% 66.7%Ashford 63.3% 61.6% 61.4% 61.3% 63.6% 62.7% 63.4%SKC 61.8% 62.0% 62.2% 62.7% 62.5% 62.9% 62.4%Thanet 62.0% 61.2% 60.6% 60.3% 60.5% 61.1% 60.4%Canterbury 65.5% 65.5% 65.5% 66.1% 65.9% 66.1% 66.1%


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Wheelchairs Service

Wheelchairs Service ImprovementsSituationSince reporting to the Governing Body in September 2018, Millbrook Healthcare has achieved steady improvement in service performance and the waiting list for equipment and repairs is reducing.

The CCGs have released the first tranche of the additional funding approved by the eight Kent and Medway CCGs during September 2018. In the knowledge that the CCGs were considering funding proposals to invest in the contract, Millbrook Healthcare’s equipment spend during August exceeded their monthly budget by 78%; this reflects additional equipment orders placed to drive waiting list clearance.

A further tranche of additional funding is due to be released by the CCGs in December 2018. Funding release will be subject to evidence of continuing service performance improvement and the decision has been delegated by the eight Kent and Medway CCGs to Thanet CCG as the lead commissioner for this contract.

To mitigate any risk associated with additional investment into this contract, Thanet CCG took and followed expert procurement advice. A notice was advertised in the Official Journal of European Union (OJEU) justifying a regulation 72 contract addendum. The 30 day deadline has passed without other provider challenge.

A response statement by the Joint Wheelchair User Group was provided to Kent’s Health Oversight Scrutiny Committee (HOSC) during a special wheelchair focused HOSC meeting in September. This positive statement acknowledges early indications of service performance improvement and the users’ commitment to working with the CCGs and Millbrook Healthcare to deliver the Service Improvement Plan.

The CCGs have continued to collaborate with service users to listen to their experiences of the service. On 21 September Thanet CCG held an independently facilitated workshop with service users, CCG Contract Management Committee colleagues and Millbrook Healthcare managers. The group agreed Terms of Reference and priorities for a Service User Improvement Group which now meets monthly to oversee delivery of the work programme and in particular Millbrook Healthcare’s performance in relation to their Service Improvement Plan. One service user representative from this group is now a member of the CCG’s Contract Management Committee.

BackgroundMillbrook Healthcare was awarded Kent’s and Medway’s Wheelchair contract from April 2017.

An independent audit was commissioned by Thanet CCG in response to Millbrook Healthcare’s feedback during year one of the contract that they had inherited a larger backlog of patients from the previous provider than had been known at the time of the procurement. The audit evidenced the backlog reported by Millbrook Healthcare confirming a significant number of patients had been waiting for more than 18 weeks at the commencement of the contract. The audit also reported that the inherited waiting list included a higher complexity case mix requiring high cost and specialist equipment.

By end of March 2018 the waiting list had increased to 443 children and 1971 adults waiting for assessment and equipment provision. Of these:

251 children and 999 adults had been waiting more than 18 weeks 62 children and 272 adults had been waiting over one year

In addition a large backlog of repair jobs had built up, with service users experiencing unacceptably long waits for repairs.


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In September, the eight Kent and Medway CCGs approved additional contract funding to enable Millbrook Healthcare to clear the long waiting lists they had inherited and that had grown during year one and to rebalance the case mix.

AssessmentThe CCGs reported early signs of performance improvement to HOSC on 13 September 2018. This included improvement in the repairs waiting list, as by this time the repairs waiting list had reduced from 461 in mid-August to 327 by end of August. By end of September this has reduced further to 229. However, of those people still waiting for repairs, 90% have been waiting for more than 10 days and hence there is further improvement to be achieved.

The waiting list for assessment and equipment provision has reduced from 3356 in August to 3308 by end of September. Whilst this reduction of 48 is small, the average 120 per month increase in the size of the waiting list since the start of the contract has ceased and this is a first month on month reduction in the net waiting list since the start of the contract. 421 referrals were closed between end of August and end of September.

Of the 3308 still on the waiting list 49.8% have had their appointment and a further 15.4% have their appointments booked.

Reduction in the size of the waiting list which has included a higher complexity case mix is beginning to balance the remaining case mix; the proportion of low/medium complexity has increased from 66% in March 2018 to 77% in September.

These early signs of performance improvement are positive, but there is considerable further work to be done to deliver the improvement plan. The Service User Improvement Group meets in early November and will review performance to date and also update about the work priorities the group has agreed around which work has already commenced.

RecommendationActions to be taken

Continue to monitor and manage progress against the improvement trajectory Work with the Service User Improvement Group on the delivery of key workstreams including:

o Personal wheelchair budgetso Review of complaints and soft intelligence receivedo Review of eligibility criteriao Review of service specification and KPIso Audit of referral pathway

Supporting Data

Will be provided in future months.


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Contract Issues

Date Issued Subject Type Status Progress Against Recovery Plan/Trajectory Date Closed

East Kent Hospitals University Foundation Trust (EKHUFT)

13/03/2015 Accident and Emergency (A&E) - 4 Hour Target

CPN Open Monitored through the A&E delivery board - see urgent care page in this document for detail.

09/09/2015 Cancer CPN Open Please see cancer page in this document

07/10/2015 Referral to Treat (RTT) CPN Open Please see RTT

Kent Community Health Foundation Trust (KCHFT)

Dec 2017 Wound Clinics CPN Closed KCHFT Thanet wound clinic has now started taking patients.

September 2018

Dec 2017 Wheelchairs backlog CPN Closed KCHFT have agreed to a value to cover the cost of the backlog of wheelchair referrals that was inherited by the new provider.

August 2018

Millbrook Healthcare

Jul 2018 Wheelchairs waiting list CPN Open Trajectory and action plan agreed. First CPN meeting held, early indications of good progress being made (see wheelchairs section above).


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Appendix 2: Risk Register Update

Lead

C

omm

ittee

Dat

e A

dded Risk

Description Including Cause and Impact to CCG

Orig

inal

R

isk

Rat

e

Actions Completed to Reduce Risks Action Planned and Progress

Date to be Completed

Ow

ner /

Ris

k R

egis

ter

1. In

tegr

ated

Com

m in

c. u

rgen

t

May

-16

There is a risk that the A&E trajectory will not be achieved, resulting in further financial loss, reputational risk, and potential quality concerns.

16

1. Urgent care action plan in place agreed between EKHUFT, commissioners to implement sustainable improvement2. EK Urgent Care monthly meetings of A&E Delivery Board and Urgent Care Operational Group in place to monitor progress of the urgent care action plan. 3. EK Urgent Care Lead in place

1.EKHUFT to review demand and capacity2. Demand management - development of primary care Hubs, MDTs, home visiting and frailty appointments3. ED - increased Psych Liaison provision, Patent Flow improvements through early discharge planning and home first initiatives, GP streaming to be in place/improved on all sites4. Bed Management - CHC and DTOC improvement plans in place5. new ED model launched across all sites to ensure consistent approach to triage, GP streaming, use of clinical measures, and consistent management and skills framework. 6. Discharge events have been taking place on all sites to discharge stranded patients and imbed good practice October 18: Further reduction in performance possibly linked to implementation of PAS.

Kare

n Be

nbow

1. In

tegr

ated

Com

m in

c.

urge

nt

May

-16

"There is a risk that the revised trajectories set for SECamb are not achieved, resulting in reputational and financial risk to the CCG (reduced quality premium).

12

1.Contract Performance Management in place with monthly dial in business meetings to address EK issues 2. Implementation of Ambulance Response Programme to enable improved triage of calls prior to vehicle despatch

1. Improved fleet mix review2. Extended clinical input in call centres and support for call handlers3.Urgent care action plan includes plan to improve ambulance handover4. Work underway by Deloitte to reassess demand and capacity modelling following implementation of ARP. 5. Workforce plan under reviewOctober 18: Demand and capacity review completed. Proposed additional funding required for service to meet targets at provider level.

Kare

n Be

nbow

2. In

tegr

ated

Pla

nned

Car

e

Jan-

18

"There is a risk that performance against the referral to treatment (RTT) target for 18 weeks will continue to deteriorate, resulting in poor patient and stakeholder experience, lack of confidence in the service, reputational risk and additional financial pressure to the CCG.

16

1. CPN raised with EKHUFT2. CPN monitored monthly focussing on specific issues at specialty level.3. Detailed RTT monitoring underway to help quickly identify areas of concern for review.

October 18:

EKHUFT are reporting that there has been a deterioration in performance due to the temporary reduction in capacity that has resulted from the PAS rollout. The Trust has also informed CCGs that performance has not dipped as significantly as the data shows as validation processes are still being restored following PAS rollout.

EKHUFT have a recovery plan in place to resolve these issues.

However, EKHUFT have indicated that they may struggle to deliver all the activity required in order to meet the RTT trajectory. CCG staff are meeting with the EKHUFT COO to gain understanding of the likely impact on performance and finance.

Kare

n Be

nbow

2. In

tegr

ated

Pla

nned

Car

e

Jan-

18

There is a risk that the number of patients waiting over 52 weeks for treatment will not reduce resulting in poor patient and stakeholder experience, lack of confidence in the service, reputational risk and additional financial pressure to the CCG. "

16

1. CPN raised with EKHUFT2. CPN monitored monthly with EKHUFT, focussing on specialty level issues.3. Weekly return on those waiting more than 46 weeks provided to CCGs to provide focus on the number who still need a decision to admit (DTA) within 52 weeks.

October 18:

EKHUFT are reporting that there has been a deterioration in performance due to the temporary reduction in capacity that has resulted from the PAS rollout. The Trust has also informed CCGs that performance has not dipped as significantly as the data shows as validation processes are still being restored following PAS rollout.

EKHUFT have a recovery plan in place to resolve these issues.

However, EKHUFT have indicated that they may struggle to deliver all the activity required in order to meet the RTT trajectory. CCG staff are meeting with the EKHUFT COO to gain understanding of the likely impact on performance and finance.

Kare

n Be

nbow

3. M

enta

l Hea

lth

May

-16

There is a risk that the current Early Intervention in Psychosis (EIP) service provided by KMPT will not be able to deliver the new access to treatment and NICE recommended interventions resulting in the possibility of the CCG failing to meet its constitutional targets.

8

KMPT have provided a business case against priority schemes identified in the2017/19 KMPT contract to recruit additional care co-ordinators in order to allow newly trained current staff to deliver NICE compliant interventions.

KMPT have recognised that east Kent CCGs are currently funding a dedicated consultant psychiatrist for EIP and are taking steps to recruit to this post - this post is expected to be filled by October 17

EIP Business Case now received and agreed with all EK CCGs.KMPT have agreed increased resource through contract negotiations and are developing updated recruitment plan. Service will provide trajectory towards full compliance by end July, current projected date October 17.October 2018 - Dedicated consultant recruitment is underway however first round of recruitment was unsuccessful. waiting times are on track but nice guidance not fully compliant

Andy

Old

field


Overall of 184

1



Title of Report: Transforming Care: Investment in Community Infrastructure for Learning Disability and Autism

Author:Jimmy Kerrigan Senior Commissioner/Transforming Care Programming Lead Emma Emery, Acting Chief Finance Officer, Thanet CCG


Finance sign-off Emma Emery, Acting Chief Finance Officer, Thanet CCG






This paper sets out the community infrastructure (services/facilities) for adults with learning disability that need to be commissioned in order to meet the requirements of the Transforming Care programme, one of the 9 “must dos” in NHS Planning Guidance. The programme represents a net cost pressure to the Kent and Medway health and social care system. A proposal to enhance community LD infrastructure is set out along with the financial implications.

Recommendation:

OPTION 3 Phase One of Full Programme Delivery is recommended.


Yes

No (state reason)

30-19 - SBAR Board Report Transforming Care Comunity Infrastructure FINAL.docOverall of 184

2

SBAR Report

Transforming Care – Investment in Community Infrastructure for Learning Disability

SITUATION:

Over several decades the strategic direction for learning disability (LD) services has been a move from institutional to community care. Several serious incidents, including abuse at Winterbourne View Hospital reported by BBC Panorama in 2011, have highlighted a lack of strategic progress in implementing policy and the inherent risks this presents to people with LD and to the local health economy; risks to people with LD, in terms of the effects of long term institutionalisation and lack of contact with family, and risks to the local health economy associated with the high cost of in-patient care that in many cases achieves limited, if any, long term positive outcomes for individuals. People with LD who are admitted to in-patient units typically present with mental health problems and/or challenging behaviour and/or offending behaviour.

The NHS Five Year Forward View sets out a vision for the future of the NHS from 2016/17 to 2020/21. One of the nine “must dos” set out for Clinical Commissioning Groups (CCGs) in this guidance is to:

“Deliver actions set out in local plans to transform care for people with learning disabilities (LD), including implementing enhanced community provision, reducing inpatient capacity, and rolling out care and treatment reviews in line with published policy”

The Kent and Medway Sustainability and Transformation Partnership (STP), requires all of Kent’s CCGs in partnership with Kent County Council and Medway Council to address the following questions:

1. “As part of the Transforming Care programme, how will your area ensure that people with learning disabilities are, wherever possible, supported at home rather than in hospital?

2. How far are you closing out-moded inpatient beds and reinvesting in continuing learning disability support?”

The Kent and Medway Transforming Care Partnership (TCP) is required to achieve a sustainable reduction in the use of specialist LD and autism hospitals to a maximum of 57 in-patients at any point in time from 31st March 2019.

Kent and Medway have a higher reliance on in-patient care than all other TCP areas in the south of England region (excluding Sussex). Despite over 70 adult discharges from hospital the TCP has roughly the same number of in-patients in December 2018 (n = 85) as in March 2013 (n = 88). This is due to admission rates to:

NHSE secure beds Tier 4 CAMHS beds patients in mainstream mental health beds being diagnosed with LD or autism and

therefore meeting the criteria for Transforming Care


3

Investment in a range of community services (e.g. community LD forensic services) and community infrastructure (e.g. housing, skilled care/support) is required to enable patient discharges and to reduce admission rates in order to achieve a sustainable and reduced reliance on in-patient care.

BACKGROUND:

The Transforming Care Programme was initiated in December 2012 with the publication of the Winterbourne Concordat (DH 2012). As in-patient numbers nationally were not reducing to expected levels, a number of policy and guidance documents were subsequently published to support TCPs in the transformation of care and support for people with LD and autism including:

Building the Right Support: A national plan to develop community services and close inpatient facilities for people with a learning disability and/or autism who display behaviour that challenges, including those with a mental health condition. (NHSE, LGA, ADASS 2015)

Supporting people with a learning disability and/or autism who display behaviour that challenges, including those with a mental health condition: Service model for commissioners of health and social care services (NHSE, LGA, ADASS 2015)

NICE Quality Standard 101 - Learning disabilities: Challenging behaviour (NICE 2015)

Transforming Care leads in commissioning and finance have worked with a range of stakeholders including local authorities, local NHS providers, national and regional assurance and finance leads in NHSE and in NHSE Specialised Commissioning to develop an understanding of:

the Transforming Care population and their needs the services and infrastructure required to meet these needs in the medium to long

term the associated financial implications

Initial local action included: Increased rate of discharges of people with LD or autism from in-patient facilities Decommissioning of the local assessment and treatment in-patient unit (The Birling

Centre) in September 2014 and reinvestment in community LD services. This has avoided 10 admissions per year.

Review and redesign of the adult learning disability care pathway to include new crisis/intensive support procedures to prevent admission (operational from January 2015) and the design of Adult Safe Accommodation where people with LD could receive crisis accommodation and intensive assessment and treatment as an alternative to hospital admission.

The above actions achieved the following outcomes:1. A reduction in the number of people with LD admitted to CCG commissioned

assessment and treatment in-patient services from the community. 2. Demonstrable evidence of improved quality of life outcomes for individuals evidenced

by a KCC commissioned review of 44 patients that had been discharged under the programme (Transforming Care Review Project: Our progress in implementing Transforming Care against the national framework, identifying gaps and taking


4

action. KCC, June 2018). The review involved former patients, their families, social care providers and clinicians/practitioners.

ASSESSMENT:

Community Infrastructure (Kent and Medway)Assessed against local needs and the national service model above, the remaining community infrastructure that now requires commissioning across Kent and Medway to ensure that people with LD receive care and treatment that accords with models of best practice and achieve the best outcomes for patients and families in the medium to long term are:

Enhance existing community learning disability services (KCC, Medway Council, Medway Community Health, KMPT and KCHFT) to meet the growing number of people with complex needs who are being discharged from hospital and also those who are receiving intensive interventions in the community to prevent admission. (See Appendix 7)

Community LD Forensic Service – To meet the needs of individuals at risk of contact with the Criminal Justice System and possible diversion to secure in-patient services. This cohort presents a pressure on total in-patient numbers. (See Appendix 7)

Adult Safe Accommodation – Revenue costs of circa £500k to staff a planned two bed new build facility from 2020/21. Capital costs will be met by an NHSE grant of £1.9m.

Hothfield – Planned individualised specialist accommodation and support packages (including clinical outreach) for three exceptionally funded individuals with very complex needs currently in a low secure LD hospital.

The commissioning and development of the above services is set against plans currently being implemented to develop the broader infrastructure across Kent and Medway including:

Developments in Children and Young Peoples Services Services for adults with autism (in the absence of LD) Housing Workforce Specialist training across the whole system including for non-paid carers New developments planned as part of the Mental Health and Secure Services New

Care Models programme

Estimated annual costs of this additional LD infrastructure is £3m recurrent.

Finance Assessment

The financial implications of the programme relate to two key elements1. Section 117 Aftercare - Costs to the local authorities and CCGs of supporting each

individual who is discharged to the community, typically on a 1:1 basis as a minimum.2. Infrastructure costs – Costs of services and facilities required to support discharged

patients and ensure that a new cohort of individuals does not take their place in hospital.

Funding streams for the above are received into the Section75 Integrated Commissioning for Learning Disability Pooled Fund in Kent and the Section 75 Better Care Fund in Medway and include:


5

Tier 3 Pooled Fund - Ring-fenced expenditure from discharged CCG patients less CCG contribution to aftercare costs.

Tier 4 Pooled Fund – Funding transfer of £2.25m received from Specialised Commissioning based on net discharges (£180k per patient/annum) from NHSE adult secure beds against a baseline total set in April 2016. This transfer of funding may be subject to “clawback” if planned discharges do not occur and the overall target number of in-patients is not achieved.

Local authority funding – Contributions to aftercare for each patient are a cost pressure to local authorities.

Financial modelling demonstrates a net cost to the Kent and Medway system associated with programme delivery; to discharge all patients when they are clinically ready and to provide expansion and enhancement of community infrastructure preventing new/re-admissions.

The options presented below for consideration have been assessed against two key criteria:

1. Enabling the ongoing discharge of all patients safely to the community in 2018/19, 2019/20 and beyond i.e. the “must do”

2. Ensuring the least financial impact on the system given the expected pooled funding available

Three options are presented below:

Option 1 – Full Programme Delivery Invest the £2.25m allocation from NHSE in 2018/19 and 2019/20*and resist potential

claw back by NHSE despite failure to achieve net discharge target. *Liaise with NHSE with a view to securing a £2.25m recurring allocation.

Invest £750,000 in community infrastructure in 2018/19 and £3m in 2019/20 to break the cycle of admissions to Tier 4 beds.

Continue the discharge of all patients when they are considered clinically ready. Proceed with the discharge of 3 complex patients to Hothfield in 2019/20. Use the remaining allocation from NHSE to mitigate aftercare costs for the

discharged patients. Results in a deficit of the pooled budget in 2018/19 of £280,587 to CCGs and

£250,649 to local authorities, full year effect for CCGs £2,540,824 and for local authorities £2,616,938.

Delivers the programme requirements through enabling the transfer of all clinically ready patients into a community environment equipped to meet their ongoing needs.

This is in addition to a £300k contribution to the adult neurodevelopmental service in 2019/20 which is an additional pressure that has already been agreed.

Option 2 – Standstill Assume that all £2.25m will be clawed back and that no allocation will be received

from NHSE for 2018/19. DO NOT Invest in community infrastructure and redesign existing services to provide

the required community infrastructure.


6

DO NOT proceed with any further discharges. DO NOT proceed with discharge of complex patients to Hothfield. Results in a deficit of the pooled budget in 2018/19 of £742,090 to CCGs and

£753,588 to local authorities, full year effect for CCGs £829,784 and for local authorities £857,403.

Does not deliver the programme requirements and hence leaves patients in an acute environment that is no longer the most suitable option for their ongoing needs and does not address admission rates.

Option 3 – Phase One of Full Programme Delivery As a starting point to develop the community infrastructure needed to deliver the

programme and discharge all patients when clinically ready and avoid new/re-admissions (as per Option 1), invest the £2.25m allocation from NHSE in 2018/19 and 2019/20*and resist potential claw back by NHSE despite failure to achieve net discharge target.

*Liaise with NHSE with a view to securing a £2.25m recurring allocation.

Invest £750,000 in community infrastructure in 2018/19 and £2m in 2019/20 to start breaking the cycle of admissions to Tier 4 beds.

Proceed with the discharge of patients deemed clinically ready. Do not proceed with funding the discharge of three complex patients to Hothfield. Results in a deficit of the pooled budget in 2018/19 of £263,090 to CCGs and

£221,715 to local authorities, full year effect for CCGs £815,439 and for local authorities £ 1,659,598.

Partially delivers the programme requirements through enabling the transfer of clinically ready patients (except the Hothfield patients) into a community equipped to meet their ongoing needs.


The financial arrangements and key considerations for each option for both 2018/19 and 2019/20 are summarised in the tables below. Implications for individual organisations are set out in Appendices 1 – 6 (pages 10-21).


9

RECOMMENDATION:

OPTION 3 Phase One of Full Programme Delivery is recommended.

This option is recommended because It has the least financial impact whilst enabling the transformation of the local health

and social care system for people with LD. It allows the ongoing discharge of patients deemed clinically ready (excluding 3

Hothfield patients)

The financial implications of Option 3 for CCGs and the local authorities are: Results in a deficit of the pooled budget in 2018/19 of £263,090 to CCGs and

£221,715 to local authorities, full year effect for CCGs £815,439 and for local authorities £ 1,659,598.


Risks associated with this option are: Does not allow for full investment in infrastructure which is likely to have an impact on

in-patient numbers in the medium to longer term. Requires negotiation with NHSE to secure recurrent £2.25 million funding which may

be challenged given this options may not deliver the target number of 57 inpatients in the foreseeable future.

Requires negotiation with NHSE to release additional funding for the 3 Hothfield patients when they are clinically ready for discharge.



10

Appendix 1 - Detailed Financial Estimations for Option 1: 2018/19 Tier 4

2018/19 Tier 4 Pool Ashford Canterbury SKC Thanet West Kent Dartford Swale Medway TotalPercentage of Tier 4 Patients 1.33% 16.00% 1.33% 9.33% 22.67% 14.67% 16.00% 18.67% 100%NHSE funds apportioned £30,000 £360,000 £30,000 £210,000 £510,000 £330,000 £360,000 £420,000 £2,250,000

2018/19 part year Infrastructure costs apportioned £7,069 £84,826 £7,069 £49,482 £120,170 £77,757 £84,826 £98,964 £530,163

Net funds paid into Tier 4 Pool £22,931 £275,174 £22,931 £160,518 £389,830 £252,243 £275,174 £321,036 £1,719,837CCG 35% (Medway 50%) £8,026 £96,311 £8,026 £56,181 £136,440 £88,285 £96,311 £112,363 £601,943LA 65% (Medway 50%) £14,905 £178,863 £14,905 £104,337 £253,389 £163,958 £178,863 £208,674 £1,117,894

2018/19 CCG's Expected Cost Ashford Canterbury SKC Thanet West Kent Dartford Swale Medway TotalAfter care costs of Tier 4 discharged patients £55,013 £93,457 £25,736 £116,179 £155,808 £446,193Planned aftercare costs for planned Tier 4 Discharges £34,993 £8,748 £22,963 £61,238 £12,498 £140,439Aftercare costs for patients discharged prior to 1st Apr 17 £34,993 £34,993Potential Hothfield costs £0

Subtotal surplus / cost pressure (-) -£46,987 -£67,132 £8,026 £30,446 £11,513 £65,322 £35,073 -£55,943 -£19,683

Reallocation of surplus to other CCGs £46,987 £67,132 -£6,091 -£23,105 -£8,737 -£49,571 -£26,616 £0Subtotal surplus/deficit £0 £0 £1,935 £7,341 £2,776 £15,751 £8,457 -£55,943 -£19,683Additional payable (-) / surplus from pool for each CCG £594 £7,133 £594 £4,161 £10,105 £6,539 £7,133 -£55,943 -£19,683

2018/19 LA's Cost Ashford Canterbury SKC Thanet West Kent Dartford Swale Medway Total

After care costs of Tier 4 discharged patients £73,802 £81,469 £45,691 £169,263 £155,808 £526,033

Planned aftercare costs for planned Tier 4 Discharges £64,987 £16,247 £51,111 £113,727 £12,498 £258,570

Aftercare costs for patients discharged prior to 1st Apr 17 £64,987 £64,987Potential Hothfield costs (3 months 18/19) £0Surplus / cost pressure (-) for LA -£58,897 -£32,580 £14,905 £58,646 £67,880 £112,847 £65,136 £40,368 £268,304Surplus / cost pressure (-) for Kent CC £227,936Surplus / cost pressure (-) for Medway CC £40,368


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Appendix 1 continued - Detailed Financial Estimations for Option 1: 2018/19 Tier 3

2018/19 Tier 3 Ashford Canterbury SKC Thanet West Kent Dartford Swale Medway TotalExisting Cost to CCG £62,370 £316,150 £201,910 £529,974 £398,090 £1,508,494CCG Aftercare costs for patients discharged from Tier 3 £45,262 £115,812 £197,717 £124,514 £483,305CCG Aftercare costs for patients planned to be discharged 18/19 £36,243 £8,748 £17,222 £12,498 £74,711CCG Aftercare costs for accelerated discharges £8,748 £8,748 £17,497Balance released to Tier 3 Pool £0 -£45,262 £17,379 £191,590 £201,910 £315,034 -£8,748 £261,078 £932,981Infrastructure Costs £2,931 £35,174 £2,931 £20,518 £49,830 £32,243 £35,174 £41,036 £219,837Balance to Local Authority -£2,931 -£80,436 £14,448 £171,072 £152,080 £282,792 -£43,922 £220,042 £713,145LA Aftercare costs for patients discharged from Tier 3 £79,255 £170,148 £249,397 £149,061 £647,860LA Aftercare costs for patients planned to be discharged 18/19 £51,240 £16,247 £38,333 £12,498 £118,317LA Aftercare costs for accelerated discharges £16,247 £16,247 £32,494Cost pressure (-) / surplus on Tier 3 Pool - Kent CC -£2,931 -£159,690 -£53,039 -£15,323 £152,080 -£4,938 -£60,169 -£144,010Cost pressure (-) / surplus on Tier 3 Pool - Medway Council £58,484 £58,484LA aftercare costs for Tier 3 patients discharged prior to Pool £78,206 £123,030 £182,200 £49,990 £433,426Total Cost pressure (-) / surplus on Tier 3 Patients - Kent CC -£81,137 -£282,721 -£235,239 -£15,323 £152,080 -£4,938 -£60,169 -£527,447Total Cost pressure (-) / surplus on Tier 3 Patients - Medway Council £8,494 £8,494CCG Aftercare costs for patients discharged prior to Pool £51,231 £87,271 £72,412 £49,990 £260,904Total Cost pressure (-) / surplus on Tier 3 Patients - CCG -£51,231 -£87,271 -£72,412 £0 £0 £0 £0 -£49,990 -£260,904


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Appendix 2 - Detailed Financial Estimations for Option 2: 2018/19 Tier 42018/19 Tier 4 Pool Ashford Canterbury SKC Thanet West Kent Dartford Swale Medway TotalPercentage of Tier 4 Patients 1.33% 16.00% 1.33% 9.33% 22.67% 14.67% 16.00% 18.67% 100%

NHSE funds apportioned £0 £0 £0 £0 £0 £0 £0 £0 £0

2018/19 part year Infrastructure costs apportioned £0 £0 £0 £0 £0 £0 £0 £0 £0Net funds paid into Tier 4 Pool £0 £0 £0 £0 £0 £0 £0 £0 £0CCG 35% (Medway 50%) £0 £0 £0 £0 £0 £0 £0 £0 £0LA 65% (Medway 50%) £0 £0 £0 £0 £0 £0 £0 £0 £0

2018/19 CCG's Expected Cost Ashford Canterbury SKC Thanet West Kent Dartford Swale Medway TotalAfter care costs of Tier 4 discharged patients £55,013 £93,457 £25,736 £116,179 £155,808 £446,193Planned aftercare costs for planned Tier 4 Discharges £0 £0 £0 £0 £0Aftercare costs for patients discharged prior to 1st Apr 17 £34,993 £34,993

Potential Hothfield costs £0

Subtotal surplus/deficit -£55,013 -£128,450 £0 -£25,736 -£116,179 £0 £0 -£155,808 -£481,186Reallocation of surplus to other CCGs £0Subtotal surplus/deficit -£55,013 -£128,450 £0 -£25,736 -£116,179 £0 £0 -£155,808 -£481,186Additional contribution (-) / Surplus for each CCG -£5,334 -£64,009 -£5,334 -£37,338 -£90,679 -£58,675 -£64,009 -£155,808 -£481,186



Planned aftercare costs for planned Tier 4 Discharges £0 £0 £0 £0 £0Aftercare costs for patients discharged prior to 1st Apr 17 £64,987 £64,987Potential Hothfield costs (3 months 18/19) £0Surplus / cost pressure (-) for LA -£73,802 -£146,456 £0 -£45,691 -£169,263 £0 £0 -£155,808 -£591,020Surplus / cost pressure (-) for Kent CC -£435,212Surplus / cost pressure (-) for Medway CC -£155,808


13


2018/19 Tier 3 Ashford Canterbury SKC Thanet West Kent Dartford Swale Medway TotalExisting Cost to CCG £281,050 £201,910 £529,974 £389,090 £1,402,024CCG Aftercare costs for patients discharged from Tier 3 £45,262 £115,812 £197,717 £124,514 £483,305CCG Aftercare costs for patients planned to be discharged 18/19 £0 £0 £0 £0 £0CCG Aftercare costs for accelerated discharges £0 £0 £0Balance released to Tier 3 Pool £0 -£45,262 £0 £165,238 £201,910 £332,257 £0 £264,576 £918,719Infrastructure Costs £0 £0 £0 £0 £0 £0 £0 £0 £0Balance to Local Authority £0 -£45,262 £0 £165,238 £201,910 £332,257 £0 £264,576 £918,719LA Aftercare costs for patients discharged from Tier 3 £79,255 £170,148 £249,397 £149,061 £647,860LA Aftercare costs for patients planned to be discharged 18/19 £0 £0 £0 £0 £0LA Aftercare costs for accelerated discharges £0 £0 £0Cost pressure (-) / surplus on Tier 3 Pool - Kent CC £0 -£124,517 £0 -£4,910 £201,910 £82,860 £0 £155,343Cost pressure (-) / surplus on Tier 3 Pool - Medway Council £115,515 £115,515LA aftercare costs for Tier 3 patients discharged prior to Pool £78,206 £123,030 £182,200 £49,990 £433,426Total Cost pressure (-) / surplus on Tier 3 Patients - Kent CC -£78,206 -£247,547 -£182,200 -£4,910 £201,910 £82,860 £0 -£228,093Total Cost pressure (-) / surplus on Tier 3 Patients - Medway Council £65,525 £65,525CCG Aftercare costs for patients discharged prior to Pool £51,231 £87,271 £72,412 £49,990 £260,904Total Cost pressure (-) / surplus on Tier 3 Patients - CCG -£51,231 -£87,271 -£72,412 £0 £0 £0 £0 -£49,990 -£260,904


14


2018/19 Tier 4 Pool Ashford Canterbury SKC Thanet West Kent Dartford Swale Medway Total

Percentage of Tier 4 Patients 1.33% 16.00% 1.33% 9.33% 22.67% 14.67% 16.00% 18.67% 100%

NHSE funds apportioned £30,000 £360,000 £30,000 £210,000 £510,000 £330,000 £360,000 £420,000 £2,250,0002018/19 part year Infrastructure costs apportioned £7,069 £84,826 £7,069 £49,482 £120,170 £77,757 £84,826 £98,964 £530,163Net funds paid into Tier 4 Pool £22,931 £275,174 £22,931 £160,518 £389,830 £252,243 £275,174 £321,036 £1,719,837CCG 35% (Medway 50%) £8,026 £96,311 £8,026 £56,181 £136,440 £88,285 £96,311 £112,363 £601,943LA 65% (Medway 50%) £14,905 £178,863 £14,905 £104,337 £253,389 £163,958 £178,863 £208,674 £1,117,894

2018/19 CCG's Expected Cost Ashford Canterbury SKC Thanet West Kent Dartford Swale Medway Total


Planned aftercare costs for planned Tier 4 Discharges £34,993 £22,963 £52,490 £12,498 £122,943Aftercare costs for patients discharged prior to 1st Apr 17 £34,993 £34,993Potential Hothfield costs £0Subtotal surplus / cost pressure (-) -£46,987 -£67,132 £8,026 £30,446 £20,261 £65,322 £43,821 -£55,943 -£2,186Reallocation of surplus to other CCGs £46,987 £67,132 -£5,456 -£20,697 -£13,773 -£44,405 -£29,789 £0Subtotal surplus/deficit £0 £0 £2,570 £9,749 £6,488 £20,917 £14,032 -£55,943 -£2,186Additional payable (-) / surplus from pool for each CCG £881 £10,575 £881 £6,169 £14,981 £9,694 £10,575 -£55,943 -£2,186



Planned aftercare costs for planned Tier 4 Discharges £64,987 £51,111 £97,481 £12,498 £226,076Aftercare costs for patients discharged prior to 1st Apr 17 £64,987 £64,987Potential Hothfield costs (3 months 18/19) £0Surplus / cost pressure (-) for LA -£58,897 -£32,580 £14,905 £58,646 £84,126 £112,847 £81,383 £40,368 £300,797Surplus / cost pressure (-) for Kent CC £260,429

Surplus / cost pressure (-) for Medway CC £40,368


15


2018/19 Tier 3 Ashford Canterbury SKC Thanet West Kent Dartford Swale Medway TotalExisting Cost to CCG £8,820 £316,150 £201,910 £529,974 £398,090 £1,454,944CCG Aftercare costs for patients discharged from Tier 3 £45,262 £115,812 £197,717 £124,514 £483,305CCG Aftercare costs for patients planned to be discharged 18/19 £36,243 £8,748 £17,222 £12,498 £74,711CCG Aftercare costs for accelerated discharges £0 £0 £0Balance released to Tier 3 Pool £0 -£45,262 -£27,423 £191,590 £201,910 £315,034 £0 £261,078 £896,928Infrastructure Costs £2,931 £35,174 £2,931 £20,518 £49,830 £32,243 £35,174 £41,036 £219,837Balance to Local Authority -£2,931 -£80,436 -£30,354 £171,072 £152,080 £282,792 -£35,174 £220,042 £677,091LA Aftercare costs for patients discharged from Tier 3 £79,255 £170,148 £249,397 £149,061 £647,860LA Aftercare costs for patients planned to be discharged 18/19 £51,240 £16,247 £38,333 £12,498 £118,317LA Aftercare costs for accelerated discharges £0 £0 £0Cost pressure (-) / surplus on Tier 3 Pool - Kent CC -£2,931 -£159,690 -£81,594 -£15,323 £152,080 -£4,938 -£35,174 -£147,570Cost pressure (-) / surplus on Tier 3 Pool - Medway Council £58,484 £58,484LA aftercare costs for Tier 3 patients discharged prior to Pool £78,206 £123,030 £182,200 £49,990 £433,426Total Cost pressure (-) / surplus on Tier 3 Patients - Kent CC -£81,137 -£282,721 -£263,794 -£15,323 £152,080 -£4,938 -£35,174 -£531,007Total Cost pressure (-) / surplus on Tier 3 Patients - Medway Council £8,494 £8,494CCG Aftercare costs for patients discharged prior to Pool £51,231 £87,271 £72,412 £49,990 £260,904Total Cost pressure (-) / surplus on Tier 3 Patients - CCG -£51,231 -£87,271 -£72,412 £0 £0 £0 £0 -£49,990 -£260,904


16

Appendix 4Appendix 4 - Detailed Financial Estimations for Option 1: 2019/20 Tier 4

FYE Tier 4 Pool Ashford Canterbury SKC Thanet West Kent Dartford Swale Medway Total


NHSE funds apportioned £30,000 £360,000 £30,000 £210,000 £510,000 £330,000 £360,000 £420,000 £2,250,0002018/19 part year Infrastructure costs apportioned £25,189 £302,271 £25,189 £176,325 £428,217 £277,081 £302,271 £352,649 £1,889,192Net funds paid into Tier 4 Pool £4,811 £57,729 £4,811 £33,675 £81,783 £52,919 £57,729 £67,351 £360,808CCG 35% (Medway 50%) £1,684 £20,205 £1,684 £11,786 £28,624 £18,521 £20,205 £23,573 £126,283LA 65% (Medway 50%) £3,127 £37,524 £3,127 £21,889 £53,159 £34,397 £37,524 £43,778 £234,525

FYE CCG's Expected Cost Ashford Canterbury SKC Thanet West Kent Dartford Swale Medway Total


Planned aftercare costs for planned Tier 4 Discharges £104,979 £26,470 £34,993 £80,919 £139,972 £49,990 £437,323Aftercare costs for patients discharged prior to 1st Apr 17 £64,987 £64,987Potential Hothfield costs £400,000 £1,000,000 £1,400,000Subtotal surplus / cost pressure (-) -£53,329 -£263,194 £1,684 -£455,273 -£1,125,464 -£62,397 -£119,767 -£202,179 -£2,279,921Reallocation of surplus to other CCGs £43 £213 -£1,014 £369 £911 £51 £97 £670Subtotal surplus/deficit -£53,286 -£262,981 £670 -£454,905 -£1,124,553 -£62,347 -£119,670 -£202,179 -£2,279,251Additional payable (-) / surplus from pool for each CCG -£34,050 -£408,604 -£34,050 -£238,353 -£578,856 -£374,554 -£408,604 -£202,179 -£2,279,251

FYE LA's Cost Ashford Canterbury SKC Thanet West Kent Dartford Swale Medway Total


Planned aftercare costs for planned Tier 4 Discharges £194,961 £55,889 £64,987 £167,209 £259,948 £49,990 £792,984Aftercare costs for patients discharged prior to 1st Apr 17 £34,993 £34,993Potential Hothfield costs (3 months 18/19) £0Surplus / cost pressure (-) for LA -£70,675 -£302,013 £3,127 -£98,947 -£186,507 -£132,812 -£222,424 -£181,974 -£1,192,224Surplus / cost pressure (-) for Kent CC -£1,010,250

Surplus / cost pressure (-) for Medway CC -£181,974


17


FYE Tier 3 Ashford Canterbury SKC Thanet West Kent Dartford Swale Medway Total

Existing Cost to CCG £392,740 £423,400 £222,650 £529,974 £611,740 £2,180,504CCG Aftercare costs for patients discharged from Tier 3 £45,262 £154,164 £197,739 £124,514 £521,680CCG Aftercare costs for patients planned to be discharged 18/19 £119,976 £34,993 £45,926 £49,990 £250,885

CCG Aftercare costs for accelerated discharges £34,993 £49,990 £84,983

Balance released to Tier 3 Pool £0 -£45,262 £237,771 £234,243 £222,650 £286,309 -£49,990 £437,236 £1,322,956Infrastructure Costs £14,811 £177,729 £14,811 £103,675 £251,783 £162,919 £177,729 £207,351 £1,110,808Balance to Local Authority -£14,811 -£222,991 £222,960 £130,567 -£29,133 £123,390 -£227,719 £229,885 £212,148LA Aftercare costs for patients discharged from Tier 3 £79,255 £213,606 £249,375 £149,061 £691,296LA Aftercare costs for patients planned to be discharged 18/19 £179,964 £64,987 £102,222 £49,990 £397,163LA Aftercare costs for accelerated discharges £64,987 £49,990 £114,977Cost pressure (-) / surplus on Tier 3 Pool - Kent CC -£14,811 -£302,246 -£21,991 -£148,025 -£29,133 -£228,207 -£277,709 -£1,022,122Cost pressure (-) / surplus on Tier 3 Pool - Medway Council £30,834 £30,834LA aftercare costs for Tier 3 patients discharged prior to Pool £78,206 £123,030 £182,200 £49,990 £433,426Total Cost pressure (-) / surplus on Tier 3 Patients - Kent CC -£93,017 -£425,276 -£204,191 -£148,025 -£29,133 -£228,207 -£277,709 -£1,405,558Total Cost pressure (-) / surplus on Tier 3 Patients - Medway Council -£19,156 -£19,156CCG Aftercare costs for patients discharged prior to Pool £51,231 £87,271 £72,412 £49,990 £260,904Total Cost pressure (-) / surplus on Tier 3 Patients - CCG £51,231 £87,271 £72,412 £0 £0 £0 £0 £49,990 £260,904


18


FYE Tier 4 Pool Ashford Canterbury SKC Thanet West Kent Dartford Swale Medway Total


NHSE funds apportioned £0 £0 £0 £0 £0 £0 £0 £0 £02018/19 part year Infrastructure costs apportioned £0 £0 £0 £0 £0 £0 £0 £0 £0Net funds paid into Tier 4 Pool £0 £0 £0 £0 £0 £0 £0 £0 £0CCG 35% (Medway 50%) £0 £0 £0 £0 £0 £0 £0 £0 £0LA 65% (Medway 50%) £0 £0 £0 £0 £0 £0 £0 £0 £0

FYE CCG's Expected Cost Ashford Canterbury SKC Thanet West Kent Dartford Swale Medway Total


Planned aftercare costs for planned Tier 4 Discharges £0 £0 £0 £0 £0 £0 £0Aftercare costs for patients discharged prior to 1st Apr 17 £64,987 £64,987Potential Hothfield costs £0 £0 £0Subtotal surplus / cost pressure (-) -£55,013 -£178,421 £0 -£40,589 -£119,096 £0 £0 -£175,762 -£568,880Reallocation of surplus to other CCGs £0Subtotal surplus/deficit -£55,013 -£178,421 £0 -£40,589 -£119,096 £0 £0 -£175,762 -£568,880Additional payable (-) / surplus from pool for each CCG -£6,445 -£77,335 -£6,445 -£45,112 -£109,558 -£70,890 -£77,335 -£175,762 -£568,880



Planned aftercare costs for planned Tier 4 Discharges £0 £0 £0 £0 £0 £0 £0Aftercare costs for patients discharged prior to 1st Apr 17 £34,993 £34,993Potential Hothfield costs (3 months 18/19) £0Surplus / cost pressure (-) for LA -£73,802 -£144,576 £0 -£64,947 -£174,679 £0 £0 -£175,762 -£633,765Surplus / cost pressure (-) for Kent CC -£458,004Surplus / cost pressure (-) for Medway CC -£175,762


19


FYE Tier 3 Ashford Canterbury SKC Thanet West Kent Dartford Swale Medway Total

Existing Cost to CCG £281,050 £222,650 £529,974 £389,090 £1,422,764CCG Aftercare costs for patients discharged from Tier 3 £45,262 £154,164 £197,739 £124,514 £521,680CCG Aftercare costs for patients planned to be discharged 18/19 £0 £0 £0 £0 £0

CCG Aftercare costs for accelerated discharges £0 £0 £0

Balance released to Tier 3 Pool £0 -£45,262 £0 £126,886 £222,650 £332,235 £0 £264,576 £901,084Infrastructure Costs £0 £0 £0 £0 £0 £0 £0 £0 £0Balance to Local Authority £0 -£45,262 £0 £126,886 £222,650 £332,235 £0 £264,576 £901,084LA Aftercare costs for patients discharged from Tier 3 £79,255 £213,606 £249,375 £149,061 £691,296LA Aftercare costs for patients planned to be discharged 18/19 £0 £0 £0 £0 £0LA Aftercare costs for accelerated discharges £0 £0 £0Cost pressure (-) / surplus on Tier 3 Pool - Kent CC £0 -£124,517 £0 -£86,720 £222,650 £82,860 £0 £94,273Cost pressure (-) / surplus on Tier 3 Pool - Medway Council £115,515 £115,515LA aftercare costs for Tier 3 patients discharged prior to Pool £78,206 £123,030 £182,200 £49,990 £433,426Total Cost pressure (-) / surplus on Tier 3 Patients - Kent CC -£78,206 -£247,547 -£182,200 -£86,720 £222,650 £82,860 £0 -£289,163Total Cost pressure (-) / surplus on Tier 3 Patients - Medway Council £65,525 £65,525CCG Aftercare costs for patients discharged prior to Pool £51,231 £87,271 £72,412 £49,990 £260,904Total Cost pressure (-) / surplus on Tier 3 Patients - CCG £51,231 £87,271 £72,412 £0 £0 £0 £0 £49,990 £260,904


20


FYE Tier 4 Pool Ashford Canterbury SKC Thanet West Kent Dartford Swale Medway TotalPercentage of Tier 4 Patients 1.33% 16.00% 1.33% 9.33% 22.67% 14.67% 16.00% 18.67% 100%NHSE funds apportioned £30,000 £360,000 £30,000 £210,000 £510,000 £330,000 £360,000 £420,000 £2,250,0002018/19 part year Infrastructure costs apportioned £16,793 £201,514 £16,793 £117,550 £285,478 £184,721 £201,514 £235,099 £1,259,461Net funds paid into Tier 4 Pool £13,207 £158,486 £13,207 £92,450 £224,522 £145,279 £158,486 £184,901 £990,539CCG 35% (Medway 50%) £4,623 £55,470 £4,623 £32,358 £78,583 £50,848 £55,470 £64,715 £346,689

LA 65% (Medway 50%) £8,585 £103,016 £8,585 £60,093 £145,939 £94,431 £103,016 £120,185 £643,850

FYE CCG's Expected Cost Ashford Canterbury SKC Thanet West Kent Dartford Swale Medway TotalAfter care costs of Tier 4 discharged patients £55,013 £113,434 £40,589 £119,096 £175,762 £503,893Planned aftercare costs for planned Tier 4 Discharges £104,979 £26,470 £45,926 £104,979 £49,990 £332,344Aftercare costs for patients discharged prior to 1st Apr 17 £64,987 £64,987Potential Hothfield costs £0Subtotal surplus / cost pressure (-) -£50,390 -£227,930 £4,623 -£34,702 -£40,513 £4,922 -£49,509 -£161,036 -£554,536Reallocation of surplus to other CCGs £1,193 £5,398 -£4,623 £822 £959 -£4,922 £1,172 £0

Subtotal surplus/deficit -£49,197 -£222,532 £0 -£33,880 -£39,553 £0 -£48,336 -£161,036 -£554,536

Additional payable (-) / surplus from pool for each CCG -£6,450 -£77,403 -£6,450 -£45,152 -£109,655 -£70,953 -£77,403 -£161,036 -£554,536


After care costs of Tier 4 discharged patients £73,802 £109,583 £64,947 £174,679 £175,762 £598,772Planned aftercare costs for planned Tier 4 Discharges £194,961 £55,889 £102,222 £194,961 £49,990 £598,023Aftercare costs for patients discharged prior to 1st Apr 17 £34,993 £34,993Potential Hothfield costs (3 months 18/19) £0Surplus / cost pressure (-) for LA -£65,217 -£236,521 £8,585 -£60,743 -£28,739 -£7,791 -£91,945 -£105,566 -£587,938Surplus / cost pressure (-) for Kent CC -£482,372

Surplus / cost pressure (-) for Medway CC -£105,566


21


FYE Tier 3 Ashford Canterbury SKC Thanet West Kent Dartford Swale Medway TotalExisting Cost to CCG £175,565 £423,400 £222,650 £529,974 £611,740 £1,963,329CCG Aftercare costs for patients discharged from Tier 3 £45,262 £154,164 £197,739 £124,514 £521,680CCG Aftercare costs for patients planned to be discharged 18/19 £119,976 £34,993 £45,926 £49,990 £250,885CCG Aftercare costs for accelerated discharges £0 £0 £0Balance released to Tier 3 Pool £0 -£45,262 £55,589 £234,243 £222,650 £286,309 £0 £437,236 £1,190,764

Infrastructure Costs £9,874 £118,486 £9,874 £69,117 £167,856 £108,612 £118,486 £138,234 £740,539

Balance to Local Authority -£9,874 -£163,748 £45,715 £165,126 £54,794 £177,697 -£118,486 £299,002 £450,225LA Aftercare costs for patients discharged from Tier 3 £79,255 £213,606 £249,375 £149,061 £691,296LA Aftercare costs for patients planned to be discharged 18/19 £179,964 £64,987 £102,222 £49,990 £397,163

LA Aftercare costs for accelerated discharges £0 £0 £0

Cost pressure (-) / surplus on Tier 3 Pool - Kent CC -£9,874 -£243,003 -£134,249 -£113,467 £54,794 -£173,900 -£118,486 -£738,185Cost pressure (-) / surplus on Tier 3 Pool - Medway Council £99,951 £99,951LA aftercare costs for Tier 3 patients discharged prior to Pool £78,206 £123,030 £182,200 £49,990 £433,426Total Cost pressure (-) / surplus on Tier 3 Patients - Kent CC -£88,080 -£366,033 -£316,449 -£113,467 £54,794 -£173,900 -£118,486 -£1,121,621Total Cost pressure (-) / surplus on Tier 3 Patients - Medway Council £49,961 £49,961CCG Aftercare costs for patients discharged prior to Pool £51,231 £87,271 £72,412 £49,990 £260,904Total Cost pressure (-) / surplus on Tier 3 Patients - CCG £51,231 £87,271 £72,412 £0 £0 £0 £0 £49,990 £260,904


22

Appendix 7 – Additional community LD service resources (assessed in October 2017)

Phase 1 Team Psychiatry Psychology Nursing OT SaLT Social Work Physio Sensory AdminMHLD Band 8A Band 6 0.5 Band 4 Band 5 Band 6 Band 3 Band 5 FORT Cons. Band 8A Band 6 Band 7 Band 5 Band 4CLDT 0.4 Band 7 KR11

Band 6 Band 6

Phase 2 Team Psychiatry Psychology Nursing OT SaLT Social Work Physio Sensory Admin

MHLD Band 8A Band 6 Band 3 Band 5 Band 6 Band 5 FORT Band 8A Band 6 Band 7 Band 3 Band 5 CLDT Band 6 Band 6 Band 6 3xKR11


23

213,719 Band 6 Band 6 MCH Band 6 Band 6

Medway Council Band 6

Total Phase 3 Team Psychiatry Psychology Nursing OT SaLT Social Work Physio Sensory Admin

CLDT Band 6 Band 6


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Title of Report: Contracting, Finance and Performance (CF&P) Joint Committee

Author: David Meikle, Turnaround Director

Executive/ Lay Sponsor: David Meikle, Turnaround Director

Finance sign-off David Meikle, Turnaround Director






The following is a summary of the key points from the Contracting, Finance and Performance Joint Committee’s meeting on 12th December 2018. Finance:

Risk Register – The issue of the 2018/19 STP budget, spend and forecast was raised. DM stated that there is a piece of work being undertaken currently across Kent and Medway to provide a better process for reporting STP spend back to Governing Bodies. ZC is liaising with Chris Buttery in the STP to produce an accurate forecast for these monies. All CCGs in K&M agreed that Internal Audit would review, as part of the 18/19 programme, the STP planning and spending. Although it was important that there should be proper accountability for monies spent by the STP it was not a significant risk and therefore it was agreed that it did not need to be added to the risk register.

Finance and QIPP- An SBAR providing an Executive Summary was circulated and would be used at the GB development session on 20th December 2018. An SBAR would be produced in future and would also be included in papers to the formal Governing Bodies. It was noted that the CCGs are managing a number of in year cost pressures, the forecast for the full year is a deficit of £38.14m however there is net unmitigated risk of £8.5m which would result in a deficit of £46.54m, as per the Financial Recovery Plan.

Risks - EKHUFT are still working to a forecast activity of £430m which is £11m above the CCGs assumptions. The Committee noted that on current trends the £11m risk is more likely to be in the region of £5m - £6m. DL noted that EKHUFTs actions were not consistent with the need to work together to create a more sustainable health system in East Kent. DM highlighted the work of the east Kent System Board to help create the right environment and culture for collaborative, whole system working.

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CHC Overspend – It was noted that the current risk was a projected overspend of £5.2m. However, an ongoing deep dive indicates that approximately £2m YTD of this projected overspend can be mitigated through invoice review and other validation checks.

Independent Sector – It was noted that the current risk was assessed at £7.3m overspend. Conversations have been had with six providers and agreement reached that they will scale back activity in the financial quarter to bring waiting times in line with EKUFT. An activity plan has been reached with most providers, but the net risk still remained around £6m.

Forecast Outturn at month 9: CCGs would need to submit a detailed forecast update to NHSE at the end of month 9. The Committee requested that they should be involved in reviewing the forecast at the next meeting before submission to NHSE.

Contracting: Independent Sector Hospitals - QIPP plan was to slow down IS activity. It was believed

that QIPP can be delivered and the number of patients waiting reaches minimum targets. Providers have been offered 3-year contracts with a 2-year extension option across Kent and Medway to include a marginal tariff.

Care Home Rollout - The proposal is to award a contract for the provision of care home enhanced clinical support. Full year funding is £557k which is budgeted in C&C CCG. Rollout is phased so the impact in the current year will be an underspend. The Committee sought and received assurance that robust KPIs had been developed and that the proposed retrospective payments could be validated

Planning Roundup - The first submission is due on 14th January 2019. Joint working with CCG and EKUFT has been encouraging. There was a workshop with EKHUFT, KCHFT and KMPT held on 17.12.18. Work is ongoing to ensure that all Committees have a forward planner which will drive the tabling of papers at the appropriate time. It was requested that further contracting reviews should be scheduled with all relevant Committees in advance of any submission to Governing Bodies for Approval.

Performance:

Overview - The first East Kent Performance Report was presented. The East Kent CCGs were showing some improvements in both Cancer targets and A&E targets. RTT is showing a static position. The overall position has been partially affected by the new PAS system rollout in September. All four CCGs are still not achieving Constitutional Targets.

Committee highlighted: 1. Significant difference between appointments offered in SKC and in the other three

CCGs under local care (Improved Access). This is because the Hub system in SKC operates throughout the day and is not set up just to provide improved access. Across the four CCGs the overall take up of appointments remains an area of concern. DNA’s for local care appointments of 5% is in line with the level experienced by general practice.

2. Dementia diagnosis performance continues to be an area of concern which is also being highlighted at NHSE Assurance Meetings. Further work is needed in this area to improve and sustain performance.

3. The report on the Wheelchair service indicates that improvements continue to be made. Improvement accords with feedback from PPE Lay members.

The performance report will evolve over the next few months and there was a need to address how Quality Metrics should be incorporated into Governing Body reports.



Recommendation:

The Governing Body should note the above report.

Combined impact assessments Has the report/recommendation/proposal been impact assessed?

Yes

X No (state reason) The report is a record of meeting held on 12th December 2018.


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Meeting Title: NHS Thanet Governing Body Agenda Item:

34/19


Title of Report: Primary Care Co-Commissioning Committee Part 1 Summary

Author: Louise Matthews, Head of Primary Care Commissioning

Executive/ Lay Sponsor: Bill Millar, Director of Primary Care for the four east Kent CCGs

Finance sign-off Not applicable

Approval Decision Assurance InformationThis paper is for:(please X as applicable)

Ashford Canterbury & Coastal

South Kent Coast Thanet

All East Kent

CCGsCCG report is for:(please X as applicable)


Y/N This paper is provided for information. Discussion may result in GP Governing Body Members being conflicted.

No YesIs circulation restricted?(please X as applicable)


This report provides NHS Thanet CCG Governing Body with a summary of the discussions that took place during the part 1 section of the East Kent CCG Primary Care Commissioning Committees in common that met on 22 November 2018 that relate to NHS Thanet CCG.

Recommendation:


Combined impact assessments Yes

No (state reason)

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Thanet CCG Primary Care Co-Commissioning Committee Part 1 Summary

Situation:

This report provides NHS Thanet CCG Governing Body with a summary of discussions that took place during the part 1 section of the East Kent CCG Primary Care Commissioning Committees in common that met on 22 November 2018 that relate to Thanet CCG.

Background:

The East Kent Primary Care Co-commissioning Committee in common comprises the following individual committees, each of which share a common terms of reference: NHS Ashford CCG Primary Care Commissioning Committee; NHS Canterbury & Coastal CCG Primary Care Commissioning Committee; NHS South Kent Coast CCG Primary Care Commissioning Committee; and NHS Thanet CCG Primary Care Commissioning Committee.

The following items were considered by the Committee:

East Kent Primary Care Co-commissioning Committee in common Revisions to Terms of Reference – the committee reviewed revisions to the terms of reference which sought to clarify the voting members. The committee approved the amendments with the exception of paragraph 18.4. The committee sought further revisions to this paragraph that would allow members of GP federations to attend but will exclude Directors of GP federations whilst giving greater clarity on how conflict of interests would be managed. The Committee also requested the Chief Finance Officer was added as a voting Executive officer member as the CCG was in financial special measures.

GP Forward View – Strategic Update – The Director of Primary Care provided a summary position on the progress the CCGs are making against the eight ambitions set out in the CCGs GP forward view plan. It was noted that funding per GPFV stream and profile of spend would be added to future versions of the report. The committee requested an amendment to the slides to show the previous month and current months’ progress. A briefing on the procurement of online consultation was also requested by the committee for the next meeting.

Primary Care Update Report – Delegated Commissioning - the Committee received a report on items that are covered by the delegation agreement. The item relating to the Bethesda Medical practice PMS Agreement was deferred as a part 2 item as it was considered commercially sensitive.

Finance report – the Committee was updated on the latest budgetary position with a predicated breakeven position at year end. It was reported that there was an underspend in Thanet of £1.3 million, it was felt that projects need to be identified for this money. The committee discussed the timing of PCCC reports and the financial month end and agreed that the Finance Team would report on the prior month’s position given the financial report cannot be finalised by the time the PCCC papers are circulated and to receive a verbal update on the latest month at the meeting.

Estates and Premises – the committee received an update on the premises issues.o Margate Hub Development – Bethesda Medical Centre – the committee received an update

on progress with the Margate Hub Development. The committee requested clarity on the correct decision making route for Margate Hub Full Business Case as the proposed space was split fairly evenly between primary care and local care space..




Quality and Governance Report - The Committee received an updated report on quality issues. It was noted that there has been an improvement on CQC ratings in General Practice. The committee approved a single process across all four East Kent CCGs in line with the RCGP framework for governance of General Practitioners with extended Roles.

Risk Register - The committee noted that work was still underway to agree a common risk template for the four east Kent CCGs. The committee reviewed the Thanet CCG primary care risks and no new risks were added.

Summary of the Primary Care Co-commissioning Operational Groups – the committee received a summary report on the work of the PCCOG and agreed for future meetings to receive the draft minutes of the meeting in part 2.

Any Other Business There were no questions from the public

Recommendation:



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Meeting Title: Governing Body Agenda Item: 35/19

Date of Meeting: January 2019

Title of Report: Terms of Reference - East Kent Joint Committee

Author: Anthony May, Acting Company Secretary

Executive/ Lay Sponsor: Caroline Selkirk, Managing Director




N



The Governing Bodies of the east Kent CCGs established the “Sustainable Acute Medical Care in East Kent Joint Committee” in 2017 to support the work of the East Kent Transformation Programme.

The committee terms of reference have been reviewed following the additional tests introduced by the NHS England guidance document “Planning, assuring and delivering service change for patients” 1, and the resulting necessary increase in potential scope of service change.

Following the review, this report details the changes to the terms of reference that are recommended for approval.

Legal advice has been sought from Capsticks to ensure that the terms of reference continue to meet the legal requirements, and a verbal update will be provided to the Governing Body

Recommendation:

1. Subject to legal assurances being received, it is recommended that the Governing Body approve the revised terms of reference and associated agreement document.

1 In March 2018 NHS England updated its guidance detailing how it will undertake the assurance of substantial service developments or variations, “Planning, assuring and delivering service change for patients”: https://www.england.nhs.uk/wp-content/uploads/2018/03/planning-assuring-delivering-service-change-v6-1.pdf

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https://www.england.nhs.uk/wp-content/uploads/2018/03/planning-assuring-delivering-service-change-v6-1.pdf




Yes

X No (state reason) – not required



Situation:

The Governing Bodies of the east Kent CCGs established the “Sustainable Acute Medical Care in East Kent Joint Committee” in 2017 to support the work of the East Kent Transformation Programme.

The committee terms of reference have been reviewed following the additional tests introduced by the NHS England guidance document “Planning, assuring and delivering service change for patients” 2, and the resulting necessary increase in potential scope of service change.

Background:

The East Kent Transformation Programme was established to plan and deliver the changes needed to deliver the best possible healthcare to the local population, as defined within the east Kent case for change, which was first published in August 2016. The east Kent case for change was further supplemented by a Kent and Medway Case for change published in April 2017, which was updated in March 2018.

Assessment:

The review has resulted in the following proposed changes:

1. Change committee name to “Sustainable Hospital Care in East Kent Joint Committee” to more accurately reflect the scope and purpose of the committee

2. Expanded introduction to:a. reference both the east Kent and Kent and Medway Case for Change to

provide contextb. reference the revised NHS England guidance referred to above.c. reference the changes to the committee name

3. Amended the role of the committee to reflect the potential increase in scope, specifically including the additional bullet points in section 3.1.1, and emphasising that the committee would propose, consult and agree future service configurations as necessary.

4. Amended paragraph 5.8 to enable the Manging Director (or Deputy) to approve the appointment of a Deputy Chair in the absence of the Committee Chair (previously this required approval of the Accountable Officers)

5. Amended Schedule 1, paragraph 4 to specifically to the NHS England “Planning, assuring and delivering service change for patients” guidance (previously draft guidance was referred to.

6. The separate “agreement document” which is referenced within the terms of reference has been updated to reflect the changes described above. No other changes have been made to this document.






Legal advice has been sought from Capsticks to ensure that the terms of reference continue to meet the legal requirements, and a verbal update will be provided to the Governing Body.

Recommendation:1. Subject to legal assurances being received, it is recommended that the Governing

Body approve the revised terms of reference and associated agreement document.


Sustainable Hospital Care in East Kent Joint Committee

Draft Terms of Reference v1.6

1. Introduction

1.1. This document and the Schedules attached to it make up the Terms of Reference for the Joint Committee of Clinical Commissioning Groups (‘Joint Committee’) for Sustainable Hospital Cost in east Kent. The Committee supports the work of the East Kent Transformation Programme, which was established to plan and deliver the changes needed to deliver the best possible healthcare to the local population, as defined within the east Kent case for change, which was first published in August 2016. The east Kent case for change was further supplemented by a Kent and Medway Case for change published in April 2017, which was updated in March 2018.

1.2. These terms of reference update the version 1.0 of the terms of reference for the “Sustainable Acute Medical Care in East Kent Joint Committee” which was established during 2017 for this purpose. The terms of reference and committee name have been amended in recognition of the additional tests associated with the NHS England assurance process1 and the necessary increase in potential scope of service change.

1.3 The role of the committee is defined within clause 3 and the full delegation is provided in schedule 1 of this document.

1.3. These Terms of Reference form part of the Agreement between Member CCGs (‘The Agreement’), which set out the arrangements that apply in relation to the exercise of the Joint Functions of the Joint Committee. If there is any conflict between the provisions of the Agreement and the provisions of these Terms of Reference, the provisions of the Terms of Reference will prevail.

1.4. These Terms of Reference are to be interpreted in accordance with Schedule 1 (Definitions and Interpretation) of the Agreement Document.

1.5. The NHS Act 2006 (as amended) (‘the NHS Act’), was amended through the introduction of a Legislative Reform Order (“LRO”) to allow CCGs to form joint committees. This means that two or more CCGs exercising commissioning functions jointly may form a joint committee as a result of the LRO amendment to s.14Z3 (CCGs working together) of the NHS Act.


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1.6. Joint committees are a statutory mechanism which gives CCGs an additional option for undertaking collective strategic decision making and this can include NHS England too, who may also make decisions collaboratively with CCGs.

1.7. For clarity, individual CCGs and NHS England will always remain accountable for

meeting their statutory duties regardless of any delegation to a joint committee. The aim of creating a joint committee is to encourage strong collaborative and integrated relationships and decision-making between partners.

1.8. The Joint Committee (‘Joint Committee’) is a joint committee of:

NHS Ashford Clinical Commissioning Group NHS Canterbury and Coastal Clinical Commissioning Group NHS South Kent Coast Clinical Commissioning Group NHS Thanet Clinical Commissioning Group

The four CCGs in east Kent, detailed above, are referred to collectively as the “east Kent CCGs”

1.9. The Joint Committee has the primary purpose of enabling member CCGs to collaborate and take joint decisions in the areas of work that they agree in order to deliver the objectives outlined within clause 3 of this document.

1.10. Guiding principles of the Joint Committee:

To make informed decisions that improve health outcomes for the population

covered by Member CCGs

Collaborate and co-operate. Do it once rather than repeating, duplicating, and delaying actions.

Be open. Communicate openly about major concerns, issues or opportunities relating to the functions delegated to the Joint Committees, as set out in Schedule 1.

Adopt a positive outlook. Behave in a positive, proactive manner.

Adhere to all statutory requirements and best practice

Engage and communicate effectively. Ensure effective public and stakeholder engagement and consultation, including formal consultation as required, to enable informed and legally compliant decision making

Deploy appropriate resources. Ensure sufficient and appropriately qualified resources are available and authorised to fulfil the responsibilities set out in these Terms of Reference and the Agreement (as updated from time to time)


2. Statutory Framework 2.1. The NHS Act which has been amended by LRO 2014/2436, provides at s.14Z3 that

where two or more clinical commissioning groups are exercising their commissioning functions jointly, those functions may be exercised by a joint committee of the groups.

2.2. The CCGs named in paragraph 1.6 above have delegated the functions set out in

Schedule 1. 3. Role of the Joint Committee 3.1. The role of the Joint Committee as delegated by Member CCGs, shall be:

3.1.1. To consider and approve a collective strategy and associated commissioning intentions for sustainable hospital care across east Kent, enabling the delivery of high quality, sustainable and financially viable clinical services. This will include proposing, consulting and agreeing future service configurations and determining the service delivery model and locations from which services will be provided. This will include consideration of:

The reconfiguration of acute unplanned (e.g. emergency) hospital services;

Co-dependent clinical services that need to be reconfigured to support the new service model for unplanned care - including more specialist and planned services where there is an interdependency in relation to supporting clinical services or bed base

The model of care and location of services for patients with complex care needs;

The role of local care (both primary and community services) and minor injuries units (MIUs) in supporting the re-configuration of acute unplanned hospital services

3.1.2. System transformation, including the development and adoption of service redesign and best clinical practice across the area for the Services.

3.1.3. Ensuring effective public and stakeholder engagement and consultation, including formal consultation as required, has taken place to enable informed and legally compliant decision making.

3.1.4. Oversight of the implementation of the approved service delivery model and any associated reconfiguration of services.

3.1.5. Representation and contribution to national, regional or other relevant Alliances and Networks, including clinical networks, as appropriate.


3.1.6. Work with the Kent and Medway Sustainability and Transformation Partnership (“STP”) Programme Board to ensure any decisions made by the Joint Committee are informed by and complement wider strategic planning.

3.2. At all times, the Joint Committee, through undertaking decision making functions of each of the Member CCGs, will act in accordance with the terms of their individual constitutions. No decision outcome shall impede any organisation in the fulfilment of its statutory duties.

4. Area of responsibility

4.1. The Joint Committee will comprise those CCGs listed in paragraph 1.6.

4.2. The role of the Joint Committee is detailed in paragraph 3. The Joint Committee is not responsible for determining the provision of the Services outside of east Kent. However, it will be responsible for ensuring any proposed change in hospital service provision, that may materially impact patients and other services of Member and non-Member CCGs, are taken in to consideration. Materiality will be determined by the Joint Committee, in discussion as appropriate with respective non-Member CCG(s) and Health Overview Scrutiny Committee(s).

5. Membership

5.1. Membership of the Joint Committee will comprise both voting and non-voting members, as follows:

5.1.1. Voting members

Each constituent CCG will be represented by:

Their Clinical Chair A non-executive clinician who is a member of the CCG Governing Body (a

GP or Practice Nurse) A Lay Member, independent member or secondary care clinician of the

constituent CCG Governing Body

5.1.2. Non-voting members:

An Independent Chair of the Joint Committee who shall be independent from all Member CCGs and any other organisation associated with the Services

The Accountable Officer of NHS Ashford, NHS Canterbury and Coastal, NHS South Kent Coast and NHS Thanet CCGs

The Managing Director of the four east Kent CCGs The Chief Finance Officer (CFO) of the four east Kent CCGs The Chief Nurse from of the four east Kent CCGs


5.2. The lay member, independent member and secondary care clinicians shall be selected

to ensure a range of skills are represented on the Joint Committee..

5.3. The Joint Committee may invite additional non-voting members to attend the Joint Committee to enable it to carry out its duties.

5.4. The Clinical Chair of the respective CCG may nominate a suitable deputy for any member of their CCG when necessary. Deputies must be like-for-like, meaning a clinician may be replaced by a clinician, a lay member replaced by a lay member, etc.

5.5. All deputies should be fully briefed and both the meeting Chair and meeting administrator informed of the arrangement in writing prior to the meeting so that quoracy can be maintained.

5.6. No person can act in more than one role on the Joint Committee, meaning that each deputy needs to be an additional person outside of the Joint Committee membership. Deputies will have the same voting rights as the individual they are representing.

5.7. The Co-ordinating Commissioner or its representative(s) will act as secretariat to the Joint Committee to ensure the day to day work of the Joint Committee is proceeding satisfactorily.

5.8. The Joint Committee will be Chaired by an independent person, independent of all organisations directly associated with the Services affected. They may appoint a deputy in their absence to Chair the Joint Committee, subject to the approval of the Managing Director (or Deputy) of the east Kent CCGs. and subject to the deputy having the same independent status as the Chair.

6. Meetings

6.1. The Joint Committee shall adopt the standing orders of the Governing Body of the Co-ordinating Commissioner (‘Co-ordinating Commissioner’), insofar only as they relate to the:

a) notice of meetingsb) handling of meetingsc) agendasd) circulation of papers ande) conflicts of interest

7. Voting

7.1. Decisions will be taken at the Joint Committee based on the evidence presented, including the support from the constituent CCGs.


7.2. The Joint Committee will wherever possible make decisions by consensus. Where this is not achieved, a voting method will be used.

7.3. Each constituent CCG has an equal share of votes, so in a Joint Committee of four CCGs, each CCG possess a 25% vote share. The vote share of each voting member present will be weighted such that they have an equal part of the vote share.

7.4. For example, where a CCG is represented by three members, each member would have a vote share of 25% divided by 3 = 8.33%. If, owing to apologies, a CCG was only represented by two members at a given meeting, each of the two members would have a vote shared of 25% divided by 2 = 12.5%.

7.5. The outcome of any decision put to a vote will be recorded in the minutes.

7.6. The Chair of the Joint Committee shall not have a casting vote.

7.7. Recommendations may only be approved if there is a simple majority (above 50%) and at least some support from each constituent CCG. For the avoidance of doubt, a simple majority will not be sufficient to pass a recommendation if there is no support from one or more constituent CCGs.

8. Quorum

8.1. The Chair of the Joint Committee and at least two voting members from each constituent CCG must be present for the meeting to be quorate. This may include deputies in accordance with paragraphs 5.3 and 5.4.

8.2. Deputies approved by the Chair of the Joint Committee contribute towards the quorum.

8.3. For the meeting to be quorate there must be a clinical majority of voting members.

9. Frequency of meetings

9.1. The Chair shall determine the frequency of meetings to facilitate the achievement of the relevant milestones of the Kent and Medway Sustainability and Transformation Partnership, and has the power to call meetings of the Joint Committees as and when they are required.

Meetings are generally expected to be held face to face, but members may participate by telephone or video conference. Joint Committee Members may participate (and count towards quorum) in a face-to-face meeting via telephone or video conference. When determining how the meeting will operate, consideration should be given to the requirements detailed in paragraph 10.


The Chair shall agree the agenda and arrange for the circulation and publication of papers at least five working days prior to the meeting, accept in the event of an extraordinary meeting, under such circumstances, three working days’ notice is acceptable.

Papers may not be tabled; they must be distributed prior to the meeting.

10. Meetings of the Joint Committee

10.1. Meetings of the Joint Committee shall be held in public unless the Chair of the Joint Committee considers that it would not be in the public interest to permit members of the public to attend a meeting or part of a meeting. As such, the Joint Committee Chair may resolve to exclude the public from a meeting that is open to the public (whether during the whole or part of the proceedings) whenever publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the proceedings or for any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time.

10.2. Members of the Joint Committee have a collective responsibility for the operation of the Joint Committee. They will participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability, and endeavour to reach a collective view.

10.3. The Joint Committee may call additional experts to attend meetings on an ad hoc basis to inform discussions.

10.4. The Joint Committee has the power to establish sub groups and working groups and any such groups will be accountable directly to the Joint Committeee.

10.5. Members of the Joint Committee shall respect confidentiality requirements as set out in the Agreement.

11. Secretariat

11.1. The secretariat to the Joint Committees will present the minutes, decisions and action notes to the governing bodies of the CCGs set out in paragraph 1.6 above.

12. Reporting

12.1. It is important that CCGs maintain effective oversight of the activities of the Joint Committee. The Joint Committee will circulate minutes of their meetings to each Member CCG Governing Body.

12.2. It is expected that CCG representatives on the Joint Committee will feedback any material discussion and all decisions made by the Joint Committee to their respective organisation.


13. Decisions

13.1. The Joint Committee will make decisions within the bounds of the scope of the functions delegated.

13.2. The decisions of the Joint Committee shall be binding on all member CCGs and shall remain binding for any Member CCG who withdraws from the Joint Committee in accordance with clause 21 of the Agreement.

13.3. All decisions undertaken by the Joint Committees will be published by the Clinical Commissioning Groups set out in paragraph 1.6, subject to the provisions of paragraph 10.1.

13.4. Where necessary, the Joint Committee agrees to make decisions by a common process for decision making with any relevant non-member CCG. This process will apply where a non-member CCG has delegated the functions within the scope of the Joint Committee to an individual or member or employee of the non-member CCG. The common process would include the non-member CCG being in the same room as the Joint Committee, with the same papers and making a decision at the same time as the Joint Committee but as a separate organisation. For clarity, the vote of any non-member organisation shall have no bearing on the vote of the Joint Committee.

13.5. Decisions taken by the Joint Committee and/or decisions taken through a common process with a CCG that is not a member of the Joint Committee will be binding on those organisations party to the arrangements, and no single organisation shall be able to veto the decision that has been taken by the Committee.

14. Review

14.1. These terms of reference will be reviewed annually by the Member CCGs.

14.2. These terms of reference may only be amended in accordance with clause 10.4 of the Agreement.

15. Withdrawal from the Joint Committee

15.1. The governing body of any member CCG can decide to withdraw from the Joint Committee, subject to the provisions of clause 21 of the Agreement.

16. Co-ordinating Commissioner

16.1. The Co-ordinating Commissioner shall be NHS South Kent Coast CCG. In the event that the Co-ordinating Commissioner withdraws from the Joint Committee or withdraws from the role of Co-ordinating Commissioner, the remaining Member CCGs will agree a successor Co-ordinating Commissioner from between them. Any clause, responsibility or liability quoted in this Terms of Reference and the associated


Agreement pertaining to the Co-ordinating Commissioner, shall then transfer to the successor Co-ordinating Commissioner.

16.2. The Joint Committee shall adopt the Financial Policies of the Co-ordinating Commissioner in respect to the operation of the Committee and any sub-committees established.


Schedule 1 - Delegation by CCGs to Joint Committees

A. The CCG Functions at clause B below will be delegated to the Joint Committee by the member CCGs in accordance with their statutory powers under s.14Z3 of the NHS Act 2006 (as amended) (“the NHS Act”). Section 14Z3 allows CCGs to make arrangements in respect of the exercise of their commissioning functions and includes the ability for two or more CCGs to create a Joint Committee to exercise functions.

B. The delegated functions relate to the health services provided to the member CCGs

by all providers they commission services from in the exercise of their functions. The CCGs delegate their commissioning functions so far as such functions are required for the Joint Committee to carry out its role, as set out in the Terms of Reference.

The CCGs delegate the above functions to enable the Joint Committee to take decisions around the commissioning and delivery of sustainable hospital services in east Kent.

C. Each member CCG shall also delegate the following functions to the Joint Committee so that it can achieve the purpose set out in (B) above:

1. Acting with a view to securing continuous improvement to the quality of commissioned services. This will include outcomes for patients with regard to clinical effectiveness, safety and patient experience to contribute to improved patient outcomes across the NHS Outcomes Framework

2. Promoting innovation, seeking out and adopting best practice, by supporting research and adopting and diffusing transformative, innovative ideas, products, services and clinical practice within its commissioned services, which add value in relation to quality and productivity.

3. The requirement to comply with various statutory obligations, including making arrangements for public involvement and consultation throughout the process and taking into account updated guidance on patient and public participation in commissioning health and care. That includes any determination on the viability of models of care pre-consultation and during formal consultation processes, as set out in s.13Q, s.14Z2 and s.242 of the NHS Act.

4. The requirement to ensure process and decisions comply with the four key tests for service change introduced by the last Secretary of State for Health, which are:

(i) strong public and patient engagement;

(ii) consistency with current and prospective need for patient choice;

(iii) a clear clinical evidence base; and

(iv) support for proposals from clinical commissioners.

and NHS England’s updated guidance (March 2018) which introduced a patient care test for hospital bed closures and other requirements, as outlined in the guidance, “Planning, assuring and delivering service change for patients”:



5. The requirement to comply with the statutory duty under s.149 of the Equality Act 2010 i.e. the public sector equality duty.

6. The requirement to have regard to the other statutory obligations set out in the new sections 13 and 14 of the NHS Act. The following are relevant but this is not an exhaustive list:

ss.13C and 14P - Duty to promote the NHS Constitutionss.13D and 14Q - Duty to exercise functions effectively, efficiently and economicallyss.13E and 14R – Duty as to improvement in quality of services ss.13G and 14T - Duty as to reducing inequalitiesss.13H and 14U – Duty to promote involvement of each patientss.13I and 14V - Duty as to patient choicess.13J and 14W – Duty to obtain appropriate advicess.13K and 14X – Duty to promote innovationss.13L and 14Y – Duty in respect of researchss.13M and 14Z - Duty as to promoting education and trainingss.13N and 14Z1- Duty as to promoting integrationss.13Q and 14Z2 - Public involvement and consultation by NHS England/CCGs s.13O - Duty to have regard to impact in certain areass.13P - Duty as respects variations in provision of health servicess.14O – Registers of Interests and management of conflicts of interests.14S – Duty in relation to quality of primary medical services

7. The Joint Committee must also have regard to the financial duties imposed on CCGs under the NHS Act and as set out in:

s.223G - Means of meeting expenditure of CCGs out of public fundss.223H - Financial duties of CCGs: expenditures.223I - Financial duties of CCGs: use of resourcess.223J - Financial duties of CCGs: additional controls of resource use

8. Further, the Joint Committee must have regard to the Information Standards as set out in s.250, 251, 251A, 251B and 251C of the Health & Social Care Act 2012 (as amended).

9. The expectation is that Member CCGs will ensure that clear governance arrangements are put in place so that they can assure themselves that the exercise by the Joint Committees of their functions is compliant with statute.

10. The Joint Committee will meet the requirement for CCGs to comply with the obligation to consult the relevant local authorities under s.244 of the NHS Act and the associated Regulations.

11. The Joint Committee will be delegated the capacity to propose, consult on and agree future service configurations that will shape the medium and long terms financial plans of the constituent organisations. The Joint Committee will have no contract





negotiation powers meaning that it will not be the body for formal annual contract negotiation between commissioners and providers. These processes will continue to be the responsibility of individual Clinical Commissioning Groups (and NHS England) under national guidance, tariffs and contracts.


Sustainable Hospital Carein East Kent Joint Committee

Agreement Document

V1.6

JC Agreement document unapproved v1.6.docOverall of 184

Acknowledgements

This Agreement has been developed based on the principles and content of the Manual Agreement of the Joint Committee of Clinical Commissioning Groups of South Yorkshire and Bassetlaw, whose assistance and agreement to use their documentation as a basis for developing this Agreement is appreciated. Introduction

1 Purpose and Interpretation

1.1 This Agreement and the Terms of Reference set out the arrangements that apply in relation to the exercise of the Joint Functions of the Joint Committee (“Joint Committee”) of the CCG’s that are signatories to it.

1.2 If there is any conflict between the provisions of the Agreement and the provisions of the Terms of Reference, the provisions of the Terms of Reference will prevail.

1.3 This Agreement is to be interpreted in accordance with Schedule 1 (Definitions and Interpretation).

2 Term

2.1 This Agreement has effect from the date all CCG Members sign the Agreement and will remain in force unless terminated in accordance with Clause 2222 (Termination).

2.2 Individual Member CCG(s) may terminate their membership of the Joint Committee in accordance with Clause 21 21(Leaving the Joint Committee).

3 Services

3.1 This Agreement and the Terms of Reference relate solely to the commissioning of services to provide sustainable hospital care in east Kent (“the Services”).

4 Overview

This Agreement sets out in practical terms how the local health system will work together to commission sustainable hospital care in east Kent.

4.1 The local health commissioners have decided to create a Joint Committee, through which they can both consider and undertake joint commissioning decisions on behalf of their organisations. The CCGs who are Members of the Joint Committee are:

NHS Ashford Clinical Commissioning Group NHS Canterbury and Coastal Clinical Commissioning Group NHS South Kent Coast Clinical Commissioning Group NHS Thanet Clinical Commissioning Group


The four CCGs in east Kent, detailed above, are referred to collectively as the “east Kent CCGs”

Legal Basis

4.2 The legal basis on which the CCGs have agreed to jointly exercise a group of their functions through delegating them to the Joint Committee, this by using their powers under section 14Z3 of the NHS Act 2006 (as amended) (“the Act”), which provides:

“(1) Any two or more clinical commissioning groups may make arrangements under this section.

(2) The arrangements may provide for—(a) one of the clinical commissioning groups to exercise any of the

commissioning functions of another on its behalf, or(b) all the clinical commissioning groups to exercise any of their

commissioning functions jointly.(2A) Where any functions are, by virtue of subsection (2)(b), exercisable jointly by two

or more clinical commissioning groups, they may be exercised by a joint committee of the groups….

(7) In this section, “commissioning functions” means the functions of clinical commissioning groups in arranging for the provision of services as part of the health service (including the function of making a request to the Board for the purposes of section 14Z9).”

As a result, the Joint Committee has been created to exercise both commissioning functions and those related to commissioning, as has been set out in each CCGs delegation to it. The actual Delegations from each CCG are set out in Schedule 1 of the Sustainable Hospital Care in East Kent Joint Committee Terms of Reference 5 Purpose of the Joint Committee

5.1 The Joint Committee has the primary purpose of enabling the CCG members to work effectively together, to collaborate and take joint decisions relating to the services relating to this Agreement, by exercising the Joint Functions.

5.2 The Joint Functions are those set out in the Delegation Document at schedule 1 of the Terms of Reference (“the Delegation Document”).

5.3 The role of the Joint Committee, as set out in the Terms of Reference for the Services pertaining to this Agreement, is:

5.3.1 To consider and approve a collective strategy and associated commissioning intentions for sustainable hospital care across east Kent, enabling the delivery of high quality, sustainable and financially viable clinical services. This will include proposing, consulting and agreeing future service configurations and determining the


service delivery model and locations from which services will be provided. This will include consideration of:

The reconfiguration of acute unplanned (e.g. emergency) hospital services;

Co-dependent clinical services that need to be reconfigured to support the new service model for unplanned care - including more specialist and planned services where there is an interdependency in relation to supporting clinical services or bed base

The model of care and location of services for patients with complex care needs;

The role of local care (both primary and community services) and minor injuries units (MIUs) in supporting the re-configuration of acute unplanned hospital services

5.3.2 System transformation, including the development and adoption of service redesign and best clinical practice across the area for the Services.

5.3.2 Ensuring effective public and stakeholder engagement and consultation, including formal consultation as required, has taken place to enable informed and legally compliant decision making.

5.3.3 Oversight of the implementation of the approved service delivery model and any associated reconfiguration of services.

5.3.4 Representation and contribution to national, regional or other relevant Alliances and Networks, including clinical networks, as appropriate.

5.3.5 Work with the Kent and Medway Sustainability and Transformation Partnership (“STP”) Programme Board to ensure any decisions made by the Joint Committee are informed by and complement wider strategic planning.

5.4 Generally, it is envisaged that the Joint Committee will work across the area to develop a strategic approach to commissioning sustainable services that are patient centred. Further, it will enable the development of integrated service delivery with other partners so that the patients receive a high quality seamless service.

Statutory Duties and Delegation 6 Complying with the Statutory Duties of CCGs

6.1 In exercising its functions, the Joint Committee must meet the statutory obligations of the CCGs which are its members. A failure to do so could lead to challenge to


decisions made and an inability to assure CCG Governing Bodies that their delegated functions are being properly exercised.

6.2 The statutory duties which need to be taken into account are summarised in the Checklist in Appendix 1.

6.3 Under Section14Z3(6) of the Act “any delegation of functions to a joint committee of CCGs do not affect the liability of a clinical commissioning group for the exercise of any of its functions.”

6.4 For clarity, this means:

a) Member CCGs need to ensure that the Joint Committee is complying with the CCGs’ statutory duties, as the Member CCGs continue to be responsible if there are any failings in decision making; and

b) Member CCGs need to ensure that an appropriate reporting mechanism from the Joint Committee to them is in place. This will allow the Member CCGs to maintain effective oversight of the Joint Committee’s processes and decision making.

6.5 In effect, the Joint Committee will stand in the place of the multiple CCGs who are its members for specific decision making, but those individual CCGs will continue to have liability for those decisions.

7 Delegation

7.1 Member CCGs have agreed to delegate functions to the Joint Committee in order to enable the Member CCGs to work effectively together, to collaborate and to take joint decisions in those areas of work delegated.

7.2 The delegation of functions from each CCG to the Joint Committee is set out in the delegation document at Schedule 1 of the Sustainable Hospital Care in East Kent Joint Committee Terms of Reference.


8 Reserved Functions

8.1 All functions are reserved for statutory organisations that are not specifically stated in the Delegation Document.

8.2 It will be important for the Joint Committee to be cognisant of the above Reserved Functions and to engage with member CCGs if any of those arise in the context of the functions which the Joint Committee are to exercise.

9 Exercise of the Joint Functions

9.1 The Joint Committee must exercise the Joint Functions in accordance with:

9.1.1 the Terms of Reference;9.1.2 the terms of this Agreement;9.1.3 the Law;9.1.4 all applicable guidance issued by health system regulators; and9.1.5 good practice.

Governance

10 Joint Committee Governance

10.1 The CCGs have established the Joint Committee in accordance with the Terms of Reference and this Agreement. The Joint Committee and each member will act at all times in accordance with the Terms of Reference. The decisions of the Joint Committee, as delegated to them, shall be binding on all Member CCGs.

10.2 It is important that CCGs maintain effective oversight of the activities of the Joint Committee. The Joint Committee will circulate minutes of their meetings to each Member CCG Governing Body. It is expected that CCG representatives on the Joint Committee will feedback any material discussion and all decisions made by the Joint Committee to their respective organisation.

10.3 Members of the Joint Committee will be nominated and attend Joint Committee meetings based on an understanding of their organisations standpoint on related matters. However, Members will attend Joint Committee meetings with an open mind and have the delegated authority to consider information presented and discussed by the Joint Committee and vote accordingly, without being constrained by or having to revert back to their CCG’s.

10.4 The Joint Committee will operate in accordance with the Terms of Reference which will be approved by each Member CCG delegating functions to it. Amendments to the Terms of Reference shall only be valid when agreed by all Member CCGs. Where appropriate, the Joint Committee shall adopt the Financial Policies of the Co-ordinating


Commissioner in respect to the operation of the Committee and any sub-committees established.

10.5 Reports from any Joint Committee sub-committee will be shared with CCGs by agreement or request of the Joint Committee.

10.6 The Joint Committee may at any time agree to make a decision or decisions through a common process with a CCG that is not a member of the Joint Committee. The common process would include the non-member CCG being in the same room as the Joint Committee, with the same papers and making a decision at the same time as the Joint Committee but as a separate organisation. The voting threshold will be such that it requires support from all constituent CCGs. Decisions taken by the Joint Committee and/or decisions taken through a common process with a CCG that is not a member of the Joint Committee will be binding on those organisations party to the arrangements, and no single organisation shall be able to veto the decision that has been taken by the Committee.

Sub committees of the Joint Committee

10.7 The Joint Committee shall be able to appoint sub-committees to enable it to discharge its functions, although sub-committees will not have delegated authority to make any decision delegated by Member CCGs to the Joint Committee.

11 Finances/ Pooled Funding

11.1 The east Kent CCGs are responsible for funding the Review on an equal shared cost basis including any administrative or management costs associated with the development and delivery of this Agreement and the Joint Committee.

11.2 Member CCGs may, for the purposes of exercising the Joint Functions under this Agreement, establish and maintain a pooled fund in accordance with section 14Z3 of the NHS Act 2006.

11.3 Specifically, member CCGs may wish to look at how to support the implementation of the decisions they make from service reconfiguration processes through to enabling strategic system change. Pooling funds for the overall benefit of all patients would ensure the best use of limited resource is achieved. It will also mean that implementation of decisions is less likely to delay due to financial challenge, in that a pooled fund provides greater cross-partner support options than CCGs seeking to implement change individually. In some instances, consideration can also be given to getting better value for money by consolidating purchasing/commissioning power in a pooled fund.

12 Secretariat

12.1 The co-ordinating commissioner will provide the secretariat to the Joint Committee in partnership with the Kent and Medway STP PMO


12.2 Funding of the secretariat is in accordance with Clause 12.1.

13 Conflicts of Interest

13.1 Member CCGs must comply with their statutory duties set out in Chapter A2 of the NHS Act 2006, including those relating to the management of conflicts of interest as set out in section 14O of the Act.

13.2 Each member of the Joint Committee must abide by NHS England’s guidance Managing conflicts of interest – statutory guidance for CCGs as updated from time to time (https://www.england.nhs.uk/commissioning/pc-co-comms/coi/) and all relevant guidance and policies of their appointing body in relation to conflicts of interest.

13.3 The Joint Committee shall operate a register of interests in accordance with the co-ordinating commissioner’s Conflicts of Interest Policy. Members of the Joint Committee shall comply with the Joint Committee’s conflicts of interest policy and shall disclose any potential conflict; where there is any doubt or where there is a divergence between the terms of the conflicts of interest policy of a member’s appointing CCG and that of the Joint Committee, the member should always err on the side of disclosure of any potential conflict.

13.4 Where any member of the Joint Committee has an actual or potential conflict of interest in relation to any matter under consideration by the Joint Committee, that member must inform the Chair of the Joint Committee and not participate in meetings (or parts of meetings) in which the relevant matter is to be discussed, or make a recommendation in relation to the relevant matter, without prior agreement of the Joint Committee Chair. The relevant appointing body may send an alternative representative to take the place of the conflicted member in relation to that matter and they shall have the same delegated authority as the original member of the Joint Committee.

13.5 Any breaches of the Joint Committee’s conflicts of interest policy or NHS England guidance on managing conflicts of interest shall be reported to the Member CCGs promptly, via the Joint Committee Chair and in any event within 5 business days of the breach having come to light.

14 Information Sharing and Data Protection protocols

14.1 Member CCGs shall all comply with the Data Protection Act (“DPA”) and any other statutory regulations relating to information sharing and data protection.

14.2 Member CCGs will enter into a Data Sharing Agreement (“DSA”) that governs the processing of information and data pursuant to this Agreement. The DSA shall:

14.2.1 Identify the information that may be processed;

14.2.2 Identify the purposes for which the information may be processed and state the legal basis for the processing in each case;


https://www.england.nhs.uk/commissioning/pc-co-comms/coi/

https://www.england.nhs.uk/commissioning/pc-co-comms/coi/

14.2.3 Confirm the Data Controller and, if appropriate, the Data Processor of any personal data, although it is not expected that personal data will be processed by the Joint Committee or any of its sub-groups;

14.2.4 Set out what will happen to the data on the termination of this Agreement

14.2.5 Explain how Member CCGs shall deal with subject access requests and other requests made under the DPA; and

14.2.6 Set out such other provisions as are necessary for the sharing of information to be fair and lawful.

14.3 Member CCGs will share all non-Personal Data in accordance with Information Law

and their statutory powers as set out in section 14Z23 of the Act.

14.4 Member CCGs agree that, in relation to information sharing and the processing of information for the purposes of the Joint Functions, they must comply with:

14.4.1 All relevant Information Law requirements including the common law duty of confidence and other legal obligations in relation to information sharing including those set out in the NHS Act 2006 and the Human Rights Act 1998;

14.4.2 Good Practice; and

14.4.3 Any relevant guidance (including guidance given by the Information Commissioner).

15 Confidentiality

15.1 Where information is shared with the Joint Committee of a confidential or commercially sensitive nature information will be treated under the confidentiality policy of the co-ordinating commissioner.

16 Freedom of Information

16.1 Each Member CCG acknowledges that the other Member CCGs are a public authority for the purposes of the Freedom of Information Act 2000 (“FOIA”) and the Environmental Information Regulations 2004 (“EIR”).

16.2 Each Member CCG may be statutorily required to disclose information about the Agreement and the information shared or generated by the Member CCGs pursuant to this Agreement and the Terms of Reference, in response to a specific request under FOIA or EIR, in which case:


16.2.1 each Member CCG shall provide the others with all reasonable assistance and co-operation to enable them to comply with their obligations under FOIA or EIR;

16.2.2 each Member CCG shall consult the others regarding the possible application of exemptions in relation to the information requested, giving them at least 5 working days within which to provide comments. Such consultation shall be effected by contacting [the CCG Representative named in Column 2 of Schedule 2 (Member CCGs)]; and

16.2.3 each Member CCG acknowledges that the final decision as to the form or content of the response to any request is a matter for the Member CCG to whom the request is addressed.

17 Liability and indemnities

17.1 In accordance with section 14Z3 of the NHS Act 2006, the Member CCGs retain liability in relation to the exercise of the Joint Functions.

18 Publicity

18.1 Member CCGs shall use all reasonable endeavours to consult one another before making any press announcements concerning the Services or the discharge of Member CCGs Functions under this Agreement.

19 Breach of this Agreement and Remedies

19.1 Any breach of this Agreement or the Terms of Reference will be raised with the Chair of the Joint Committee who will determine the action to be taken. Disputes will be dealt with under Clause 20 below.

20 Dispute Resolution

20.1 Where any dispute arises within the Joint Committee in connection with this Agreement of the Terms or Reference, the relevant Member CCGs must use their best endeavours to resolve that dispute on an informal basis within the Joint Committee.

20.2 Where any dispute is not resolved under clause 20.1 on an informal basis, any CCG Representative (as set out in Column 2 of Schedule 2 (Member CCGs) may convene a special meeting of the Joint Committee to attempt to resolve the dispute, with the agreement of the Joint Committee Chair.

20.3 If any dispute is not resolved under clause 20.2, it will be referred by the Chair of the Joint Committee to the Accountable Officers of the relevant Member CCGs, who will co-operate in good faith to resolve the dispute within ten (10) days of the referral.

20.4 Where any dispute is not resolved under clauses 20.1020.320.1 to 20.3 any Member CCG Accountable Officer may refer the matter for mediation arranged by an


independent third party to be appointed by the Chair of the Joint Committee and any agreement reached through mediation must be set out in writing and signed by and the relevant Member CCGs.

20.5 Where mediation under clause 20.4 does not result in resolution of the dispute any Member CCG Accountable Officer may refer the matter to the Centre for Effective Dispute Resolution or, where agreed by all relevant parties, any other independent adjudicator, for adjudication and binding resolution, which will be final and not subject to appeal.

21 Leaving the Joint Committee

21.1 Any Member CCG can decide to withdraw from this Agreement by giving a minimum of six months’ written notice to all other Member CCGs.

21.2 The Member CCG who wishes to withdraw from the Joint Committee will work together with the other Member CCGs to ensure there are suitable alternative arrangements in place in relation to the exercise of the Joint Functions.

21.3 The CCG leaving the Joint Committee shall continue to be a member of the Joint Committee and shall be bound by the decisions made by the Joint Committee and any associated liabilities up to the date of leaving the Joint Committee.

21.4 The CCG leaving the Joint Committee CCG shall no longer be a Member CCG from the day of leaving the Joint Committee, but shall continue to be bound by the decisions made prior to leaving the Joint Committee and shall be bound by the following Clauses of this Agreement after leaving the Joint Committee:

21.4.1 Clause 13: Conflicts of Interest21.4.2 Clause 14: Information Sharing and Data Protection protocols21.4.3 Clause 15: Confidentiality21.4.4 Clause 16: Freedom of Information21.4.5 Clause 18: Publicity21.4.6 Clause 21: Leaving the Joint Committee21.4.7 Clause 26: Waiver

22 Termination of this Agreement

22.1 This Agreement and the Terms of Reference of the joint Committee shall no longer apply if the Joint Committee is terminated.

22.2 Such termination shall be effective if:

22.2.1 all Member CCGs agree in writing that the Joint Committee shall end and withdraw the delegation of their functions to the Joint Committee; or

22.2.2 no more than two [2] Member CCGs remain party to this Agreement.


22.3 The provisions of the following clauses shall survive termination of this Agreement however caused and shall continue in full force and effect:

22.3.1 Clause 13: Conflicts of Interest22.3.2 Clause 14: Information Sharing and Data Protection protocols22.3.3 Clause 15: Confidentiality22.3.4 Clause 16: Freedom of Information22.3.5 Clause 18: Publicity22.3.6 Clause 21: Leaving the Joint Committee22.3.7 Clause 26: Waiver

23 Notices

23.1 Any notices given under this Agreement must be in writing, must be marked for the [CCG Representative noted in Column 2 to Schedule 2 (Member CCGs”)].

23.2 Notices sent:

23.2.1 by hand will be effective upon delivery;

23.2.2 by post will be effective upon the earlier of actual receipt or five (5) working days after mailing;

23.2.3 by email will be effective when sent (subject to no automated response being received).

24 Variations

24.1 Any variation to this Agreement, or any of the Schedules or Appendices to the Agreement, will only be effective if it is made in writing and signed by each of the Member CCGs, or is required by Law.

24.2 All agreed variations to this Agreement, or any of the Schedules or Appendices to the Agreement, will be appended as a Schedule to this Agreement.

25 Severability

25.1 If any term, condition or provision contained in this Agreement shall be held to be invalid, illegal, unlawful or unenforceable, to any extent and for any reason by any court or competent jurisdiction; such term, condition or provision shall be severed and shall not affect the validity, legality or enforceability of the remaining provisions of this Agreement, which shall continue in full force and effect as if this Agreement had been executed with the invalid provisions eliminated.


25.2 In the event of a holding of invalidity so fundamental as to prevent the accomplishment of the purpose of this Agreement, the Parties shall immediately commence good faith negotiations to remedy such invalidity.

26 Waiver

26.1 The failure of any Member CCG to abide by any of the provisions of this Agreement at any time shall not be construed to be a waiver of any such provision and shall in no matter affect the right of that CCG thereafter to abide by such provision.

27 Counterparts

27.1 This Agreement may be executed in any number of counterparts, each of which when executed and delivered shall constitute an original of this Agreement, but all the counterparts shall together constitute the same Agreement.

28 Applicable Law

28.1 This Agreement shall be interpreted in accordance with the laws of England and Wales and each party to this Agreement submits to the exclusive jurisdiction of the courts of England and Wales.

29 Co-ordinating Commissioner

29.1 The co-ordinating Commissioner shall be NHS South Kent Coast CCG. In the event that the Co-ordinating Commissioner withdraws from the Joint Committee or withdraws from the role of Co-ordinating Commissioner, the remaining Member CCGs will agree a successor Co-ordinating Commissioner from between them. Any clause, responsibility or liability quoted in this Agreement or the Terms of Reference, or any associated Schedule or Appendix pertaining to the Co-ordinating Commissioner, shall then transfer to the successor Co-ordinating Commissioner.

30 Review

30.1 This Agreement will be reviewed annually by the Member CCGs.

SIGNED BY:

Managing DirectorFor and on behalf of NHS Ashford CCG, NHS Canterbury and Coastal CCG, NHS South Kent Coast CCG and NHS Thanet CCG

…………..…………………………..

Caroline Selkirk


Schedule 1of the Agreement Document that accompanies the

Sustainable Hospital Care in East Kent Joint Committee Terms of Reference

Definitions and Interpretation The following words and phrases will bear the following meanings in this Agreement: Agreement means this agreement between the Member CCGs

comprising the body of the Agreement, its Schedules and Appendices

Data Controller shall have the same meaning as set out in the DPA

Data Subject shall have the same meaning as set out in the DPA

Delegation means the delegation of functions set out in Schedule 1 to the Terms of Reference of the Sustainable Hospital Care in East Kent Joint Committee

DPA means the Data Protection Act 1998 (as amended)

Good Practice means using standards, practices, methods and procedures conforming to the law, reflecting up-to-date published evidence and exercising that degree of skill and care, diligence, prudence and foresight which would reasonably and ordinarily be expected from a skilled, efficient and experienced individual

Guidance means any applicable health and social care guidance, guidelines, direction or determination, framework, standard or requirement issued by NHS England or any other regulatory or supervisory body, including the Information Commissioner, to the extent that the same are published and publicly available

Information Law

the DPA, the EU Data Protection Directive 95/46/EC; regulations and guidance made under section 13S and section 251 of the NHS Act; guidance made or given under sections 263 and 265 of the Health and Social Care Act 2012; the Freedom of Information Act 2000; the common law duty of confidentiality; the Human Rights Act 1998 and all other applicable laws and regulations relating to processing of Personal Data and privacy

Joint Committee

means the joint committee of the Member CCGs established on the terms set out in the Terms of Reference


Joint Functions

means the functions jointly exercised by the Member CCGs through the decisions of the Joint Committee in accordance with the Terms of Reference and as set out in detail in the Delegation Document

Co-ordinating Commissioner

means the CCG with responsibility for overseeing the co-ordination and administration of the Joint Committee

Law means: (i) any applicable statute or proclamation or any delegated or subordinate legislation or regulation; (ii) any enforceable EU right within the meaning of section 2(1) European Communities Act 1972; or (iii) any applicable judgment of a relevant court of law which is a binding precedent in England and Wales, in each case in force in England and Wales

Member CCG means the CCGs which are signatories of this Agreement

NHS Act 2006 means the National Health Service Act 2006 (as amended by the Health and Social Care Act 2012 or other legislation from time to time)

NHS England means the National Health Service Commissioning Board established by section 1H of the NHS Act, also known as NHS England

Non-member CCG

Non-Personal Data

means a CCG which is not a signatory to this Agreement

means data which is not Personal Data

Personal Data shall have the same meaning as set out in the DPA and shall include references to Sensitive Personal Data where appropriate

Terms of Reference means the terms of reference for the Joint Committee agreed between the Member CCGs


Schedule 2of the Agreement Document that accompanies the

Sustainable Hospital Care in East Kent Joint Committee Terms of Reference

Member CCGs, voting members and non-voting members

Column 1Organisation or nomination

Column 2Representatives

Member CCGs Voting RepresentativesThe vote share will be divided equally between each CCG and then equally between each voting member in attendance for each CCG. The Clinical Chair of each CCG will determine who represents their CCG, to meet the requirements shown below.

NHS Ashford Clinical Commissioning Group

1. Clinical Chair2. A non-executive clinician who is a member of the Governing

Body (GP or Practice Nurse)3. Lay member, independent member or secondary care clinician

NHS Canterbury and Coastal Clinical Commissioning Group



NHS South Kent Coast Clinical Commissioning Group



NHS Thanet Clinical Commissioning Group



Non-voting posts and representativesWhere appropriate, representation will be determined through agreement by the Accountable Officers to meet the requirements shown below.

1. Independent Joint Committee Chair

2. The Accountable Officer of NHS Ashford, NHS Canterbury and Coastal, NHS South Kent Coast and NHS Thanet CCGs

3. The Managing Director of the four east Kent CCGs

4. The Chief Finance Officer (CFO) of the four east Kent CCGs

5. The Chief Nurse of the four east Kent CCGs


Appendix 1Checklist of Statutory Duties

This document is an appendix to the Agreement Document which accompanies the Terms of Reference of the Sustainable Hospital Care in East Kent Joint Committee

The following is a checklist of statutory duties and protocols that Clinical Commissioning Groups should abide by Public Law Issues (including the NHS England guidance, “Planning, assuring and delivering service change for patients”1)

1. Case For Change

The starting point is to have established a clear Case for Change that both commissioners and providers agree is clinically and financially sound.

2. Engagement with Public and Patients

CCGs must comply with various statutory obligations to engage with and consult the public and patients throughout the process. That includes any determination on the viability of models of care pre-consultation and during formal consultation processes. – see s.13Q, s.14Z2 and s.242 of the NHS Act 2006 (as amended) (‘the Act’)

3. The Government’s four tests of service reconfiguration

It is important throughout the reconfiguration process to be mindful of the four key tests introduced by the last Secretary of State for Health, which are:

(i) strong public and patient engagement;

(ii) consistency with current and prospective need for patient choice;

(iii) a clear clinical evidence base; and

(iv) support for proposals from clinical commissioners.

Decision makers will need to show compliance when making a final decision on service change.

4. NHS England’s new patient care test for hospital bed closures:

NHS England will only support hospital bed closures arising from proposed major service change where one of the following three conditions can be met:

(i) Demonstrate that sufficient alternative provision, such as increased GP or community services, is being put in place alongside or ahead of bed closures, and that the new workforce will be there to deliver it; and/or

(ii) Show that specific new treatments or therapies, such as new anti-coagulation drugs used to treat strokes, will reduce specific categories of admissions; or

1 NHS England guidance detailing how it will undertake the assurance of substantial service developments or variations, “Planning, assuring and delivering service change for patients”: https://www.england.nhs.uk/wp-content/uploads/2018/03/planning-assuring-delivering-service-change-v6-1.pdf




(iii) Where a hospital has been using beds less efficiently than the national average, that it has a credible plan to improve performance without affecting patient care (for example in line with the Getting it Right First Time programme)

5. Equality

All NHS statutory bodies must also ensure compliance with their duty under s.149 of the Equality Act 2010 that is their public sector equality duty.

6. Statutory obligations

Commissioners must also have regard to the other statutory obligations set out in sections 13 and 14 of the Act. In looking at CCG duties the following, amongst others, are relevant:

• 14P – Duty to promote NHS Constitution

• 14Q – Duty as to effectiveness, efficiency etc.

• 14R – Duty as to improvement in quality of services

• 14T – Duty as to reducing inequalities

• 14V – Duty as to patient choice

• 14X - Duty to promote innovation

• 14Z1 – Duty as to promoting integration

• 14Z2 – Public involvement and consultation by CCGs (see above)

7. Cabinet Office

All consulting NHS bodies should consider and comply with Cabinet Office Guidance on Consultation. This sets out what the Cabinet Office recommends needs to be done to undertake a lawful public consultation exercise.

8. Governance

As to decision making it is important that clear governance arrangements are put in place that are compliant with statute.

9. Local authorities

CCGs must comply with their obligation to consult the relevant local authorities under s.244 of the Act and the associated Regulations.

10. Clear plan

CCGs should have a clear plan in place which ensures they give the public sufficient information for them to provide informed responses.





Title of Report: East Kent Joint Executive Meetings Summary Oct – Nov 18

Author: Lorraine Goodsell, Deputy Managing Director

Executive/ Lay Sponsor: Caroline Selkirk, Managing Director




N


None identified: members to declare conflicts as necessary


This is a summary of key discussions and decisions taken by the East Kent Joint Executive at their weekly meetings.

Recommendation:Governing Body members note the content of for information and assurance.

Monday 1st October 2018The meeting focussed upon the review of Executive structures and portfolios, identifying any key resource gaps against delivery of key CCG priorities and mitigating plans for addressing these.

Monday 8th October 2018 Commissioning Intentions and Q1 Close down letter. Reviewing the current QIPP update with agreement that this will become a standing item

for scrutiny by the team on a weekly basis. The forthcoming pre-consultation listening events which would be taking place in 8

locations across east Kent. The receipt of the east Kent systems assurance letter with an agreed approach to actions

required. A review of the current business support arrangements across the four CCGs and how

working arrangements will be more closely aligned to support east Kent working.

Monday 15th October 2018 Further preparations for the pre-consultation public listening events. Preparation for the east Kent assurance meeting with NHS England. Contracting and Performance support from Optum. Key members of Optum were invited

to update the executive on how they are improving their approach to delivering effective contracting and performance challenge to NHS providers. The executive sought

37-19 - SBAR Summaries of Joint Exec Oct and Nov 18.docOverall of 184


assurance from Optum that Q2 close down would be achieved within required timelines. Winter Planning.

o It was agreed the Winter Plan would be monitored weekly. Recruitment Policies. The policy had been updated to include the requirement for a

three month probationary period to be put in place for any new employees of the CCGs. This was reviewed and ratified by the team.

Monday 22nd October 2018 Independent Sector Update. The six largest independent providers have now agreed

final budgets for the year 18/19. Formal letters were sent out reflecting the changes and included the requirement for monthly meetings to ensure activity meets the revised profiles. It was noted that there was a mix of over and under performance by the independent sector but close scrutiny would be required against Q3 and Q4 activity.

Mid-Year Review update. It was confirmed that Clinical chairs were briefed on the QIPP plan. At this point we are £780,000 off our QIPP plan – all variants put down to “timing” issues with the expectations that plans will reach trajectory by the year end.

NHSE Joint Planning Update. The letter from NHSE/NHSI was reviewed by members. There is a need for a whole system sign off at the east Kent System Board.

Application for funding Eclipse Conference – agreed QIPP Update Winter Plan GP Practice Staff Pay - Brought attention to members regarding the letter dated 8th

October 2018 that BMA have issued in relation to GP practice staff pay 2018. Right Care/GIRFT briefing. It was noted that a review of resourcing this programme of

work would be undertaken.

Monday 29th October 2018 Mid-year assurance review. QIPP Update Community Paediatric Services. An SBAR was presented for the team to review current

provision and consider recommendations to procure a new service. Further work up and information was requested before this paper could be considered further.

Action log for Governing Body Meetings. These were reviewed to ensure all actions had been completed.

Winter plan review. East Kent CCGs/LMC Liaison Meeting. Agreed that the agenda for the forthcoming

meeting would be brought to a future executive to enable preparation and agree representation.

Monday 5th November 2018 Feedback was provided from the first two public engagement events. Key concerns

raised by members of the public related to maternity services, travel times and ambulance transit times.

A draft agenda was considered for the December Governing Body Development session. QIPP Update The forthcoming planning round. It was confirmed that the system plan will be updated by

14th January. It was noted that NHS England are supportive of Lightfoot working alongside us to

produce and deliver the EK Joint Improvement Plan. The current content of the BCF was reviewed, specifically the winter funding element was

discussed and how this would support the work to reduce the number of delayed discharges within EKHUFT.

It was noted that there was an opportunity to bid for capital funds to support Primary Care



and it was agreed to commence work on this as quickly as possible. As a result of the recent executive realignment, it was noted that there were a number of

secondment opportunities available for staff and it was agreed to advertised these as soon as possible.

Monday 12th November 2018 QIPP Update The Kent and Medway Integrated Urgent Care programme update was discussed with an

agreement that the procurement paper would be required to be presented at the Governing Body meeting on the 20th December. There would be a requirement for an extraordinary GB meeting to take place before the development session on the same date.

Community Hospital Reviews/Health and Social Care Village Beds. It was agreed that a review of all would be undertaken.

Review of recent Governing Body meetings. The executive discussed what went well and what could be improved. An action was for the Company Secretary to produce Chairs briefings for future GB meetings. It was also agreed that Exec leads need to ensure they attend for their papers or agree in advance who will attend on their behalf, ensuring this is communicated to the business support teams so that Agendas are correct.

Winter performance/flu outbreak chart. A winter dashboard was produced highlighting key target pressures. It was agreed this would be updated and discussed on a weekly basis.

An update on staff secondments was given.

Monday 19th November 2018 The content of the letter from NHSE was noted following East Kent CCGs Formal

Assurance Meeting. Actions were assigned to individuals to enable a formal reply to be produced and sent by 23rd November.

The planning round Road Map was presented and discussed to ensure everyone was clear of key timelines for submission of information and plans.

QIPP Update Anti- Coagulation Paper was presented updating the group in relation to the current

issues within the local service. Enhanced services reviews were discussed and the group were made aware of new

funding for certain treatments in 2020. An update on the review and proposed changes to the provision of Health and Social

Care Village Beds was discussed and it was confirmed that a risk analysis had been produced to support a paper that would be discussed at the East Kent System Board.

A detailed summary of the BCF was presented and it was agreed that further discussion with KCC was required to better understand the impact of the schemes set out in the BCF.

Winter dashboard was reviewed. Wheelchair Service User Communications. An update was provided in relation to a

recent meeting with the Wheelchair service user group. Office plans regarding Christmas. It was noted that there would be office closures over

the Christmas holiday period and guidance would be provided to staff who were working during this period.

Monday 26th November 2018 Staff retention was discussed with plans for redistribution of work should this be required. QIPP Update KMPT commissioning intentions letter was discussed with a response to be produced. The draft Programme for the all Staff Meeting on Monday 17th December was discussed



with agreement on approach and presenters. Draft Agenda for the January Governing Body meetings was reviewed and amended in

readiness for discussion with Clinical Chairs. Capacity Tracker – A web-based car home bed tracker is being put into place by Friday

18th January. Winter Plan updated was provided. Primary Care finance report was presented. A proposal for a small HQ for executives was discussed which would reduce a significant

amount of travelling time across east Kent alongside a reduction in emails and enable better communications between the team. All of the team felt this would be beneficial, improve communication and potentially speed up decision making processes.

Executive team cover over the Christmas period was discussed.


Yes

No (state reason)


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