Governance and Performance Report - Lambeth · 2016-09-21 · 4x5=20 5 Almost Certain 1x5=5 2x5=10...

INTEGRATED GOVERNANCE AND

PERFORMANCE REPORT

NHS Lambeth Clinical Commissioning

SEPTEMBER 2016

Our Mission: Our Mission is to improve the health and reduce health inequalities of Lambeth people and to commission the highest quality health services on their behalf.

Contents 1 INTRODUCTION ................................................................................................ 1

2 EXECUTIVE SUMMARIES ................................................................................ 2

2.1 CCG ASSURANCE – four domains and six clinical priorities ...................... 2

2.1.1 CCG Assurance Framework 2016/17 ......................................................................... 2

2.1.2 Leadership (Domain 4) ............................................................................................... 4

2.1.3 Financial Duties (Domain 3) ........................................................................................ 5

2.1.4 Performance against national constitutional standards 2016/17 .................................. 6

2.2 STRATEGIC AND OPERATIONAL DELIVERY ................................................ 7

2.2.1 Programme Assurance Statements – 2016/17 latest summary position ...................... 7

2.3 QUALITY ASSURANCE ................................................................................... 8

3 CCG ASSURANCE ......................................................................................... 23

3.1 National CCG Assurance Framework 2015/16 ............................................. 23

3.2 NHS Lambeth CCG Assurance 2016/17 ....................................................... 23

4 COMPONENTS OF THE CCG ASSURANCE FRAMEWORK ........................ 24

4.1 Leadership ...................................................................................................... 24

4.1.1 Board Assurance Framework .................................................................................... 24

4.2 Delegated Functions ...................................................................................... 31

4.3 Financial Management ................................................................................... 31

4.3.1 Financial Position ...................................................................................................... 31

4.3.2 QIPP Performance .................................................................................................... 35

4.4 Performance Dashboards ............................................................................. 35

4.4.1 NHS England National Constitution Standards ......................................................... 35

4.4.2 RTT (Referral to Treatment Times for Lambeth Patients) ......................................... 38

4.4.3 Diagnostics (Lambeth Patients) ................................................................................ 40

4.4.4 A & E Waiting Times ................................................................................................. 41

4.4.5 Cancer Waiting Times ............................................................................................... 42

4.4.6 Ambulance Response Times .................................................................................... 43

4.4.7 Improved Access to Psychological Therapies (IAPT) ................................................ 43

4.4.8 New Early Intervention In Psychosis 2 Week Standard ............................................. 44

4.4.9 Dementia Diagnosis Rate ......................................................................................... 45

4.5 Quality Premium 2016/17 ............................................................................... 46

4.6 Quality Alerts .................................................................................................. 48

4.7 Infection Control ............................................................................................ 48

4.8 Mixed Sex Accommodation........................................................................... 48

5 STRATEGIC AND OPERATIONAL DELIVERY – OUR PROGRAMMES ...... 49

5.1 Integrated Children and Young People (including Maternity) Programme 49

5.1.1 Programme’s Purpose .............................................................................................. 49

5.1.2 Programme Assurance Statement Quarter 1 2016/17 .............................................. 50

5.1.3 Children and Maternity Programme Board Dashboard .............................................. 53

5.2 Integrated Adults Programme (Elective, Urgent Care, Cancer) ................. 55

5.2.1 Programme Purpose ................................................................................................. 55

5.2.2 Programme Assurance Statement Quarter 1 2016/17 ............................................... 55

5.2.3 Integrated Adults Programme: Older Adults (including Committee in Common and

joint arrangements with Lambeth Council) ............................................................................ 59

5.2.4 Integrated Adults Programme: Long Term Conditions and Medicines Optimisation .. 64

5.2.5 Integrated Adults (Programme Dashboard & commentary) ....................................... 68

5.3 Better Care Fund (BCF) ................................................................................. 69

5.4 Integrated Mental Health for Adults .............................................................. 70

5.4.1 Programme Assurance Statement ............................................................................ 70

5.4.2 Mental Health Whole System Dashboard .................................................................. 71

5.5 Learning Disability ......................................................................................... 74

5.6 Staying Healthy (Led by London Borough of Lambeth) ............................. 76


5.6.2 Staying Healthy Dashboard ...................................................................................... 79

5.7 Primary Care Development ........................................................................... 83


5.7.2 Primary Care Programme Dashboard ....................................................................... 87

5.8 Enabler Programmes ..................................................................................... 88

5.8.1 Governance and Development Risk Register............................................................ 88

5.8.2 Equalities .................................................................................................................. 91

5.8.3 Organisational Development ..................................................................................... 93

5.8.4 IM&T ......................................................................................................................... 94

5.8.5 Estates...................................................................................................................... 99

5.8.6 Workforce ............................................................................................................... 101

6 QUALITY ASSURANCE ................................................................................ 104

6.1 PALS and Complaints .................................................................................. 104

6.2 Serious Incidents ......................................................................................... 106

6.3 Never Events ................................................................................................ 107

6.4 Freedom of Information (FOI) ...................................................................... 108

Acronyms

AMH Adult Mental Health SLaM South London and Maudesley NHS

Foundation Trust

CCG Clinical Commissioning Group

BCP Business Continuity Plan UCC Urgent Care Centre

CQC Care Quality Commission SMI Serious Mental Illness

CQRG Clinical Quality Review Group LAC Looked After Children

CQUIN Commissioning for Quality and

Innovation Payment

MECS Minor Eye Condition Scheme

CSU Commissioning Support Unit YOS Youth Offending Service

CTR Care and Treatment Review BME Black and Minority Ethnic

EIA Equality Impact Assessments CWD Children with Disabilities

EIP Early Intervention in Psychosis CLAMHS Children Looked After Mental Health

Service

EPRR Emergency Preparedness

Resilience and Response

EQA Equality Analysis

FPN Fair Processing Notice H@H Hospital at Home

GSTFT Guy’s and St. Thomas’ NHS

Foundation Trust

PLT Protected Learning Time

IPSA Integrated Personal Support

Alliance

IRT Integrated Respiratory Team

IST Intensive Support Team QIPP Quality Innovation Productivity and

Prevention

IT Information Technology WIC Walk In Centre

KCH Kings College Hospital NHS

Foundation Trust

STP Sustainability and Transformation Plan

LCCG Lambeth Clinical Commissioning

Group

HSCIC Health and Social Care Information Centre

LCSB Local Children’s Safeguarding

Board

NHSI NHS Improvement

LWN Living Well Network DTOC Delayed Transfer of Care

NHSE NHS England NEA Non Elective Admission

PMO Programme Management Office LARC Lambeth Alcohol Recovery Centre

PTL Patient Tracking List STEIS Strategic Executive Information System

PCIF Primary Care Infrastructure

Fund

PRUH Princess Royal University

Hospital, Bromley

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1 INTRODUCTION

NHS Lambeth Clinical Commissioning Group (CCG) comprises 47 member GP Practices organised

into three localities.

The NHS Lambeth CCG Governing Body is responsible for ensuring that the CCG has appropriate

arrangements in place to exercise its functions effectively, efficiently and economically and in

accordance with the CCG Constitution and our principles of good governance. Membership of the

Governing Body is drawn from our Member Practices, appointed individuals with statutory roles and

nominees from our key Lambeth partners.

The Governing Body is supported by the Lambeth Clinical Network. The purpose of the Clinical

Network is to provide the CCG Board members with sound clinical advice on commissioning care

services, clinical pathways and best practice. The Clinical Network consists of care and clinical

“subject matter experts” from within Lambeth including GPs, practice managers, nurses, pharmacists,

opticians and social care colleagues.

This report sets out how NHS Lambeth CCG is performing against its agreed objectives under the

leadership of the NHS Lambeth Clinical Commissioning Governing Body. It is a tool for providing

assurance to the Governing Body that objectives are being delivered or, where performance is behind

plan, that mitigating actions are in place to address performance improvement.

The 2016/17 Business Plan sets out NHS Lambeth CCG’s corporate objectives. Later is this report,

NHS Lambeth CCG’s Programme Boards and Enabler Work streams report on delivery of their

2016/17 objectives. The Integrated Governance and Performance Report provides a consolidate

picture of delivery of NHS Lambeth CCG’s corporate objectives.

NHS Lambeth CCG Corporate Objectives 2016/17

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2 EXECUTIVE SUMMARIES

2.1 CCG ASSURANCE – four domains and six clinical priorities

2.1.1 CCG Assurance Framework 2016/17

For 2016/17, NHS England introduced a new Improvement and Assessment Framework for CCGs

(CCG IAF). This has replaced the 2015/16 CCG Assurance Framework. In the Government’s

Mandate to NHS England, this new framework takes an enhanced and more central place in the

overall arrangements for public accountability of the NHS.

The Five Year Forward View, NHS Planning Guidance and the Sustainability and Transformation

Plans (STPs) for each area are all driven by the pursuit of the “triple aim”: (i) improving the health and

wellbeing of the whole population; (ii) better quality for all patients, through care redesign; and (ii)

better value for taxpayers in a financially sustainable system. The new framework aligns key

objectives and priorities, including the way NHS England assesses and manages partnership working

with CCGs.

The new 2016/17 Assurance Framework covers health priority indicators located in four domains:

Domain 1: Better Health: this section looks at how the CCG is contributing towards

improving the health and wellbeing of its population;

Domain 2: Better Care: this principally focuses on care redesign, performance of

constitutional standards and outcomes, including priority clinical areas; Maternity, Dementia,

Cancer, Learning Disabilities, Diabetes and Mental Health.

Domain 3: Sustainability: this section looks at how the CCG is remaining in financial

balance, and is securing good value for patients and the public from the money it spends;

Domain 4: Leadership: this domain assesses the quality of the CCG’s leadership, the quality

of care plans, how the CCG works with its partners and the governance arrangements that

the CCG has in place to ensure that it acts with probity, for example in managing conflicts of

interest.

The diagram below summarises the framework:

3

The CCG Improvement and Assessment Framework includes a set of 57 indicators across 29 areas.

It is intended that the indicators will be reported quarterly. Not all indicators will be based on data

available each quarter: some indicators will be refreshed quarterly, some will use moving averages to

provide a more up-to-date view and some will only be refreshed annually. Baseline data for each of

the indicators will be available on NHS Lambeth’s website in September.

NHS England has a statutory duty to conduct an annual performance assessment of every CCG.

CCG’s will therefore receive a rating against the four domains, Better Health, Better Care,

Sustainability and Leadership. The rating for this section will be described as follows:

Outstanding

Good

Limited Assurance

Required Improvement

The six clinical priorities will have independent moderation and will be given one of the following ratings:

Top performing

Performing well

Needs improvement

Greatest need for improvement

Ratings will be published on the My NHS website.

https://www.nhs.uk/Service-Search/performance/search

https://www.nhs.uk/Service-Search/performance/search

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2.1.2 Leadership (Domain 4)

The NHS Lambeth CCG Board Assurance Framework (BAF) is included in this report, along with a Heat Map showing the number of risks at each

score for all risks recorded on Lambeth CCG’s Risk Register not just those scoring 12 or above. The BAF and supporting Risk Register are living

documents, updated regularly.

Risk Matrix Impact

Likelihood 1 Negligible 2 Minor 3 Moderate 4 Major 5 Catastrophic 5 4x4=16 2C A&E Performance

4x4=16 2M Community Nursing Vacancy Level

4x4=16 2N RTT Performance

4x4=16 4NCBC SEL Strategy - inadequate workforce capacity

4x4=16 4NCBC SEL Strategy - integrated IT systems

1 3x5=15 1A Safeguarding children

12 3x4=12 2A Community Nursing Service Improvement Plan

3x4=12 2B Safeguarding Adults

3x4=12 2K Cancer referral to treatment 62 days

3x4=12 3C Risk to SLaM Contract

3x4=12 3M IPSA Alliance

3x4=12 3N LWN reduction in secondary care demand

3x4=12 5BPCC Provision of weekend Walk In Centre

3x4=12 6K CSU procurement process risk

3x4=12 6N Change of IT Provider risk

3x4=12 7A Financial Planning Risk

3x4=12 7B QIPP delivery risk

3x4=12 PMCF07 Sustainability of Access Hubs

4 4x3=12 5CPCC Walk in Centre cross-charge risk

4x3=12 5DPCC Minor Ailments Scheme

4x3=12 5SPCC PMS Contract Review funding impact

4x3=12 5WPCC PMS Contract Review delay

1 Rare

1x1=1 1x2=2

4x5=20

5 Almost Certain

1x5=5 2x5=10 3x5=15 4x5=20 5x5=20

4 Likely

4x1=4 4x2=8 4x3=12 4x4=16

3x5=15

2 Unlikely

2x1=2 2x2=4 2x3=6 2x4=8

3 Possible

3x1=3 3x2=6 3x3=9 3x4=12

1x3=3 1x4=4

Risks scoring 12 and above

1x5=5

2x5=10

4 4

11261

1 54

2

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2.1.3 Financial Duties (Domain 3)

Financial performance to Month 4 is summarised below.

Performance Area Commentary

Month 4

Position

Revenue Surplus

Lambeth CCG is reporting a surplus of £2.584m for the first four

months of 2016/17 and is forecasting a surplus of £7.752m for the

year. This is in line with our target of delivering a 1% surplus

Cash Limit

Cash balances are planned to be maintained at low levels (less

than 1.25% at 31st July 2016. Lambeth CCG's cash balance at

bank at the end of July was £239k. The CCG expects to meet its

cash limit target for the year.

QIPP The CCG is forecasting full QIPP delivery of its annual QIPP target

of £9.151m.

Public Sector

Payment Policy

Public sector payment target is 95% on numbers. The CCG paid

99.53% of NHS invoives based on numbers and 99.99% by value. .

Performance for the first four months for Non NHS invoices is

96.06% on numbers and 95.02% by value.

Running CostThe CCGs running cost allowance is £7.6m. The CCG is reporting

a break even position against its running costs budgets.

Key Financial Performance Duties

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2.1.4 Performance against national constitutional standards 2016/17

Our performance against the 2016/17 National Performance Measures is set out below and shows the latest validated position.

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2.2 STRATEGIC AND OPERATIONAL DELIVERY

2.2.1 Programme Assurance Statements – 2016/17 latest summary position

Programme Status/Risks RAG Rating (Red/Amber/Green)

Integrated Children and Young People (Including

Maternity)

Many objectives on track but some risks

identified going forward.

Integrated Adults (Elective, Long Term

Conditions, Older Adults Urgent Care)



Integrated Mental Health for Adults Objectives on track

Staying Healthy Objectives on track

Primary Care Development Objectives on track

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2.3 QUALITY ASSURANCE

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Guy’s & St Thomas’ Hospital (GSTT) – Month 2 - May 16/17 data commentary Please note that the majority of M2 data from GSTT has not yet been received due to the internal timelines for the publication of the Trust’s M2 Integrated Quality and Performance Report and therefore there is a reduced commentary.

Friends and Family Test

o Achieving the internal target of 97% for Inpatient (IP) in May, which is higher than the previous month (96%) and at the same

time last year (95.9%).

o Not achieving the target of 88% for A&E.

o FFT repose rates are below internal target levels for both FFT IP, 26% against a target of 33%, and A&E at 13% against a

target of 18%.

Maternity

o There has been an increase in the Caesarean section rate reported in May 32.4% compared to 29.1% in April. Although, this is

lower than last year at this time (33.6%). Maternity C-section rates continue to be outside of the 27% target. There are on-going

discussions about C-section rates at the Lambeth and Southwark Joint Maternity Working Group (with representation from

Lambeth and Southwark CCGs, KCHFT and GSTFT).

o The number of births per midwife has increased from 26.5 in April to 27.6 in May.

Safeguarding

o The Trust continues to perform well against the Safeguarding targets in May. Children Level 2 and Level 3 Safeguarding

figures are both above 80% and Adults Safeguarding Level 2 training exceeds 90%.

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GSTT (Month 2 – May 2016) CQRG commentary

The information provided in this section is a summary of discussions in the May CQRG meeting, attended by senior Trust representatives, including the Medical and Nursing Directors, Clinical Commissioners and Directors of Quality from Lambeth and Southwark CCGs.

Emergency and Urgent Care Discussions included issues raised by the CQC, including social services’ capacity, the large increase in

ED attends and emergency admissions and ‘bed blocking’ Emergency Observation Unit (EOU) patients. There was a KHP-wide

workshop in June to help address some of the mental health related discharge challenges (led by the national Emergency Care

Improvement Programme). There has been a significant increase in ED attendances, noting that alternatives to ED are not yet working

with further work required to ensure alternative urgent care provision is having maximum impact. The Trust is working on internal

improvements and reviewing good practice elsewhere in London (notably UCLH as a critical friend) for further improvement options.

The Trust reported an issue with mental health patients who are ‘bed blocking’ in the EOU which is leading to problems as this unit is

crucial to ED flow. The beds in EOU should have a 12-hour turnaround time and often mental health patients remain in beds for up to a

week while waiting for a placement. Assistance is required from other health partners is being addressed to improve the situation.

The group recognised and applauded the outstanding rating that the Trust recently received from the CQC for its Emergency Care services. The outstanding rating was impressive given the refurbishment and expansion currently on-going; however it was acknowledged that this is making it difficult for the Trust to address current A&E 4 hour wait performance. In light of the challenging performance issues the Trust is attempting to maximise limited opportunities, such as locating additional space for the AAU team to mitigate the impact of the rebuild. The work of the Frailty Team was particularly noted as they ‘pull’ patients through in a timely way from ED. The level of weekend discharges needs to be improved and there will be a focus on discharge processes, weekend discharge, nurse led discharge and increased morning discharges (partly via the 2016/17 Improving Discharge CQUIN). Both Trust and Commissioners welcomed the introduction of the Local Unified Care Record as an efficient and practical way to improve the information exchange across organisational boundaries.

Fit Notes (Fit to work notes)There has been new guidance relating to the issuing of Fit Notes, which has clarified the responsibility of secondary care to issue Fit Notes for patients at point of discharge. The Trust confirmed that they will be working to implement the new guidance but recognised it will take time to change practice internally. This work will be taken forward collaboratively with Guy’s and St Thomas’ Hospital to ensure a consistent approach across KHP.

11

Other items to note

- National access targets the Trust reflected on the challenges in meeting the 4 key national access targets and the group noted the

level of work taking place across the system to support achievement of these.

- Never Event The Trust presented an update on the Never Event action plan and noted that a 2 week ‘Always Safe’ Campaign is

underway which is an opportunity to both ensure key messages about Never Events are spread across the Trust but also as a way

to gain staff feedback and learning from Never Events to improve management.

- National Safety Award The Trust recently won a National Safety Award (CHKS Quality Award).

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Kings College Hospital (KCH) – Month 2 - May 16/17 data commentary

Falls

o There is a slight increase in the number of ‘moderate’ falls reported in May with a total of 3 across both sites (1 at the PRUH

and 2 at DH) compared to 2 reported in April and 0 at this time last year.

o The number of ‘major’ falls has increased from 0 in April to 2 in May (1 at the DH and 1 at the PRUH).

o There is a slight increase in the number of all hospital acquired pressure ulcers in month 2 with a total of 29 (grades 2-4)

across both sites compared to 25 in April. This is less than in the previous year at this time (36). There is a noticeable difference

in the number of all hospital acquired pressure ulcers between two sites, 25 at the DH and 4 at the PRUH. The majority of

pressure ulcers reported at both sites are Grade 2. There and no Grade 4 ulcers reported.

They were no Never Events reported in month 2 across both sites.

Healthcare Associated Infections

o 6 C-Difficile cases were reported in May, which is 10 cases across both sites YTD, and in-line with the trajectory. They were 9

YTD at DH.

o There have been 0 MRSA cases reported since beginning of the financial year.

Staffing

o The Trust is not meeting its internal vacancy rate (<8%) across both sites, with poorer performance at the PRUH (16.5%)

compared to 10.7% at the DH. This is worse than this time last year when the vacancy rate was 12.3% and 8.5% respectively.

o There has been a slight improvement in the statutory and mandatory training rates at DH from 80% in April to 82% in May,

and compared to last year at this time (77%). Similarly, at the PRUH there has been an increase from 83% in April to 84% in

May.

Friends and Family Test

o Inpatient. 93.5% of patients recommended DH for in-patient (IP) care in May, which is the same as previous year at this time.

95% of patients would recommend PRUH for IP care, which is higher than May 2015 (92%).

o There has been a slight increase at the DH in response rate for IP FFT from 13.4% in April to 14.0% in May. The response rate

for IP FFT at the PRUH has decreased from 11% in April to 7.7% in May.

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o A&E There has been a slight decrease in the percentage of patients recommending A&E across both sites in May. 77% of

patients recommended PRUH for A&E in May compared to 81% in April. 80% of patients would recommend DH for A&E in May

compared to 81% in April.

o The response rate for A&E FFT dropped across both sides (DH 3%, PRUH 3.2%) compared to previous month (DH 8.2%,

PRUH 13.4%).

Complaints o The number of complaints reported at DH dropped in May. At DH there were 47 complaints reported in May compared to 52 in

the previous month. The number of complaints reported in May at the PRUH was the same as the previous month (26). There were more complaints at the PRUH than last year at this time (18 in May 2015).

Safeguarding

o Training levels remain a challenge at both sites, particularly at DH when the 80% target for Level 2-5 Adult Safeguarding is not

being met with 70.3% compliance in May. Level 2 (69.1%) and Level 3 (79%) Children’s Safeguarding training targets have also

not been met in May. Similarly, Adults training level 2-5 was not met at the PRUH with 74.9% compliance in May. The situation

is better in terms of safeguarding training for Children’s Level 2 (80%) and Level 3 (85.4%) at the PRUH in May.

Outliers

o The numbers of outliers have decreased. There has been a decrease in the number of outliers at DH in month 2 from 37 beds

in April to 32 in May. Similarly, at the PRUH the number of outliers has decreased from 63 beds in previous month to 59 in May.

Deteriorating patients

o The number of deteriorating patient incidents has improved at both sites with 1 case reported in May compared to 5 cases in

April at DH and 10 cases reported in May compared to 16 in April at the PRUH. It is worth noting the difference in numbers

across both sites, with higher numbers reported at the PRUH.

Maternity

o Maternity C-section rate continues to be within the target of <27% at the PRUH (25.1%) as well as within the target of <26% at

the DH (25.2%) in May. This represents an improvement compared to the performance last year when C-section rates were

>29% across both sites.

o The numbers of women booked 12 weeks plus did not meet the target of 90% across either site.

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King’s (M2 – May 2016) CQRG commentary

The information provided in this section is a summary of discussions in the May CQRG meeting, attended by senior Trust representatives, including the Medical and Nursing Directors, Clinical Commissioners and Directors of Quality from Lambeth, Southwark and Bromley CCGs.

Adults Safeguarding - There were two key areas noted for improvement from the recent Care Quality Commission (CQC) inspection.

Both related to training – improving the uptake for medical staff and improving training for Mental Capacity Act (MCA) and Deprivation of

Liberty (DoLS). The Trust recognised that performance in these areas still required improvement. It was noted that the Nursing and

Midwifery team have the highest compliance among all staff groups while the admin and clerical, medical and dental and healthcare

scientist were all under 50% compliance. The Trust confirmed that safeguarding training compliance will be added to the Trust risk

register. One of the key challenges related to the lack of space/venues to provide physical training for staff, particularly at the PRUH.

The Trust will also look at potential options for electronic delivery of training to support this. ‘Prevent’ training was also recognised as an

area for further development.

Childrens Safeguarding - The commissioners expressed some concern about the change in structure of the safeguarding team which

has resulted in the removal of the named nurse at PRUH. The Trust noted that the changes made do meet the intercollegiate Child

Safeguarding (2014) requirements. In light of the significant level of discussion during the CQRG both the Trust and Commissioners

agreed that a time-limited sub group will be established to support a consistent understanding of, and a collaborative approach to, any

safeguarding areas requiring further focus.

Infection Control

o There have been zero MRSA cases at Denmark Hill (DH) and 3 cases of VRE bacteria reported in April 2016, which is above

the YTD trajectory of 2.

o C-difficile there were 4 cases reported in April, which is below the trajectory of 5.

o In April, there were 3 cases of MSSA bacteria reported at the DH, which is above the trajectory of 2.

o There were 7 confirmed and 10 presumptive CPE cases in April 2016. The strain identified had not been seen before and ‘at

risk’ patients were susceptible and there had been 1 fatality in critical care. Weekly screening is now being undertaken in critical

care as well as environmental screening. It was noted that increased screening will inevitably mean rates will increase.

o Infection control rates were much lower at PRUH although there have been 2 outbreaks of norovirus.

17

Fit Notes (Fit to work notes)There has been new guidance relating to the issuing of Fit Notes , which has clarified the responsibility of secondary care to issue Fit Notes for patients at point of discharge. The Trust confirmed that they will be working to implement the new guidance but recognised it will take time to change practice internally. This work will be taken forward collaboratively with Guy’s and St Thomas’ Hospital to ensure a consistent approach across KHP.

Workforce As part of the usual monthly update on Workforce, the Trust reported good performance on recruitment noting however that it is harder to recruit at the PRUH than at DH. This is in part due to the fewer specialities at the PRUH and it being outside the inner London pay weighting area. The Trust is operating a rotation between sites as one way to support this. The Trust confirmed that the Trust was meeting the NHS E agency cap target.

Other items to note

o The testicular torsion pathway for under 5’s had been clarified and communicated to GPs

o The Trust were congratulated on the improved position at the PRUH with regards to Harms Reporting

o The 2015/16 final position for achievement in the Local Incentive Scheme (LIS) was noted and the Trust was congratulated for

their achievement in all areas.

18

St Georges Hospital

19

St Georges CQRG Commentary

The information provided in this section is a summary of discussions in the June CQRG meeting, attended by senior Trust representatives, including the Medical and Nursing Directors, Clinical Commissioners and Quality Leads from Wandsworth, Sutton, Merton and Lambeth CCGs.

Cancer Update - 100 Day RCAs It was agreed the process for RCAs is not working. Paperwork was received extremely late and it appears there is no clinical engagement or ownership to this process as there is no evidence in the reports of what harm was caused to the patient or any outcomes / learning. The Trust agreed that improvement was needed around internal engagement for the continued failure to produce robust analysis/ RCA and assessment of the clinical harm to patients in the 100 day + waits. The Trust is going to produce an improvement plan identifying the delays that can be controlled and reduced by the Trust, and noting the ones that are created by patients. There is a requirement to flag two or three key areas to allow confidence in system. It was recognised that an owned and transparent process existed but engagement is a problem and that clinicians do not own the problem of delay.

Anticoagulation Services A paper was shared with the group outlining issues raised through MAD alerts relating to the anticoagulation services at St George’s Hospital which raised awareness of quality surrounding the initiation and management of the new anticoagulation drugs. The review, led by Dr Nicola Jones at NHS Wandsworth CCG, highlighted that the introduction of NOAC drugs to patients increased activity and the Trust had not increased capacity, so patients who need to be seen within 2 weeks have been waiting up to 8 weeks for an appointment resulting in a lack of confidence from Commissioners. The Trust describe this as a capacity issue but reported that an additional locum pharmacist had been appointed to cover the interim solution while a permanent solution was found; discussions had taken place over a number of months with NHS Wandsworth CCG and the Trust had submitted a proposal for a new service model. The Trust was required to provide assurance and it was noted that the Trust did not appear have a process to escalate and address issues.

Never Event There was a report of a never event of wrong site surgery. This related to the wrong tooth being removed in error on a paediatric patient. The tooth was re-implanted.

Appointment Delays Out Patient booking system errors were discussed in relation to the appointment delays resulting in declaration of an SI, a cohort of 437

patients classified as urgent had a delay in appointment booking due to capacity constraints in some specialties. 313 have been

rescheduled, some were duplicates which have been cleared and 4 patients have dates scheduled in July due to having DNA’d.

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Patients not being booked immediately is still an on-going issue which is tied into RTT / deeper system problems. The weekly PTL

meeting is tracking those patients waiting over 18 weeks. The out-patient transformation programme is being developed to address

capacity. Commissioners enquired if patients are notified of delay and whether an option to choose an alternative Trust is given. A

clinical harm definition and full assessment covering psychological and medical harm was required. Commissioners were not assured

that the action plan was up to strength to prevent this happening again in future and requested a sustainable solution with clinical input.

South London & Maudsley

21

South London & Maudsldey CQRG Commentary The information provided in this section is a summary of discussions in the June CQRG meeting, attended by senior Trust representatives, including the Medical and Nursing Directors, Clinical Commissioners and Quality Leads from NHS England and Croydon, Lewisham, Southwark and Lambeth CCGs.

CAS Governance

o The Trust made a presentation following Patient Safety Alert NHS/PSA/D2014/006 “Improving medical device incident reporting

and learning”. The alert required the Trust to dentify a board level director to have the responsibility to oversee medical device

incident reporting and learning; identify a Medical Devices Safety Officer (MDSO) and email their contact details to the Central

Alerting System and identify an existing or new multi-professional group to regularly review medical device incident reports,

improve reporting and learning and take local action to improve the safety of medical devices.

o NHS England was notified by the Central Alerting System that SlaM had reported that they had implemented the Patient Safety

Alert before notifying them of the MDSO. NHS England had sought assurance from SLaM that the Trust had robust processes

and governance arrangements relating to the Central Alerting System.

o The Trust presented a revised process and governance structure to the meeting and an audit of 15 CAS alerts from 2015.

o Commissioners welcomed the revised procedures and noted that the Trust will need more than 3 days for the final part for the

more complex Alerts.

o The Group received the audits as assurance that the 2016 CAS Alerts had been implemented.

Recurrent themes in SIs

Recurrent themes noted in SIs included: - Risks assessments

- Interagency working

- Family Engagement.

22

Place of Safety Update The Trust reported that there had been a discussion at Southwark Overview and Scrutiny Committee (OSC). The OSC has asked for 3 more months of public consultation and this has delayed the plans. However building work continues and the Trust is acting as if going ahead. Four Steps to Patient Safety

o The Trust gave an update on Four Steps to Patient Safety.

Funded by Health Foundation

Evaluated by UCL

Aims to reduce harm incidents by 50%

o The Trust is rolling out the strategy across wards in cohorts and report seeing increased reporting and a reduction in severity of

incidents.

o The strategy comprises 9 standardised interventions and will be fully rolled out by September 2017.

o Evaluation includes use of an ethnographer on the wards to record what is happening – one outcome of this is better involvement of

bank and agency staff in the programme and includes lots of user involvement.

o Evaluation will be complete 3 to 6 months after the project in September 2017.

Medicines Management and Patient Safety The Trust gave a presentation about medicines optimisation across the organisation. There is a medicines optimisation programme in the Trust and an annual report to the Qualty Sub Committee and the Board. The CQC noted that medicines were well managed in the Trust. A main part of the work is an Annual Prescribing Observatory Audit Quality improvement programmes fall out of this work and results are disseminated via CAGs who work with pharmacy to develop action plans. A wide range of other medicines safety audits are carried out. The Trust reported 569 medication errors during 2015 and follow airline industry standards and aim to report all medication errors.

23

3 CCG ASSURANCE

3.1 National CCG Assurance Framework 2015/16

On 21 July 2016 NHS Lambeth CCG received formal notification of their performance against the

National CCG Assurance Framework 2015/16. The CCG was rated as ‘Good’ by NHS England. Few

CCGs have achieved this rating in London due to the challenging circumstances the NHS currently

faces, but with the support of our staff, our membership and our partners we have made significant

achievements over the past year. Lambeth CCG is one of 13 CCGs in London rated ‘Good’ and one

of only two CCGs in South London.

The CCG has been commended for being well led, having good financial management, a robust

approach to planning and contracting and service developments across the health and social care

economy. Our work to engage with patients and local people and Continuing Healthcare has been

highlighted with some elements described as ‘outstanding’. NHS England also praised our

work on improving access to talking therapies and support for people with dementia.

3.2 NHS Lambeth CCG Assurance 2016/17

NHS Lambeth CCG met with NHS England on 22 July 2016 to discuss CCG performance against the

2016/17 Assurance Framework. The assurance team at NHS England congratulated NHS Lambeth

CCG for achieving a rating of ‘Good’ against the 2015/16 assessment framework, however current

under-performance against the constitutional requirements for Quarter 1 2016/17 at both GSST and

Kings places NHS Lambeth CCG in a more challenging position.

The CCG fully acknowledges current pressures and challenges ahead and will be working closely

with providers, the CSU, and Primary Care to review and manage demand across the system.

The publication of the ‘Strengthening Financial Performance and Accountability 2016/17’ on 21 July

2016 sets out a series of actions designed to support the NHS to achieve financial sustainability and

operational performance.

Monthly Board meetings will be set up for the rest of 2016/17 to monitor performance and instead of

Quarterly assurance meetings, monthly touch point sessions will take place, the first of which is

scheduled for 26 August 2016.

The South East London Sustainability and Transformation Plan (STP) was submitted to NHS England by 30 June 2016, in line with the national requirement. NHS England are in the process of reviewing these plans (one for each of the 44 STP footprints) and meeting each STP leadership team to provide feedback and agree specific, targeted support where it is needed. Final STP Delivery Plans are to be submitted in October 2016 by each footprint.

24

4 COMPONENTS OF THE CCG ASSURANCE FRAMEWORK

4.1 Leadership

4.1.1 Board Assurance Framework

The NHS Lambeth CCG Board Assurance Framework (BAF) is included along with a Heat Map showing the number of risks at each score for all risks recorded on Lambeth CCG’s Risk Register not just those scoring 12 or above. The BAF and supporting Risk Register are living documents, updated regularly. The BAF includes the key mitigating actions and tracks progress of risk scores over the previous 12 months.

o Three new risks have been added to the Board Assurance Framework:

o 5BPCC ‘Risk that the CCG will be unable to secure weekend Walk In Centre service from September 2016 as SELDOC have given notice to end contract’

o 5CPCC ‘Financial risk (forecast 262k) as Lambeth are unable to fully cross-charge other CCGs Walk In Centre activity due to

insufficient patient level data on non-Lambeth patients’.

o 5DPCC ‘Financial risk of overspend on Minor Ailments Scheme’.

o One risk has been removed from the BAF, but remains on the Integrated Adults Programme Board Risk Register with a score of 8. 2O

‘Mental Capacity Act Risk’. Following MCA training, the likelihood of this risk occurring was amended from possible to unlikely.

o 6N ‘Risk that failure to identify all exisiting data structures in advance of changes to IT delivery partner could result in loss of data for the

CCG or loss of service to GP Practices’ as the new provider now has access to the servers and the governance process in place is more

robust.

Following restructuring of the Primary Care Programme Board, a number of risks have been recoded to reflect the new structure as follows: o 5N has been recoded to 4NCBC

o 5R has been recoded to 4RCBC

o 5S has been recoded to 5SPCC

o 5W has been recoded to 5WPCC

25

Heat Map

Risk Matrix Impact

Likelihood 1 Negligible 2 Minor 3 Moderate 4 Major 5 Catastrophic 5 4x4=16 2C A&E Performance

4x4=16 2M Community Nursing Vacancy Level

4x4=16 2N RTT Performance

4x4=16 4NCBC SEL Strategy - inadequate workforce capacity

4x4=16 4NCBC SEL Strategy - integrated IT systems

1 3x5=15 1A Safeguarding children

12 3x4=12 2A Community Nursing Service Improvement Plan

3x4=12 2B Safeguarding Adults

3x4=12 2K Cancer referral to treatment 62 days

3x4=12 3C Risk to SLaM Contract

3x4=12 3M IPSA Alliance

3x4=12 3N LWN reduction in secondary care demand

3x4=12 5BPCC Provision of weekend Walk In Centre

3x4=12 6K CSU procurement process risk

3x4=12 6N Change of IT Provider risk

3x4=12 7A Financial Planning Risk

3x4=12 7B QIPP delivery risk

3x4=12 PMCF07 Sustainability of Access Hubs

4 4x3=12 5CPCC Walk in Centre cross-charge risk

4x3=12 5DPCC Minor Ailments Scheme

4x3=12 5SPCC PMS Contract Review funding impact

4x3=12 5WPCC PMS Contract Review delay

1 Rare

1x1=1 1x2=2

4x5=20

5 Almost Certain

1x5=5 2x5=10 3x5=15 4x5=20 5x5=20

4 Likely

4x1=4 4x2=8 4x3=12 4x4=16

3x5=15

2 Unlikely

2x1=2 2x2=4 2x3=6 2x4=8

3 Possible

3x1=3 3x2=6 3x3=9 3x4=12

1x3=3 1x4=4

Risks scoring 12 and above

1x5=5

2x5=10

4 4

11261

1 54

2

26

There are currently 22 risks rated 12 or above.

UPDATED Aug 2016

Sep

t

Oct

No

v

Dec

Jan

Feb

Mar

Ap

ril

May

Ju

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Ju

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g

Key Actions

Denis

O'Rourke3C

Risk to SLaM Contract – possible risk

that the delivery of AMH redesigns

fails to reduce relapse rates and use of

beds

8 12 12 12 12 12 12 12 12 12 12 12 12

SLaM looking to see how to reduce length of stay and understand more about those unknown to services - August 2016

SLaM have undertaken a comprehensive review of data quality and accuracy and are feeding this through the contract negotiation process for

2016/17. Agreed trajectory for 2016/17 and currently on track.

Proposition to create an alliance contract in relation to LWN, voluntary sector, IPSA and SLaM and develop a single operating framework.

Denis

O'Rourke3M

Possible risk that the IPSA Alliance

contract fails to deliver service and

financial outcomes resulting in poor

outcomes for people and financial

challenge 4 12 12 12 12 12 12 12 12 12 12 12 12

1. Supporting alliance in relation to housing supply. Procurement process in place to secure additional housing provision.

2. Proposition to create an alliance contract in relation to LWN, voluntary sector, IPSA and SLaM and develop a single operating framework.

ASSURANCE FRAMEWORK 2016/17 – PROGRESS SUMMARY

Strategic Aim Executive LeadOperational

Lead

Corporate Objective 1.1: Quality,

Safety & Effectiveness - To improve

health outcomes, address

inequalities and secure a parity of

esteem

Director of

Integrated

Commissioning,

Adults

Risk

Register

Ref

Target

Risk Score

and

Direction

of Travel

Principal Risk (Obstacle to

achievement of Strategic Aim)

2015 Monthly Progress 2016

27

UPDATED Aug 2016

Sep

t

Oct

No

v

Dec

Jan

Feb

Mar

Ap

ril

May

Ju

ne

Ju

ly

Au

g

Key Actions

Director of

Integrated

Commissioning,

Children

Avis

Williams-

McKoy

1A

Zero Tolerance Risk - Risk of failure

to safeguard children and identify and

respond appropriately to abuse 5 15 15 15 15 15 15 15 15 15 15 15 15

On-going review of SCR in collaboration with Lambeth Safeguarding Childrens Board and NHS England - June 2016.

Implement subsequent SCR commissioning recommendations as required

LSCB Executive and Sub working groups now refreshed. Learning and Improvement Sub working group developing key performance indicators -

draft indicators in progress.

Review safeguarding arrangements with regards to health visiting and school nurses at IGC/Governing Body - Aug 2016

Liz Clegg 2A

Possible risk to service quality and

safety of community nursing due to

failure to implement the Service

Improvement Plan for Community

Nursing

8 12 12 12 12 12 12 12 12 12 12 12 12

Going forward GSTT plan to:

Introduce mobile technology after the introduction of advanced care notes in September 2015 - The introduction of new reporting system Care Note

has and continues to experience functional problems. Mitigation plan is set to achieve functioning system by Autumn 2016. Mobile technology on

hold until Care notes upgrade happens in August.

Developing the community matron workforce with the introduction of a deputy matron role to grow staff into the role as are unable to find staff with

the skill set readily available. Completed implementation of theTransformation plan.

Develop action plans by continuing to measure our services through our patients’ experience - Development of third party (e.g. Age UK Lambeth,

Lambeth Healthwatch) review of patient centred outcomes Q4 15/16 and Q1 16/17, for roll out Q2 16/17 - DN service has team targets for patient

feedback surveys and working this year towards each team analysing their results monthly and meeting together to decide what they need to

change or do more of as a result. Wound management outcomes and palliative care being developed.

Work better across the local hospitals, community and primary care to support patient pathways ensuring smooth transfers of care and to develop

a transfer of care strategy - Community Matrons working with KCH and GSTT on in-reach to wards to support discharge of patients identified as

frequent users of A&E. Considering test of similar in-reach for community nursing - some good progress being made with recruiting to Community

Matrons. Have recruited two deputy matrons band 6 with an aim to promote to band 7 in one year. Theadvert is out to recruit a further two.

Ensure that clinical strategy is underpinned by working closely with social care and voluntary sector.

New models of care are being tested in pilot form early 2016. Test and learn model of care using Buurtzorg methodology, to be launched

September 2016 - Three nurses have been recruited to for Buurtzorg and will start in September. Likely to go live in late October 2016 following

induction for staff.

Complete audit of response form completed for declined referrals - this is underway in Q2.

Repeat of Age UK survey

CCG: To continue to monitor improvement via CQRG and contract monitoring meetings. Most recent update provided at CQRG March 2016.

Liz Clegg 2B

Zero Tolerance Risk - Risk of failure

to safeguard adults and identify and

respond appropriately to abuse

8 12 12 12 12 12 12 12 12 12 12 12 12

Implement the accountability and assurance framework for safeguarding vulnerable people - Implement recommendations from NHSE deep dive.

Influence NHSE contracts to include safeguarding training requirements - ongoing.

Complete a training needs analysis

Practices to nominate staff to attend 'Alerters' safeguarding training - as part of practice visits

Recruit designated doctor for adult safeguarding

Develop training strategy for primary care - March 2016

Stand alone Safeguarding Adults Policy (non-commissioning), including SC Supervision Policy - 31/05/16

Ratify CCG Prevent Policy 31/05/2016

Discussions with commissioners/providers to consider gaps around incomplete assurance processes with independent providers and formulate

action plan - 30/04/16

Liz Clegg 2M

Likely risk service delivery due to

vacancies in community nursing

resulting in inability to provide quality

safe community nursing

16 16 16 16 16 16 16 16 16 16 16 16 16

GSTFT forward plan:

Implement actions arising from cultural barometer - Cultural barometer complete. Action around training for staff and IT

Continue to implement the recruitment strategy - Ongoing and vacancy rate is reducing. Current vacancy in DN service 22%, 25 staff in the pipeline

(14 NQN’s) which will bring the vacancy down, however, some retirements and staff leaving coming up. Rolling advert for DN service and inpatient

units and applicants for every advert. Recruited two band 7 Clinical Nurse Leads since changing the title and have three more to interview on 3rd

August

New models of care are being tested in pilot form early 2016. Test and learn model of care using Buurtzorg methodology, to be launched

September 2016 - Three nurses have been recruited to for Buurtzorg and will start in September. Likely to go live in late October 2016 following

induction for staff. Start dates for Buurtzorg is 8th Aug, 15th Aug and 15th Sept

CCG: To continue to monitor recruitment levels via CQRG, contract monitoring meetings. Last update provided in March 2016.

Director of

Primary Care

Development

Ursula Daee 5BPCC

Risk that the CCG will be unable to

secure weekend Walk in Centre

service from September 2016 as

SELDOC have given notice to end

contract.

4 12 12

1. Legal advice to be sought around if SELDOC can be held to 12 months notice period - action due July 2016 (Ursula Daee)

2. If short term caretaking contract is required, consideration to be given to longer contract with break clause in March 2017 for full re-procurement

process due July 2016 (Ursula Daee)

Risk

Register

Ref

Corporate Objective 1.2: Quality,

Safety & Effectiveness - To improve

the quality and safety of local

services

Strategic Aim Executive Lead


Director of

Integrated

Commissioning,

Adults

Operational

Lead



Target

Risk Score

and

Direction

of Travel


28

UPDATED Aug 2016

Sep

t

Oct

No

v

Dec

Jan

Feb

Mar

Ap

ril

May

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Key Actions

Bisi

Aiyeleso/

Sara White

2C

Likely risk of not achieving the agreed

access performance levels for A&E

resulting in longer waits for patients

and failure of the CCG to meet the

national target

12 16 16 16 16 16 16 16 16 16 16 16 16

A repatriation project has commenced across SE and SW London. has delivered significant improvements; the numbers of patients awaiting

repatriation to local hospitals from Kings, for example, was regularly reported in excess of 30 and this has now reduced to below 10 on a daily

basis. Complete by end of March 2015.

A&E performance remains challenging at both GSTT and Kings. The CCG is now represented at the weekly performance meeting at GSTT.

Winter schemes agreed to support additional capacity.

Tripartite visit made to GST ED including Lambeth CEO following significant drop in performance. Acknowledged that performance targets will be

challenging during building works/moves and consequential loss of capacity. ECIP visit scheduled for November to assist with immediate

improvements.

Jan 16 – Improvement to performance in Dec 2015 but slight dip again in January. Platinum call established bi-weekly and chaired by the CCG to

help unblock issues and facilitate faster discharge of patients (DTOCs).

Urgent care dashboard developed and will be reviewed at the UCWG at every meeting to identify trends and work through with partners to unblock

issues.

Meetings taken place with GST and GP practices on improving processes for the Diversion scheme.

Lambeth and Southwark CCGs ED diversion and Mental Health monthly meeting with acute trusts to identify schemes that can support the

management of activity within the ED and reduction of pressure points e.g. issues with mental health patient flows.

Harriet

Agyepong2K

Possible risk of not achieving the

access performance levels for timely

access to cancer treatment (as

measured by the standard for 62 days

from GP referral to treatment)

impacting on the CCG Quality

Premium and Assurance Framework

12 16 16 16 16 16 16 16 16 12 12 12 12

GSTT and KCH have trajectories for achieving the target.

ACN being developed to work across South East London and achievement of performance targets will be part of their remit.

Harriet

Agyepong2N

Ongoing risk of not achieving the

agreed NHS Constitution access

performance levels for RTT for

incomplete pathways impacting on the

CCG Quality Premium and Assurance

Framework

12 16 16 16 16 16 16 16 16 16 16 16 16

KCH and GSTT outsourcing some elective activity to private providers to assist with the reduction of the backlog - ongoing

A Lambeth and Southwark Planned Care workstream is being established to assist in optimising clinical pathways and managing referrals.

KCH have a trajectory/plan to reduce long waiters in non-neurosurgery by October, however the plan for neurosurgery is subject to agreement with

specialist commissioning.

Chief Financial

Officer

Christine

Caton7A

Risk that current planning and

strategic approach is not sufficiently

robust to manage pressures and

deliver sustainable position in the

context of potential reduction in growth

resulting from the implementation of

the CCG allocation formula

8 12 12 12 12 12 12 12 12 12 12 12 12

SE London CCGs are working as an SPG to deliver transformation across boroughs and providers.

The CCG is represented on each Clinical Leadership Group and Enabler work stream.

The Finance and QIPP Working Group and Governing Body have had oversight of the 2015/16 Operational Plan as it was developed and are

responsible for in-year performance management of programme delivery - ongoing.

The CCG delivers transformation through its programmes -ongoing and is working the SELPMO to assess the impact of the STP plans to support

local delivery - ongoing.

The CFO is a member of the Financial Provider, Commissioner and LA leadership group responsible for agreeing the financial and activity

assumptions that underpin the SEL Strategic Plan and developing business cases for service change where appropriate.

The CCG Five Year Strategy and SEL Five Year Sustainability and Transformation Plan (STP) was submitted in June 2016. CCGs are required to

deliver two Operating Plan and contracts by December 2016.

Work is underway to assess activity and finance impact at SEL and CCG level and business cases will be developed where applicable.

Provider Collaborative Productivity workstream underway to support delivery of efficiency savings across SEL.

Plan is being produced to agree 2017/18 to 2018/19 Commissioning Intentions and delivered accelerated business planning timetable.

Programme delivery plans are in place to achieve our 2016/17 commissioning intentions and these have been built into our signed contracts.

Business case development is underway across SE London to implement STP where applicable and transformation programme is being built

into local plans.

The 2016/17 financial framework and start budgets were approved by the GB on 2 March.

CCGs required to hold 1% NR fund to mitigate health strategies. Existing CCG reserves are being used to fund NR investment including SELPMO

and investment under review to mitigate risk because of reduced flexibility.

SEL Five Year STP, submitted in June 2016.

Christine

Caton7B

Risk of failure to deliver QIPP and

acute overperformance leading to CCG

risk on financial sustainability

8 12 12 12 12 12 12 12 12 12 12 12 12

We have developed plans that have impact going into 2016/17 to make sure we are in a position to meet the financial challenges that lay ahead -

March 2016.

The CCG continues to review its performance reporting to improve the way in which we manage delivery including reflecting the new CCG

assurance framework- ongoing

The CCG undertakes in year risk assessments and develops contingency plans to deliver variances from plan - ongoing.

Commissioning Intentions were reviewed and prioritised by programmes for 2016/17 Operating Plan.

The overall content and financial framework was approved by GB in January 2016 and start budgets on 2 March. Business cases for investment

and project plans for programmes including QIPP have been produced to deliver 2016/17 Operating Plan.

CCG is now working through integrated teams and with the CSU MDT to develop Commissioning Intentions for 2017/18 and 2018/19 to inform two

year Operating Plan and contracts by December 2016 as required by NHSE/NHSI guidance of 21 July 2016.

CCG is working with providers to agree robust demand management plans to address rising demand and performance delivery issues as CCG is

to be held accountable for these in 2016/17.

Risk

Register

Ref

Operational

Lead

Corprate Objective 2.2: Sustainable

Delivery & Governance - To ensure

good governance, financial stability

of the local health economy, VfM

and the delivery of statutory

responsibilities


Strategic Aim

Corporate Objective 2.1:

Sustainable Delivery & Governance

- To secure delivery of the NHS

constitutional rights and pledges

for all Lambeth residents

Executive Lead

Director of

Integrated

Commissioning,

Adults



Target

Risk Score

and

Direction

of Travel


29

UPDATED Aug 2016

Sep

t

Oct

No

v

Dec

Jan

Feb

Mar

Ap

ril

May

Ju

ne

Ju

ly

Au

g

Key Actions

Andrew

ParkerPMCF07

Prime Ministers Challenge Fund /

Access Hubs - Risk that there will be

insufficient resources to maintain the

Access Hubs operational capacity

beyond March 2016 4 16 16 4 12 12 12 12 12 12 12 12 12

1. To be discussed and updated at regular contract meetings with CCG and Federations - ongoing

2. Monitoring of utilisation of Access Hubs from October 2015 - COMMENCED

3. Development of a plan for the use of the freed up capacity of General Practice, which improves care and reduces the use of other services -

30/11/15 (TF and JC) - Action never commenced

4. Plan the evaluation of effects on other services - results of the evaluation will inform the provision going forward. Evaluation completed and

Federations have submitted options going forward.

5. Business Case to be developed for continuation of service after March 2016 - based on existing funding of £1.5million plus additional

investment - there will be some provision of access hubs from April 2016. Exact configuration is to be decided from outcome of commissioning

intentions - Ongoing, in discussion with the Federations

Ursula Daee 5CPCC

Financial risk (forecast 262k) as

Lambeth are not able to cross-charge

other CCGs WIC due to insufficient

patient level data on non-Lambeth

patients

4 12 12

1. Following up receiving patient level data in required format for Monday to Friday attendances

Ursula Daee 5DPCC

Financial risk of overspend on Minor

Ailments Scheme.

3 12 12

1. Post payment verification audit to be instigated into the payments made to date - action for Ursula Daee .

2. Key pharmacies identified. LPC advised that these audits will be undertaken

Ursula Daee 5SPCC

Likely risk that the review of the PMS

contract will result in changes to levels

of funding to GP practices impacting

on service delivery and service

disruption

6 12 12 12 12 12 12 12 12

1. Project plan to be updated and contain actions 2-3 - COMPLETED

2. Develop a detailed communications plan, especially regarding communication sessions with practices and patient and public involvement

groups - 31/01/16; in draft - ongoing.

The last GP Bulletin (March 16) included information to practices about the halt in negotiations and will be reflected in a revised action plan.

3. Uncoupling of the PMS KPI and the GPDF services discussions, in light of the pause in the national PMS review.

4. GPDF services are being progressed outside of the PMS negotiations with providers in order to have 16/17 contracts in place by the end of Q1,

enabling the CCG to deliver it’s commissioning intentions.

Ursula Daee 5WPCC

Risk that delays in completing the

review of the PMS contract and

subsequent delay in confirmation of

the 2016/17 PMS contract will impact

on the ability to deliver on the CCGs

commissioining intentions.

3 12 12 12 12

1. Uncoupling of the PMS KPI and the GPDF services discussions, in light of the pause in the national PMS review has had to take place.

2. GPDF contract has been progressed outside of the PMS negotiations with providers in order to have 16/17 contracts in place by the end of Q1,

enabling the CCG to deliver it’s commissioning intentions.

Risk

Register

Ref


Strategic Aim Executive LeadOperational

Lead

Corprate Objective 2.2: Sustainable

Delivery & Governance - To ensure

good governance, financial stability

of the local health economy, VfM

and the delivery of statutory

responsibilities

Director of

Primary Care

Development



Target

Risk Score

and

Direction

of Travel


30

UPDATED Aug 2016

Sep

t

Oct

No

v

Dec

Jan

Feb

Mar

Ap

ril

May

Ju

ne

Ju

ly

Au

g

Key Actions

Corporate Objective 3.1: System

Transformation - Commission

Proactive care focused on

prevention and early detection of

illness; Improve outcomes for

Lambeth patients, achieve better

value, integreated care through

transformation programmes in

partnership

Director of

Integrated

Commissioning,

Adults

Denis

O'Rourke3N

Possible risk that the LWN does not

reduce demand on secondary care

resulting in the system becoming

unsustainable and costs in relation to

higher bed usage 8 12 12 12 12 12 12 12 12 12 12 12 12

Negotiating with GP Federation becoming part of the LWN Provider Alliance Group and future alliance agreement – Sept 2016

Meeting held with voluntary sector providers to signal where heading and how to best organise alliance - ongoing meetings, further meeting Sept

2016.

Working towards an alliance agreement to support the LWN – April 2016. Workshop in Oct 2015 for whole market providers to outline plans.

Project plan agreed to take this forward. Commissioning intentions for 2016/17 include provision for CCG tapered pick up of LWN posts previously

funded by GSTT.

LWN - next phase of design work commenced. Identified two key prototypes - testing local area co-ordination and integration of LWN and CMHT.

Scoping out project.

Developing procurement plan for the next phase - draft in testing phase - Aug 2016

Proposition to create an alliance contract in relation to LWN, voluntary sector, IPSA and SLaM and develop a single operating framework.

Una Dalton 4NCBC

SEL Risk for information: Risk that

inadequate workforce capacity/skills

and a lack of integrated information

systems will affect the delivery of the

SEL Strategy in providing new models

of integrated, high quality care

4 16 16 16 16 16 16 16 16 16 16 16 16

1. Workforce action plan to be developed from each CRG

2. Borough workforce plan to be reviewed (CEPN plan)

Andrew

Parker4RCBC

SEL risk for information: Risk that a

lack of integrated information systems

will affect the delivery of the SEL

Strategy in providing new models of

integrated, high quality care

4 16 16 16 16 16 16 16 16 16 16 16

Full alignment to CCG Programme Enablers

Andrew

Parker6N

Risk that failure to robustly identify all

existing data structures in advance of

changes to IT delivery partner could

result in loss of data for the CCG or

loss of service to GP practices

8 16 16 12

Completion of discovery phase and identification of transition tasks for the current and new IT provider - ongoing

Development of data cleansing guidance for CCG

Communications to Practices

HR meetings in place for staff transferring

New timeline to be produced - 31/07/16

Chief Financial

Officer/Director of

Governance and

Development

Christine

Caton/Una

Dalton

6K

Risk that ineffective management of

commissioning support service

procurement process may lead to poor

quality service procured.

8 12 12 12 12 12 12 12

1. Action plan in place for management of procurement process for each service line (GP IT and CCG IT in progress) - some delays expected with

the transfer to the new provider (NEL) but interim arrangements in hand with SECSU.

2. Begin procurement process for all other services - planned for Sept 2016


Executive Lead


Operational

Lead

Risk

Register

Ref



Target

Risk Score

and

Direction

of Travel

Corporate Objective 3.2 System

Transformation - To ensure the

CCG’s commissioning resource

and organisational capability are

effectively aligned to deliver its

objectives

Director of

Primary Care

Development

Strategic Aim

31

4.2 Delegated Functions

NHS Lambeth CCG will be considering options for full delegation of GP commissioning

during the course of the year. Expression of interest to become a Level 3 CCG needs to be

submitted Quarter 3 2016/17.

4.3 Financial Management

4.3.1 Financial Position

To deliver financial control totals for resource and cash and support the delivery of

statutory financial duties for 2016/17

The CCG is required by statute to meet certain financial duties to ensure that public funds

are used appropriately. CCGs are required not to exceed the revenue (administration and

programme) and capital resource limits in any one year and to have cash balances of no

greater than 1.25% of the main monthly drawdown for March 2017.

Lambeth CCG’s financial performance as at July 2016 is a surplus of £2.584m. The

year end forecast is an underspend of £7.752m which is in line with our planned target of

delivering a minimum 1% surplus.

Running Costs budgets are breaking even at month 4 and are within the £22.50 per

head Running Cost allowance. We are forecasting a year end breakeven position.

The CCG has drawn down £143.9m of cash at the end of month 4. The maximum

cash drawdown limit for 2016/17 is £458.597m. The cash balance at the end of July

2016 was £239k.

Revenue Resource Limit

Month 3 - June Changes Month 4 -

July

£'000 £'000 £'000

Issued Budgets - Programme 440,926 1,389 442,315

Issued Budgets - Admin (Running Cost) 7,627 0 7,627

Reserves 11,249 (1,762) 9,487

Planned Surplus 7,752 7,752

Total Allocation 467,554 (373) 467,181

Summary of Budgets - July 2016

32

Performance Area Commentary

Month 4

Position

Revenue Surplus

Lambeth CCG is reporting a surplus of £2.584m for the first four

months of 2016/17 and is forecasting a surplus of £7.752m for the

year. This is in line with our target of delivering a 1% surplus

Cash Limit

Cash balances are planned to be maintained at low levels (less

than 1.25% at 31st July 2016. Lambeth CCG's cash balance at

bank at the end of July was £239k. The CCG expects to meet its

cash limit target for the year.

QIPP The CCG is forecasting full QIPP delivery of its annual QIPP target

of £9.151m.

Public Sector

Payment Policy

Public sector payment target is 95% on numbers. The CCG paid

99.53% of NHS invoives based on numbers and 99.99% by value. .

Performance for the first four months for Non NHS invoices is

96.06% on numbers and 95.02% by value.

Running CostThe CCGs running cost allowance is £7.6m. The CCG is reporting

a break even position against its running costs budgets.

Key Financial Performance Duties

33

Summary Budgets – Financial Position for July 2016/17

It is essential that the CCG maintains strong internal financial controls to enable it to achieve its

statutory duties, delivers value for money and have a clean bill of audit health.

Actions being taken include:

Delivery of the 2016/17 Internal Audit Plan and making sure that recommendations are

implemented promptly. This is closely monitored by the CCG’s Audit Committee.

Embed understanding across Governing Body Members/Head of Collaborative Forum of

Internal and External Audit including the use of induction for new Governing Body

Members.

Review Standing Orders, Prime Financial Policies and Scheme of Delegation under

review to make sure that they best reflect the needs of CCG and to support accountability

through programme boards.

The CCG is developing and implementing a training programme that along with the

Budgetary Framework supports effective budget management and control.

Delivery of the action plan from the Financial Control Environment Assessment.

Plan Actual Plan Actual

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

Resource Allocation

Programme Resource 151,410 151,410 0 0% 459,554 459,554 0 0%

Running Cost Resource 2,542 2,542 0 0% 7,627 7,627 0 0%

Total Resource Allocation 153,953 153,953 0 0% 467,181 467,181 0 0%

Programme Expenditure

Acute 92,733 92,471 262 0% 278,200 278,484 (284) (0.10%)

Mental Health 23,236 23,283 (47) (0%) 69,709 70,105 (395) (0.57%)

Community Health 6,671 6,710 (38) (1%) 20,014 20,157 (143) (0.71%)

Continuing Care/Free Nursing

Care 5,469 6,022 (554) (10%) 16,406 18,004 (1,598) (9.74%)

Primary Care 14,664 14,769 (105) (1%) 43,992 44,265 (273) (0.62%)

Other Programme Costs

including Corporate 2,791 2,972 (180) (6%) 8,374 9,555 (1,181) (14.11%)

Total Programme Costs 145,565 146,227 (662) (0%) 436,694 440,569 (3,875) (0.89%)

Running Cost

Pay 1,300 1,371 (72) (6%) 3,899 3,991 (91) (2.35%)

Non Pay 1,242 1,171 72 6% 3,728 3,636 91 2.45%

Total Running Cost 2,542 2,542 0 0% 7,627 7,627 0 0.00%

Reserves including

contingency 3,262 2,599 662 20% 15,108 11,233 3,875 25.65%

Total CCG Expenditure 151,369 151,369 - 0 (0%) 459,429 459,429 - 0 (0.00%)

Surplus 2,584 2,584 - 0 (0%) 7,752 7,752 - 0 (0.00%)

EXECUTIVE SUMMARY - FOR THE PERIOD - APRIL - JULY 2016

Variance ((Adv)/Fav) Variance ((Adv)/Fav)

Year to Date Forecast Outturn

34

QIPP Analysis By Delivery Area

2016/17 QIPP Delivery by area is shown in the table below.

2016/17 QIPP Annual

Plan Plan Actual Variance % Actual Variance %

Acute

Guys & St Thomas NHSFT

Emergency Admissions 1,404 468 468 0 100% 1,404 0 100%

Outpatient redesign and activity reduction 1,525 508 508 0 100% 1,525 0 100%

Prescribing 271 90 90 0 100% 271 0 100%

GSTT NHSFT - TOTAL QIPP 3,200 1,067 1,067 - 100% 3,200 - 100%

Kings Healthcare NHSFT

Emergency Admissions 1,237 412 412 0 100% 1,237 0 100%

Outpatient redesign and activity reduction 926 309 309 0 100% 926 0 100%

Prescribing 38 13 13 0 100% 38 0 100%

KINGS NHSFT - TOTAL QIPP 2,201 734 734 - 100% 2,201 - 100%

TOTAL ACUTE QIPP 5,401 1,800 1,800 - 100% 5,401 - 100%

Mental Health

Acute & Early interventions 873 291 291 0 100% 873 0 100%

Acute Triage 18 6 6 0 100% 18 0 100%

Mental Health Older Adults 475 158 158 0 100% 475 0 100%

Cascaid Service 56 19 19 0 100% 56 0 100%

IPSA 508 169 169 0 100% 508 0 100%

Mental health Other 332 111 111 0 100% 332 0 100%

Total 2,262 754 754 0 100% 2,262 - 100%

Medicines Management 1,199 400 400 0 100% 1,199 0 100%

Primary Care Savings 212 71 48 (23) 68% 144 (68) 68%

Other Programme Services 607 202 202 0 100% 607 0 100%

CH - Contracts - Other Providers (non nhs) 220 73 73 0 100% 220 0 100%

Grand Total Gross QIPP 9,901 3,300 3,278 (23) 99% 9,833 (68) 99%

Investment (750) (250) (227) 23 91% (682) 68 91%

Net QIPP 9,151 3,050 3,050 0 100% 9,151 - 100%

Year to Date (July ) Forecast Outturn

QIPP DELIVERY FOR THE YEAR 2016/17

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4.3.2 QIPP Performance

The table below shows headline RAG-rating each of the NHS Lambeth CCG QIPP schemes for 2016/17.

QIPP Scheme Month 04 2016/17 Update RAG rating

Acute

Continuation of existing schemes from last year and extension of new areas such as outpatient redesign scheduled for later on in 2016/17.

Mental Health On track for reduction in occupied bed days for Lambeth activity at SLAM.

Medicines Management All schemes deliverying to plan.

Other Other savings in primary care, other prescribing and community health on track

4.4 Performance Dashboards

4.4.1 NHS England National Constitution Standards

The performance dashboard covers the National Constitution Standards as set out in the

national 2016/17 Assurance Framework. Lambeth CCG’s performance for each of these

measures for the financial year 2016/17 is set out in the table on page 36.

36

NHS Lambeth CCG National Performance Measures for 2016/17.

37

NHS Lambeth CCG Performance by Provider Month 2 – May 2016

38

4.4.2 RTT (Referral to Treatment Times for Lambeth Patients)

CCG performance is driven by a combination of both GSTT and King’s. Current performance against trajectories appears on track, however this positive performance masks a significant increase in the PTL at both trusts and is a real concern in terms of future sustainability.

GSTT Current Performance

Not meeting the 92% standard, but above planned trajectory so far this year

Performance position masks an underlying increase in the overall PTL, with referrals to GSTT continuing to increase

Q1 refreshed RTT sustainability plan

Internal outpatient toolkit launched – focus on reducing variation and inconsistency across directorates

Concerted focus on reviewing clock stops and closing appropriate pathways. Actions Taken

2015/16 Recovery Programme to support waiting list management and delivery of the Trusts activity plan focused on key challenged specialities and robust waiting list validation

2016/17 demand and capacity planning to provide assurance that activity plans reflect backlog clearance trajectory requirements and that capacity is in place to support delivery.

Quarter 1 targeted validation programme covering 5,000 patients.

Outsourcing arrangements put in place for adult ENT services, focused on non-admitted activity – ENT accounts for 20% of trust’s backlog.

Further Actions underway or planned

Enhanced performance management approach for challenged specialities, combined with enhanced support to directorates (eg booking parties, Elective Assurance Team training, outsourcing)

Implementation and launch of Planned Care Board to focus on demand management – Programme manager to be recruited, clinical leads identified.

System Wide update

Enhanced focus on demand management in line with national demand management

Q4

15/16OP std 16/17

Apr-16

ActualApr-16 Plan

May-16

ActualMay-16 Plan

86.5% 92% 87.4% 85% (2.4%) 87.5% 85.5% (2.0%)

91.6% 92% 92.1% 91.3% (0.8%) 92.6% 91.8% (0.8%)

80.4% 92% 80.7% 80.5% (0.2%) 80.9% 80.6% (0.3%)

RTT Incomplete pathway

Lambeth

GSTT

Kings

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initiatives

Scoping exercise on outsourcing options for providers ie orthopaedics, ENT King’s Current Performance

Not yet meeting the 92% standard, but above planned trajectory so far this year.

Performance position masks an underlying increase in the overall PTL over 18 week

backlog and non neuro over 52 week waiters, noting that Trust wide activity is below plan.

External support – a further external support offer from MBI is being discussed and

scoped.

Demand management – enhanced focus on demand management in line with national

demand management initiatives.

Actions Taken

RTT refresh exercise – to review the robustness of the Trust’s current plans in the context of month 1 and 2 trends and the outcome of the Quarter 1 demand and capacity plan outputs.

Neurosurgery and neurology refreshed forward plan reflecting end of May performance position, system decision on catchments/London wide waiting list approach, implementation of the referral gateway initiative, potential further outsourcing for complex cases.

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4.4.3 Diagnostics (Lambeth Patients)


Currently not meeting the <1% standard, but above planned trajectory for May 2016 by 0.1%. Performance of 1.2%.

Actions Taken

Additional MRI capacity is coming on stream in 216/17 when the Guy’s Cancer Centre opens.

Process related service improvement work to reduce monthly breaches and timely tratement alongside specific work in urology and cystoscopy.

TSCT phase 2 diagnostic demand and capacity work with a need to link this to a review and assessment of sustainability requirements post recovery.

Outsourcing – further testing of the scope to outsource key diagnostic tests, through the SEL outsourcing initiative to provide further risk mitigation. For some tests where the demand is increasing there is limited alternative provision (GA, Paediatric MRI and paediatric sleep studies)

Wider performance improvement work –diagnostics within the cancer timed pathways and elective demand management work.

King’s Current Performance

Currently not meeting the standard and below trajectory for May by 4% (performance

8%) with further deterioration expected in June.

KCH trajectory was informed by a Quarter 4 deterioration in performance and the

planned pace of 2016/17 recovery. Performance has however deteriorated in April

and May on the Denmark Hill site – consequently the risk associated with delivery of

thr August trajectory for a return to compliance is now material.

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Actions Taken

KCH is reworking the reocevery plan and actions, to confirm that the current trajectory can still be delivered to provide further assurance in relation to additional recovery actions, risk and mitigations.

TSCT phase 2 diagnostic demand and capacity work – with a need to link this to a review and assessment of sustainability requirements post recovery.

Outsourcing – further testing of the scope to outsource key diagnostic tests, through the SEL outsourcing initiative, to provide additional risk mitigation and contingency against further staffing or equipment failure risks.

Wider performance improvement work – diagnostics withing the cancer timed pathways and elective demand management work – will provide a focus on diagnostics as part of overall care pathway planning and delivery.

4.4.4 A & E Waiting Times

The national standard states that 95% of patients should be seen within four hours in an A&E department.


Bipartite agreed recovery trajectory for 2016/17

Currently not meeting the 95% standard

The Trust has breached the trajectory YTD with April performance of 91.9% (2.5% under plan) and May performance of 89.1% (6.2% under plan)

Recovery and delivery of June to March trajectory represents a significant challenge.

Key issues have been overall demand, noting rebuild space constraints compounded by issues in relation to outflow from A&E.

Ongoing delivery of recovery plan plus new initiatives. Ie, medical staffing model and rotas, senior lead and revised processes to focus on UCC breaches, refreshed internal escalation processes, electronic live bed state, dedicated vascular ambulatory care beds, enhanced capacity and focus on discharge, including process redesign.

Other initiatives include review and re-phasing of elements of the rebuild programmed to mitigate impact of rebuld and maximise available space to manage demand, plus a review of @home/enhanced rapid response services to ensure that they are being targeted to maximise impact on A&E performance/alleviating bed pressures.

King’s Current Performance

Bipartite agreed recovery trajectory for 2016/17

Q1 15/16 Q2 15/16 Q3 15/16 Q4 15/16Outturn

15/16OP std 16/17

Apr-16

ActualApr-16 Plan

May-16

ActualMay-16 Plan

95.3% 93.4% 93.1% 90.3% 92.9% 95% 91.1% 94.4% (-2.5%) 89.1% 95.3% (-6.2%)

A&E Waits (Denmark Hill) 90.8% 92.4% 89.3% 78.1% 84.6% 95% 83.5% 81.4% (2.1%) 84.7% 83.8% (0.9%)

Patients spending 4 hours

or less in A&E before

treatment or admission

A&E waits (GSTFT)

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Currently not meeting the 95% standard

The Trust met the performance trajectory in both April 83.5% (2.1% over plan) and May 84.7% (0.9% over plan). However significant challenge for months 3-12.

Recovery Plans six point focus: ED capacity, minor injuries/UCC, emergency/acute care pathway clean sheet redesign, additional bed capacity (Business Case completed, engagement and implementation process commencing), frailty pathway, discharge.

Urgent Care Centre – new co-designed CCG/KCH service in place from October 2016, with the UCC moving to its expanded location in January 2017. Clean sheet emergency acute care pathway redesign – programme launched in June 2016, pathway changes to impact on performance from Quarter 3.

Bed Capacity – increased bed capacity (63 beds Trust wide, 43 of which will be at

Denmark Hill)

System Wide

Implementation of demand management initiatives including the roll out of enhanced active redirection of patients across GSTT and Kings.

Implementation of a joint Mental Health breach reduction plan between GSTT, King’s and SLaM – CCG/ECIP facilitated workshop to support this process.

System wide communications campaign developed and delivered. Also, to raise awareness of service options and sign-post patients appropriately.

System wide review and implementation of nationally mandated U&EC initiatives, where there are current provision gaps.

Agreed utilisation of winter funding to support resilience over the winter months.

4.4.5 Cancer Waiting Times

Current performance remains challenged at both main provider sites. Existing recovery

plans are being reviewed. The Accountable Care Network are focussing on action to

support the 62 days standard, in particular care pathway design for tumor groups and

referral criteria.

62 day standard Current Performance

Actions Taken

Outturn

15/16OP std 16/17

Apr-16

ActualApr-16 Plan

May-16

ActualMay-16 Plan

92.5% 93% 89.5% 93.1% (-3.6%) 91.1% 93.1 (-2.0%)

93.5% 93% 81.1% 93.3% (-12.2%) 90.4% 93.3% (-2.9%)

97.3% 96% 98.6% 97.3% (1.3%) 98.8% 97.3(1.5%)

96.2% 94% 91.7% 94.7% (-3.0%) 93.3% 94.7 (-1.4%)

99.3% 98% 100.0% 100% 97.8% 100% (-2.2%)

96.9% 94% 83.9% 97.0% (-13.1) 100.0% 97% (3.0%)

82.9% 85% 84.1% 87.25 (-3.1%) 70.0% 87.2% (-17.2%)

67.7% 85% 70.9% 67.7% (3.2%) 69.7% 69.7% (0%)

88.1% 85% 87.3% 85.3% (2%) 80.8% 85.3% (-4.5%)

97.1% 90% 83.3% 100% (-16.7%) 80.0% 100% (-20.0%)

Cancer 31 days (subsequent - radiotherapy)

Cancer 62 days (GP referrral)

Cancer 62 days (referral NHS screening)

GSTT

King's

Constitutional Standards

Cancer 2 weeks (GP referral)

Cancer 2 weeks (breast symptoms)

Cancer 31 days (first definitive)

Cancer 31 days (subsequent - surgery)

Cancer 31 days (subsequent - drug)

Current performance against the 85% standard is not being met

May’s performance relates to 14 breaches (9 GSTT, 3 KCH, 2 Royal Marsden). 5 were

ITT (Inter Trust Transfer) referrals. Three patients waited over 104 days, 6 of the

breaches were categorised as avoidable all administrative errors. GSTT performance

against this target remains challenging.

Overall trust-wide performance improvement is linked to reducing late referrals into the

Trust from other providers as well as maintaining internal performance of 85%.

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Actions taken

4.4.6 Ambulance Response Times

LAS Current Performance

The Performance standard was met for Cat A (Red 1) 8 minutes and 19

minutes for April and May 2016.

The Performance standard for Cat A (Red 2) was not met

Actions Taken

Throughout May and June the LAS has continued to make progress against

their Quality Improvement Plan

Patient Transport Service has been working with NHS England, North West

London Commissioners and End of Life leads from across London to agree a

pilot to enable end of life patients to pre-book journeys for treatment

4.4.7 Improved Access to Psychological Therapies (IAPT)

A system wide recovery trajectory has been agreed at tripartite level, separate

trajectories from both GSTT and KCH outlining improvement in the amount of patients

referred to GSTT withing 38 days have been produced. However with this information

GSTT is predicted to not meet the 85% target trust wide across 16/17 due to the impact

of referrals from outside of SE London.

GSTT has committed to meet the target for internal patients for all months. Actions to

reduce late referrals from other providers will support a Trust wide improvement for

GSTT but are considered high risk.

SPG Cancer Improvement Plan is being developed through the 62 day cancer waits

group. The plan will be agreed by the 9th of September.

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The standard for people with depression referred for and accessing psychological therapy is 15% for 2016/17. The CCG continues to perform well in this area, exceeding the target in Q1 for 2016/17. The actual target number per quarter is 1656 (3.75%) with this being exceeded in Q1 with 1,962 (4.44%) accessing treatment. The standard for the proportion of people who complete therapy and move to recovery is 50%. Performance in this area for Q1 has been 50%. NHS Lambeth CCG has performed consistently well against the target for the proportion of Lambeth patients finishing a course of treatment receiving their first appointment within 6 weeks of referral. The target for Q1 in 2016/17 was exceeded with 95% achievement against the 75% target. Strong performance is also being maintained against the 95% target for the proportion of patients finishing a course of treatment receiving their first appointment within 18 weeks of referral. In Q1 for 2016/17 the service achieved 99%.

4.4.8 New Early Intervention In Psychosis 2 Week Standard

The NHS Guidance for the Implementation of the EIP Access and Waiting Time Standards defines clock stop as when:

An individual is accepted onto the caseload of an EIP service capable of

providing a full package of NICE concordant care, and;

Allocated to and engaged with an EIP care co-ordinator.

The SLaM EIP pathway interpreted the guidance to mean that individuals require a face to face assessment for suitability for EIP services, as well as a face to face contact with a care co-ordinator to evidence the beginning of engagement, within 14 days. However, it has become apparent that the requirement to have both a face to face assessment and a further follow up face to face appointment with an EI care coordinator to stop the clock is a higher bar than that set by the standard, as agreed by the London EIP Clinical Reference Group. This has impacted on the achievement of the EIP target.

Lambeth initially achieved the target in April (66%) but have missed it in May (33.33%) and June (16.67%).

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4.4.9 Dementia Diagnosis Rate

The Health and Social Care Centre (HSCIC) has now published data for Dementia

Diagnosis Rate for the year to June 2016.

Based on previously reported data NHS Lambeth CCG continues to perform highly in this

area.

The graph shows published data for NHS Lambeth CCG’s GP practices, for the percentage

of patients for the CCG with a dementia diagnosis recorded against estimated prevalence.

The rate would be expected to fluctuate slightly month on month as patients join and leave

GP practices.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

% o

f E

xp

ecte

d P

rev

ale

nce w

ith

R

eco

rded

Dia

gn

osis

% Recording by GP Practice of Dementia Diagnoses against Expected Prevalence April

2015 - June 2016

46

4.5 Quality Premium 2016/17

The Quality Premium (QP) scheme rewards CCGs for improvements in the quality of the services they commission. The scheme also incentivises CCGs to improve patient health outcomes and reduce inequalities in health outcomes and improve access to services.

Quality Premium 2016/17

The QP will be paid to CCGs in 2017/18 to reflect the quality of the health services commissioned by them in 2016/17. It will be based on measures that cover a combination of national and local priorities, alongside the requirement to fullfil the expectations of the Quality, Financial and NHS Constitutional Gateways.

National Measures There are four national measures and in total are worth 70% of the QP

Cancer diagnosed at an early stage (20% of quality premium) - To earn this portion of the

quality premium, the CCG will need to either:

- Demonstrate a 4 percentage point improvement in the proportion of cancers (specific

cancer sites, morphologies and behaviour) diagnosed at stages 1 and 2 in the 2016

calendar year compared to the 2015 calendar year or;

- Achieve greater than 60% of all cancers (specific cancer sites, morphologies and

behaviour*) diagnosed at stages 1 and 2 in the 2016 calendar year.

Cancer diagnosed at an early stage

Current Performance (IAF 122a)

54.9% (2014)

Ongoing work to support earlier diagnosis has included:

The implementation of the NICE 2WW referral forms

A cancer PLT focused on approaches to support early diagnosis and increasing patient understanding of an urgent referral for suspected cancer

The dissemination to GP practices of tools to support patient conversations regarding an urgent appointment for suspected cancer

GP Patient Survey overall experience of making a GP appointment (20% of quality premium) - To earn this portion of the QP, the CCG will need to demonstrate in the July 2017 publication, either:

- Achieve a level of 85% of respondents who said they had a good experience of making an

appointment, or;

- A 3 percentage point increase from July 2016 publication on the percentage of

respondents who said they had a good experience of making an appointment.

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E-Referrals increase in the proportion of GP referrals made by e-referral

(20% of quality premium) - To earn this portion of the QP, the CCG will need to,

either:

- Meet a level of 80% by March 2017 (March 2017 performance only) and

demonstrate a year on year increase in the percentage of referrals made

by e-referrals (or achieve 100% e-referrals), or;

- March 2017 performance to exceed March 2016 performance by 20

percentage points.

E-referrals

Current Performance (IAF 128b)

26.2% (April 2016)

March 2016 performance = 22% utilisation

March 2017 requirement to meet quality premium = 41.6%

April 2016 performance – 26% The development of an e-referral working group

Continued work with the e referrals leads at GST and Kings to increase the number

of services available for direct booking on e-referral

Workshop held across Lambeth & Southwark in April 2016 to agree focus for 2016;

focus on implementing an ERS training package agreed and being implemented.

Work to support an increase in use of the e-referral system for referrals into the LIMS service

Improved antibiotic prescribing in primary care (10% of quality premium)

Antibiotic prescribing

Current Performance (IAF 107a)

0.8%

Data unavailable at time of writing report

Quality Premium - Local Measures For 2016/17, the local element of the QP focuses on the Right Care programme and is worth 30% of the overall QP. NHS Lambeth CCG has selected the following three local measures for 2016/17 each worth 10%:

Mental health admissions to hospital: Rate per 100,000 population aged 18+

Based on a steady increasing trajectory from our baseline position we are targeting

a reduction of 5 emergency mental health admissions for 2016-17. This is in

additional to the reduction required to address increases relating to population

growth.

This figure represents a decrease of 1% of admissions in Quarter 1 of 2016-17,

followed by a reduction of 1.5%, 2% and 2.5% in subsequent months as the

benefits of our mental health programme are realised over the course of the year.

We are proposing an end of year only figure to allow for in year variations.

48

Respiratory: Emergency admission rate for children with asthma per 100,000

population aged 0–18 years

NHS Lambeth CCG is targeting a decrease of 5% of emergency admissions for

children with asthma which translates into a reduction of 11 children's admissions

during 2016-17. We are basing this target on the business case for our new

asthma service elements of which are already in place, others of which will come

on-line throughout the financial year.

Trauma and injury: Injuries due to falls per 100,000 population ages 65+

NHS Lambeth has a large scale programme of work in progress in relation to falls

prevention underway in Lambeth. Based on expected trajectories towards this

target, we are targeting a redcution of 1% of injuries across 2016/17.

Our targets recognise that performance will accelerate over time as increasing

numbers of patients access the service and continue to benefit from it year on year.

At the time of writing Quarter one data was not available.

4.6 Quality Alerts

The Quality Alerts data for Quarter 1 2016/17 will be reported in October 2016.

4.7 Infection Control

4.8 Mixed Sex Accommodation Currently there have been no mixed sex accommodation breaches reported during 2016/17.

49

5 STRATEGIC AND OPERATIONAL DELIVERY – OUR PROGRAMMES Further details on all Programme areas can be found on the internet through Programme Governance sturctures and meetings.

5.1 Integrated Children and Young People (including Maternity) Programme

Responsible Director Maria Millwood, Director of Integrated Commissioning (Children & Young People, Adult Disabilities)

Clinical Lead Dr Nandini Mukhopadhyay

Programme Lead Emma Stevenson, Assistant Director Children & Maternity

IAF Indicators (Annex A) 101a, 102a, 124a, 124b, 125a, 125b, 125c

5.1.1 Programme’s Purpose

The Integrated Children and Young People and Maternity (CYPM) Programme is responsible for making and implementing decisions in relation to commissioned services for children, young people and maternity across the Borough of Lambeth. The remit of the programme extends across both physical and mental health. As an integrated programme, the aim is to ensure that children and young people’s physical, psychological and social needs are addressed in a comprehensive, cohesive manner. Our children and families services are provided from pregnancy to 18 years old (up to 25 for young people with a disability). They cover a range of services provided both in hospital and in the community. Services are planned and bought through an integrated health and social care team, with the aim of ensuring:

Children have the best start in life

Children and young people are strong and have positive lifestyles and behaviours

Children and young people achieve their ambitions and do well at school Early intervention in children’s health and wellbeing is vital to help reduce the number of years of life lost by the people of Lambeth from treatable conditions. It also helps to improve the quality of life of people with one or more long-term conditions. The CYPM programme is made up of three overarching areas of work:

Children and adolescents mental health services (CAMHS)

Child health and early intervention services

Maternity Services

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The programme Board maintains a strategic overview of the quality of services being delivered to children, young people and pregnant women in the Borough, holding providers to account where appropriate. Working in partnership with the Primary Care Development Board the CYPM Programme maximises the care of children and young people in primary care. Working in partnership with the Primary Care Development Board, Lambeth Early Action Partnership (LEAP) and the Children and Young People Health Programme, the CYPM Programme maximises the care of children and young people in primary care and the development of evidence based early intervention services that improve health and wellbeing outcomes.

5.1.2 Programme Assurance Statement Quarter 1 2016/17

Assurance Status/Risks RAG Rating (Red/Amber/Green)

Is your programme delivering as planned – is it

on target?



51

Key aims for 2016-17:

Develop and implement CAMHS Strategy and Transformation Plan, including reduced waiting times and reduction in Tier 4 activity

Develop comprehensive perinatal mental health pathway

Develop comprehensive paediatric asthma pathway

Reduce paediatric admissions through re-commissioning of comprehensive community children’s nursing service

Develop Integrated Early Years Pathway (as part of Healthy Child Programme)

Implement and deliver LEAP Programme

Improve child health pathways through CYPHP

Implement Maternity Transformation Programme and community midwifery models

Deliver borough wide Youth Violence programme

Develop integrated adolescent pathway (as part of HCP)

Key Achievements Quarter 1:

Waiting times to EI CAMHS has reduced to 11wks (on track to

achieve target of 10wks by Q4)

CAMHS Transformation Plan on track. First Co-production Group

took place informing JCG. Plans for 16/17 underspend agreed

Perinatal MH engagement work complete, including with GP’s &

women

GP delivery scheme up and running. Plans in place for a childhood

asthma workshop to align all the work across Lambeth and

Southwark

H@H evaluation going well, report due in Sept. Notice has been

given to Lewisham for current CCNT

EY HCP working group in place, developing pathway and key

milestones

On-going involvement with SEL Maternity Network, 17/18 QS

priorities agreed. GST presented community midwifery model to

CMB, attending All Practice locality mtgs

16/17 budget for youth violence to fund A&E programmes. Multi-

agency youth violence task & finish group being set up as part of

SLP

Work has started to scope integrated adolescent health pathway with PH

Children and Young People

52

Key challenges to date:

Completed CCG SEND self-assurance. Gaps identified that need progressing through an action plan

LBL budget cuts continue to impact on the CCG and health of CYP. Integrated commissioning approach essential to ensure good outcomes are achieved

CAMHS Review delayed until Sept ‘16– still missing some data etc from SLAM. This is being managed via the contract, but remains a concern

C-Section thresholds agreed for 16/17 GST and KCH contracts, however there is on-going issue of how to improve rate of natural births. This is being worked up through the joint L&S Maternity group and the CMB coms strategy

Transfer from RIO to Care Notes system has caused problems for GST re accuracy of data. This is being monitored but has impacted on accuracy of EYMDS reporting

Key risks 2016-17:

Shortage of BCG vaccination continues, only high risk babies to be vaccinated. This is being progressed by GST but remains an international issue, PHE continue to advise

Although there is good progress with waiting times to CAMHS EI service, it remains a risk until we have reached the 10wks target

Safeguarding continues to be a risk with increased numbers of SCR and low level IMR’s

Health Visiting review 1&2 continue to be low and are at risk in light of cuts to PH Grant. An improvement plan is in place with GST (reporting issues and accuracy of data due to Care Notes also having an impact)

Loss of organisational memory with two senior posts leaving. This is being addressed through recruitment and we have interim AD replacement already started to ensure continuity & effective handover

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5.1.3 Children and Maternity Programme Board Dashboard

54

Due to the continued delay on the provision of four data items it has not been possible provide an full outturn report. The current RAG rating of the 29 indicators based on latest published data on the dashboard is as follows: 8 rated Green, 7 rated amber, 5 rated red.

RAG Indicator description Notes

PAE4 Percentage of paediatric A&E attendances

EHC2 Percentage breastfeeding 6-8 weeks after birth Although this indicator has been red RAG rated, The problems experienced by GSTT in the transition of the old data system to the new Care Notes System (as reported in 2015-16) persist. The reported achievement of 43.6% for this indicator may be unduly low.

EHC8 Percentage of health review 1 completed in line with target

Due to data migration issues there is a question over the accuracy of the quarter three and four figures. GSTT have advised ‘We would expect these to be higher. A review of data

sources and recording will be undertaken’.

EHC9 Percentage of health review 2 completed in line with target

SAF 1

Admission of full-term babies to neonatal care unit (without congenital abnormalities) (GSTT)

Data subject to revision in reporting by GSTT during the year.

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5.2 Integrated Adults Programme (Elective, Urgent Care, Cancer)

Responsible Director Moira McGrath, Director of Integrated Commissioning (Older Adults)

Clinical Lead Drs. Di Aitken, John Balazs, Martin Godfrey & Paul Heenan

Programme Lead Sara White / Bisi Aiyeleso

IAF Indicators (Annex A) 105a, 122a,122b, 122c, 122d, 127c, 127a, 127d, 127c, 127d, 129a

5.2.1 Programme Purpose Work within Elective Care is aimed at collectively bringing together acute care clinicians to work closely with primary care to ensure seamless referral for testing, diagnosis and onward referral to appropriate specialist services. This will support the provision of equality across the borough for services regardless of geographical location or provider providing care. This work also supports the achievement of national targets (such as referral to treatment and cancer targets) as well as areas that are nationally mandated (such as the delivery of the e-referral service). We are supporting an increase in appropriate referrals into secondary care through the provision of tools, training and other forms of support to ensure that referrals, diagnostics and community based care is consistent across our whole geography. We are striving to ensure standardisation and reflection of best practice. Cancer work within 2016/17 will look at approaches to support the uptake of guidelines promoting the early diagnosis and treatment of cancer, the implementation of new pathways for rapid diagnosis for people with “vague symptoms” that may result from cancer or other serious illness and improved levels of screening e.g. bowel screening. Work within the Urgent Care workstream is focused on ensuring that patients are able to access the right care at the right time when medical care is required urgently. This includes commissioning services that provide an alternative to A&E such as the Integrated Urgent Care service (previously known as 111) and GP access hubs. Work also includes providing sufficient pressure surge management support to the urgent care system, particularly in winter but also and other times of pressure such as heatwaves or infection outbreaks, bank holidays and during industrial action.

5.2.2 Programme Assurance Statement Quarter 1 2016/17



on target?



56

Key aims for 2016-17: Elective

Maximising the quality and appropriateness of outpatient referral through use of the electronic tools available, reducing unwarranted variation between clinicians and practices

Ensuring that patients are treated along the most appropriate care pathway throughout their healthcare interventions

Securing the delivery of 18-week referral to treatment targets

Ensure that there is effective use of diagnostics across the primary and secondary care systems. Cancer

Improve cancer screening rates, identifying cancer earlier, instigating the early treatment of patients with cancer through improvement in the 62-day wait cancer performance in order to deliver improved outcomes for patients Urgent Care

Supporting the commissioning of services within the urgent care system including the integrated urgent care service

Commissioning to ensure that Urgent Care is better configured to deliver for example a front ended co-located Urgent Care Centre within ED on the St Thomas’ site, supported by consistent communications and signposting of patients.

Key Achievements Quarter 1: Elective

Implementation of the elective care element of the GP delivery framework

Commenced review of the community gynaecology ultrasound service

Cancer PLT session held with over 80 clinicians and 60 administrative staff attending

Cancer

Development of resources to increase patient understanding of urgent referral for cancer appointments and support improvement in 62 wait target performance in conjunction with the TCST Urgent Care

Negotiation of an increase in slots available for redirection from St Thomas’ to Waterloo Health Centre

Commencement of direct patient booking from St Thomas’ into the Lambeth GP access hubs

Implementation of Southwark and Lambeth task and finish group to help issues related to demand management and mental health within St Thomas’ and Kings DH EDs

Elective, Urgent Care and Cancer

57

SEL 111 Service update

The purpose of the following information is to provide information on SEL 111 performance for June 2016.

111 KPIs 2016 (Unify Sit Rep Data)


Increasing practice use of ERS – area of focus currently is the use of ERS for referrals into the LIMS service

Time required to manage the providers of the MECS schemes (A business case has been taken to the Integrated Adults board with an approach to help address this challenge)

Continued increasing activity within ED departments

Continued difficulties with achievement of RTT targets

Key risks 2016-17:

Limited capacity to deliver work across the project areas

Engagement of whole system to deliver a recovery plan for RTT and A&E performance

The Delivery Framework may not deliver the expected outcomes for GP outpatient referrals

Difficulty with recruitment to consultant post within Multidisciplinary Diagnostic Centre could lead to delay in implementation of the model

58

Exception Report for July 2016

Key Performance indicators were met except for the following areas

38.7% of calls were warm transferred to an NHS 111 nurse advisor within 30 seconds where required (target 98%)

56.9% of patients were called back within 10 minutes by an NHS 111 nurse advisor (target 100%)

9.3% of calls were asked to attend an A&E department (target of <5%)

The 111 service has experience very different call levels to the levels compared with predicted levels (2015 levels uplifted by 5% for growth).

Analysis was completed to try and identify any potential causes for the increased call volume.

Service Update for Impact on Urgent Care System

QR11 Attend Accident & Emergency Department, last 13 months

While red ambulance dispositions have decreased in July 2016, green ambulance dispositions have risen slightly. LAS still have the lowest

percentage of ambulance dispositions, when compared to the other London 111 providers.

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5.2.3 Integrated Adults Programme: Older Adults (including Committee in Common and joint arrangements with Lambeth Council)


Clinical Lead Di Aitken

Programme Leads Liz Clegg (AD, Older People), Cllr Jackie Meldrum

IAF Indicators (Annex A) 104a, 105b, 105c, 106a, 106b, 127b

Programme Purpose The specific outcomes for this project are:

To support older people to remain independent and able to manage their health well with the right level of timely support and advice when they need it to remain at home

That fewer older people will be admitted to hospital or residential care reducing the number of beds required and shifting resources to community based care

To provide good quality care and achieve cost efficiencies by providing more integrated health and social care.

60

Key aims for 2016-17: BCF deliverables including reducing the number of delayed transfer

of care, reduction in number of people going into residential care, reduction in the number of emergency admissions and percentage of people remaining at home 90 days post reablement/rehabilitation

To ensure that all Previously Un-assessed Periods of Care (PUPOC) Continuing Healthcare claims are managed and resolved in line with the national deadline

Increase the pace of implementation of the new format of the new version of the Coordinate My Care (CMC) register

To maintain and increase the diagnosis of dementia against the estimated prevalence

To work together with Southwark, Lewisham and Croydon to agree a service redesign (proposed by SLaM) for the delivery of inpatient and specialist mental health services for older people.

To commission post diagnostic support for people with dementia

To support LBL with the engagement of alternative day opportunity offers for older people

Key Achievements Quarter 1: BCF Management and Narrative Plan 2016/17 submitted by 3 May

deadline, feedback from London BCF Team is plan is agree and low risk, plan to be submitted for national moderation.

Reporting to be agreed following national moderation.

Evaluation community development programme in Vassall and Coldharbour (Project Smith) indicates successful engagement and quality outcomes

All, except one, of the remaining Previously Un-assessed Periods of Care (PUPOC) Continuing Healthcare claims have been investigated locally with outcomes notified to claimants.

GP PLT event focusing on End of Life Care, which included a presentation and update on the re-launch of the new version of the Co-ordinate My Care (CMC) register

Data from June 2016 shows that 84.2% of the estimated prevalence of those with dementia in Lambeth have a diagnosis recorded on their GP’s Dementia QoF Register. GP referral rates continue to be steady to the memory service.

The 4 boroughs are working well together and have already agreed the common dataset required and drafted a project timetable for deliverables and decision making.

Two engagement workshops have already been held with key stakeholders and they are working collaboratively to put a proposal together regarding meeting the needs of these people.

A comprehensive review of all clients has taken place, including engagement with service users.

Older People

61

Key challenges to date: Working across 4 boroughs with regard to the SLaM MHOA

inpatient and specialist care service redesign – each borough has slightly different demands and needs, and commonality and compromise must be agreed.

30% (3/10) of care homes for older adults currently suspended due to quality issues, requiring intensive quality monitoring. One home identified as high risk with possibility of closing.

Key risks 2016-17:

A risk of delay with the SLaM service redesign if the model is not agreed – this would have a financial impact on each CCG.

Social care provider issues – maintaining quality.

62

CQC Inspection Reports The following inspection reports were published in Q1 2016/17 regarding care homes/services in Lambeth and out of borough homes/services where Lambeth residents are using these services (Source: CQC).

Safe Effective Caring Responsive Well-led Overall rating

Lambeth Chinese

Community Association 24/02/2016Good

The service did not have a regis tered manager at the time of this inspection 06/04/2016

Fairlee House 12/02/2016 Good 08/04/2016

Oasis Care and Training

Centre 14 & 23 /03/2016Good

28/04/2016

Acacia Care Centre 14 - 15 /04/2016 Good 04/05/2016

Havelock Court Nursing

Centre

23 - 24 /03/2016

Requires

Improvement

The provider was not meeting regulatory requirements and was in breach of one

regulation of the Health and Socia l Care Act 2008 (Regulated Activi ties ) Regulations 2014.

CQC is cons idering the appropriate regulatory response to resolve the problems found in

respect of this regulation and wi l l report on action taken in respect of these breaches

when i t i s complete.

The service was not a lways safe. The provider had not ensured there were a lways

sufficient s taff on duty to meet people's needs safely. This meant people were at ri sk of

receiving unsafe and inappropriate care.

The provider had mande improvements to the service about s taff relations but feedback

received was that there was a culture of mistrust amongst some staff and management.

Some members of s taff fel t unsupported and fel t unable to approach the regis tered

manager. 06/05/2016

British Homes and Hospitals

Incurable 16 & 24 /02/2016Good

12/05/2016

Bluebird Care (Lambeth) 13/04/2016 Good 20/05/2016

Frontier Support Services,

Croydon

26/02/2016 & 01 -

02/03/2016Good

The provider had not effectively communicated to people that their tenancy could not be

ended i f they s topped us ing the service. This meant that some people did not feel

comfortable making a compla int as they feared this could lead to them los ing their home.20/05/2016

Unique Personnel (UK)

Limited - Brixton Branch 13 & 21 /04/2016Good

27/05/2016

L'Arche Lambeth The

Sycamore28/04/2016 Good 27/05/2016

Nightingale House

(Wandsworth)22 - 24/02/2016 Good 01/06/2016

Acorn Lodge Care Centre 05 - 08/04/2016 GoodThe provider did not meet the Care Qual i ty Commiss ion regis tration requirements

regarding the submiss ion of a noti fication about a safeguarding incident, for which they

have a legal obl igation to do so. 03/06/2016

Rating

Site

CQC inspection

date Issues identified

Date report

published

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Safe Effective Caring Responsive Well-led Overall rating

Aquaflo Care Limited 03/05/2016Requires

Improvement

We found the provider did not operate effective s taff recrui tment procedures . This was

because the provider had fa i led to undertake a l l the relevant employment checks on

prospective new staff before they s tarted working for the agency. This meant people might

be at ri sk of receiving care from staff who were not fi t to work in the adult socia l care

sector.

The provider had a lso fa i led to noti fy the CQC without delay about the occurrence of a

safeguarding incident involving a person who used the service. This meant the CQC had

not been able to check i f the action taken by the provider to deal with these incidents was

appropriate at the time because we were unaware of their occurrences .

We identi fied two breaches of the Health and Socia l Care (Regulated Activi ties )

Regulations 2014 and the Care Qual i ty Commiss ion (Regis tration) Regulations 2009 during

our inspection. You can see what action we told the provider to take at the back of the ful l

vers ion of the report.

03/06/2016

Brook House (Brent) 04/04/2016 Good 04/06/2016

Meadbank Care Home 04 & 05/04/2016 Good

There were some issues with regard to the adminis tration of medicines that meant

people’s medicines were not a lways being managed safely. We found that people being

prescribed medicines that were label led ‘do not crush’ were having their medicines

crushed prior to adminis tration thereby placing them at ri sk of unsafe adminis tration.

Some PRN or ‘as needed’ medicines protocols were not deta i led enough to adequately

ins truct care s taff. We a lso found that some people with higher than expected blood

glucose levels were not being referred for further medica l advice or ass is tance as needed.

14/06/2016

Joybrook (Joy Care Home

Services Limited)18/05/2016 Good

We found that the provider had breached Regulation 18 (2) (a) of the Health and Socia l

Care 2008 (Regulated Activi ties ) Regulations 2014. The breach of the regulation relates to

s taffing. The regis tered manager had not a lways supported s taff in their roles . Al though

s taff told us they were supported by management, they had not received one to one

supervis ions or annual appra isa l to reflect on their practice.

15/06/2016

Bluebird Care (Hillingdon) 16 & 17/05/2016Requires

Improvement

Not a l l the records relating to the prompting or adminis tration of medicines were accurate.

The provider had systems in place to monitor the qual i ty of the care provided. However,

these did not a lways provide appropriate information to identi fy i ssues and address the

qual i ty of the service.

Found breaches of The Health and Socia l Care Act 2008 (Regulated Activi ties ) Regulations

2014 which related to medicines management and qual i ty assurance systems.

16/06/2016

Southside Partnership - 227

Norwood Road12/05/2016 Good 17/06/2016

Home Instead Senior Care

(Wandsworth)23/05/2016 Good 22/06/2016

Home Instead Senior Care

(Greenwich and Bexley)31/05/2016 Good 25/06/2016

Site

CQC inspection

date

Rating

Issues identified

Date report

published

64

5.2.4 Integrated Adults Programme: Long Term Conditions and Medicines Optimisation


Clinical Lead Dr John Balazs

Programme Leads Vanessa Burgess Assistant Director and Chief Pharmacist

IAF Indicators (Annex A) 103a, 103b, 105d, 107a, 107b, 128a

Programme Purpose The 15 million people in England with long term conditions have the greatest healthcare needs of the population (50% of all GP appointments and 70% of all bed days) and their treatment and care absorbs 70% of acute and primary care budgets in England. The impact of multi-morbidity is profound. People with several long-term conditions have markedly poorer quality of life, poorer clinical outcomes and longer hospital stays, and are the costliest group of patients that the NHS has to look after. The purpose of this workstream is to improve the quality and length of life of people, people with three or more long term conditions, and to promote the clinical and population behaviours which allow the right care to be delivered in the right setting. To ensure meaningful access to effective services, and to maximise the efficiency of those services, a well-coordinated and collaborative patient journey between physical, psychological and mental health components of pathways is required, as well as cross-cutting pathways where common co-morbidities exist and the interdependency of mental and long term physical health conditions is recognised. Medicines are a highly valued and effective intervention but medicines are not always taken as intended (30% to 50% of medicines) and medicines side effects are known to cause 5-8% of hospital admissions. Therefore, a key theme is to support patients in understanding and taking their medicines better. Primary care prescribing expenditure is growing nationally by 3% and hospital medicines expenditure on medicines by 15%, some of which are medicines commissioned by CCGs. A strong theme of the work is to deliver cost effective, value based prescribing, and support the CSU in managing CCG commissioned high cost drugs spend. Management of antimicrobial resistance is also a key theme with targeted use of appropriate antibiotics only when necessary being a key deliverable.

65


Design and implement an integrated and personalised approach to managing the physical and mental health of people with one or more long term condition underpinned including increasing use of Care and Support Plans. Integrate approaches from the NHS England best practice programmes (Right Care, Long Term Conditions).

Maximise the potential of community and primary care to support individuals with diabetes through development of our Integrated Model for Diabetes including review and commissioning of a sustainable intermediate care service.

Focus on prevention of diabetes through joint working with Lambeth Council and South London partners to implement the National Diabetes Prevention Programme in Lambeth.

Develop community services for people with Cardiovascular disease that successfully maintain individuals within outside of acute care including commissioning heart failure virtual clinics, reviews and optimisation for people with hypertension and re-commissioning of the Ambulatory Blood Pressure Monitoring Service.

Continue our work to prevent stroke in people with Atrial Fibrillation in line with the London Stroke Prevention in Atrial Fibrillation group and London Stroke Strategic Clinical Network.

Further develop systems and ways of working in the integrated respiratory service to ensure a comprehensive service that directs referrals effectively and provides easy access to the most appropriate care. Improve diagnosis and management of individuals with respiratory symptoms through improved access to and quality of spirometry.

Support improvements medicines review and adherence to enable self-care and the best health gain from medicines.

Ensure best value and patient outcomes from the primary care

Key Achievements Q1:

The Medicines Optimisation and Long Term Conditions Virtual Clinics Schemes has been developed and launched.

3 Locality Based Medicines Optimisation Scheme launch events were held with representatives from 41 practices present. The events received very positive feedback.

Optimise Rx (prescribing decision support software) has been rolled out across all practices, to replace ScriptSwitch.

Disease Modifying Anti Rheumatic Drugs shared care service launched to practices.

South East London Area Prescribing Committee developed and published guidance relating to the management of Asthma and Chronic Obstructive Pulmonary Disease, drugs used in epilepsy and drugs used in hypersalivation; update to the Rheumatoid arthritis biologics pathway and agreement to use biosimilar drugs in rheumatoid arthritis.

Commissioned the Lambeth integrated clinical pharmacy service for older people in the community on complex medicines and related community pharmacy Medicines Plus service.

Commissioned additional clinical pharmacy support for people living in nursing homes

Worked with Local Care Networks to produce Care Co-ordination Cohort recommendations

Reviewed the 3 Dimensions for Diabetes (3DFD) service model to understand success factors and launched Diabetes and Mental Health Holistic Care Pathway

Extended the current diabetes intermediate care team contract through procurement period.

Commissioned Heart Failure virtual clinics

Reviewed and agreed key performance indicators and service specification for Community Heart Failure team (GSTT) to

Long Term Conditions – Medicines Management

66

prescribing budget and CCG commissioned “high cost” medicines by working in partnership with clinicians and people across the health economy

Support achievement of the NHS England quality premium related to antimicrobial prescribing.

support appropriate referrals.

Agreed virtual clinic plan and key performance indicators with the Integrated Respiratory Team (KCH)

NHS England National Diabetes Prevention Programme (Healthier You) referral pathway developed. Launch of the programme is on track for quarter 2.


Commissioning of a Spirometry service for Lambeth CCG patients

Implementing key findings of the review of ambulatory blood pressure monitoring

Key risks 2016-17:

Potential for lack of engagement by General Practice in Medicines Optimisation and Long Term Condition Virtual clinics Schemes via GP Delivery Framework

The primary care prescribing budget may not remain within budget for 16/17 due to the introduction of new drugs on the market, e.g. New Oral Anticoagulant medicines, NICE approved drugs, newer diabetes drugs and the impact of NICE Guideline 28 (NG 28).

There are significant and large potential projects requiring project and procurement resource – spirometry, Ambulatory Blood pressure monitoring and the Community diabetes service. Resource and time constraints may lead to non-delivery of these projects.

67

Medicines Optimisation & Long Term Conditions – data element A. Overall Performance 2016/17 (Month 2) Overall the prescribing budget overspent at Month 2 by £1276 (0.0%, see finance report). The North Locality is underspent by 2.5%. The South East and South West Locality are overspent by 0.7% and 1.1% respectively. B. Spend per ASTRO-PU (data available quarterly) Data unavailable at time of writing report. C. NHS England Antibiotic Quality Premium Monitoring Dashboard (12 month rolling data) Data unavailable at time of writing report D. QIPP Savings (Prescribing data)

2016/17 Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar

Projected savings

£66,611

£66,611 £66,611 £66,611 £66,611 £66,611 £133,222

£133,222

£133,222

£133,222

£133,222 £133,222

Cumulative £66,611

£133,222

£199,833

£266,444

£333,056

£399,667

£532,889

£666,111

£799,333

£932,556

£1,065,778

£1,199,000

Actual savings ePACT prescribing data

£22,616

£45,619 Data not available

Data not available

Actual savings OptimiseRx/Waste & deprescribing

£49,734

£46,809 £49,399 £51,703

*Total actual savings (cumulative)

£72,350

£164,778

£214,177

£265,880

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5.2.5 Integrated Adults (Programme Dashboard & commentary)

The Integrated Adults Programme Dashboard is currently under development to reflect new key performance indicators and prirorities

for 2016/17. The work is being led jointly by the Integrated Commissioning Directorate and the Performance and Information Team.

The 2016/17 dashboard will be presented the next Programme Board meeting on 31st of August and published in the Integrated

Governance and Performance Report which will go to the IGC on 19th October and the Governing Board on 2nd November 2016.

69

5.3 Better Care Fund (BCF)

The Better Care Fund (BCF) was announced by the Government in the June 2013 spending round, to

ensure a transformation in integrated health and social care. The Better Care Fund (BCF) creates a

local single pooled budget to incentivise CCGs and local authorities to work more closely together

around people, placing their well-being as the focus of health and care services.

NHS Lambeth CCG and London Borough of Lambeth continue their commitment to develop integrated

care and broadening the scope of integrated commissioning.

In the 2015/16 BCF plan, Lambeth council and CCG collectively pooled £23.4million under a section 75

arrangement. The 2016/17 pooled BCF fund is £23.5million.

Performance against BCF metrics for 2016/17 are outlined in the table below and latest performance

where available.

Non-elective admissions (NEA) - Measured by the rate of non-elective admissions per 100 000

population.

Delayed Transfers of Care (DTOC) – Measured by the number of DTOC per 100 000 population for

people aged 18+

Reablement – Measured by the proportion of older people 65+ who are still at home 91 days after

discharge from hospital into reablement/rehabilitation services. Target 90.1%

Permanent admissions to residential care - Measured by long term support needs of older people

aged 65+ met by permanent admission to residential or nursing care per 100,000 population.

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5.4 Integrated Mental Health for Adults

Responsible Director Moira McGrath, Director of Integrated Commissioning (Older People)

Clinical Lead Dr Paul Heenan

Programme Lead Denis O’Rourke, Assistant Director

IAF Indicators (Annex A) 107a, 123a, 123b, 123d, 123e

Programme Purpose The mental health programme covers adults of working age in Lambeth. It is supported by the Lambeth Living Well Collaborative (LLWC), which is the partnership platform aiming to apply co production practice to the commissioning and delivery of mental health care and support in the borough. The overall aim of the programme is to ensure that people with mental health problems obtain access to support as early (and so avoid crisis) and as close to home as possible. We are aiming to re model our high cost low volume investment pattern to one which supports a larger number of people at lower cost through the provision of holistic support delivered by an alliance of providers working together to deliver the programmes (and collaborative's) big 3 outcomes.

5.4.1 Programme Assurance Statement



on target?

Objectives on track

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5.4.2 Mental Health Whole System Dashboard

72

1. OBDs - SLaM have reported an actual target of OBDs as 2148, which is significantly lower than the trajectory. We are working on clarifiying the commisisoned trajectory with the activity that SLaM are actually reporting via the SLaM Core Contract meeting. 4. EIP - During April 6 people experiencing their first episode of psycohisis waited for treatment with 2 people seen within 2 weeks, giving a total of 33.33%. This figure is low due to SLaM taking a literal view of 'assessment' and not including first contact. This should be recitfied for next month. 6. AMHPs - There were a total of 81 assessments for May. Of the 81 assessments 51 assessments lead to detention, 3 leading to informal admission, 4 not leading to admission, 3 S135 warrants obtained, 5 S135 warrants executed, 5 S136 was used. 8. DTOC - During May there was a total of 63 OBDs lost to DToC. The % of DToC is based on the monitor definition, which is 0%. This will be clarified at the SLaM Core Contract meeting. 9. LWN - There were a total of 381 introductions to the hub in April with 259 closures. Of the 381 introductions: 231 came from GPs, 56 from police, 25 from other, 19 from IAPT, 16 self introductions, 13 from Local Authority, 2 JCP, 6 from SLaM MAP, 2 from LWN agency, 2 from A&E, 1 SLaM PR NE, 2 from IPTT and 6 blank. The main reasons for introduction are: Depression (37), Other (29), Psychosis (21), and Concerns about mental state (20). 10. GP+ - There are currently 99 people on the GP+ scheme, with a total of 108 people who have used the service since the beginning. In April there were 79 people on the scheme with 20 new people in May. 11/12. Talking Therapies - NHSE no longer require monthly updates from providers, therefore data is not available. We will contact SLaM and to ask that they send this on a monthly basis even though it is not a requirement of NHSE. 13. IPSA - This is the number of people who have been in either residential care or rehabilitation beds where the IPSA team have worked with them to move into the new service offer. 14. IPSA - The target is the estimated number of new people who would have entered the previous system (rehab or residential care), the actual shows how the new service has been effective at diverting 'new people' away from bed based provision.

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Developing the Living Well Network to provide integrated multiagency support to individuals with mental health problems

Redesigning the services we commission from our local mental health provider (SLaM)

Implementing the Integrated Personal Support Alliance to deliver recovery focused personal care and support for people with complex needs


Secured GSTC grant award of £1.9m – effective from 1 September 2016 through to 31 August 2017.

Evening Sanctuary – out of hours (6.00 p.m. to 2.00 a.m.) support for people experiencing crisis – went live June 2016.

>400 introductions per month to LWN being sustained.

GP Plus scheme now supporting >100 people.

Draft proposition for next phase of LWN out for comment with partners.

Joint DWP, Lambeth council, GSTC and LWN Employment workshop held in June to discuss next steps for father joint work.

Pilot agreed between SLaM and LWN to support Early Intervention in Psychosis support.

IPSA Procurement process commenced in relation to two new supported living schemes >20 units

Talking Therapy targets met

Delayed Transfers of care are well within target


Delivery of EIP target remains challenging across all four SLaM boroughs. Part of the issue is the definition of first contact/assessment. This being worked on between the Trust and four CCGs.

Key risks 2016-17:

Procurement of next phase of LWN fails to attract a response from providers capable of delivering the system wide outcomes and savings we are seeking

SLaM Contract – delivery of AMH redesigns fails to deliver the planned reduction in relapse rates and use of beds

IPSA Alliance fails to deliver transformation and savings as planned

Workforce culture change is slow to adapt to the need for co-productive/personalised approach

System interface – perverse incentives, behaviours not addressed by new rules

LA funding reductions impacts on delivery of social care and support outcomes.

Changes to housing benefit rules constrain development of supported living schemes.

Mental Health

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5.5 Learning Disability

Responsible Director Maria Millwood

Clinical Lead Dr Nandini Mukhopadhyay

Programme Lead Sharafat Ali

IAF Indicators (Annex

A)

124a, 124b

Programme’s purpose The CYPM programme is also responsible for the strategic commissioning of Adult learning disability and physical disability services and is the governance mechanism by which Lambeth manages its commitment under the South East London Transferring Care Programme.

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Key aims for 2016-17: SEL Transforming Care Programme (SRO is Greenwich)

Coordinate all local Transforming Care related monitoring and activity

Embed Care Treatment Review (CTR) process across Adult and Children’s

Develop Enablement Centre in Lambeth

Positive Behaviour Support Service – determine best funding option and agree implementation plan

Personalisation agenda

Primary Care

Key achievements Quarter 1 The South East London Transforming Care Partnership

Transformation Plan was assured by NHSE and funding confirmed. £145k for year 1

The Lambeth Transforming Care Steering Group was established

The Transforming Care Caseworker now in post

Working with 2 providers to develop operating model for the enablement centre and to realise potential for savings

Contributed to the learning disabilities health check communication plan

Have linked up Social Finance to explore the potential (as part of their project with DH/NHSE), of social investment supporting the development of a PBS team


The CCG has not developed its plans to expand personal health budgets, so that that people with learning disabilities outside of CHC criteria are included

NHSE Specialised Commissioning data poor quality

At Risk of Admission Register

CTRs within 10 days of admission to an ATU, as diagnosis of LD or Autism not formerly diagnosed

Key risks 2016-17:

SEL TCP requirement is to discharge people into the community but

the inpatient population is remaining fairly static as we haven’t yet implemented alternative services to prevent people with LD/ASC being admitted – this continues to be a risk going forward

CCG Dowries – Lambeth CCG has to provide dowries for people in CCG commissioned places, who have been there for five years or more from 1 April ‘16

Unquantified risks resulting from patients transferring from Low/Medium beds (funded by NHSE) to locked rehab beds (funded by the CCG)

Risk of collating timely and accurate data to develop and maintain the At Risk of Admission Register across Children and Adults

Development of enablement centre is dependent on securing capital investment from Lambeth Council

Learning Disability

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5.6 Staying Healthy (Led by London Borough of Lambeth)

Responsible Director Dr Sarah Corlett, Interim Director of Public Health, Lambeth

Maria Millwood, Director of Integrated Commissioning (Public Health, Children & Young People, Adult Disabilities)

Clinical Lead Dr. Raj Mitra

Programme Lead London Borough Lambeth

Programme’s Purpose The Lambeth Staying Healthy Partnership Board (SHPB) is the lead partnership body reporting directly to the Health & Wellbeing Board on strategy, action, investment and progress to prevent ill health, promote health and wellbeing and reduce health inequalities of the Lambeth population. The Board is led jointly by Lambeth Council and Lambeth CCG with the Director of Public Health and a Staying Healthy Clinical lead acting as co-chairs. It has oversight of local delivery against the Public Health Outcomes Framework and the commissioning of health services where responsibility has transferred to local government. In addition, the SHPB has responsibilities, as delegated by the Health and Wellbeing Board, to advise and steer the JSNA process and assure JSNA products such as specific needs assessments and factsheets. The Board also has oversight for the development and approval of Patient Group Directions (PGDs) by having an agreed policy and process for PGD development and approval. The SHPB formally reports to the Lambeth Health and Wellbeing Board, and to the Lambeth Clinical Commissioning Group through the Integrated Governance Committee.

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Key aims for 2016-17: Redesign/recommissioning of health improvement

services (ie: smoking cessation, weight management, exercise referral, health checks)

Transformation of sexual health service offer in line with goals set out by London Sexual Health Transformation Project (ie: channel shift online and clinic rationalisation) and introduction of new Integrated Sexual Health Tariff

Redesign/recommissioning of substance misuse and homeless health services

Integrating specialist/commissioning teams

Redesign of HIV care and support pathways

Work with GP Federations to lead population health contracts

Refresh of the Health and Wellbeing Strategy

Contribute a health and wellbeing perspective in the development of the Lambeth Community Plan

Oversight to the JSNA process and sign off of relevant products

Key Achievements Quarter 1: Completed consultation on savings/service changes associated with Public

Health grant cut and communicated decisions to providers in line with deadlines and met savings target

Launched a new Lambeth, Southwark, Lewisham sexual health prevention/promotion partnership/service

Transition work to ensure that the specialist team can return to Lambeth council during quarter two

Agreed new tri-partite commissioning partnership/contract for sexual health with Lewisham and Southwark councils and CCGs

Work with GP Federations on new model/oversight of primary care services across substance misuse and health improvement

Links made between Health and Wellbeing Strategy and Community Plan, particularly around tackling health inequalities

GLA agreed Food Flagship Programme objectives achieved

Established new GUM contracting arrangements across Lambeth and Southwark, including integration of online offer

Key challenges to date: Financial position – impact of Government cuts and

council need for savings to help balance budget, will affect outcomes detrimentally given scale of cuts

Re-integration of the specialist PH team within the council and filling vacancies that have been carried prior to and during the restructure with Southwark

Increasing levels of need and increasing population levels

London wide GUM negotiations and open access issues

Key risks 2016-17: Resource/time available to undertake the redesign and consultation work needed

to achieve a balanced budget in 17/18 and beyond

London not moving towards transformation at the same pace and ambition as Lambeth, leaving the potential for growth in use of out of borough clinics at the expense of those that have been redesigned locally

Austerity – cuts to advice services, cuts to social care, welfare benefit changes, increased homelessness, etc

Loss of Mayoral funding for offender/substance misuse services which Public Health joint funds

Loss of specialist Public Health capacity to work effectively across the local health economy

Staying Healthy

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Assurance Status/Risks RAG Rating

(Red/Amber/Green)

Is your programme delivering

as planned – is it on target?

Yes

What are the risks you have

identified to date and how are

you mitigating against these?

Risks have been identified and are being mitigated or managed as far as possible. The

risks include:

1. Financial – we have experienced a 10% cut to PH Grant during the period 2016/17 to

2019/20 and a programme of work is underway to determine how to deliver the reduction in

spend. The cut represents a loss of gross of over £5m. There is likely to be further pressure

on the PH budget linked to the need for council-wide savings to meet a £50m budgetary

shortfall. The loss of grant is likely to mean services are reduced and outcomes are

detrimentally affected. We are mitigating this by working strategically to remodel and

recommission key services and with a close eye on health inequalities.

2. Structural – the PH specialist team is returning to Lambeth as a stand-alone team but with

some funding reductions that mean staff posts will not be able to be filled and a restructure

is needed. The setting up of new systems and IT and the move back to Lambeth presents

some short term risks to service continuity as arrangements bed in.

3. External – continued/extended programme of welfare cuts likely to negatively impact on

housing, youth homelessness, income/poverty, mental well-being, etc. The impact of these

wider determinants of public health creates a risk to the success of the programme in

meeting intended outcomes.

4. Sexual health – continuing growth in need/demand for services, efforts to manage

costs/demand proving problematic (complicated by open access issues, market

development issues and differences in London-wide approach to issue).

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5.6.2 Staying Healthy Dashboard

The Public Health Outcomes Framework (PHOF) was used to identify the national indicators relevant to each of the three main commissioning areas

(sexual health, substance misuse, health and wellbeing). Commissioners were also consulted to identify the local priorities. Where KPIs are annual,

local data will be used where possible and appropriate to provide quarterly updates. The Staying Healthy Board is to agree which other indicators

could help to demonstrate progress against the wider determinants of health that are specifically within the Board’s remit.

Sexual Health Source Freq-uency

Reporting RAG Comment

PHOF 2.4 Under 18 conceptions

PHOF Annual

Date 2011 2012 2013 2014

Red

No performance data update since last IGC report. Recent increase is not statistically significant compared to change from 1998. Lambeth's change from 1998 baselines is 60%, compared to 51% nationally.

per 1,000 pop

34.8 33.2 24.7 33.8

London 28.7 25.9 21.8 21.5

PHOF 3.2 Chlamydia diagnoses for 15-24

PHOF Annual

Date 2012 2013 2014 2015

Green Lambeth consistently performs above the London average, although downward trend observed and will be monitored.

per 100,000 pop

4585 4463 4364 4045

London 2263 2328 2313 2200

PHOF 3.4 HIV presentations at late stage

PHOF Annual

Date 2009-11 2010-12 2011-13 2012-14

Amber No performance data update since last IGC report.

per 100,000 pop

39.7 39.3 34.7 29.9

London 46.7 44.6 40.5

% Repeat terminations for under 25s

PHE Annual

Date 2012 2013 2014 2015

Amber Performance improvement from Red to Amber in consistent downward trend.

% 32.9 31.9 30.7 29.8

London 33 32.6 32.3 32.3

% Post-abortion LARC

Provider Quarterly Date 2015/16

Q1 2015/16

Q2 2015/16

Q3 2015/16

Q4 N/A

LARC uptake continues to improve at bpas due in part to their staff training

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Sexual Health Source Freq-uency


uptake

% 33.9 29.8 35.2 33.4

programme on contraceptive counselling. Levels have reached those of MSI and in in some instances surpassed them. We will continue to closely monitor and encourage LARC uptake.

SH24 uptake by kits ordered and received

Provider Monthly

Date Dec-15 Jan-16 Feb-16 Mar-16 Green

Service no longer commissioned as standalone contract. Indicator to be removed.

% (Cumulative)

70.5 73.8 68.4 51.1

Substance Misuse

Source Freq-uency


PHOF 2.15i Successful completions from treatment (Opiates)

NDTMS Monthly

Date Feb-16 Mar-16 Apr-16 May-16

Amber

Provider has now established project working group to address slippage in performance by implementing robust data assurance process. To be monitored closely through monthly business meeting with service leads and quarterly contract monitoring.

% 6.6 6.4 5.7 5.6

PHOF 2.15ii Successful completions from treatment (Non-opiates)

NDTMS Monthly

Date Feb-16 Mar-16 Apr-16 May-16

Green

Continued to improve in this key metric, now GREEN. Performance will continue to be monitored through provider forum and individual contract monitoring to ensure positive direction of travel is maintained.

% 41.96 41.4 42.6 42.4

PHOF 2.18 Alcohol-related hospital admissions

PHOF Annual

Date 2011/12 2012/13 2013/14 2014/15

Amber

No performance data update since last IGC report. Continued monitoring of local initiatives, incl. alcohol care teams in hospital settings and work undertaken with GP Federations to improve early detection and delivery of alcohol brief interventions.

per 100,000 pop

658 642 626 646

London 572 554 541 526

PHOF 2.16 PHOF Annual Date 2012/13 Red No performance data update since last

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Substance Misuse

Source Freq-uency


Prison treatment starts

% 61.9 IGC report. New performance indicator, to be assessed and understood as part of recommissioning of Integrated Offender Management.

London 57.1

% Hepatitis B vaccine completions

NDTMS Quarterly

Date 2015/16

Q1 2015/16

Q2 2015/16

Q3 2015/16

Q4 Red

Provider asked to bring forward remedial plan to address apparent decline in screening and vaccination rates, which will be monitored via contract review process.

% 20.2 18.9 19.5 19.3

National 27 27 28 28

Health Improvement

Source Freq-uency


PHOF 2.14 Smoking Prevalenc

PHOF Annual

Date 2012 2013 2014 2015

Red

Local tobacco control strategy to be refreshed as part of overall healthy adult strategic plan, which will seek to support primary and secondary prevention targeted at key groups at high risk of smoking in order to address related health inequalities.

% 22 20 19 21.2

London 18.0 17.3 17.0 17.0

Take up of NHS Health Checks

Local Quarterly

Date 2015-16

Q2 2015-16

Q3 2015-16

Q4 2016-17

Q1

Amber

Working in partnership with GP Federations to agree a targeted approach to NHS Health Check programme for those most at risk, which will be monitored through agreed local metrics.

% 17.7 22.4 19.1 23.1

England 45.5 49.6 52.5

PHOF 2.17 Recorded Diabetes

PHOF Annual

Date 2011/12 2012/13 2013/14 2014/15

N/A

No performance data update since last IGC report. Further work to review current diabetes detection and intervention pathway to be undertaken as part of local delivery of national diabetes prevention programme during 2016/17.

% 4.4 4.7 5.0 5.2

London 5.6 5.8 6.0 6.1

PHOF 4.04ii PHOF Annual Date 2009-11 2010-12 2011-13 2012-14 Amber No performance data update since last

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Health Improvement

Source Freq-uency


Mortality from preventable CVD

per 100,000 pop

61 54 50.3 51.9 IGC report.

London 55.1 52 50.2 49.2

% successful four-week quitterswho set a quit date

Local Quarterly

Date 2015-16

Q1 2015-16

Q2 2015-16

Q3 2015-16

Q4

Amber

Overall decrease in number setting a quit date, but rate of successful quits continues to increase. Work currently ongoing in partnership with CCG to recommission smoking and related lifestyle behaviour change services.

% (n)

32% 36% 37% 38.1%

(273 of 848)

(592 of 1664)

(887 of 2387)

(332 of 872)

Number of smokers setting a quit date

Local Quarterly Date

2015-16 Q1

2015-16 Q2

2015-16 Q3

2015-16 Q4

Amber As above. n 848 1664 2387 872

Risk Register

It was agreed at the Staying Healthy Programme Board meeting on the 12th of August that the Staying Healthy Risk Register would be not be reported in the Integrated Governance and Performance Report, as the risks relate to Public Health. NHS Lambeth CCG will continue to review and monitor these risks through the Programme Board meetings.

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5.7 Primary Care Development

Responsible Director Andrew Parker, Director Primary Care Development

Clinical Lead Dr. Martin Godfrey

Programme Lead Ursula Daee, Assistant Director Primary Care

IAF Indicators (Annex A) 128b, 128c,128d

Programme’s Purpose This programme seeks to enable a transformation of Community based /out of hospital care where high quality, locally responsive and sustainable primary care is the building block for the future health and care system. Through this, Lambeth citizens can expect a primary care system that is proactive in its approach, accessible and responsive to local needs and coordinated around the individual. The programme aims to enable a general practice system that can collaborate successfully across the borough, with patients and citizens, and be a valued, well developed and attractive place to work. The programme will coordinate the key system enablers of Estates, workforce and digital technologies to facilitate this transformation. In July 2016 NHS Lambeth CCG launched a new Community Based Care Programme Board developed out of the Primary Care Development Programme as discussed at our last meeting. The Primary Care Development Programme Board will continue to meet, and the additional Community Based Care Programme Board will help provide direction and oversight to core components of both Lambeth CCG Strategic and Operational plans and the SEL STP, and the future challenges that Primary Care faces which include budgetary, and contractual arrangements. The two separate formal arrangements as follows: 1. Community Based Care Programme Board with the key transformational responsibilities will include: Development and Delivery of South East London ‘Community Based Care’ strategy to include:

General practice ‘at scale’ through Federation and Local Care Networks.

Development and Delivery of London transforming primary care and GP Five year Forward view

Development and delivery of three enabler programmes – estates, workforce and digital technologies

‘Super enabler’ to other key CCG programmes for Integrated Adults, Integrated Children, Mental Health, Staying Healthy.

Reducing inequalities

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2. Primary Care Commissioning Sub-Committee responsibilities will include:

Oversight and assurance regarding financial and budgetary management, performance, contracts and quality – Lambeth Clinical Commissioning Group and joint commissioners.

Discharge Joint Commissioning responsibilities with NHS England The Community Based Care Programme Board will continue to be chaired by the CCG Governing Body Primary Care clinical lead.



Is your programme delivering as planned

– is it on target?

Objectives on track

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Key aims for 2016-17: GP Patient Survey – overall experience of making a GP appointment

– a) Achieve a level of 85% of respondents who said they had a good experience of making an appointment; or b). A 3 percentage point increase from July 2016 publication on the percentage of respondents who said they had a good experience of making an appointment

Developing local Clinical Leadership and new ways of working across Healthcare system

Develop General Practice to work at scale

Make Primary Care a more attractive place to work

Primary Care Commissioning

Develop new ways of working to reduce variation in Primary Care

Give people in Lambeth the opportunity for their voice to be heard

Primary Care is better configured to deliver an increased range of services to patients

Unscheduled care

Develop enhanced Primary Care Access in Lambeth

Utilise the community pharmacy network & other community services to improve outcomes for patients through integrated care and by improving safety, access and focussing on prevention

Reduce variation in equality for local populations

Key Achievements Quarter 1: July 2016 GP Survey results show Lambeth CCG at 85% for this

indicator

Boards for all 3 LCNs established and meetings commenced – work programmes, of which the key one being the LTC cohort, progressing.

Contract negotiations completed with Federations for Access Hubs and infrastructure. Contracts being finalised in readiness for sign off by COI panel in September.

National PMCF evaluation being supported

GP Delivery Framework launched and contracts issued to all practice

Specification for GP+ agreed with Federation, to be signed off by COI Panel in August

ETTF bids submitted

All LCNs have named pharmacy lead

Equality Objectives agreed. Dashboard revised to include these

Key challenges to date: On-going pause in negotiations with the LMC regarding the PMS

Premium

Negotiations with the Federations over Access Hub Model going forward and sustainability of Federations as organisations took considerably longer than expected. Successful conclusion is dependant on agreement by CCG and NHSE that contract can be issued for 3 years.

SELDOC WIC contract – agreement and implementation of next steps since receipt of termination notice received

Fully robust budgetary/ contractual control

Key risks 2016-17: WIC income for non-Lambeth residents. Data from M_F service still

inadequate.

Minor ailments – review of future requirement and controls on verification of claims

Federation model doesn’t deliver the changes in primary care models

LCN development not at speed required to deliver the changes needed in Lambeth

Primary Care Development

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Safe Effective Caring Responsive Well-led Older people

People with

long term

conditions

Families,

children and

young people

Working age

people

People

whose

circumstanc

es may make

them

vulnerable

People

experiencing

poor mental

health

Beckett House Practice 07/01/2016 Good

The areas w here the provider should make improvement are:

The practice should ensure that all staff complete annual basic life support training.

The practice should review the systems to ensure mediciens are f it for use.

The practice should review their f ire safety policy and consider f ire safety training for all staff.

The practice should consider instituting a programme of clinical audits. 06/04/2016

The Sandmere Road Practice 25/02/2016 Good


Review the arrangements for clinical w aste storage.

Provide online facilities enabling patients to book appointments and order repeat prescriptions.

Review their practice around coding to ensure that patients w ith long term conditions and carers are being identif ied.

Undertake analysis of the appointment system review ing w aiting times and patient perceptions of w aiting times

16/05/2016

Herne Hill Road Medical Practice 09/02/206 Good

The areas w here the provider must make improvement are:

Improve its signif icant events procedures to ensure that action is taken to address all concerns identif ied.

Ensure that mandatory training is completed in accordance w ith current guidelines.

Ensure that pre-employment checks are completed for all staff and that systems are in place to monitor their professional registrations.

The areas w here the provider should make improvements are:

Consider review ing its mechanisms for recording meetings.

Consider documenting a strategic business plan.

The practice should take further proactive steps to identify patients w ith caring responsibilities

31/05/2016

The Vauxhall Surgery 03/02/2016Requires

improvement

The areas w here the provider must make improvements are to:

Ensure staff receive safeguarding training and are familiar w ith the process to make referrals.

Determine the immunisation status of all relevant staff, and in particular those w ith close patient contact.

Ensure staff do not w ork outside the scope of their training and qualif ications.

Ensure all medicines and equipment are in date.

Carry out a risk assessment w ith regard to the decision not to have a defibrillator on site.

Ensure the practice has oxygen on site.

Provide staff w ith basic life support training.

Carry out regular and systematic clinical audit, including quantitative audits of the care of groups of patients against defined criteria (w ith re-

audit to demonstrate change).

Provide clinical and non clinical staff w ith regular supervision.

Ensure patient care plans are correctly documented.

In addition the provider should:

Ensure patient group directions are appropriately dated, in line w ith legislative guidance.

Record details of verbal employment references and record new staff induction.

Improve the system to record the cleaning carried out by the cleaning contractor so that the practice can determine w hat has been cleaned

and w hen.

Review regularly and update procedures and guidance.

Review the system for dissemination of safety alerts and clinical guidance across the practice.

Review staff training needs, including infection prevention and control and Deprivation of Liberty Safeguards training.

03/06/2016

Palace Road Surgery 09/03/2016Requires

improvement

The areas w here the provider must make improvements are:

Ensure that the practice provides and maintains a clean and appropriate environment that facilitates the prevention and control of infections.

Must ensure that there are appropriate systems in place for recording consent.


Consider putting in place formalised care plans for service users w here appropriate.

Review the practice’s clinical auditing process w ith a view to improving patient outcomes in accordance w ith national clinical guidance.

Ensure that all staff are aw are of the location of emergency medicines and w hich medicines are available.

Ensure that a record is kept of staff inductions.

Consider advertising translation services in the reception area.

Consider undertaking a review of patients to verify w hy the prevalence of Coronary Heart Disease is low er than the national average.

Consider w ays to increase the number of diabetic patients w ho receive a seasonal f lu vaccination

23/06/2016

Hetherington Group PracticeRequires

improvementGood

The areas w here the provider must take improvement are: Put an effective system in place for

analysis of signif icant events; ensuring that any action or learning from events is clearly documented and communicated to staff.

Ensure that the practice recruitement policies are implemented and that there are systems in place to review the professional registrations of

clinical staff. Ensure that there is a full stock of emergency medicines on site and that there are systems in place to replace medicines w hen

required. The areas w here the provide should make improvements are: Ensure complaints policy and

responses comply w ith requirements of The Local Authority Social Services and NHS Complaints (England) Regulations 2009.

Ensure that all staff have recieved mandatory training including f ire sfaety, information governance and infection control.

Continue to review and monitor telephone and appointment access. Consider drafting a formal strategic business plan.

Consider undertaking regular internal appraisals for salaried GPs and review the appraisal process for all staff.

Review patients w ith mental health concerns and put strategies in place to ensure that their alcohol consumption is discussed and recorded.

Continue to review patients to ensure that people w ith Coronary Heart Disease are identif ied. Review the process of internal audit,

clearly documenting the action taken to improve outcomes and consider putting this into a structured w ritten format.

20/06/2016

Date report

publishedPractice Name

Date of CQC

Inspection

Ratings

Overall rating

Ratings of specific services

Issues Identified

CQC Inspections of GP Practices in Lambeth The CQC published inspection reports for the following practices in Q1 2016/17 (Source: CQC).

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5.7.2 Primary Care Programme Dashboard

The Primary Care Programme Dashboard is currently under development to reflect new key performance indicators and prirorities for

2016/17. The work is being led jointly by the Locality Network Managers and the Performance and Information Team.

The 2016/17 dashboard will be presented at the next Programme Board meeting on the 14 of September and published in the Integrated

Governance and Performance Report which will go to the IGC on 19th October and the Governing Board on 2 November 2016.

88

5.8 Enabler Programmes

5.8.1 Governance and Development Risk Register

For risk 6K, scored 12 and risk 6N, scored 16, please see the Board Assurance Framework.

Risk Title

Risk Register

where Risk is managed

Current Risk

Score Approach Action Plan Summary

Possible failure of the CCG to have robust business continuity plans to ensure ongoing service delivery resulting in delay in delivery of CCG outputs, potential non-compliance with NHSE Assurance Framework and impact on relationships/loss of confidence with providers, members and NHSE.

Programme Board /

Directorate Risk Register

6 Mitigate CSU BCPs reviewed. NHS Property BCPs to be obtained and reviewed – to await revision post environmental risk assessment June 2016. Undertake a Lower Marsh EPRR exercise – by 31/10/2016 Undertake LCCG Communications exercise – by 30/09/2016 Table top CCG BCM exercise completed March 2016 - initial amendments made. CCG BCP's refreshed. Amendments made in light of recent junior doctor strike - Completed.

Equality Act Risk - Likely risk that the CCG does not currently collect information that provides assurance that they are meeting public sector equalities duties; public engagement work doesn’t systematically target groups of protected characteristic and therefore CCG cannot demonstrate how it fosters good relations. This could result in a breach of the law and loss of reputation; non compliance could result in the CCG in an employment tribunal or county court.

Programme Board /


8 Mitigate EIA's to be carried out as a key feature of commissioning intentions process Programmes and enablers to continually collect EDS evidence Targeting of groups for specific engagement, eg GP interpreting, IUC procurement, OHSEL EOC proposals

Possible risk of non-compliance with information governance requirements

Programme Board /

6 Mitigate To review the retention and destruction schedule to include retention of quality alert data - to add to the Records

89

Risk Title

Risk Register


Current Risk


relating to processing of personal confidential data on QUIC system, resulting in a breach of personal confidential information


Management Policy July 2016 Follow up with GP Practices completion of FPN actions - to discuss at IGSG Amend Fair Processing Notice to make quality alerts section more explicit.

Ongoing unlikely risk of staff shortage and recruitment and retention problems causing disruption to critical services/essential business functions

Programme Board /


6 Mitigate Ensure all plans are ratified and implemented Ensure that, so far as is reasonably practicable, staffing levels and skill mix in critical services are protected from financial pressures.

Ongoing unlikely risk to premises resulting in denial of access/loss of use of premises causing disruption to critical services/essential business functions.

Programme Board /


8 Mitigate Ensure all parts of the organisation have integrated arrangements for response to a major incident. Ensure all critical services and essential business functions have business continuity plans in place which are aligned with ISO 22301. Maintain current Southwark Access list and physically test ability of a selection of staff to log in at Tooley Street

Ongoing unlikely risk to technology resulting in disruption to critical services and essential business functions.

Programme Board /


8 Mitigate Assess situation against information governance toolkit Ensure plans keep pace with the introduction of new technology and the increasing dependency on technology Ensure that, so far as is reasonably practicable, that arrangements are in place with suppliers of critical systems to ensure swift replacement and commissioning into service Review CSU Disaster Recovery Plan against CCG Business Continuity recovery assumptions

Risk that failure to manage and apply information security standards leads to the introduction of viruses and software to electronic devices and IT networks,

Programme Board /


9 Mitigate CCG Internet Acceptable Use Protocol - discuss CCG staff sign up to CSU policies at July IGSG. This will need to reflect new provider. Staff training and awareness - discuss CCG staff sign up to

90

Risk Title

Risk Register


Current Risk


resulting in a loss or breach of CCG data CSU policies at July IGSG. This will need to reflect new provider. Agree format of reporting attempted cyber attacks to IGSG - agree CCG access to SUSI to view relevant reports Upgrade CCG systems from Internet Explorer 7 to version 10 or above - roll out in progress

There is a risk CCG data held on the incident management system is not securely protected due to gaps in the contract held with software provider, resulting in a potential breach of data and loss of public confidence in the CCG

Programme Board /


8 Accept Regular review at IGSG New account manager to discuss concerns further within organisation.

91

5.8.2 Equalities

Responsible Director Una Dalton, Director Governance and Development

Clinical Lead Dr. Paul Heenan

Programme Lead Cathrine Flynn, Engagement Manager

Purpose: To enact the Public Sector Equality Duty

Equalities

92


Build skills and knowledge of staff and Governing Body: induction on legal duties, promote, provide or commission training and development in areas of engagement; coaching, modelling, mentoring

Manage relationships with key stakeholders: Scrutiny, Health and Wellbeing Board, Healthwatch; coordinate briefings, inductions, ensure reports are provided and responded to

Use CCG and partner websites and e communications to promote involvement opportunities

Support public participation in work of Governing Body: promote public forum, support development of patient stories for papers

Develop and support patient and public involvement in CCG programme areas: provide policy and legal guidance and practical support as required

Ensure statutory reporting completed

Key Achievements Q1:

Engagement objectives and progress reviewed at Engagement, Equalities and Communications Committee (Apr, Jun)

Up-to-date induction materials in place for all staff and GB members re: legal and policy frameworks and CCG approaches

‘Patients in control’ virtual training commissioned and delivered for CCG staff (May)

Final Plain English training session (5/5) for CCG staff delivered to support clear communications and engagement

Briefings for Scrutiny as required re: OHSEL programme; input into SE London JHOSC in particular re development of proposals for elective orthopaedic care

Chairs meetings continue, shaping agendas for HWB; pre-meet in April (open forum for public) involved workshop discussion on STP (local care networks, prevention, technology)

CCG website used to promote Governing Body and public forum, open meetings of Lambeth Health and Wellbeing Board and the South-East London Primary Care Joint Committee; also promoted Healthwatch meetings eg on Black Wellbeing, and Council consultation on public health services

CCG public forum well-attended with broad range of questions addressed

Development of engagement plans with adults programme (ultrasound), across LSL (GP interpreting) advice and guidance as required in other areas

Funding of PPG Network to support development of patient voice into quality of primary care and CCG commissioning; production of film to support development of PPGs and launch at Patient Participation Awareness Week event

Work across SEL to engage in OHSEL and STP; targeted engagement in line with equality analysis on EOC proposal development; series of workshops with Healthwatch to engage them directly and to inform and support HW work planning for 2016-17; clinical commissioner engagement through CCG localities (EOC)


Volume and pace of work taking place at supra-Lambeth level (eg OHSEL, STP, PCJC, Strategic Partnership)

Key risks 2016-17:

Legal duty to involve

Engagement

93

5.8.3 Organisational Development


Programme Lead Lucy Day / Janie Conlin

Purpose:

Develop CCG to best support delivery of the organization’s priorities

Ensure the CCG supports staff and provides resources to enable them to carry out their work

Assess development needs of Governing Body to enable it to function most effectively

94

5.8.4 IM&T

Responsible Director Christine Caton, Chief Financial Officer, Andrew Parker, Director of Primary Care Development

Clinical Lead Dr Adrian McLachlan

Programme Lead Jeremy Burden and Graham Crawford Business Intelligence & ICT (CSU) Jo Steranka, Digital and Business

Intelligence Development Manager

IAF Indicators (Annex A) 144a, 144b

Scope of business area This business area covers both business information support and information systems. This business is provided to

Lambeth CCG by South East CSU.

Objectives of business area

The overall aim of the IM&T enabler work stream is to ensure that good quality clinical information is accessible in an

integrated shared clinical record and to ensure that information systems are available to support the clinical business

needs of NHS Lambeth Clinical Commissioning Group. A robust IT infrastructure needs to be in place to enable this to

happen.

95

Key aims for 2016 – 17:

GP Information Management & Technology

* Ensure smooth transition to new GP IM&T Delivery Partner (NE

London CSU).

* Ensure alignment of GP IM&T service delivered by the IM&T

Delivery Partner (NE London CSU) with the NHS England GP IT

Operating Framework, the CCG Practice Agreement and the GP

Forward View.

* Deploy available capital resources to support GP IT in a timely

manner.

* Review General Practice technology requirements, develop bids

and deploy resources to support innovation in Primary Care.

* Develop existing digital resources (including clinical content

management system, SMS texting, arrival and calling-in boards

and national systems such as Electronic Prescription Service and

NHS e-Referrals) to work towards Paperless at the Point of Care

in Lambeth by 2020.

Digital Roadmap

* Work with the 5 other CCGs in the South East London (SEL)

Digital Footprint (Bexley, Bromley, Greenwich, Lewisham and

Southwark) to develop the SEL Digital Roadmap for submission

alongside the SEL Sustainability and Transformation Plan.

* Work with relevant Lambeth Programmes and leads to deliver the

SEL Digital Roadmap Universal Capabilities:

- Professionals across care settings can access GP-held

information on GP-prescribed medications, patient allergies

and adverse reactions

- Clinicians in urgent and emergency care settings can

access key GP-held information for those patients

Key achievements Quarter 1:


* CCG staff are fully engaged with the new GP IM&T Delivery

Partner’s contract mobilisation processes for both GP and CCG

IT, attending meetings and providing information as required.

* The GP IT Operating Model 2016/18 was published at the

beginning of June 2016. At the end of quarter 1, we were still

waiting for the Primary Care Digital Maturity Assessment to be

published by NHS England. This has now been published. A

summary of the outcome of the Assessment for NHS Lambeth

CCG is contained in the ICT Progress Report elsewhere in this

agenda.

* During quarter 1, our CSU GP IT Delivery Partner deployed 599

PCs and 29 servers across 44 practices funded by the NHS

England 2015/16 GP IT Capital Allocation. A small number of

printers and scanners were also deployed.

* A number of bids supporting transformation of GP IT and working

practices were submitted to the Estates & Technology

Transformation Fund at the end of June 2016. The outcome of

this bidding round will be announced in November 2016.

Additionally, bids were submitted to NHS England for 2016/17

Business as Usual GP IT hardware refresh. At the end of quarter

1, NHS England had not confirmed the outcome of that bidding

round. NHS England has now confirmed that funding will be

available.

Digital Roadmap

* NHS Lambeth CCG worked closely with colleagues in the other 5

CCGs in the South East London Local Digital Footprint to deliver

the draft Local Digital Roadmap for submission at the end of June

IM&T

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previously identified by GPs as most likely to present (in

U&EC)

- Patients can access their GP record

- GPs can refer electronically to secondary care

- GPs receive timely electronic discharge summaries from

secondary care

- Social care receive timely electronic Assessment,

Discharge and Withdrawal Notices from acute care

- Clinicians in unscheduled care settings can access child

protection information with social care professionals

notified accordingly

- Professionals across care settings made aware of end-of-

life preference information

- GPs and community pharmacists can utilise electronic

prescriptions

- Patients can book appointments and order repeat

prescriptions from their GP practice

* Work through Our Healthier South East London processes to

improve secondary care digital maturity.

* Revise the draft Lambeth CCG IM&T Strategy to incorporate the

aspirations of the Digital Roadmap

Lambeth DataNet

* Ensure successful data warehouse development.

* Work with partners and stakeholders to develop business

intelligence resources to support innovation in Primary Care.

Corporate Information Management & Technology

* Ensure smooth transition to new GP IM&T Delivery Partner (NEL

2016. Work on the final texts of the narrative document and

appendices is ongoing.

* The SEL Local Digital Roadmap has been co-ordinated by the

Our Healthier South East London Programme Management

Office (PMO). The PMO is co-ordinating work to improve

secondary care digital maturity.

Lambeth DataNet

* In June 2016, NHS Lambeth CCG and Guy’s and St. Thomas’s

NHS Foundation Trust signed the contract for their IT department

to host the DataNet data warehouse. Since then, EMIS has

completed the first quarterly data extract and data warehouse

development can begin.

* The Lambeth DataNet Steering Group, with representation from

the 3 stakeholder organisations – NHS Lambeth CCG, London

Borough of Lambeth Public Health Department and Kings

College London continues to oversee development of Lambeth

DataNet.

Corporate Information Management & Technology

* Transfer of corporate IM&T to the new Delivery Partner is

happening in parallel to that for GP IT. Progress and issues are

the same for both.

IM&T Support to Programmes

* In June 2016, the Community Based Care Programme Board

approved Terms of Reference for a new Digital Technology

Group to support Programmes to innovate and achieve change

using new technologies.

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CSU)


* Support Programmes to use IM&T to innovate and achieve

change

Key outstanding issues:


* New GP IT service: Mobilisation of newly procured GP IT service

began in May 2016. Insufficient information was available to the

new supplier to complete mobilisation within the expected period,

with go-live on 01/08/2016. Planning for transfer to the new

supplier continues.

* The Primary Care Digital Maturity Assessment (DMA) has

highlighted a significant number of areas where improvement is

needed to deliver the GP IT service specified by NHS England.

Development of an action plan to take this forward is required.

* 2015/16 GP IT Refresh: At the end of the quarter, network switch

deployment was delayed for reasons outside the control of the

GP IT Delivery Partner.

* Funding bids for 2016/17 GP IT hardware refresh remain to be

finalised with NHS England. The outcome of bids to the Estates

and Technology Transformation Fund (ETTF) will not be known

until November 2016.

* Introduction of new technologies: Plans for the introduction of

new technologies has been dependent on allocation of funding by

NHS England. Final funding levels have yet to be confirmed.

Digital Roadmap

* Finalisation of the texts of the narrative and appendices will

continue during autumn 2016. Preliminary feedback has been

Key risks going into 2016-17:


* New GP IT service: Significant challenges posed lack of internal

systems within the outgoing GP IT Delivery Partner forces

transfer to the new supplier over a protracted period. This could

impact on service to General Practice and reputational damage to

NHS Lambeth CCG.

* Primary Care DMA: Failure to deliver to Primary Care the GP IT

service specified in the GP IT Operating Model 2016/18 could

undermine transformation in delivery of Primary Care services.

* Funding Bids: Underfunding of the introduction of technology

such as e-consultation and mobile working undermines the ability

of Primary Care to deliver transformation in patient care.

* Introduction of new technologies: late approval of funding bids

risks there being insufficient time to implement schemes before

the end of the financial year and loss of funding therefore.

Digital Roadmap

* Risks associated with the Local Digital Roadmap are around

delivery of the Universal Capabilities, which involve

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received from NHS England London and work is under way to

respond to that feedback.

* Work with Programmes on delivery of the Universal Capabilities

will begin once the Roadmap has been approved.

* Revision of NHS Lambeth CCG’s IM&T Strategy could not begin

until the Primary Care Digital Maturity Assessment and Local

Digital Roadmap were available.

Lambeth DataNet

* Once the data warehouse has been built, it will be tested by

analysts from Lambeth Public Health, Kings College and NHS

Lambeth CCG. Once it has been signed off, a piece of technical

work will be needed to enable use of the data in the data

warehouse. It is anticipated that this will be complete before

Christmas 2016.

* Whilst some high-level work has been carried out to identify how

Lambeth DataNet can support innovation in Primary Care, further

work is needed to identify opportunities for high quality business

intelligence.


* The Digital Technology Group will have its first meeting at the

end of August 2016. Preparation for this is under way.

transformation for primary, secondary and social care. At this

stage these risks await quantification.

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5.8.5 Estates

Responsible Director Christine Caton, Chief Financial Officer

Clinical Lead Dr. Adrian McLachlan

Programme Lead Claire Hornick

IAF Indicators (Annex A) 145a

Scope of business area This business area is responsible for ensuring maximum use of the CCG commissioned estate across Lambeth.

Objectives of business area

The purpose of the Estates enabling work stream is to make sure that we are getting value for money from the estate

we commission and that this estate supports the delivery of effective and high quality new models of healthcare

provision.

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To Review the potential use of Section 106 Funds already received and create a plan for allocation

Completion of a Norwood review

Completion of a North Lambeth Feasibility Review

Feasibility on the Akerman Health Centre

Secure funding for additional capacity for the Nine Elms Vauxhall Programme

Strategic review on the utilisation of accommodation in each locality

Actively participate in the SEL Estates Enabler Workstream of the Sustainability and Transformation Plan (STP) and ensure that outputs of productivity workstream from pan SEL providers (SLAM, GSTT, KCH) are built into Lambeth Local Estates Planning

Secure Section 106/CIL Funding for the development of Estate within Lambeth

Communicate the Improvement Grant process to all practices


Submission of the Estates Technology and Transformation applications

Implementation of the Lambeth Estates Strategy

Norwood Review Workshop


ETTF applications submitted but the outcome has been delayed until October 2016

Nine Elms residents arrive in advance of accommodation being funded and ready for occupation in Wandsworth will impact in Lambeth

Ensuring all practices are aware of Improvement Grant opportunities for 17/18

Key risks 2016-17:

North Lambeth Feasibility is required before the outcome of the ETTF process is known

Nine Elms residents arrive in advance of accommodation being funded and ready for occupation in Wandsworth will impact in Lambeth

Secure Section 106/CIL Funding for the development of Estate within Lambeth

Estates

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5.8.6 Workforce


Clinical Lead Dr. Adrian McLachlan

Programme Lead Fiona Stirling , HR Business Partner, South London CSU

IAF Indicators (Annex A) 128d, 163a, 163b, 164a

Scope of business area To purpose of this business area is to ensure the provision of an effective

Human Resource service to staff and managers across the organisation.

Objectives of business

area

The objectives of this business area are to ensure that managers and staff

across the CCG have access to up to date advice and support on all

matters relating to the recruitment, management and development of staff

within the CCG.

Our Human Resources services are provided by South Commissioning Support Unit and we have a

named Business Partner, Fiona Stirling, providing support to managers and staff within the CCG. Since

March 2015 payroll and pensions services is been provided by SECSU in-house team.

June 2016

Our workforce profile is as follows:

As at 30 June 2016 the CCG has a headcount of 77 and a FTE of 67.84. Over the past 12 months staffing levels have slightly increased month on month. There is a total increased headcount of 14 from 1 July 2015 to 30 June 2016.

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Staff turnover

The overview of the last 12 months is inconsistent and increases and decreases each month with a peak in August / September 2015. Generally speaking the CCG has a higher turnover rate than the national average (which may be attributable to the London factor) although the position has improved from April 2016 where the CCG has a lower rate than the national CCG average rate of 2.14% (this is the latest data that can be retrieved from Iview).

Starters - Rolling 12 Months (Headcount & FTE)

There has been 4 starters in June 2016, and 25 starters in total through-out the preceding 12 months.

Leavers - Rolling 12 Months (Headcount & FTE)

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There has been 11 leavers in total over the preceding 12 months. Each month has been consistent with 1 or 2 employee's leaving each month with a peak in July, August and September 2015.

Sickness Absence

Sickness absence figures are currently available as at 31 May 2016. The sickness absence percentage rate for Lambeth CCG has increased from 2.44% in April to 3.46% in May. The target is 2.50%. The national CCG average for March 2016 was 2.92%, which is the latest data that can be retrieved from Iview. Cases are being managed in accordance with the Lambeth CCG Promoting Attendance at Work Policy with appropriate support through HR and Occupational Health.

Employee Relations cases

There are nil employee relations cases progressing to a formal hearing stage.

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6 QUALITY ASSURANCE

6.1 PALS and Complaints NHS Lambeth CCG received a total of 25 PALS enquiries and 9 complaints from April to June 2016. PALS There were 25 new PALS in this quarter. This exceeds the figures for new PALS received in the same quarter of 2015/16. Of the new PALS cases recorded, 16 were for the CCG to provide a response to and nine were for other providers to action. On the whole, compared to the same period in 2015/16, there has been a 20% increase in the number of PALS cases recorded in 2016/17. Please note that the overall figure for PALS cases in this quarter also include MP related PALS cases.

Complaints There were 9 new complaints in this quarter. This is almost the same number of new complaints received in the same quarter of 2015/16. Of the new complaints received four were for the CCG to respond to and five were for other providers to provide a response to. Overall, so far in 2016/17, there has been an 11% increase in complaints compared to 2015/16.

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Number of Open Complaints and PALS cases There are currently 5 cases that remain open – 1 PALS and 1 MP PALS case received on 7 and 13 June 2016 respectively. There are also 3 complaint cases which remain open. One was received on 25 April, and the other 2 on 17 May and 29 June 2016. The other 23 PALS cases and 6 complaint cases received between April to June 2016 have all been dealt with and closed.

Number of MP Cases There were ten MP PALS cases recorded between April to June 2016. There were no specific themes or trends of note.

Number of Public Health Services Ombudsman Decisions There are no complaints with the PHSO at present.

Complaints responded to within 25 working days The target for providing a response to a CCG related complaint is 25 working days. From the data held, South East CSU can report that all CCG related complaints recorded for the quarter were closed inside the 25 working day timescale. Of the CCG related complaints received in the quarter, all responses were sent to the CCG for approval and signing within the 25 day KPI target.

Themes There are no common themes for direct CCG complaint and PALS cases that were received between April to June 2016 Complaints Risk Grading (only complaints are risk graded) Formal complaints are graded accordingly on receipt by South East CSU using the Risk Grading Matrix below. Grading is based on the actual consequences and also the potential for future complaints on a similar issue. Grading of Complaints provides the potential to flag serious risks to the CCG. Where a complaint is graded at 15 or above, the Complaints team will alert the CCG.

Any complaints listed as ungraded are complaints that are not dealt with by South East CSU Complaints team, but by other organisations in the area i.e. GP complaints referred to NHS England or hospital complaints.

Risk Grading Matrix used in Grading Complaints

Cases of Special Interest: It is accepted that all complaints cases are of special interest to the complainant and the CCG; and SECSU maintains an interest in all cases and outcomes that can improve patient experience. There are some cases which are of specific and special interest due to the complexity and nature of the complaint.

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There may also be a special interest in themes from complaints. Between April to June 2016, there were

no cases of special interest recorded.

6.2 Serious Incidents

NHS England published a revised Serious Incident (SI) Framework in March 2015.

Serious Incidents are defined as:

Acts and/or omissions resulting in unexpected or avoidable death of one or more people;

includes suicide/self-inflicted death and homicide by a person in receipt of mental health

care within the recent past;

Unexpected or avoidable injury to one or more people that has resulted in serious harm;

Unexpected or avoidable injury to one or more people that requires further treatment by a

healthcare professional in order to prevent the death of the service user or serious harm;

Actual or alleged abuse where healthcare did not take appropriate action/intervention to

safeguard against such abuse occurring or where abuse occurred during the provision of

NHS-funded care.

A Never Event

An incident (or series of incidents) that prevents, or threatens to prevent, an

organisation’s ability to continue to deliver an acceptable quality of healthcare services,

including (but not limited to) failures in the security, integrity, accuracy or availability of

information; Property damage; Security breach/concern; Incidents in population-wide

healthcare activities like screening and immunisation programmes; Inappropriate

enforcement/care under the Mental Health Act (1983) and the Mental Capacity Act (2005)

including Deprivation of Liberty Safeguards (MCA DOLS); Systematic failure to provide an

acceptable standard of safe care or Activation of Major Incident Plan

Major loss of confidence in the service, including prolonged adverse media coverage or

public concern about the quality of healthcare or an organisation.

Incidents Requiring Investigation

In Quarter 1 2016/17 a total of 40 Serious Incidents were reported to the CCG via STEIS.

It is possible that SI’s reported during this period may be de-escalated at a later date if found not

to meet the criteria following further investigation.

Forty incidents required an investigation, as noted by provider in the following table.

Table 1: Q1 2016/17 Serious Incidents requiring investigation reported by provider

Provider Apr-16 May-16 Jun-16

GSTFT 7 15 7

KCH 3 1 0

SLaM 2 2 3

GSTFT reported serious incident numbers are larger than KCH and SLaM as they include all

incidents. KCH SIs are only for Lambeth residents. Of the 7 incidents reported by SLaM, one

concerns a non-Lambeth patients receiving services in Lambeth, where NHS Lambeth CCG

retains oversight of the SI.

Table 2: Serious Incident categories by Provider for SI’s requiring investigation, Quarter 1 2016/17

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Of the incidents reported by GSTFT, all 29 required investigation.

The Serious Incident Framework requires that serious incident investigation reports are submitted to the

CCG within 60 working days of the incident reported on STEIS. Overall, 55% of reports from GSTFT and

9% from SLaM due for submission within the quarter were submitted on time.

The Serious Incident Framework allows the CCG twenty calendar days to evaluate a submitted serious incident investigation report. NHS Lambeth CCG evaluated 72.9% of submitted SI reports within the stated timeframe.

6.3 Never Events

NHS England published a revised Never Events Policy and Framework along with the revised Serious

Incident Framework in March 2015.

The definition of a Never Event has also revised:

They are wholly preventable, where guidance or safety recommendations that provide strong

systemic protective barriers are available at a national level, and should have been implemented

by all healthcare providers

Each type has potential to cause serious patient harm or death (but may not).

Evidence that never event type has occurred in the past and risk of recurrence remains.

Occurrence of the Never Event is easily recognised and clearly defined.

There were three never events reported to the CCG via STEIS in Quarter 1 by GSTFT. These included one wrong site surgery, one wrong implant and one wrong route administration of medication. A robust action plan is in place in the Trust regarding the management of never events and is monitored via CQRG. All serious incident issues are followed up at on-going provider Serious Incident Monitoring meetings for each provider, this includes reviewing the progress of overdue investigation reports. These meetings are chaired by the CCG Clinical Quality Lead. Serious incidents are closed by the CCG through the Serious Incident Review Group, which is a sub-committee of the Integrated Governance Committee.

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6.4 Freedom of Information (FOI) The number of requests received by the CCG is similar to the number of requests received by other CCGs South East CSU provide a Freedom of Information (FOI) service to, although at the higher end. The table below shows the number of requests received by month and by quarter for the financial year 2016/17. It also shows the number of requests received in 2015/16 for comparison. There has been a 7% increase in the total number of requests received for the year to date (YTD) when compared to the same point in 2015/16.

Performance Indicators Targets which are given within the Freedom of Information Act: The FOIA states that applicants should be given a response within 20 working days. Good practice guidance suggests that at least an 85% response rate should be achieved. The table below shows the CCG’s performance for this quarter. Figures for 2015/16 have been provided for comparison.

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The CCG achieved a 96% response rate for the quarter. This is a good achievement and exceeds the current good practice guidance suggested by the ICO. South East CSU’s FOI Team continues to work hard with CCGs staff to ensure the number of occasions which the CCG are unable to respond within the 20 workings days is kept to a minimum.

Governance and Performance Report - Lambeth · 2016-09-21 · 4x5=20 5 Almost Certain 1x5=5 2x5=10...

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