Governance and Performance Report - Lambeth CCG · 2017. 1. 10. · January 2017 Our Mission: ......

INTEGRATED GOVERNANCE AND

PERFORMANCE REPORT

NHS Lambeth Clinical Commissioning

January 2017

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 ................................................ 8

2.2.1 Programme Assurance Statements – 2016/17 latest summary position ...................... 8

2.3 QUALITY ASSURANCE ................................................................................... 9

3 CCG ASSURANCE ......................................................................................... 20

3.1 NHS Lambeth CCG Assurance 2016/17 ....................................................... 20

4 COMPONENTS OF THE CCG ASSURANCE FRAMEWORK ........................ 21

4.1 Leadership ...................................................................................................... 21

4.1.1 Board Assurance Framework .................................................................................... 21

4.2 Delegated Functions ...................................................................................... 28

4.3 Financial Management ................................................................................... 28

4.3.1 Financial Position ...................................................................................................... 28

4.3.2 QIPP Performance .................................................................................................... 32

4.4 Performance Dashboards ............................................................................. 32

4.4.1 NHS England National Constitution Standards ......................................................... 32

4.4.2 RTT (Referral to Treatment Times for Lambeth Patients) ......................................... 35

4.4.3 Diagnostics (Lambeth Patients) ................................................................................ 37

4.4.4 A & E Waiting Times ................................................................................................. 38

4.4.5 Cancer Waiting Times ............................................................................................... 39

4.4.6 Ambulance Response Times .................................................................................... 41

4.4.7 Improved Access to Psychological Therapies (IAPT) ................................................ 41

4.4.8 New Early Intervention In Psychosis 2 Week Standard ............................................. 41

4.4.9 Dementia Diagnosis Rate ......................................................................................... 42

4.5 Quality Premium 2016/17 ............................................................................... 43

4.6 Quality Alerts .................................................................................................. 45

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

4.8 Mixed Sex Accommodation........................................................................... 49

5 STRATEGIC AND OPERATIONAL DELIVERY – OUR PROGRAMMES ...... 50

5.1 Integrated Children and Young People (including Maternity) Programme 50

5.1.1 Programme’s Purpose .............................................................................................. 50

5.1.2 Programme Assurance Statement Quarter 2 2016/17 .............................................. 51

5.1.3 Children and Maternity Programme Board Dashboard .............................................. 54

5.2 Integrated Adults Programme (Elective, Urgent Care, Cancer) ................. 56

5.2.1 Programme Purpose ................................................................................................. 56

5.2.2 Programme Assurance Statement Quarter 2 2016/17 ............................................... 56

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

joint arrangements with Lambeth Council) ............................................................................ 61

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

5.2.5 Integrated Adults Programme Dashboard ................................................................. 72

5.3 Better Care Fund (BCF) ................................................................................. 64

5.4 Integrated Mental Health for Adults .............................................................. 73

5.4.1 Programme Assurance Statement as at Quarter 2 .................................................... 73

5.4.2 Mental Health Whole System Dashboard .................................................................. 74

5.5 Learning Disability ......................................................................................... 77

5.6 Staying Healthy (Led by London Borough of Lambeth) ............................. 79

5.6.1 Programme Assurance Statement ............................................................................ 82

5.6.2 Staying Healthy Dashboard ...................................................................................... 83

5.7 Primary Care Development ........................................................................... 91

5.7.1 Programme Assurance Statement ............................................................................ 91

5.7.2 Primary Care Programme Dashboard ....................................................................... 94

5.8 Enabler Programmes ..................................................................................... 95

5.8.1 Governance and Development Risk Register............................................................ 95

5.8.2 Equalities and Engagement ...................................................................................... 98

5.8.3 Organisational Development ................................................................................... 103

5.8.4 IM&T ....................................................................................................................... 105

5.8.5 Estates.................................................................................................................... 109

5.8.6 Workforce ............................................................................................................... 111

6 QUALITY ASSURANCE ................................................................................ 114

6.1 PALS and Complaints .................................................................................. 114

6.2 Serious Incidents ......................................................................................... 117

6.3 Never Events ................................................................................................ 118

6.4 Freedom of Information (FOI) ...................................................................... 119

Acronyms

AMH Adult Mental Health SLaM South London and Maudsley 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 IP Inpatient

PRUH Princess Royal University Hospital,

Bromley

SCR Serious Case Review

IMR Infant Mortality Rate

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1 INTRODUCTION

NHS Lambeth Clinical Commissioning Group (CCG) comprises 46 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

Clinical Priorities 2016/17 baseline assessment

Baseline assessment ratings for 2016/17 have been formally published for all 6 Clinical Priority areas. Detailed information can be found on the My NHS website via the link above. NHS Lambeth CCG is performing well in four out of six of the clinical priorities with overall assessment rating details by Clinical Area below.

Clinical Priority 2016/17 Baseline Assessment

Dementia Top Performing

Diabetes Performing Well

Learning Disabilities Needs Improvement

Cancer Needs Improvement

Mental Health Performing Well

Maternity Performing Well

The CCG continues to ensure that the performance of each of these priorities is embedded in its reporting through the relevant Programme Boards, continuing to build on the areas where the CCG is performing well and making progress against plans where further work is required.

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 1 5x4=20 2N RTT Performance

3 4x4=16 2C A&E Performance

4x4=16 2M Community Nursing Vacancy Level

4x4=16 7A Financial Planning Risk

1 3x5=15 1A Safeguarding children

11 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 4NCBC SEL Strategy - inadequate workforce capacity

3x4=12 6K CSU procurement process risk

3x4=12 7B QIPP delivery risk

3x4=12 8B End of Lower March lease

3x4=12 8D Premises needs at Clapham Park

1 4x3=12 5DPCC Minor Ailments Scheme

1x3=3 1x4=4

Risks scoring 12 and above

1x5=5

2x5=10

3 Possible

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

2 Unlikely

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

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

4 5

11191

2 31

1

1

11

5

2.1.3 Financial Duties (Domain 3)

Financial performance to Month 8 is summarised below.

Performance Area Commentary

Month 8

Position

Revenue Surplus

Lambeth CCG is reporting a surplus of £5.168m for the first eight

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 30th November 2016). Lambeth CCG's cash

balance at bank at the end of November was £1.16m. 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

99.42% of NHS invoices based on numbers and 99.76% by value.

Performance for the first eight months for Non NHS invoices is

95.2% on numbers and 94.45% by value.

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

an underspend of £97k against its running costs budgets.

Key Financial Performance Duties

6

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)

Many objectives on track but some risks


Integrated Mental Health for Adults Some objectives on track but some risks


Staying Healthy Objectives on track

Primary Care Development Objectives on track

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2.3 QUALITY ASSURANCE

Indicator Source Units Target Reporting Sep-15 Q1 Apr May June Q2 Jul Aug Sep Q3 Oct Nov Dec Q4 Jan Feb March 16/17

Yearly

rating

Incidents resulting in severe harm (STEIS) Integrated Quality & Performance Report Number not spec Monthly 5 1 3 2 3 3

Incidents resulting in moderate harm (STEIS) Integrated Quality & Performance Report Number not spec Monthly 1 0 3 0 2 4

Patient falls with moderate or severe harm Integrated Quality & Performance Report Number not spec Monthly 3 2 2 2 2 5

Pressure ulcer acquisitions (grade 2 and above) Integrated Quality & Performance Report Number <5 Monthly 2 11 4 2 2 5

Admissions with pressure ulcers (grade 2 and above) Integrated Quality & Performance Report Cases not spec Monthly 43 30 46 49 41 35

Never Events declared (number) Integrated Quality & Performance Report Number 0 Monthly 0 1 2 0 1 1

Summary Hospital -level Mortality Indicator (SHMI) Integrated Quality & Performance Report Ratio <90 Monthly 79 74.5 74.5 74.5 74.5 76

C-Difficile acquisitions (Trust attributed)(number) * Integrated Quality & Performance Report Cases 51 Monthly 7 9 2 2 4 3

MRSA - number of cases (Trust -attributable) Integrated Quality & Performance Report Number 0 Monthly 0 0 0 0 0 0

Staff Vacancy % rate Integrated Quality & Performance Report Percentage <10% Monthly 11.9 10.7 11.3 11.2 12.3 12.5

Mandatory % training compliance Integrated Quality & Performance Report Percentage >95% Monthly 86.9 85.5 85.3 85.2 84.9 84.9

Staff FFT - recommended as a place to work (%) NHS England website Percentage >70% Quarterly 76 78

Staff FFT - recommended for care or treatment(%) NHS England website Percentage >80% Quarterly 92 94

Staff FFT - Response rate ** NHS England website Percentage not spec Quarterly 10.9 8.73

FFT- Inpatient (Response Rate) NHS England website Percentage >=33% Monthly 29.6 26 26.1 25.7 25.7 25.2 25.8

FFT- Inpatient (% Recommended) NHS England website Percentage >=97 Monthly 95 96 97 97 96 97 97

FFT- A&E (Response Rate) NHS England website Percentage >=18% Monthly 17.8 12.3 13.8 16.2 17.9 14.8 13.7

FFT - A&E(% Recommended) NHS England website Percentage >=88 Monthly 84 83 85 87 84 86 84

Complaints opened in Month (number) Integrated Quality & Performance Report Number not spec Monthly 114 121 80 102 93 83

Time taken to respond to complaints (median wait in days) Integrated Quality & Performance Report Number not spec Monthly 49 53 58 50 65 61

Maternity: % women booked 12 weeks 6 days Trust Obstetric dashboard Percentage >90% Monthly 84.5 86.9 87 88.3 88 85.8 84.2

Maternity: % C- Section total rate Trust Obstetric dashboard Percentage <27% Monthly 30.6 29.1 32.4 31.7 27.6 32.9 35.9

Maternity: Birth per midwife (annualised) Trust Obstetric dashboard Ratio <28 Monthly 28.94 26.59 27.06 28.22 28.89 26.92 27.87

Safeguarding % Adults Level 2 Trust Percentage 80% Monthly 90.41 90.45 90.35 68.11 71.56 73.47 73.4

Safeguarding % Children Level 2 Trust Percentage 80% Monthly 87.81 82.83 82.63 83.50 83.55 84.19 85.64

Safeguarding % Children Level 3 Trust Percentage 80% Monthly 86.74 81.42 82.65 83.36 82.02 81.27 82.53

QUALITY INDICATORS - GSTT SPECIFIC

Safe Staffing - ratio of actual to planned hours Integrated Quality & Performance Report Percentage not spec Monthly 99.6 98.9 99.7 99.6 99.6 100.7

Measure of harm free care -NHS ST Integrated Quality & Performance Report Percentage >95% Monthly 96.9 96.1 95.7 96.1 0 no data

above target

** calculated by CSU in line with the target

QUALITY INDICATORS - ALL TRUSTS

* CSU suggested trajectory target for 16/17 based on 51 contractual requirement Q1=13, Q2=13, Q3=13, Q4=13

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Guy’s & St Thomas’ Hospital (GSTT) – Month 6 – September 16/17 dashboard data commentary Please note that the majority of M6 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. Patient Experience The Trust has continued to achieve internal targets in the percentage of patients recommending the Trust in the In Patient Friends and Family Test (IP FFT). The Trust is at 97%, which is higher than the London average (95%), in September. The Trust % of patients recommending the IP FFT is similar to performance in Q1 16/17 (97%). It should be noted that the response rate has dropped when compared to Q1 16/17 and remains below internal target of >33%, however higher than national average of 24.9%, with 25.8% reported in September. The percentage of patients recommending A&E services as measured through the A&E Friends and Family Test (A&E FFT) has not met the internal target of >88% during Q2 16/17 and is similar to performance in Q1 16/17. In September 84% of patients recommended A&E, which is the same as London average (84%). The response rate slightly decreased at the end of Q2 16/17 and is below the London average of 14.4%, with 13.7% reported in September 2016. The overall Q2 response rate for the A&E FFT is higher in Q2 16/17 compared to the previous quarter. Please note that Quarter 2 2016-17 Staff FFT data is not available on the NHSE website until the 24

th of November 2016.

Safety The Trust continues to achieve targets Safeguarding Children Level 2 and Level 3 training targets in Q2 16/17 with > 80% each month. In September 16/17 the Trust did not meet the target of 80% of staff trained in Level 2 Adult training, with only 73% compliance. The Trust explained that this is due to a change in the way the data is being reported. The Trust has committed to meeting th3e >80% target by the end of December. Effective and Well –Led There has been deterioration in the percentage of women booked before 12 weeks plus 6 days at GSTT in Quarter 2, with fewer women booked each month. In September 84.2% of women were booked within 12 weeks plus. Maternity C-section rates continue to be outside of <27% target during the Q2 16/17 with 35.9% reported in September. The number of births per midwife is in line with the Trust internal target of <28 during Q2 16/17, with 27 midwifes per birth reported in September.

The information provided in this section is a summary of discussions in the September CQRG meeting. This meeting is attended by senior Trust representatives, including the Medical and Nursing Directors, Clinical Commissioners and Directors of Quality from Lambeth and Southwark Clinical Commissioning Groups (CCGs). A progress update on the Fit Notes issue came to September meeting. The Trust noted that there had been a number of discussions with KCH colleagues about how to embed the correct ‘Fit Notes’ process at both trusts (in line with recent national guidance). Commissioners asked the Trust to produce a firm plan with clear milestones by the end of November and to provide assurance that the plan will be implemented by 1st April 2017. An update was provided on the Medchart Serious Incident Root Case Analysis (RCA) investigation, which has now been submitted to the Commissioners and it was noted that the Carenotes SI RCA will be submitted by 30

th September. The Trust updated that the work supporting the resolution of these issues is still

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ongoing; these incidents were in large part responsible for triggering the wider review of clinical IT systems across the trust. There has also been an IT review by an external consultancy and their report will be presented to the Executive Directors and Non-Executive Directors within the next month. Trust reps noted that this is a clinical systems review that will look at all Trust IT systems. The CQRG requested that this be shared when available. Commissioners noted the poor community IT infrastructure support provided to the Trust by the CSU (relating to Carenotes), however it was noted that a plan is being put into place to try to resolve this. An update was provided on complaints. The Trust reported that the number of ‘open’ complaints have been steadily reducing and the ‘lessons learnt’ from complaints are being applied. There are plans to address learning outcomes across the Trust. Further information was requested by commissioners regarding the patient perspective of care. The main agenda item focussed on the quality of Safeguarding Services for Adults and Children. The Trust reported that Safeguarding Adults training compliance is currently at 73% and it is expected to be on target (>80%) by the end of December. In regards to the Prevent Training, Level 1 training compliance is 55.6% and Level 2 compliance 26.4%, with a trajectory intention to achieve 80% by April 2017. An increase in numbers of referrals (n=85) for Deprivation of Liberty Safeguards (DoLS) was noted. The recent CQC inspection indicated that the Mental Capacity Act 2005 (MCA) was not fully embedded within the organisation. The Trust has addressed the issue and as a result 3 additional Clinical Nurse Specialist posts have been created within the team. Specifically, in regards to patients refusing treatment, the Trust flagged that health care professionals should collectively review the care plan and strategies should be identified when dealing with these patients. A patient refusing treatment cannot be seen as a ‘permission to disengage’ with the patient. In regards to the Children Safeguarding, the Trust continues to demonstrate strong safeguarding governance arrangements; since January 2016 the Trust has had a quarterly joint Adults and Children Safeguarding Committee to lead on all safeguarding activities. Trust reps flagged a number of child safeguarding work streams such as FGM, Child Sexual Exploitation, Domestic Violence. It was also noted that there is a review to see how Maternity Services and A&E can work together better to support the delivery of care. There has been a significant increase in admissions of children requiring mental health care. A working group has been established to review the care and resources needed. Other key points to note from the meeting;

The Trust presented an update on Children Services IQPR and noted that overall there is an increase in the number of paediatric referrals YTD (in line with overall referrals).

In regards to RTT, there has been 17% growth YTD in both GP and tertiary referrals compared to the same period last year, which has driven poorer RTT performance.

The Q1 2016/17 CAS Report was shared prior to the meeting and the Group noted 2 outstanding CAS alerts, which have been escalated.

In terms of the RTT 52 week breaches, there has been a slightly increased amount of 52 week breaches related mainly to patient choice; on-going work to improve capacity is taking place.

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Quality | King’s (Denmark Hill) Local Dashboard

1. Denmark Hill site

Source Units Target Reporting Sep-15 Q1 Apr May June Q2 Jul Aug Sep Q3 Oct Nov Dec Q4 Jan Feb March 16/17

Yearly

rating

Red Adverse Incidents (inc medication errors) number KCH Scorecard Number 0 Monthly 9 8 9 3 7 0 9

Falls (moderate) KCH Regulatory team Number <3 Monthly 3 2 2 3 3 0 0

Falls (major) KCH Regulatory team Number not spec Monthly 2 0 1 2 2 0 0

All hospital acquired pressure ulcers KCH Regulatory team Number 10 Monthly 26 23 25 20 22 13 19

Grade 2 pressure ulcers KCH Regulatory team Number 0 Monthly 26 23 23 18 18 13 17



Never Events declared (number) KCH Scorecard Number 0 Monthly 0 0 0 0 0 0 0

SHMI (National External) KCH Scorecard Index 100 Monthly no data 83 82 84 85 88 86

C- Difficile (cases YTD) * KCH Scorecard Cases-

cumulative53 Monthly 29 4 9 12 17 19 27

MRSA-number of cases (cases-YTD) KCH Scorecard Cases -


Vacancy rate KCH Performance Report Percentage 5-8% Monthly 9.8 10.6 10.7 11.7 11.9 11.5 11.3

Statutory & Mandatory Training KCH Performance Report Percentage 80 Monthly 77 80 82 82 80 76 74

Staff FFT - recommended as a place to work (%) Trust wide NHS England website Percentage not spec Quarterly 64 42

Staff FFT - recommended for care or treatment(%) Trust wide NHS England website Percentage not spec Quarterly 85 68

Staff FFT - Response rate Trust wide ** NHS England website Percentage not spec Quarterly 1.9 1.25

FFT- Inpatient & day case (Response Rate) NHS England website Percentage 30 Monthly 12.9 13.4 14.0 15.4 14 12.3 11.8

FFT- Inpatient & day case (% Recommended) NHS England website Percentage 93 Monthly 95 96 93 95 95 92 93

FFT- A&E (Response Rate) NHS England website Percentage 10 Monthly 14.9 8.2 3.0 8.6 9.5 11.8 5.9

FFT- A&E (% Recommended) NHS England website Percentage 89 Monthly 83 81 80 74 75 79 78

Number of complaints KCH Performance Report Number 45 Monthly 57 52 47 64 85 73 55

Complaints response >25 working days KCH Performance Report Number 0 Monthly 39 19 14 32 38 48 53

Maternity: % women booked 12 weeks 6 days (CCG adj. figure) Obstetrics Scorecard Percentage 90% Monthly 71.5 80.4 84.1 82.9 83.9 84 83.8

Maternity: % caesarean section rate Obstetrics Scorecard Percentage <26 Monthly 28.2 24.2 25.2 28.5 25.8 25.1 27.3

Maternity: midwife /birth ratio Obstetrics Scorecard Ratio 1:30 Monthly 1.33 1.3 1.26 1.24 1.24 1.24 1.26

Safeguarding % Adults Level 2-5 KCH Regulatory team Percentage 80% Monthly 67.1 68.9 70.3 70.3 67.8 65.3 71.4

Safeguarding % Children Level 2 KCH Regulatory team Percentage 80% Monthly 77.3 68.8 69.1 68.3 66.5 57.3 64.6

Safeguarding % Children Level 3 KCH Regulatory team Percentage 80% Monthly 76 78.5 79 79.5 79.9 75.3 75.6

Outliers KCH Scorecard Beds 0 Monthly 12.5 37.7 32.8 35.6 34.3 41.7 41.7

Deteriorating Patient Incidents KCH Performance Report Number 9 Monthly 1 5 1 2 2 1 2

Red Shifts KCH Scorecard Number 0 Monthly 101 142 93 90 131 110 129

above target

** calculated by CSU in line with the target

* Based on Trust IC Surveillance report :target 16/17 DH=53 Q1=14, Q2 =13, Q3=13, Q4=13


QUALITY INDICATORS - KCH SPECIFIC (DH PERFORMANCE)

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Quality | King’s (PRUH) Local Dashboard

2.PRUH site

Source Units Target Reporting Sep-15 Q1 Apr May June Q2 Jul Aug Sep Q3 Oct Nov Dec Q4 Jan Feb March 16/17

Yearly

rating

Red Adverse Incidents (inc medication errors) number KCH Scorecard Number 0 Monthly 16 12 6 6 2 2 2

Falls (moderate) KCH Regulatory team Number <3 Monthly 0 0 1 1 0 1 2

Falls (major) KCH Regulatory team Number not spec Monthly 1 0 1 3 1 3 0

All hospital acquired pressure ulcers KCH Regulatory team Number 10 Monthly 7 2 4 9 8 5 6




Never Events declared (number) KCH Scorecard Number 0 Monthly 1 (QM) 1 0 1 0 0 0

SHMI (National External) KCH Scorecard Ratio 100 Monthly no data 89 88 91 92 92 93

C- Difficile (cases YTD) ** KCH Scorecard Cases-

Cumulative19 Monthly 18 1 1 2 4 8 9

MRSA-number of cases (cases-YTD) KCH Scorecard Cases -


Vacancy rate KCH Performance Report Percentage 5-8% Monthly 16.1 17.3 16.5 14.6 16.2 15.4 14.7

Statutory & Mandatory Training KCH Performance Report Percentage not spec Monthly no data 83 84 84 84 78 74

Staff FFT - recommended as a place to work (%) Trust wide NHS England website Percentage not spec Quarterly 64 42

Staff FFT - recommended for care or treatment(%) Trust wide NHS England website Percentage not spec Quarterly 85 68

Staff FFT - Response rate Trust wide*** NHS England website Percentage not spec Quarterly 1.9 1.25

FFT- Inpatient & day case (Response Rate) NHS England website Percentage 30 Monthly 13.9 11 7.7 11.3 13.3 9.3 11.8

FFT- Inpatient & day case (% Recommended) NHS England website Percentage 93 Monthly 94 96 95 96 95 96 95

FFT- A&E (Response Rate) NHS England website Percentage 10 Monthly 22 13.4 3.2 13.9 14.6 16.5 8.2

FFT- A&E (% Recommended) NHS England website Percentage 89 Monthly 80 81 77 80 82 85 82

Number of complaints KCH Performance Report Number 45 Monthly 28 26 26 36 32 37 40

Complaints response >25 working days KCH Performance Report Number 0 Monthly 25 14 12 7 17 19 25

Maternity: % women booked 12 weeks 6 days (CCG adj. figure) Obstetrics Scorecard Percentage 90% Monthly 92.3 89.7 92.2 90 88.6 90.5 93.5

Maternity: % caesarean section rate Obstetrics Scorecard Percentage <27 Monthly 25.4 23.7 25.1 20 24.6 25.7 24.6

Maternity: midwife /birth ratio Obstetrics Scorecard Ratio 1:30 Monthly 1.34 1.30 1.30 1.30 1.30 1.30 1.30

Safeguarding % Adults Level 2-5 KCH Regulatory team Percentage 80% Monthly 67.9 73.5 74.9 75.6 74.8 72.8 75.1

Safeguarding % Children Level 2 KCH Regulatory team Percentage 80% Monthly 84.1 80 80 78.7 76.9 72.2 76.5

Safeguarding % Children Level 3 KCH Regulatory team Percentage 80% Monthly 84 85.3 85.4 88.4 90.5 89.4 86.3

Outliers KCH Scorecard Beds 0 Monthly 23 63.5 59.9 52.1 57.1 54.7 60.8

Deteriorating Patient Incidents KCH Performance Report Number not spec Monthly 3 16 10 1 1 2 0

Red Shifts KCH Scorecard Number 0 Monthly 21 41 32 30 41 34 41

* Queen Mary's Hospital Sidcup (QMH) above target

in line with the target

***calculated by CSU

** Based on Trust IC Surveillance report :target 16/17 PRUH=19 Q1=4, Q2 =5, Q3=5, Q4=5

QUALITY INDICATORS - KCH SPECIFIC (PRUH PERFORMANCE)


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Kings College Hospital (KCH) – Month 6 - September 16/17 CQRG & data commentary Patient Experience Overall there has been an increase in the number of complaints reported in Q2 when compared to the previous quarter, from 251 to 322 respectively across both sites. The data show that there were fewer complaints at Princess Royal University Hospital (PRUH) site (109) compared with Denmark Hill (DH) site (213) in Q2. At DH there were 213 complaints reported in 2 compared to 163 in Q1 16/17. The number of complaints reported each month during Q2 was above the internal target of 45, culminating in 55 complaints reported in September 2016. The number of complaints still open or not responded to within 25 working days at DH is currently at 53 cases, which is the highest number since beginning of the year. At PRUH the number of complaints reported also increased from 88 in Q1 to 109 complaints reported in Q2 16/17. However, the number of complaints reported each month during Q2 remained in target each month, with 40 complaints reported in September 2016 (target 45). The number of complaints still open or not responded to within 25 working days at PRUH is currently at 25 cases, up from 17 at the start of the quarter 2.The Trust continues to achieve internal targets in the % of patients recommending the Trust for the Inpatient (IP) Friends and Family Test (FFT) with monthly scores during Q2 of at least 92% across both sites in Q2 16/17. The percentage of patients recommending IP FFT is below London average (95%) at DH and in line with the London average at the PRUH in month 6; in September 93% at DH and 95% at the PRUH of patients would recommend IP services to their friends and family. The response rates in IP FFT at DH (11%) and at PRUH (11%) were below the internal Trust targets for each month in Q2, as well as the London average of 24.9% in September. In Q2 the Trust did not meet its internal target in the percentage of patients recommending A&E and also fell below the London average of 84% at both sites (78% DH and 82% PRUH) in September. However, the Trust % of patients recommending the A&E FFT in Q2 is higher when compared to Q1 16/17 (DH 74% and PRUH 80%). The Trust response rate to A&E FFT (DH 5.9% and PRUH 8.2%) is below the London average of 14.4% in September.

Safety No Never Events were reported at the DH and PRUH sites during Q2 16/17. Overall, there is an improvement on performance from Q1 16/17 when 2 Never Events were declared across the sites. Overall, there has been a decrease in the numbers of falls reported in quarter 2 across both sites. The number of falls resulting in moderate harm remains in line with internal targets across both sites. Trust wide there has been a decrease in the total number of moderate falls in Q2 16/17 (n=6) compared to 9 reported in the previous quarter. There have been 6 falls resulting in major harm in Q2 16/17 compared to 7 falls resulting in major harm in Q1 16/17. Across the Trust the number of all hospital acquired pressure ulcers has decreased in Q2 16/17 (n=73) compared to the previous quarter (n=83). In Q2 there were 54 cases reported on the DH site of which 6 were classified as Grade 3, which is a reduction from 68 cases reported in the previous quarter. There were 19 cases at the PRUH site and all were classified as Grade 2 with no Grade 3 reported. There is a noticeable difference in performance across sites, where performance at DH is consistently above the internal target of 10 for all pressure ulcers. There has been no Grade 4 pressure ulcers reported year to date. There was 1 MRSA case reported in September at DH (on Donne ward), therefore 3 MRSA cases have been attributed to the Trust year to-date and all have been at DH. No MRSA cases have been reported at PRUH. 36 cases of C-Difficile (CDI) were reported across both sites cumulatively YTD at the end of Q2. There were 9 new CDI cases reported in September, of which 8 were at DH and 1 at PRUH. 36 cases YTD is equal to the cumulative trajectory of 36 cases for September YTD position and in an improved situation when compared with the same time in 15/16 (n=47). The number of Red Shifts reported in Q2 has increased from 428 in Q1 to 486 in Q2 16/17. There is a difference in performance across both sites with more Red Shifts reported at DH (n=370) compared to the numbers reported at PRUH (116). There has been an improvement in the number of Deteriorating Patient Incidences across both sites in September (n=2) compared to the previous month (n=3). Safeguarding training levels remain below target. At DH the 80% target has not been met in any months during Q2 16/17 for Children and Adult training. At PRUH Level 3 for Children’s training was achieved every month in Q2 16/17. Targets for Adults and Children Safeguarding Level 2 have not been met in Q2 2016/17.

15

Effective and Well-led The Trust target of <27% for caesarean section rates was achieved at PRUH during Q2 16/17. PRUH is currently reporting performance of 24.6% in September 2016, which is an improvement compared to the last year at this time (25.4% in September 2015). DH performance is slightly above target at 27% although noting the target was achieved in July (n=25.8%) and August (n=25.1%). There has been an improvement in the percentage of women booked 12 weeks plus 6 days at PRUH in Quarter 2, with the target exceeded in September (93.5%). At DH the number of women booked did not meet the target in any of the months in Q2 16/17 similar to Q1 16/17 performance. There has been a slight increase in the number of outliers reported in Q2 across both sites (n=290) compared to previous quarter (n=281). There is a difference in performance across both sites with more outliers reported at PRUH (n=172) compared to the number reported at DH (n=117) during Q2. The vacancy level at both sites continues to remain above the 5-8% internal target with the highest vacancy rate at PRUH in September (14.7%) although noting this is an improved position since the start of the quarter (16.2%). The vacancy levels at DH remain similar in Q2 16/17 (in September 11.3%) compared to the previous quarter (in June 11.7%). Statutory and mandatory training performance has deteriorated slightly since the middle of the Q2 across both sites and is below 80% in September (DH and PRUH -74%). The information provided in this section is a summary of discussions in the September CQRG meeting. This The meeting is attended by senior Trust representatives, including the Medical and Nursing Directors, Clinical Commissioners and Directors of Quality from Lambeth, Southwark and Bromley Clinical Commissioning Groups (CCGs). Please note that the September CQRG was shortened due to the clash with the Trust’s ‘Safer, Faster Hospital’ week. It has therefore been agreed to proceed with an hour-long CQRG with a specific focus on the main agenda item only. A CQC Action Plan Progress review was the main agenda item for discussion at the September CQRG. The Trust noted that KPMG auditors had been invited in April 2016 to conduct an audit of Trust progress against its CQC Action Plan. The auditors noted that there was some lack of consistency across wards and across different hospital sites, with the organisation not able to demonstrate full adherence to CQC standards. The CQC Action Plan has been refreshed and aligned with the actions from both the KPMG audit to form a ‘consolidated’ action plan. It was noted that all actions are being addressed through Executive-led work programmes and ownership of the overall position will be through the CQC Delivery Board. The Trust is prioritising organisation and safety on the wards, with a ‘back to basics’ audit and work programme being rolled out across the Trust, in seven tranches or ‘cycles’, underpinned by ward accreditation. In terms of the Requirement Notices and Must Do’s, all are being addressed. ICU space issues are being addressed through the ICU new build (albeit this new ICU capacity won’t be fully opened until 2018); maternity births on William Gillatt have reduced by 65% and the flooding, syringe drivers and concealment trolley issues have been resolved. In terms of Safer Surgery, there are ongoing audits and related actions (Safer Surgery Project Plans) in place to improve completion of the Safer Surgery Checklists for every surgical patient. There has also been a business case approved for the action related to dietician access in Critical Care. Furthermore, it was noted that for Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) training and assessment, Level 1 training is now very good and Level 2-5 performance now at 75%, with a 5% increase in training for doctors and dentists, which had been two of the worst performing staff groups.

16

Trust reps updated that the first ‘cycle’ of the Trust’s ‘Back to Basics’ nursing programme has now been completed. It was received relatively well within the wider nursing teams and is being delivered through weekly audits and related action plans. It covers 160 separate areas (including all wards and theatres). The Trust reported that around 66% of audits have been completed, which is seen as positive for cycle 1; the expectation is that this will improve through the remaining cycles. Challenges involve the complexity of organising the programme, lack of space and issues related to IT/ computers. However, progress is definitely being made. There have been a range of results from the cycle 1 audits completed – c.50% through to 100% compliance.

St Georges CQRG Commentary – September 2016 Heart Failure Service After an external review and audit it was proven that there was a high rate of readmissions linked to heart failure patients particularly those with co-morbidities. The proposal to provide integrated hospital services and specialist care in a dedicated area was agreed and the initial funding was via a CQUIN. Commissioners providing funding to open the HF unit. Since the unit opened the following reductions in Mortality and length of stay can be seen in the data below; Report for May – September 2016 incl (11 beds)

Inpatient mortality = 5.6% compared to 9.6% Nationally

30 day mortality post discharge = 0.5% (National average 5.4% in Cardiology, 6.8% in

medicine and 8.3% in other areas)

28 day readmission rate = 13% compared to 23% for St George’s in 2015/16

LOS on HFU 7 days, and on other wards 10.5 days

20% of patients are admitted directly via community via HF nurses, relieving A+E/AMU

pressures

An internal business case is being submitted to ensure service sustainability. Capacity is an

issue as currently there are only 11 beds and an average wait of 4-5 days for admissions to

the unit. It was noted that the reduced LOS enabled increased throughput and consequently

increased income for the service. On-going sustainability is a significant concern for the

service and the recent decision to apply a 10% headcount reduction as part of the wider

programme of efficiency has resulted in the LOS of 2 HCA posts in August 2016. It was stated

that the headcount reductions across the Trust would only apply to non-clinical staff and would

not apply to band 5s and below.

Commissioners advised St Georges that they should highlight the extremely positive results

that the service has achieved such as morbidity and length of stay reduction rates when it

comes to submitting their case for the unit. HCA reduction was queried and Commissioning

representatives requested assurance from the Trust that clinical staff in the service would not

be affected by the headcount reduction.

Trust Directors present at the meeting confirmed that there were to be no headcount reduction

against clinical posts.

Serious Incidents (SI) The review of the SI declaration process has been transferred into the trust quality improvement plan with feedback from the CQC review of the SI process to be fed into this. There are some elements of the plan that still have an amber or red risk rating such as

17

awaiting results for work from health and safety team, intranet page refresh, implementation of dashboard on Datix and backlog of incidents trajectory to be agreed. Duty of Candour training has been booked but currently amber as not complete yet.

The plan status is currently work in progress and this may need to be revisited if some of the actions are found to be not as effective as they should be. Commissioners feel that the issues during the trust processing SIs still exist and time to declaration is a concern. There needs clearer governance processes on decisions as to whether the incident is an SI. Trust advised that the recognition of what constitutes an SI is still problematic. The Trust reported that all are reported on Datix and all those that need declaring are filtered, there are some which are not so clear cut which might have a longer reporting period of up to 6 days whilst the status is determined Assurance is to be provided by the Trust that clinicians are able to use Datix and of the process and next steps when Datix identifies severe or permanent harm. Commissioners stressed the need to ensure that processes are completely embedded in the organisation.

Commissioners raised further concern regarding the time it has taken to resolve the SI issue which had been discussed and actions agreed a year ago, given the potential risks there was a need to ensure that this is resolved at pace. The Trust have advised that they were confident that they were compliant with national standards and had been advised as such by NHSI.

Cancer RCAs There is a meeting to be held around the contractual process for the performance notice relating to the Cancer 100 day RCAs on the 21st of October. RTT number and timescales currently unknown, next meeting to agree.

Infection Control

Naso Endoscopies Further review of the nasal endoscopy service following an audit to be reviewed at the next CQR in November.

Moorfields site visit There were concerns raised by Islington CCG during a site visit these included issues with estates, single sex wards and infection control issues in the ‘Dragon Centre’. Estates and Infection Control leads had undertaken another site visit in July, in the main this had been positive but there were some outstanding issues where recommendations had not been followed through , specifically 2 areas: Fire shutter, which the Fire Officer, has advised cannot be changed. New seating which has been ordered and the trust is awaiting delivery.

SLAM CQRG Commentary – September 2016 Safer Staffing for nursing workforce remains an issue and creates challenges for SLaM, there was a spike in breaches in April (22) resulting from vacancies and recruiting issues. The Trust is trying to make more effective use of E Rostering. There have been a number of unplanned absences and the Trust is working with NHSP (NHS Professionals) to improve support.

Patients in private beds utilisation of private beds had increased in the beginning of the year.

The Trust is managing this through bed management and is developing a quality dashboard for private providers. It is noted that the use of private beds presents a major financial risk. The Trust is aiming to get use down to near zero. The Trust has increased internal PICU capacity to try and mitigate against the financial risks. It is not clear why the need for private beds peaked in

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February but this seems to be a common factor across London and the country. There has also been a gradual increase in length of stay and there are thought to be wide ranging factors driving this. There were no worrying incidents or complaints arising out of using the private sector. Friends & Family Test there has been a dip in FFT performance and this was reported to be related to change of contractor so devices to capture the data were not available for a while. Since the change there has been a large increase in the response rates that should be noted in future reporting.

Lessons Learned Report Themes of incidents and lessons learned were discussed. These

included:

How the Trust works with patients with ADHD on acute settings and the use of a new “Green Light Toolkit” across the wards.

Issues around managing complex care needs and support to carers in cases of suspected suicide

Garden units need to be secure

Health and safety issues related to windows – a full audit of all windows across the Trust is underway and where needed windows will be replaced. This work will be finished by October.

Issues around carer’s work

how staff members communicate with carers

what information can be shared

how to share risk information

how to support family members after an incident or complaint.

There will be a Learning Lessons Event in October about this aimed at drawing out human skills.

It was noted that there is variance between the number of Serious Incidents graded A – C and those reported in one of the SIs The Trust described the work around benchmarking expected / unexpected deaths and how the Trust reviews whether there were care issues in unexpected deaths. A Mortality Review Group has been established to do this work. Nutrition Strategy The Trust has a Nutrition Screening Group. It was noted that the MUST nutrition screening tool was as not fully appropriate to mental health. The mental health population group experience more obesity than the general population. SLaM has developed an initial nutrition screening tool that are more suited to the client group – it captures specific dietary needs including cultural requirements as well as clinical – also about does the person need support to eat or be reminded to eat. There is a second screen looking at healthy weight / fluid intake. Finally the Trust looks at medicine prescribing and its effect on weight / weight management. The two screens are merged into one for the community teams. The Trust has a healthy eating menu suitable for patients with diabetes and other conditions and separate menu for kosher and halal meals. There are specialist menus for children, for those with eating disorders and for older adults.

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The Trust reported the results of audits that showed screening levels were good but care planning was poorer, in terms of the numbers of care plans created. – A cultural shift is needed so that staff see nutrition planning as part of the care process. Family and Carer’s Strategy Benchmark work has been completed across all the wards A Carer’s Survey has been completed. High levels of compliance reported - as shown by the CQUIN outcome The report shows that the main activity has been linked to the “Triangle of Care Principles” The Trust worked with carers in the Boroughs to develop more carer friendly communities. There are plans to work with young people to develop a bid for 18-25 year old carers “How can we support young carers to move into adulthood?” The Trust is working to improve the website for carers and involve them more in operational matters. Working with psychosis and art students to develop a film about caring – “driven by carers” The Trust is rolling out the “Think Family” approach across the 4 Boroughs. CQC Action Plan Update The Trust presented the Must Do Action Plan. Two actions are outstanding from the plan relating to ligature risk assessments and audits around recruitment and vacancy. Quality Improvement The Trust presented an overview of a Quality Improvement project being carried out with the Institute of Health Improvement. Work completed to date includes a Diagnostic Assessment Aims:

Improve the overall value of care

Engage with staff on quality improvement

Develop a single approach to Quality Improvement – using IHI

Use more data to improve practice

Standardise variations in care A Small Team has been set up to support improvement work

Developing tools

Choosing projects to start with

Will train a 100 staff in the programme to begin with

Looking at acute care pathway as a priority

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3 CCG ASSURANCE

3.1 NHS Lambeth CCG Assurance 2016/17 Due to the accelerated timetable for completing the contracting and planning round for 2017-19, there was no formal Quarter 2 assurance meeting, although a teleconference took place on the 9 September 2016. The next formal assurance meeting will take place on the 27 January 2017. The meeting will review latest performance against the Improvement and Assessment Framework indicators and a deep dive into the Diabetes Clinical Priority area.

21

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 Two risks have been added to the BAF:

o 8B ‘Risk of possible failure to plan for future premises needs when Lower Marsh Lease ends 2017’

o 8D ‘Risk of possible failure to plan for future premises needs at Clapham Park’

o One risk has been re-graded on the BAF:

o 4NCBC ‘Risk that inadequate workforce capacity/skills will affect the delivery of the SEL Strategy in providing new models of

integrated, high quality care’. This risk has been downgraded following review of the SEL Strategy risk register.

o Three risks have been removed from the BAF:

o 5CPCC ‘Financial risk as Lambeth are not able to cross-charge other CCGs WIC due to insufficient patient level data on non-Lambeth

patients’. This has been removed as the target score has been achieved and all actions completed/resolved.

o 4RCBC ‘Risk that a lack of integrated information systems will affect the delivery of the SEL Strategy in providing new models of

integrated care’. This risk has been downgraded to a score of eight following review of the SEL Strategy risk register.

o 6N ‘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’. This has been downgraded to a score of eight, as the new provider has now taken over and has access to the

servers, reducing the risk of data loss.

22

There are currently 17 risks rated 12 or above.

UPDATED Dec 2016

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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

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

out for comments. Report to the Governing Body and LA cabinet - Nov 2016.

SLaM looking to see how to reduce length of stay and understand more about those unknown to services - revised trajectory as part

of contract negotiations for 2017/18.

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

process for 2017/18. Detailed report taken to IGC re not meeting trajectory in month 6 and data quality issues.

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. One

scheme in operation; one going through procurement process.

2. IPSA Alliance Leadership Team has signed off an activity plan which will deliver the required service outcomes. A revised service

and financial activity plan considered at IPSA ALT. Plan forecasts delivery of savings by end of financial year. Positive progress on

outcome to enable people to move on to independent living.

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

framework is out for comments. Report going to the Governing Body in Nov 2016 and meeting in public in January 2017.

Director of

Integrated

Commissioning

Children

Avis Williams-

McKoy1A

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

Child J review completed and published.

New joint review of SCR in collaboration with Lambeth and Croydon Safeguarding Children's Board and NHS England, led by

Croydon - April 2017.

Implement subsequent SCR commissioning recommendations as required - action plan updated and being implemented.

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

performance indicators - LSCB dataset KPIs to be reported to the board quarterly.

Discussed safeguarding arrangements with regards to health visiting and school nurses.

Director of

Primary Care

Development

Christine

Caton/Claire

Hornick

8D

Risk of possible failure to

plan for future premises

needs at Clapham Park

4 12

Work with NHSE to secure capital funds for Phase 1 development, following unsuccessful ETTF bid.

Confirm funds secured for development of Business Case to presented to LCC for 14 February (completion by 23 January)

Submit BAU capital bid for Phase 2 development

Secure S106 Funding for Phase 2 development linked to Clapham Park Development

Work with NHSPS to agree lease for February 2017

Corporate Objective

1.2: Quality, Safety &

Effectiveness - To

improve the quality

and safety of local

services

Target

Risk

Score

and

Direction

of Travel

Principal Risk (Obstacle

to achievement of

Strategic Aim)

ASSURANCE FRAMEWORK 2016/17 – PROGRESS

Strategic AimExecutive

Lead

Operational

Lead

Corporate Objective


Effectiveness - To

improve health

outcomes, address

inequalities and

secure a parity of

esteem

Director of

Integrated

Commissioning

Adults

Risk

Register

Ref

2015 Monthly Progress 2016

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UPDATED Dec 2016

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Key Actions

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. Pilot started on 26/09/16 with 20 ipads for

District Nurses. Update 23/11/16 more IPADs are being rolled out to support the nurses.

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.

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.

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 - 24/11/2016

progress being made with recruiting to Community Matrons.

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.

24/11/2016 Go Live achieved in beginning of Nov and now expanding the team.

CCG: To continue to monitor improvement via CQRG and contract monitoring meetings. Update Nov 2016 and will be reviewed

again in January 2017.

Liz Clegg 2B

Zero Tolerance Risk -

Risk of failure to

safeguard adults and

identify and respond

appropriately to abuse8 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 GP practice 'stock take' - 30/11/2016

Formulate action plan on basis of stock take - 30112/2016

Recruit designated doctor for adult safeguarding - 31/12/2016

CCG Safeguarding Adults Policy (non-commissioning), including SG Supervision Policy - 30/11/2016

Ratify CCG Prevent Policy 31/12/2016

Agree dataset with providers that can form basis of all contracted service assurance - 31/12/2016


to achievement of

Strategic Aim)

Target

Risk

Score

and

Direction

of Travel


Operational

Lead

Risk

Register

Ref


Lead

Corporate Objective


Effectiveness - To

improve the quality

and safety of local

services

Director of

Integrated

Commissioning

Adults


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UPDATED Dec 2016

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Key Actions

Corporate Objective


Effectiveness - To

improve the quality

and safety of local

services

Director of

Integrated

Commissioning

Adults

Liz Clegg 2M

Likely risk service delivery

due to vacancies in

community nursing

resulting in inability to

provide quality safe

community nursing16 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 steady at 22%. Some progress has been made with

recruiting senior staff.

Rolling advert for DN service and inpatient units and applicants for every advert.

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

24/11/2016 Go Live achieved in beginning of November and now expanding the team.

CCG: To continue to monitor recruitment levels via CQRG, contract monitoring meetings. Next update is September 2016.

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.

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.

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.

Provider plans for winter schemes are being agreed through the Lambeth and Southwark A&E Delivery Board - Winter plan for

16/17 agreed at A&E Delivery Board

Data requirements being reviewed to establish impact of primary care hubs on A&E activity.

Harriet

Agyepong2K

Possible risk of not

achieving the access


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 12 12 12 12 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.

Consolidated South London plan submitted on 09/09/16 sets out system actions to deliver start year trajectories - awaiting feedback

from NHS England - Oct meeting with NHSE has reviewed these plans and monthly revisions by trust have been provided.

Harriet

Agyepong2N

Ongoing risk of not

achieving the agreed NHS

Constitution access


RTT for incomplete

pathways impacting on the

CCG Quality Premium

and Assurance

Framework

12 16 16 16 16 16 16 16 16 20 20 20 20

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 has been 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.

An System Oversight Group has been established co chaired by NHSE and NHSI to oversee RTT in the context of the findings of the

external review at KCH.


to achievement of

Strategic Aim)

Target

Risk

Score

and

Direction

of Travel

Executive

Lead

Director of

Integrated

Commissioning

Adults

Risk

Register

Ref

Operational

Lead


Strategic Aim

Corporate Objective

2.1: Sustainable

Delivery &

Governance - To

secure delivery of the

NHS constitutional

rights and pledges

for all Lambeth

residents


25

UPDATED Dec 2016

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Au

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No

v

De

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Key Actions

Christine

Caton7A

Possible risk that current

planning and strategic

approach is not sufficiently

robust to manage

pressures and deliver

sustainable financial

position in the context of

lower levels of growth in

the period to 2020/21’.

8 12 12 12 12 12 12 12 12 12 16 16 16

SE London CCGs and providers have ownership of STP to deliver transformation across boroughs and providers.

The Finance and QIPP Working Group and Governing Body have had oversight of the developing 2017/19 Operating Plan.

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 CCG Five Year Strategy and SEL Five Year Sustainability and Transformation Plan (STP) was published in Oct 2016.

CCGs are working to deliver two year Operating Plan and contracts by December 2016. Contract negotiations are underway to

meet these deadlines.

The finance and activity impact of 2017-19 commissioning intentions at CCG and SEL level and these will be built into provider

contracts and responsibility for delivery assigned. CCG is risk assessing QIPP schemes for 2017/19 including phasing and impact

and developing further options for consideration, including use of outputs of the RightCare Programme where deliverable.

In recognition of the increased financial risk to the CCG from 2017/18, the CCG is undertaking detailed 2016/17 in-year review of all

budgets to seek to recover activity over-performance, create budget flexibility to manage risk in 2017/18 onwards and identify where

costs can be reduced.

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

is being developed.

Plan has been produced to agree 2017/18 to 2018/19 Commissioning Intentions and deliver 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.

CCGs have been required to deliver SEL wide control total which has been reflected in the draft 2017-19 Operating Plan submitted

on 24 November.

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.

The CCG continues to work with SLAM to understand the drivers of the underlying Mental Health QIPP position and is putting in

place a plan with to mitigate pressures on inpatient bed usage.


to achievement of

Strategic Aim)

Target

Risk

Score

and

Direction

of Travel

Risk

Register

Ref

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

Chief Financial

Officer



Lead

Operational

Lead


26

UPDATED Dec 2016

Ja

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Key Actions

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

Ursula Daee 5DPCC

Financial risk of

overspend on Minor

Ailments Scheme.

3 12 12 12 12 12 12

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

Auditors have taken place (October 2016). Awaiting feedback from Auditors to confirm when they will start the post-payment

verification audits.

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

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,

integrated 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. Not proceeding

with GP+ Scheme. Meeting Nov 2016 to discuss potential participation in whole system alliance.

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

LWN and CMHT. Both projects ongoing.

Developing procurement plan for the next phase - taking to Governing Body in Nov 16 and meeting in public in Jan 2017.

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

framework is out for comments. Report to be presented to Governing Body in November and meeting in public Jan 2017.


to achievement of

Strategic Aim)


Operational

Lead

Target

Risk

Score

and

Direction

of Travel

Strategic Aim

Risk

Register

Ref

Executive

Lead


27

UPDATED Dec 2016

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No

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Key Actions

Director of

Primary Care

Development

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 12 12

1. Workforce action plan to be developed from each CRG

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

3. Risk to be discussed and reviewed by members at October 2016 CBC Programme Board to ensure that all controls and

assurance (including any gaps) have been identified and mitigating actions agreed if required

4. Title of risk "Risk that inadequate workforce capacity/skills will affect the delivery of the SEL Strategy in providing new models of

integrated, high quality care" to also be be discussed at the CBC Programme Board to ensure that it captures the local risk

5. Brian Reynolds checked the status check the status of this risk on the SEL Risk Register as the risk was originally copied from

there. Discussed at CBC Programme Board on 28/11/2016 - score to remain as a 12. Una Dalton to go back to SEL and enquire

about more info on the OHSEL workforce risks for CBC Programme Board.

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 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) - transition to

NEL for GP IT/CCG IT is well underway and progressing well. Informal feedback that staff/membership recieving better support since

the transfer. A formal partnership will come into being from 01/04/2017 between SELCSU and NELCSU.

2. Begin procurement process for all other services - the CCG is taking advice on a revised procurement timetable.

Director of

Primary Care

Development

Christine

Caton/Claire

Hornick

8B

Risk of possible failure to

plan for future premises

needs when Lower Marsh

Lease ends 2017

4 12

NHSPS to undertaking a review of current and alternative sites to on appraisal and VFM - For end Dec 2016

Working closely with CSU to consider further options

Discussions with LBL on potential co-location options.

Corporate Objective

3.2 System

Transformation - To

ensure the CCG’s

commissioning

resource and

organisational

capability are

effectively aligned to

deliver its objectives


2015 Monthly Progress 2016Target

Risk

Score

and

Direction

of Travel


Lead

Operational

Lead

Risk

Register

Ref


to achievement of

Strategic Aim)

28

4.2 Delegated Functions Following a definitive membership vote in favour of applying for Full Delegation and agreement at the GB Meeting in Public on 2 November, the CCG has made a formal application to NHSE by the due timescale. An NHS Lambeth CCG application has been made alongside applications from the 5 other SEL CCGs. We expect to hear the outcome in January 2017.

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.

NHS Lambeth CCG’s financial performance as at November is a surplus of

£5.168m. 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 showing a small underspend of £97k at month 8 and are

within the £22.50 per head Running Cost allowance. We are forecasting an underspend

of £150k for the year.

The CCG has drawn down £273.25m of cash at the end of month 8. The maximum

cash drawdown limit for 2016/17 is £468.385m. The cash balance at the end of

November 2016 was £1,161k.

Revenue Resource Limit

Month 7 -

October

Changes Month 8-

November

£'000 £'000 £'000

Issued Budgets - Programme 449,820 1,295 451,115

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

Reserves 9,640 9,640

Planned Surplus 7,752 7,752

Total Allocation 474,839 1,295 476,134

Summary of Budgets - November 2016

29

Performance Area Commentary

Month 8

Position

Revenue Surplus

Lambeth CCG is reporting a surplus of £5.168m for the first eight

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 30th November 2016). Lambeth CCG's cash

balance at bank at the end of November was £1.16m. 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

99.42% of NHS invoices based on numbers and 99.76% by value.

Performance for the first eight months for Non NHS invoices is

95.2% on numbers and 94.45% by value.

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

an underspend of £97k against its running costs budgets.

Key Financial Performance Duties

30

Summary Budgets – Financial Position for November 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.

Plan Actual Plan Actual

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

Resource Allocation

Programme Resource 310,346 310,346 0 0% 468,507 468,507 0 0% 0 0

Running Cost Resource 5,084 5,084 0 0% 7,627 7,627 0 0% 0 0

Total Resource Allocation 315,431 315,431 0 0% 476,134 476,134 0 0% 0 0

Programme Expenditure

Acute 188,228 187,784 444 0% 282,343 282,374 (31) (0.01%) 2,887 (3,169)

Mental Health 46,676 47,601 (924) (2%) 70,014 71,380 (1,366) (1.95%) (1,367) (1,953)

Community Health 13,505 13,681 (175) (1%) 20,258 20,521 (263) (1.30%) (178) (551)

Continuing Care/Free Nursing

Care 10,937 12,786 (1,849) (17%) 16,406 18,922 (2,516) (15.34%) (1,212) (3,286)

Primary Care 29,366 29,200 167 1% 44,050 43,885 165 0.37% 737 (582)

Other Programme Costs

including Corporate 10,610 10,351 259 2% 15,914 15,632 283 1.78% (167) (735)

Total Programme Costs 299,323 301,402 (2,079) (1%) 448,985 452,713 (3,728) (0.83%) 700 (10,276)

Running Cost

Pay 2,672 2,785 (113) (4%) 4,024 4,183 (159) (3.95%) 150 67

Non Pay 2,412 2,202 209 9% 3,603 3,294 309 8.57% - -

Total Running Cost 5,084 4,987 97 2% 7,627 7,477 150 1.96% 150 67

Reserves including

contingency 5,855 3,873 1,981 34% 11,770 8,192 3,578 30.40% 3,578 3,578

Total CCG Expenditure 310,262 310,263 (0) (0%) 468,382 468,382 0 0.00% 4,428 (6,631)

Surplus 5,168 5,168 (0) (0%) 7,752 7,752 0 0.00% 12,180 1,121

EXECUTIVE SUMMARY - FOR THE PERIOD - APRIL TO NOVEMBER 2016

NHS LAMBETH CCG

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

Year to Date Forecast Outturn

Best Case

Variance

Worst Case

Variance

31

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 % Actual Variance %

Acute

Guys & St Thomas NHSFT

Emergency Admissions 1,316 877 877 0 100% 1,316 0 100% 1,200 (116) 91%

Outpatient redesign and activity reduction 1,570 1,047 1,047 0 100% 1,570 0 100% (1,570) 0%

Prescribing 314 209 209 0 100% 314 0 100% 314 (1) 100%

GSTT NHSFT - TOTAL QIPP 3,200 2,133 2,133 - 100% 3,200 - 100% 1,514 (1,687) 47%

Kings Healthcare NHSFT

Emergency Admissions 1,237 825 825 0 100% 1,237 0 100% - (1,237) 0%

Outpatient redesign and activity reduction 926 617 617 0 100% 926 0 100% - (926) 0%

Prescribing 38 25 25 0 100% 38 0 100% 38 0 100%

KINGS NHSFT - TOTAL QIPP 2,201 1,467 1,467 - 100% 2,201 - 100% 38 (2,163) 2%

TOTAL ACUTE QIPP 5,401 3,601 3,601 - 100% 5,401 - 100% 1,552 (3,850) 29%

Mental Health

Acute & Early interventions 873 582 582 0 100% 873 0 100% - (873) 0%

Acute Triage 18 12 12 0 100% 18 0 100% - (18) 0%

Mental Health Older Adults 475 317 317 0 100% 475 0 100% 475 (0) 100%

Cascaid Service 56 37 37 0 100% 56 0 100% 56 0 100%

IPSA 508 338 338 0 100% 508 0 100% 508 0 100%

Mental health Other 332 221 221 0 100% 332 0 100% 332 0 100%

Total 2,262 1,508 1,508 0 100% 2,262 - 100% 1,371 (891) 61%

Medicines Management 1,199 799 799 0 100% 1,199 0 100% 1,199 0 100%

Primary Care Savings 212 141 96 (45) 68% 144 (68) 68% 144 (68) 68%

Other Programme Services 607 405 405 0 100% 607 0 100% 607 0 100%

CH - Contracts - Other Providers (non nhs) 220 147 147 0 100% 220 0 100% 220 0 100%

Total 2,238 1,492 1,447 (45) 97% 2,170 (68) 97% 2,170 (68) 97%

Grand Total Gross QIPP 9,901 6,601 6,555 (45) 99% 9,833 (68) 99% 5,093 (4,808) 51%

Investment (750) (500) (455) 45 91% (682) 68 91% (682) 68 91%

Net QIPP 9,151 6,101 6,101 0 100% 9,151 - 100% 4,411 (4,740) 48%

Year to Date (November) Underlying PositionForecast Outturn

QIPP DELIVERY FOR THE YEAR 2016/17

32

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 06 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. The forecast year-end outturn expects a 100% delivery against the 2016/17 QIPP plan as a consequence of contractual commitments

Mental Health

The forecast year-end outturn expects a 100% delivery against the 2016/17 QIPP planned reduction in occupied beddays as agreed contractually.

Medicines Management All schemes delivering 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 33.

33

NHS Lambeth CCG National Performance Measures for 2016/17.

34

NHS Lambeth CCG Performance by Provider – Month 7 (October 2016)

35

4.4.2 RTT (Referral to Treatment Times for Lambeth Patients)

The CCG breached the incomplete target in October 85.1% compared to September at 85.7% against the 92% standard. Performance was primarily driven by the KCH position however GSTT activity was also under 92%. Lambeth performance at KCH was at 79.1% for the month.

GSTT Current Performance

GSTT failed to meet the RTT target in October. The Trust has not met the target since August 2016.

The increase in referrals, which is likely to affect GST incomplete performance throughout the rest of the year, remains an issue. Whilst, overall,

referrals in month 6 are down slightly from the previous month, the total volume of referrals is 8% higher than for the same period in 2015/16.

Increase in referrals mainly due to an increase in GP referrals for Lambeth, which is showing a 14% increase from the same month in 2015/16, and a 12% increase YTD compared with the same period in 2015/16.

Actions Taken

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.

Planned Care Board established across the system to focus on demand management schemes and options. Workstreams identified and being established.

36

King’s Current Performance

Not meeting 92% standard. Current performance is 79.1%. Based on the current performance trajectory KCH will put the CCG into an

underperformance position for each month of 2016/17

The Trust has submitted an improvement trajectory to get to 88% (trust wide) by March 2017. The Trust has also submitted an over 18 week backlog

reduction trajectory. This highlights the continued issues with backlog reduction.

Actions Taken

The Trust continues to work to an agreed RTT action plan to improve performance and reduce backlog over the year.

Review of waiting list management by an external consultancy has identified operational and leadership issues for RTT which need to be addressed.

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.

Planned Care Board established across the system to focus on demand management schemes and options. Workstreams identified and being

established.

37

4.4.3 Diagnostics (Lambeth Patients)


Did not meet the <1% standard as at September 2016, however performance was at 0.8% for October. Performance at a CCG level has been met since August 2016.

Audiology had seen an improvement from previous months. Going forward compliance was expected and no issues foreseen over the Christmas period.

Actions Taken

The new Cancer Centre at GSST is now open, providing additional MRI capacity.


KCH has met the target since September 2016.

38

4.4.5 A & E Waiting Times

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


Currently not meeting the 95% standard. Performance for October was 86.7% which shows a reduction in performance from the September position (89.2%).

GSTT’s performance is driven by higher levels of acuity; impact of the A&E re-building programme; and overall capacity constraints.

GSTT has been developing and implementing a comprehensive ED action plan and have established and Urgent and Emergency Care Board that will be attended by Commissioners.


Currently not meeting the 95% standard. Performance for October was 81.3% which shows a slight dip in performance from the September position which was 82%.

The Trust will not meet the national standard for the remainder of 2016/17.

39

KCH has produced an ED Recovery plan this covers: Out of hospital actions (focused on admission avoidance; proactive care; access to ambulatory and rapid access specialist services; early supported discharge; and enhanced community services). In hospital actions covering a 6 point plan for DH and 7 point plan for PRUH (reviewing and re-designing the urgent care pathway, non-elective end to end transformation programme); and bed capacity (increase and reconfigure bed capacity across PRUH, DH, and Orpington). The Trust recently revised downwards its performance projections for the remainder of the year and has shared this with its regulator NHSI and commissioners.

4.4.6 Cancer Waiting Times

Lambeth achieved 1 of 9 cancer targets in October 2016.

Cancer 2 week wait.

Trajectory 93% actual 92.3% for October. There is a particular issue at GSTT for patients referred for lower GI cancers. The Trust is working to improve its booking processes direct from the telephone triage to ensure the endoscopy can happen sooner. Performance is expected to improve over the coming months. Cancer 31 day subsequent treatment – drugs Trajectory 98% actual 97.7%. October’s performance relates to 1 breach at GSTT due to patient choice. There is a particular issue at GSTT for patients referred for lower GI cancers. A telephone triage clinic has been set up which allows patients to book directly into Endoscopy diagnostics. Whilst this change in the pathway speeds up the process of attending the diagnostic appointment it means the previous outpatient appointment does not occur to stop the 2 week wait clock resulting in breaches. The clock now stops when the diagnostic takes place. On occasion this is after 2 weeks.

40

The Trust is working to improve its booking processes direct from the telephone triage to ensure the endoscopy can happen sooner. Performance is expected to improve over the coming months. Cancer 2 weeks breast symptoms – This target was met for the first time in September 2016, achieving 94.7% against a target of 93%. Performance however dipped below the standard again in October achieving 86.5%.

62 day standard Current Performance

Actions Taken

Actions taken

Current performance against the 85% has not been met.

The standard was met in August and September, but performance deteriorated

in October to 69.8%

GSTT’s performance against this target remains challenging. Overall trust-wide

performance improvement is linked to reducing later referrals into the trust from

other providers, as well as maintaining internal performance of 85%.

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 within 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, but

has been below this target, the Trust now predict to meet internal performance in

Q4 . 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 has been developed through the 62 day cancer

waits group. This pulls together an agreed set of actions from all Trusts.

41

4.4.7 Ambulance Response Times

LAS Current Performance

The performance standard for Cat A (Red 1) was met in October and, with the

exception of August performance, has been met every month this financial

year. This is a notable improvement compared to performance during

2015/16.

The Performance standard for Cat A (Red 2) has been variable and the year

to date performance just below the 75% threshold at 74.6%.

4.4.8 Improved Access to Psychological Therapies (IAPT)

The standard for people with depression referred for and accessing psychological therapy is 15% for 2016/17. The actual target number per quarter is 1656 (3.75%). This was exceeded in Q1 and in Q2. For the first month of Q3 – October the access was narrowly missed (548 against monthly target of 552). The standard for the proportion of people who complete therapy and move to recovery is 50%. Performance in this area for Q2 was 49.2%. For October the service achieved 46.1%. 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 Q2 in 2016/17 was exceeded with 95.52% 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 Q2 for 2016/17 the service achieved 100%. For the first month of Q3 it was also 100%.

4.4.9 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.

42

Lambeth initially achieved the target in April (66%) but have missed it in May (33.33%) and June (16.67%). In Q2 they achieved 50%, 62.5%, and 85.7% for July, August and September respectively. For October they achieved 69.23%.

4.4.10 Dementia Diagnosis Rate

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

the year to November 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.

From April 2017, NHS England is changing the way it calculates the dementia prevalence. It will use the

total number of people registered on a GP Practice list as the baseline for the population of that borough,

rather than using the ONS data as it currently does. As a result of this proposed change, the estimated

prevalence of the number of people with dementia living in Lambeth will increase by 257, from 1,534 in

October 2016 to 1,791 in April 2017. If there is no change in the number of people registered on their

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

De

c-1

6

Jan

-17

Feb

-17

Mar

-17

Early Intervention in psychosis 2 week standard

Actual Performance

Operating Standard

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 - Oct 2016

43

GP Dementia Register, this will mean that the diagnosis rate will be 73.5% rather than its current 86.7%.

The national target to achieve is 66.7%.

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 fulfil 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.

Latest published data in July 2016 shows performance at 84.7%.

44

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)

23% (September 2016)

25% (April 2015-September 2016)

March 2016 performance = 22% utilisation

March 2017 requirement to meet quality premium = 41.6%

September 2016 performance – 23%

E-referral group to be enhanced with accountability into the Planned Care

Programme Board.

Revised planning required to develop plans to deliver planning guidance

targets for the next 2 years

Proposal to develop advice & guidance function taken to Digital Technology

group

The first joint E-referrals steering group between Lambeth and Southwark

took place on the 9th of December 2016.

The targets will be more stretching in 2017-19 with the expectation for

CCGs to meet 80% in 2017/18 and 100% by 2018/19.

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

Antibiotic prescribing

Current Performance (IAF 107a)

Target Value by the end of 2016/17

to be equal or less than 1.161

Latest data August 2016 0.774% (achieving the target)

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

addition to the reduction required to address increases relating to population

growth.

45

This figure represents a decrease of 1% of admissions in Quarter 1 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.

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.

The above data shows a decrease in emergency admissions (18.8%) from Quarter

1 to Quarter 2.

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 reduction 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.

4.6 Quality Premium 2015/16 outcome The outcome of the 2015/16 Quality Premium assessment was shared with all CCGs on 30 December 2016. In order for a CCG to receive a financial award, the organisation had to achieve four of the specified constitutional standards and pass both assurance gateways; RTT, A&E 4 hour waits, cancer 2 week wait, LAS Ambulance Red 1 calls, Quality and Financial gateways. NHS Lambeth CCG met the assurance gateway

0

20

40

60

80

100

120

Q1 Q2 Q3 Q4

Emergency Admission rate for children with asthma per 100 000 (2016/17)

Rate per 100 000

46

measures, but did not meet the 4 specified constitutional standards. Failure to meet the constitutional targets resulted in a non-award payment. The CCG monitored its performance against the suite of indicators set out in the Quality Premium payment framework throughout 2015/16 and had forecasted the non-award payment outcome. The table below highlights the CCGs performance benchmarked against the 10 most demographically similar CCGs, ranked for Quality Premium achievement without adjustments.

47

4.7 Quality Alerts There were 54 quality alerts reported by Lambeth GPs and 114 by Southwark GPs in

Quarter 1 and 2 regarding Guy’s and St Thomas’ NHS Foundation Trust (GSTFT). In

addition, two incidents were reported.

Chart 1 Q1 and Q2 2016-17 Quality Alerts regarding GSTFT by Category

Source: QUIC (Lambeth CCG) and Southwark CCG Datix

Additionally there were 27 Quality Alerts reported by Lambeth GPs relating to KCH for Quarters 1 and 2, four for SLaM, three for St George’s Hospital, four related to GP’s, one regarding an out of area hospital, one regarding community pharmacy, one regarding the CCG and two regarding independent providers. One quality alert was made by KCH regarding clinical care at a Lambeth Practice. The majority of Quality Alerts related to clinical care, communication, referrals and discharge. Themes included the following: - No appointments received/booked - Referrals to service missed - Failure to follow up - Discharge letters/ summaries not received - Fax usage - Issues with issuing discharge medication The most quality alerts were received in relation to Emergency Services, District Nursing, Gynaecology and Trauma and Orthopaedics. Quality Alert Actions Key learning and actions identified by GSTFT and KCH in their Quarter 1 reports in relation to the themes are summarised below:

GSTFT and KCL Discharge Improvement Group have decided that the Electronic

Discharge Letter (EDL) will now be called Transfer of care, which will be written for

48

patients and carers. A copy of this letter will also be forwarded to the GP. The KCH

electronic discharge notification is in place.

GSTFT Cardiology have placed a more up to date referral form on Point-Of-Care

(DXS) and the GP zone. Information about where to send each referral and up to

date telephone numbers for most enquiries is now available.

GSTFT District Nursing - admin staff have been reminded to escalate queries

relating to referrals not seen, to the Duty Nurse or another senior person in the

team. The daily safety briefing now goes through all referrals received to ensure

they have been actioned. All staff have been reminded about their responsibilities

in following the referrals processes, to ensure that they are allocated.

GSTFT Trauma and Orthopaedics have recently revised their pathway into

Orthopaedics and other onward services. The new pathway will allow the service to

add patients to the waiting list for another service direct from referral/triage decision

which will minimise delays.

Fax usage – GSTFT Elective Assurance are working with the GP liaison team, the

digital team, the communications team and clinical services to ensure the website

and correspondence have been updated to reflect the service NHS.net email

addresses

KCH added guidance to the Trust Access Policy regarding consultant to consultant

referrals. The guidance is in-line with the requirements detailed in the NHS

standard contract for hospitals for onward referrals.

GSTFT Podiatry service have produced a new easier to use referral form and new

telephone management system.

GSTFT MCATs are changing the call centre number to manage call volume.

Patients are now given information in clinic on the expected time frame for

investigation feedback, where relevant and a contact telephone or clinician e-mail if

contact has not been made in the agreed time. In addition, the service have stated

that they will continue to ensure patients are aware of triage decisions if a referral

is not being accepted into the service they were referred to.

4.8 Infection Control

MRSA - There have been 0 cases of MRSA reported to date. C.Difficile – There have been 27 cases of C.Difficile reported to date against a target of 44.

49

4.9 Mixed Sex Accommodation

There have been four mixed sex accommodation breaches reported during the year so far, against a zero tolerance. All of these cases occurred in the first two quarters of 2016/17.

50

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

5.1 Integrated Children and Young People (including Maternity) Programme

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

Clinical Lead Dr Nandini Mukhopadhyay

Programme Lead Amy Buxton Jennings, Director, Integrated Commissioning, Children

IAF Indicators 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 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

51

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 3 2016/17

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

Is your programme delivering as planned – is it

on target?

Some objectives on track but some risks


52

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 3 (October – November):

Waiting times to EI CAMHS has increased from 11wks to 15wks average

after Q2 – aim to be back on track to achieve target of 10wks by Q4. The

additional funding is recurrent to add capacity to this team.

CAMHS Transformation Plan was refreshed in October 16. Plans for

16/17 underspend agreed, with engagement and consultation events held.

Service reviews of CAMHS underway, due to be completed end of April

17.

Perinatal MH engagement work complete for Mild to Moderate levels –

report commissioned. Perinatal Strategy group begun and pathway

development work starting.

Asthma pathway work started, engagement event held with key clinicians

and practitioners. GP incentive scheme for asthma being developed for

17/18

H@H evaluation going well. Work is taking place around the redesign of

the Community Nursing Service with partners and providers, Southwark

leading on this. Notice has been given to Lewisham for current CCNT.

EY HCP working group in place, developing pathway and key milestones.

Initial stakeholder workshop and governance arrangements in place.

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

agreed. GST presented community midwifery model to CMB, attending All

Practice locality meetings.

16/17 budget for youth violence to fund A&E programmes set and funding

allocated to Oasis. Multi-agency youth violence task & finish group being

set up as part of SLP and a Lambeth Youth Violence Strategy Group.

Additional NHSE funding for Health and Youth Justice has been received –

piloting functioning Family Therapist role and Conduct behaviour work for

under 5s, plus trauma training for the children’s workforce.

Work has started to scope integrated adolescent health pathway with PH New Director for Integrated Commissioning – Children has started (on 28

Nov) with new Assistant Director for Children and Maternity appointed and due to start on 13 Feb.

Children and Young People

53

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. PH budget cuts also mean a heavily reduced service for schools through PSHE and EI provision. Integrated commissioning approach essential to ensure good outcomes are achieved

CAMHS data is repeatedly received late. Outcomes data requested within SDIP and contract and is due end of Q3.

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

We need to embed the Transforming Care Agenda with CAMHS to identify young people with LD at risk of becoming inpatient

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)

CAMHS dedicated post is now vacant. Team workload is already high, therefore risk of deadlines not being met and wider picture of CAMHS transformation not being fulfilled.

54

5.1.3 Children and Maternity Programme Board Dashboard

55

The current RAG rating of the 29 indicators based on latest published data on the dashboard is as follows: 11 rated Green, 13 rated amber, 4 rated red (1 no rating).

56

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 work stream 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 2 2016/17



on target?

Some objectives on track but some risks


57

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 3 (October – November) : Elective

Agreement at Integrated Adults Programme Board to progress with a single contract for MECS with a Direct Award to the Local Ophthalmic committee (following Procurement advice)

Planned Care Board established across Lambeth, Southwark GST, KCH, Chaired by the Southwark CCG CEO. Workstream specialties agreed.

Peer review questionnaire completed with GP practices and baseline established. Cancer

Bowel cancer work plan initiated with specific initiatives focusing on bowel cancer screening.

MDC pilot commenced 1st December, receiving referrals from across

Lambeth and Southwark. Urgent Care

A&E Delivery Board oversight and sign off of 2016/17 Winter plan and are continuing to monitor the plan.

Lambeth CCG members of new bi-weekly Urgent and Emergency Board at GST


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

Elective, Urgent Care and Cancer

58

SEL 111 Service update

The purpose of the following information is to provide information on SEL 111 performance

for September 2016.

111 KPIs 2016 (Unify Sit Rep Data)

Exception Report for December 2016

Key Performance indicators were met except for the following areas:

94.8% of calls were answered within 60 seconds at the end of the introductory message (target >95%)

47.5% of calls were warm transferred to an NHS 111 nurse advisor within 30 seconds where required (target 98%)

60.9% of patients were called back within 10 minutes by an NHS 111 nurse advisor (target 100%)

9.9% of calls were asked to attend an A&E department (target of <5%)

QR5 Call waiting time LAS narrowly missed this target by 0.02%. QR6 Life threatening referrals LAS have completed an audit to understand where the three minute target is exceeded; what the reasons are; and therefore inform what actions are required. A total of 35 calls in May 2016 breached the three minute target and all 35 calls were included in an audit to understand why there was a delay between the need for an ambulance being established and the Call Handler or Clinical Advisor selecting the send button on the system. Out of the 35 calls audited the following findings were observed:

8 Calls were due to Caller/Patient delay -These were calls taken by Clinical Advisor or Call Handler where the need for an ambulance was established but for a variety of reasons the delay was caller/patient related i.e.; Patient refusing the ambulance

11 Calls were due to Call Handler/Clinical Advisor delay whilst seeking advice regarding outcome. 10 were Call Handlers which may be attributed to lack of confidence. There was one call where a Clinician sought advice for a 22 year old with severe crushing chest pain.

12 Calls were due to Clinical Advisor seeking further clarification from caller/patient after establishing the need for an Ambulance.

59

4 Calls were related to a system failure i.e.; call had to be handed over manually or call cut off from caller.

Next Steps A further audit is currently taking place for calls that breached the three minute target during June and July. On completion of the three month audit the findings will be reviewed with recommendations which may include changes to current operations procedures.

Attend Accident & Emergency Department, last 13 months (Data taken from LAS’s weekly UNIFY2 submissions)

There has been a slight increase in Emergency Treatment Centre (ED and UCC) referrals during September 2016. QR12 Warm Transfers & QR13 Time taken for call back The commissioners have agreed a let for QR12 and QR13, in order to allow LAS to carry out a pilot to prioritise warm transfers and call backs according to clinical need.

Service Update for Impact on Urgent Care System

QR11 Attend Accident & Emergency Department, last 13 months

60

Ambulance dispositions have increased in September 2016. However, LAS still have the lowest percentage of ambulance dispositions, when compared to the other London 111 providers. Service Update for Impact on Urgent Care System

QR11 Attend Accident & Emergency Department, last 13 months

61

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.

62

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 2 (October – November): BCF Q2 report 161/7 report being submitted 25 November – refer to BCF

dashboard for performance. Ongoing issues with data provision – refer to challenges section.

All of the Previously Un-assessed Periods of Care (PUPOC) Continuing Healthcare claims have been investigated locally with outcomes notified to claimants. NHS England informed that deadline has been and was ratified at call with NHSE in October. Action now completed

Data from October 2016 shows that 86.6% of the estimated prevalence of those with dementia in Lambeth have a diagnosis recorded on their GP’s Dementia QoF Register, this has increased slightly from the previous month. GP referral rates continue to be steady to the memory service.

The 4 CCG MHOA commissions have agreed bed numbers and configuration for acute care to separate out organic and functional units. Bed price not yet agreed.

Individual reassessments of day centre users continue. Expected to be completed by February 2017

Held a very successful older People’s Alliance Contract workshop with over 50 attendees from a wide section of stakeholders.

Nurses recruited to Buurtzorg test and learn site. Due to go live in early 2017

Older People

63


Working across 4 boroughs with regard to the SLaM MHOA specialist care service redesign – each borough has slightly different demands and needs, and commonality and compromise must be agreed

Performance issues with social care providers. One home closed at the end of August. Of the remaining 9 homes 3 remain suspended due to quality issues, requiring intensive quality monitoring. Three home care agencies are currently high risk. Two are currently suspended. Market factors are having an impact on DTOC (see below)

BCF – unable to report reablement metric in Q1/Q2 due to data

issues

BCF – performance for delay transfers of care (DTOC) is below plan,

currently working via A&E Delivery Board on mitigation.

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 and impact on the rest of the system including increased DTOC

Lack of pace on implementation of new reablement model

Vacancy levels in adult community services and the impact of the

agency cap

Quality of community nursing and interface with primary care

64

5.2.4 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+

6200

6300

6400

6500

6600

6700

6800

6900

7000

Q1 16/17 Q2 16/17 Q3 16/17 Q4 16/17

Actual

Plan

0

100

200

300

400

500

600

700

800

Q1 16/17 Q2 16/17 Q3 16/17 Q4 16/17

Delayed Transfers of Care

Actual

Plan

65

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%

There are ongoing data issues with reporting the reablement position. This is currently being reviewed by

Council data team and data should be available at the end of Quarter 3.

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.

0

20

40

60

80

100

120

140

160

Q1 16/17 Q2 16/17 Q3 16/17 Q4 16/17

Actual

Plan

66

5.2.5 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 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 work stream 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.

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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 Q3 (October – November):

Care Co-ordination Cohort recommendations defined collaboratively with Local Care Networks and supported the development of the care planning element

Contributed to the Medicines Optimisation theme within the Our Healthier South East London Sustainability and Transformation Plan.

Mental Health Virtual Clinics started for cohorts of complex patients on the SMI register

NHS England National Diabetes Prevention Programme (Healthier You) launched.

100% of practices submitted National Diabetes Audit 2015-16 data by deadline

Community heart failure team key performance indicators and service specification agreed

Supported the implementation of the Dawn AC Anticoagulation software yellow slip system for anticoagulation results (replacing yellow books) at GSTT

Won the Service Redesign category in this year's PrescQIPP Innovation Awards for Lambeth CCG’s Optimising medicines for COPD and asthma – an integrated approach project

Agreement reached with KCH for extension of the IRT role to include Oxygen, Spirometry, Single Point of Referral re-designs and pathways as of 1.4.17.

Successfully held learning events on Diabetes and Respiratory

South East London Area Prescribing Committee updated guidance relating to: stroke prevention in Atrial Fibrillation; Anticoagulants in Venous Thromboembolism; Blood Glucose Control pathway; Seronegative Spondyloarthropathy pathway; shared care guidelines for use of cinacalcet; shared care guidelines for use of azathioprine and mercaptopurine for the treatment of Inflammatory Bowel Disease in adults; management of Cow's Milk Protein Allergy guidelines; heart failure management guidelines and South London Policy for Patients Self-testing International Normalised Ration (INR); adult focal epilepsy treatment pathway; share care prescribing guidelines for somatropin (growth hormone) in paediatrics; shared care prescribing

Long Term Conditions – Medicines Management

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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.

guideline for attention deficit hyperactivity disorder in children, adolescents and adults; oral anticoagulant alert card (information for healthcare professionals); Guidance for the Management of Hypertriglyceridaemia; Guidance on Prescribing Statins and Lipid Management for the Primary and Secondary Prevention of Cardiovascular Disease (CVD) in Adults and developed new guidance on: sacubitral valsartan for chronic heart failure; botulinum toxin; dulaglutide and guanfacine.

Care Home Pharmacists completed 3/10 care home reviews delivering savings of £20,843 and hence is on track to deliver the project savings

Prescribing Support Dietician report estimated savings of £53,804 for Quarter 1 2016-17

Waste campaign launched

Individual practice visits completed

Quarter 1 2016-17 Medicines Optimisation Prescribing Dashboard disseminated

Practice achievements and payments for the medicines optimisation scheme 15/16 completed.

Antibiotic prescribing guidelines review started and discussions with Lambeth Public Health (PH) colleagues to scope delivery of NHS England Quality Premium continues

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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 –Ambulatory Blood pressure monitoring and the Community diabetes service. Resource and time constraints may lead to non-delivery of these projects

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Medicines Optimisation & Long Term Conditions – data element A. Overall Performance 2016/17 (Month 6) Overall, the prescribing budget was underspent at Month 6 by £463,798 (2.7%, see finance report). The North Locality is underspent by 4.2%, the South East by 3.2% and the South West by1.4 %. B. Spend per ASTRO-PU (data available quarterly)

2016/17 Spend per APU Achievement

Threshold CCG

average

No of practices achieving threshold (out of 47)

Q1 2016/17 <£8.30 £8.03 31

Q2 2016/17 <£8.30 £7.90 34

Q3 2016/17 <£8.30

Q4 2016/17 <£8.30 C. NHS England Antibiotic Quality Premium Monitoring Dashboard (12 month rolling data)

NHS England Antibiotic Quality Premium monitoring dashboard (12 months rolling data) Green = target met

Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16

Antibacterial items/STAR PU13

Target Value by end of 2016/17 to be equal to or less than 1.161:

0.774 0.775 0.772 0.774 0.774 Data not available

Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

Data not available

Co-amoxiclav, Cephalosporins & Quinolones

Target Value by end of 20116/17 to be equal to or

Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16

9.5% 9.4% 9.2% 9.0% 9.0% Data not available

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less than 10% Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

Data not available

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 £48,604 £45,931 £47,515 £42,989 Data not available

Actual savings OptimiseRx/Waste & deprescribing

£49,734 £46,809 £49,399 £51,703 £79,175 £80,706 £77,860

*Total actual savings (cumulative)

£72,350 £164,778

£262,782

£360,416

£487,107

£610,802

£688,662

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5.2.6 Integrated Adults Programme Dashboard

The draft indicators were presented and discussed at the Integrated Adults Progamme Board on the 23rd November 2016. A fully populated dashboard will be available in January 2017.

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5.3 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.

5.3.1 Programme Assurance Statement as at Quarter 2



on target?

Some objectives on track, but some risks

identified.

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5.3.2 Mental Health Whole System Dashboard

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1. OBDs - These beds include Acute, Triage and PICU. 4. EIP - During September 7 people experiencing their first episode of psychosis waited for treatment with 6 people seen within 2 weeks, giving a total of 85.71%. 6. AMHPs - There were a total of 65 assessments for August. Of the 65 assessments 49 assessments lead to detention, 1 leading to informal admission, 5 not leading to admission, 11 S135 warrants obtained, 0 S135 warrants executed, 8 S136 used, 12 not assessed and 1 assessed yet no bed available. 8. DTOC - During September DToC is 1.8%. 9. LWN - There were a total of 418 introductions to the hub in September. 10. GP+ - There are currently 152 people on the GP+ 11/12. Talking Therapies - SLaM is only slightly below target for numbers entering treatment, yet they are achieving the recovery rate. 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


Black Well Being Partnership – CCG resolved to join the BWBP (Oct). The BWBP is waiting on the outcome of its bid to GSTcharity for additional development funding (due Nov).

>400 introductions per month to LWN being sustained.

GP Plus scheme now supporting >160 people.

IPSA activity and financial plan on target.

Prototype focused on improving interface between LWN and CMHT commenced aimed at supporting asset based approach.

Proposed procurement approach to LWN discussed at GB seminar and informal cabinet – approvals to proceed being sought Jan 2017.

Early Intervention in Psychosis and Talking Therapy targets met

Acute pathway OBDs reducing for 3rd month in row – detailed work with SLaM on addressing high LOS; overall admissions have reduced.


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.

OBD trajectory.

SLaM contract 17/19 negotiation.

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 – planned OBD reduction is not delivered. .

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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5.4 Learning Disability

Responsible Director To be confirmed

Clinical Lead Dr Nandini Mukhopadhyay

Programme Lead Sharafat Ali

IAF Indicators 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 3 (October – November) The Transforming Care Caseworker chaired 3 Community CTRs

which have prevented hospital admissions, and 4 inpatient CTRS, of which 3 people were identified as ready for discharge and should be discharged within 6 months Launch event at Lambeth Walk GP Practice to pilot engagement approach to promote LD Health check


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 have improved marginally but still an area of concern

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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5.5 Staying Healthy (Led by London Borough of Lambeth)

Responsible Director Dr Sarah Corlett, Interim Director of Public Health, Lambeth

TBC, 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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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


Set a balanced budget and determined savings proposals

Worked with GSTT and Healthwatch to complete consultation on channel shift and changes to sexual health clinics

Public health specialist team now embedded in Lambeth local authority

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

Commissioning intentions communicated to key partners

Implemented agreed changes to HIV Care and Support pathways and transitional group established

Three-year contract extension agreed with SLAM in respect of the Integrated Treatment Consortium

Agreement around Integrated Sexual Health Tariff London-wide

Excellent progress with regard to recommissioning and remodelling of adolescent sexual health/substance misuse services and Staying Healthy services

Health and Wellbeing Strategy refresh signed off by the Health and Wellbeing Board


Financial position – impact of Government cuts and council need for savings to help balance budget, will affect outcomes detrimentally given scale of cuts

Establishing 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

Rising levels of STIs

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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5.5.1 Programme Assurance Statement

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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5.5.2 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 Frequency 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 baseline 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 continues to have good chlamydia screening coverage and rate of diagnoses.

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 changed from Red to Amber, continuing improving trend compared to national average. U18 conception rates in Lambeth started to come down from 2004, which will continue to impact on repeat abortions to under 25s.

% 32.9 31.9 30.7 29.8

London 33.0 32.6 32.3 31.0

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Sexual Health Source Frequency Reporting RAG Comment

% Post-abortion LARC uptake

Local Provider

Date 2015/16 Q1

2015/16 Q2

2015/16 Q3

2015/16 Q4

N/A LARC uptake has improved due to a staff training programme on contraceptive counselling. % 34 30 35 33

Substance Misuse Source Frequency Reporting RAG Comment

PHOF 2.15i Successful completions from treatment (Opiates)

NDTMS Monthly Date Mar-16 Apr-16 May-16 Jun-16 Red 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. In addition, this will be a core metric for Integrated Treatment Consortium contract extension.

% 6.4 5.7 5.6 5.1

PHOF 2.15ii Successful completions from treatment (Non-opiates)

NDTMS Monthly Date Mar-16 Apr-16 May-16 Jun-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.

% 41.4 42.6 42.4 43.6

PHOF 2.15iii Successful completions from treatment (Alcohol)

NDTMS Quarterly Date 2015/16 Q4

2016/17 Q1

Green New indicator. Initial performance GREEN, will continue to monitor through provider forum and individual contract monitoring to ensure good performance is maintained.

% 44.3 47.6

PHOF 2.18 Alcohol-related hospital

PHOF Annual Date 2011/12 2012/13 2013/14 2014/15 Amber Continued monitoring of local initiatives, incl. alcohol care teams in per 100,000 pop 658 642 626 646

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Substance Misuse Source Frequency Reporting RAG Comment

admissions London 572 554 541 526 hospital settings and work with GP Federations to improve early detection and delivery of alcohol brief interventions.

PHOF 2.16 Prison transfers to community treatment

PHOF Quarterly Date 2016/17 Q1

N/A New performance indicator, to be assessed and understood as part of recommissioning of Integrated Offender Management.

% 16.9

National 30.3

% Hepatitis B vaccine completions

NDTMS Quarterly Date 2015/16 Q2

2015/16 Q3

2015/16 Q4

2016/17 Q1

Red This will be a core metric to be included in revised SLA for Integrated Treatment Consortium contract extension. Performance to be tied to CQUIN payment.

% 20.2 18.9 19.5 18.8

London 27 27 28 28

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Health Improvement Source Frequency Reporting RAG Comment

PHOF 2.14 Smoking Prevalence

PHOF Annual Date 2012 2013 2014 2015 Red Working with Public Health Specialist team to refresh local tobacco control strategy, to take into account changing population demographics in the borough, which includes evidence of entrenched smoking behaviours within key at-risk populations.

% 22.0 19.9 19.0 21.2

London 18.2 17.1 17.2 16.3

Take up of NHS Health Checks

Local Quarterly Date 2015-16 Q2

2015-16 Q3

2015-16 Q4

2016-17 Q1

Amber Evidence of slight improvement. Ongoing re-specification of Health Checks will examine best approach to target and motivate those at the most vascular risk, to improve uptake amongst these populations.

% 17.6 22.4 19.1 23.1

England 48.6

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. % 4.4 4.7 5.0 5.2

London 5.6 5.8 6.0 6.1

PHOF 4.04ii Mortality from preventable CVD

PHOF Annual Date 2009-11 2010-12 2011-13 2012-14 Amber No performance data update since last IGC report. per 100,000

pop 61 54 50.3 51.9

London 55.1 52 50.2 49.2

% successful four-week quitters who set a quit date


2015-16 Q3

2015-16 Q4

2016-17 Q1

Amber Performance remains variable. Work currently onging in partnership with CCG to recommission smoking and related lifestyle behaviour changing services.

% (n) 40% 37% 38% 35.7%

(324 of 817)

(269 of 732)

(332 of 872)

(272 of 762)

Number of smokers setting a quit date


2015-16 Q3

2015-16 Q4

2016-17 Q1

Amber As above.

n 817 732 872 762

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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.

Risk Title Category Type Nature Risk / Opportunity Cause Effect Current Likelihood

Current Impact

Current Risk Score

Risk Owner

SH GUM Costs Increase [CCMM0005]

Operational Threat Financial

The cost of GUM services may exceed expected amount

LSHTP does not deliver in line with local transformation, and GUM activity and costs increase past baselines

Wider public health budget will be impacted

Likely (3) Major (8) High Andrew Billington

PHC Budget Reductions [CCMM0014]

Strategic Threat Customer/Citizens

Public Health services may experience increased demand (e.g. worsening wider determinants of health) and restricted supply (e.g. decommissioning services)

Budget reductions across the public sector, incl. Public Health Commissioning, other Lambeth departments, and the NHS

Increased pressure on existing services and commissioning budgets and worsened health for local population

Very Likely (4)

Serious (4) High Michelle Binfield

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Current Impact

Current Risk Score

Risk Owner

PH Embedding Prevention

Strategic Threat Management

Significant short-term savings may not allow for long-term investment in prevention

Although importance of prevention is acknowledged, treatment and care services experiencing high demand

Lack of systematic approach to prevention leading to increased demand for local health and social care services

Likely (3) Serious (4) Medium DPH

PHC Staffing Operational Threat Management

The number of staff in Public Health Commissioning team could be reduced as staff leave and are not replaced

Lambeth has changed staffing practices in light of financial pressures (e.g. enhanced redundancy, recruitment freeze)

Remaining team will need to deliver on all responsibilities with reduced number of staff

Likely (3) Significant (2)

Medium Michelle Binfield

PHC Commissioning Partnerships

Operational Threat Management

Financial and operational risks and pressures faced by other boroughs could impact on Lambeth's commissioning strategy

Lambeth commissions services in partnership with other boroughs

Services commissioned by Lambeth in partnership with other boroughs will be negatively affected


Medium Michelle Binfield

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Current Impact

Current Risk Score

Risk Owner

PHC Wider Determinants

Strategic Threat Customer/Citizens

The wider determinants of health could be affected by changes across other council departments through reduced budgets

Lambeth Council experiencing severe financial and budgetary difficulties

The long-term health of the population will be compromised.


Medium Maria Millwood

PHC Primary Care Invoicing

Operational Threat Reputational

Primary Care providers may experience significant delays in payment

Deficiencies in internal business processes hinder activity validation and financial administration

Primary Care providers may disengage from service provision, with impact on demand management and financial forecasting


Medium David Orekoya

PH Joint Strategic Needs Assessment

Operational Threat Management

Insufficient capacity provided across the council and CCG to support the work of the JSNA

PH Specialist Team lead on JSNA, require partnership working with council and CCG contacts who are not yet identified

Delay in refresh of JSNA


Medium DPH

90


Current Impact

Current Risk Score

Risk Owner

PHC Decommissioning

Operational Threat Customer/Citizens

Commissioned public health services may not be able to meet the needs of the local population

Public Health Commissioning decommission existing services or recommission to focus on prevention

The long-term health of the population will be compromised.

Unlikely (2) Significant (2)

Low Michelle Binfield

HIVPP Withdrawal Operational Threat Management

London boroughs may choose to reduce or stop their annual contributions to the London HIV Prevention Programme

All London boroughs are subject to considerable financial pressures and budget reductions

London HIVPP will be forced to limit interventions and commissioned activity

Unlikely (2) Significant (2)

Low Paul Steinberg

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5.6 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 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.

5.6.1 Programme Assurance Statement


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 3 (October – November): LCN development, in particular around the patient cohort is

progressing. Recruitment for LCN Chairs progressing

VEAT notice published to advise of our intention to directly award the contract for the Access Hubs for 1.4.17 – 31.3.19. No challenge received so drafting and agreement of contracts now in progress.

National funding for Extended Access now confirmed, although reduced by approx. 30%.

First contract review meeting undertaken with GP Federations as well as a Board to Board meeting held in October to agree how both the CCG and GP Federations can work together and engage with, what is a common membership.

Review of Hub utilisation completed as part of the WIC review. Recommendations now being implemented.

Primary Care Team working together with GP Federations to access and deliver OD support through the GP Forward View.

Secured funding and interim appointment of Senior Primary Care Transformation Manager through the GPFV.

CEPN working with practice leads to develop training support to admin/ reception staff – funded via GPFV

First part of the Patient Listening Scheme (part of GPDF) has been approved for payment. Projects progressing in practices.

Commissioning intentions issued to primary care and discussions commenced on how these can be realised, with primary care and commissioning colleagues.

GPDF Task and Finish Group for 2017/18 scheme commenced.

Review of WIC, A&E redirection service and Gracefield Gardens access hub completed. Recommendations discussed and agreed at PCCSC and GB t-con. Engagement plan progressing.

PMS contract negotiations can now proceed, and are expected to be concluded by end March 2017.

Membership has agreed to move to fully delegated commissioning, Minor Ailment Scheme review commenced with recommendations

that have been approved to be implemented for 2017/18.

Primary Care Development

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Key challenges to date: Negotiations with the LMC regarding the PMS Premium – pause

prevented progress. Discussions now proceeding

Negotiations with the Federations over Access Hub Model. Procurement issue now overcome as no challenge to VEAT notice

SELDOC WIC contract – agreement reached with SELDOC for the continuation of the service until 31

st March 2017, which aligns with

implementation of WIC review recommendations

Fully robust budgetary/ contractual control

Key risks 2016-17: Continued poor uptake of extended access hub capacity, especially

at weekends

WIC implementation of recommendation by 31st March –

engagement process and final agreement to fit into timeline for delivery on 31

st March 2017

Minor ailments – recommendation of future commissioned service may be challenged by LPC. This is being mitigated through regular discussion with LPC.

Federation model doesn’t deliver the changes in primary care models. This is being mitigated through Board to Board discussions and contract meetings

Preparedness for Level 3 – fully delegated commissioning – Re-structure of Primary Care Team to take on the impacts of this change on the primary care function within the CCG.

LCN development not at speed required to deliver the changes needed in Lambeth. This has been mitigated through the appointment of AD for LCN Development as well as discussions on how to utilise the both the GPDF and PMS premium funding to support transformational change.

94

5.6.2 Primary Care Programme Dashboard

The Primary Care Programme dashboard was last reported to the IGC in October. The indicators are currently being refreshed and will be presented at the next Prorgamme Board meeting on the 14th of December 2016. The dashboard will be included in the Integrated Governance and Performance Report which will go to the Board on the 18th of January 2017.

95

5.7 Enabler Programmes

5.7.1 Governance and Development Risk Register

For risk 6K, scored 12, please see the Board Assurance Framework. The Business Continuity Risks 6H, 6I and 6J have been removed from the register. A new Business Continuity Management Plan has been published with a different set of risks which are currently being reviewed and validated before being added to the register.

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 NHS Property BCPs to be obtained and reviewed – to await revision post environmental risk assessment June 2016. Undertake a Lower Marsh EPRR exercise and LCCG Communications exercise – to be discussed at November Health and Safety Working Group November 2016.

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, e.g. GP interpreting, IUC procurement, OHSEL EOC proposals

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Risk Title


managed

Current Risk


Possible risk of non-compliance with information governance requirements relating to processing of personal confidential data on QUIC system, resulting in a breach of personal confidential information

Programme Board /


6 Mitigate To review the retention and destruction schedule to include retention of quality alert data - amended Records Management Policy to Nov 2016 IGSG. Follow up with GP Practices completion of FPN actions - to discuss at IGSG

Risk that failure to manage and apply information security standards leading to hacking of CCG public internet pages and the introduction of viruses and software to electronic devices and IT networks, resulting in a loss or breach of CCG data.

Programme Board /


9 Mitigate CCG Internet Acceptable Use Protocol - Support from new provider to be agreed as regards providing policies for adoption by the CCG. To be discussed at Nov IGSG. Staff training and awareness - discussed at Sept 2016 IGSG. Staff will need to sign up to CSU policies once adopted and for this to be included in induction. Support from new provider to be agreed and discussed at Nov 2016 IGSG. Agree format of reporting attempted cyber attacks to IGSG - CCG contacts given access to SUSI to view relevant reports, however these reports not yet available. Upgrade CCG systems from Internet Explorer version 11 - some issues with Windows updates not having been completed, so roll out delayed.

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 the organisation

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Risk Title


managed

Current Risk


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

Programme Board /


8 Mitigate Completion of discovery phase and identification of transition tasks for the current and new IT provider - ongoing Development of data cleansing guidance for CCG - IT team have attended Staff Briefing at CCG and will attend each directorate meeting. Audits completed in general practice and taken place at the CCG.

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5.7.2 Equalities and Engagement

Responsible Director Una Dalton, Director Governance and Development

Clinical Lead Dr. Paul Heenan

Programme Lead Catherine Flynn, Engagement Manager

Purpose: To enact the Public Sector Equality Duty

99

Key aims for 2016-17: Data use

Review data requirements for 2016/17 target setting and action plans against equalities objectives

Bring equalities data focus to CQRG specs

Review opportunities with GSTT for focus in specific area – e.g. learning disabilities

Engaging diverse voices

Ensure that engagement activity is appropriately targeted at programme and corporate level

Use agreed templates for planning involvement activity to highlight equalities focus

Record equality data concerning participants in engagement activity – standard forms

Health inequalities

Ensure CCG programmes have clear and measurable equalities objectives and targets and workplans in place

Workforce

Implement WRES; equality analysis of HR policies Leadership

Ensure inclusive recruitment procedures and processes

Collect equality data on applications and appointments to governing body and senior management

Produce annual statutory compliance report(s) as required

Key Achievements Q3 (October – November) : Equalities objectives and progress reviewed at Engagement, Equalities

and Communications Committee (Apr, Jun, Sept, Nov) – detailed reports in Q2-3 from primary care, adults programme and cyp programme boards

Clear and measurable targets set, with data sources identified for reporting; programme boards scheduling discussions and reports against their equalities objectives – gaps remain in cyp data

Data anomalies reviewed re: primary care programme’s objective on learning disability health checks – data coding issues identified and resolved – this has resulted in a new baseline for progress against this objective

Equalities annual reports from GSTT, KCH and SLaM part of CQRG agendas; broader discussions with providers about bringing equalities dimension into presentations and reports on clinical agenda items more routinely

Further discussion initiated with GSTT equalities lead re: equality data in reports to CQRG and on complaints, incidents etc. (to be continued in Q3/4)

Learning disabilities ‘task force’ continues with clinical leadership

Templates in use for planning inclusive engagement at CCG level

Stage 1 equality analysis of OHSEL elective orthopaedic proposals undertaken (SEL-wide), - key groups identified

Pre-consultation engagement undertaken with key groups identified by equality analysis as likely to be affected by OHSEL elective orthopaedic proposals

Templates in use for planning inclusive engagement at CCG level

Continuing engagement with Portuguese speakers in North Lambeth - workshop discussion with members of Portuguese-Speakers’ Community Centre on NHS 111 and procurement of integrated urgent care service – Sept 16)


Finalising equalities targets and workplan for children’s programme objectives

Mainstreaming approaches to equality objective-setting and reporting across all CCG programmes

Key risks 2016-17:

Compliance with Equality Act

Current incomplete reporting on programme equalities objectives

Equalities

100

Engagement

101


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 Q3 (October – November) :

Engagement objectives and progress reviewed at Engagement, Equalities and Communications Committee (Apr, Jun, Sept, Nov)

Up-to-date induction materials in place for all staff and GB members re: legal and policy frameworks and CCG approaches; induction meeting with new GB lay member for patient and public involvement

Briefings for Scrutiny as required re: OHSEL programme; input into SE London

JHOSC in particular re development of proposals for elective orthopaedic care;

members of South-east London Stakeholder Reference Group (including OSC

members) provided assurance on thorough and responsive engagement to date in

OHSEL, particularly on elective orthopaedic plans across SEL;

Chairs meetings continue, shaping agendas for HWB; July pre-meet (open forum for public) involved workshop discussion on refresh of Lambeth’s Health and Wellbeing strategy and links with Lambeth’s Community Plan. It included a discussion on the four Health and Wellbeing key themes of: early action and prevention, integration, health and wellbeing in all policies and housing, along with discussion on related aspects of the Community Plan on narrowing the gap and focus on inequalities; the CCG submitted papers for the October health and Wellbeing Board on primary care co-commissioning, elective orthopaedic centre proposals and the South-east London Sustainability and Transformation Plan; the pre-meeting had a focus on children’s services in Lambeth

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; we invited people via our website (among other channels) to our event about improving GP services and co-commissioning in October; we promoted opportunities for people to get involved with Healthwatch activity, advertising trustee vacancies, promoting meetings on Black Wellbeing, and encouraging people to take Healthwatch’s survey on mental health support from GPs; we posted our film on community-based care and also advertised Lambeth Council’s consultation on public health services

CCG public forum well-attended with broad range of questions addressed (Jul, Sept, Nov)

Engagement

102

Development/delivery of engagement plans for ultrasound, GP interpreting, NHS

111, elective orthopaedic care (OHSEL), children and young people’s emotional

wellbeing capacity-building, and primary care co-commissioning; advice and

guidance to engage on review of NHS walk-in centre and as required in other

areas; discussion with long term conditions and local care network leads on

models for engagement in LCNs and care co-ordination work

Continuing funding of PPG Network to support development of patient voice into

quality of primary care and CCG commissioning; dissemination of film to support

development of PPGs (launched at Patient Participation Awareness Week event);

engagement with people with learning disabilities to inform campaign materials to

increase uptake of health checks

Our Healthier South-East London and Sustainability and Transformation Plan (STP) work across SEL; targeted engagement in line with equality analysis on elective orthopaedic care proposal development; series of workshops with Healthwatch to engage directly and inform and support HW work planning for 2016-17; clinical commissioner engagement through CCG localities (elective orthopaedic care);

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)

Annual report submitted to NHS England by 31 October 2016 and to Governing Body 2 Nov 2016


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

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5.7.3 Organisational Development


Programme Lead Lucy Day / Janie Conlin, Assistant Director Organisational Development

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

104


Develop CCG to best support delivery of the organisation’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

Key Achievements Q3 (October - November):

Launch of national staff survey and associated communications

Recruitment for new Collaborative Forum Chair and lessons learned

Evaluation of de-mystifying commissioning training and input to Clinical Network event to help embed training and explore future development needs

Range of activities associated ith Healthy living week, participation in Healthy workplace award ceremony and video for Mayor’s office

Induction of new OD admin support to OD activities

Diagnostic discussion with senior primary care team to inform next steps of OD interventions for primary care development programme

Engagement with NHSE regarding 360 process for 2016/17

Successful completion of Leadership Academy Postgraduate Certificate in Organisational Change Management

Orientation in commissioning intentions to help inform OD priorities for Q4 and 2017/18

Initial engagement of MT and Ads in OD diagnostic on behavioural changes needed to support successful delivery of CCG


Prioritising development time and activity over immediate deliverables

Key risks 2016-17:

Ensuring the organisation prioritises some development time and activity over immediate deliverables

Effective engagement of our membership

Succession planning clinical leadership

Establishing new ways of working with revised skill mix in OD team

105

5.7.4 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.

106

Key aims for 2016 – 17:

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 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

Key achievements Quarter 3 (October – November):

Mobilisation of the new contract continues. The SE CSU IM&T

department was integrated into NE London CSU on 1st November

2016. Much of the transition work has now been completed, including a

full audit of IT equipment in General Practice. This will provide the CCG

with an Asset Register. Practice level Registers have also been

requested.

Quality of GP IM&T is judged against the NHS England GP IT Operating

Framework and associated documents and measured using the GP IT

Digital Maturity Assessment. Following publication of the 2016 data, an

Action Plan has been prepared to monitor improvements to the service.

2016/17 funding for the replacement of IM&T equipment in General

Practice has been confirmed by NHS England. Planning in underway

for deployment to practices. Bids have now been submitted for funding

for equipment replacement in 2017/18 and 2018/19.

The Estates and Technology Transformation Fund was massively over-

subscribed across London. 92 technology schemes were submitted;

NHS England only supported 26 of these to the next stage of due

diligence. Unfortunately, none of the Lambeth bids were successful.

Alternative funding sources are being sought to support the different

schemes.

Digital Roadmap

Mobilisation of the new contract continues. The SE CSU IM&T

department was integrated into NE London CSU on 1st November

2016. Much of the transition work has now been completed, including a

full audit of IT equipment in General Practice. This will provide the CCG

with an Asset Register. Practice level Registers have also been

requested.

Quality of GP IM&T is judged against the NHS England GP IT Operating

Framework and associated documents and measured using the GP IT

Digital Maturity Assessment. Following publication of the 2016 data, an

Action Plan has been prepared to monitor improvements to the service.

IM&T

107

- 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 CSU)

IM&T Support to Programmes

Support Programmes to use IM&T to innovate and achieve change

2016/17 funding for the replacement of IM&T equipment in General

Practice has been confirmed by NHS England. Planning in underway

for deployment to practices. Bids have now been submitted for funding

for equipment replacement in 2017/18 and 2018/19.

The Estates and Technology Transformation Fund was massively over-

subscribed across London. 92 technology schemes were submitted;

NHS England only supported 26 of these to the next stage of due

diligence. Unfortunately, none of the Lambeth bids were successful.

Alternative funding sources are being sought to support the different

schemes.

Lambeth DataNet

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.

Following some delay in data extraction by the IM&T department at

Guy’s & St. Thomas’s NHS Foundation Trust due to misunderstandings

about the structure of the data extract provided by EMIS, data has now

been loaded to the data warehouse. User Acceptance Testing is now

under way.

Corporate Information Management & Technology

Transfer of corporate IM&T to the new Delivery Partner is happening

in parallel to that for GP IT. Work is beginning on documenting data

files on the existing servers prior to moving them onto the new

servers of the CCG’s new Delivery Partner

IM&T Support to Programmes

The Digital Technology Group continues to meet, with a packed

agenda.

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Key outstanding issues:

GP Information Management & Technology

New GP IT service: General Practice aspirations for their IM&T need

to be defined and incorporated into a plan and programme of work to

deliver effective and efficient technology.

Primary Care Digital Maturity: Improvement in Primary Care digital

maturity will be a long-term project. Development of consistent use

of systems such as e-Referral and GP2GP across all Practices will

take effort over a number of years.

Funding: Estates and Technology Transformation Fund bids were

not successful. This has a significant impact on transformation of

Primary Care through use of technology. Alternative funding sources

are being sought.

Digital Roadmap

Once the SEL Digital Roadmap has been submitted, work will need

to begin to set up the structures and implement the aspirations the

Roadmap contains.

Work by Lambeth Programmes on delivery of the Universal

Capabilities is under way. The Universal Capabilities are based

around NHS technologies which have proved difficult to implement.

This means that long-term delivery plans are required to ensure

milestones are met and the technologies are fully utilised.

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

User acceptance testing of the new data warehouse continues.

Issues are being fed back to the Guy’s & St. Thomas’ NHS

Foundation Trust IT Helpdesk. Whilst some high-level work has

been carried out to identify how Lambeth DataNet can support

innovation in Primary Care, further work is required.

Key risks going into 2016-17:

GP Information Management & Technology

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.

Fundings: 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.

Digital Roadmap

Risks associated with the Local Digital Roadmap are around

delivery of the Universal Capabilities, which involve transformation

for primary, secondary and social care. At this stage these risks

await quantification.

109

5.7.5 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.

110

Key aims for 2016-17: 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


Gracefield Gardens Estates and Technology Transformation Fund (ETTF) application successful

Lambeth One Public Estate expression of interest was successful. The CCG, GSTT, KCH, the Metropolitan Police and LAS, lead by LBL have been awarded £50k to develop a Service and Asset Delivery Plan to bid for up to £500k fund to pump prime estates schemes

Nine Elms Vauxhall practice infrastructure funding approved in principal by LB Lambeth from Section 106/Community Interest Levy Funding. This will be submitted, with the LB Wandsworth funding proposal to the NEV Strategy Board on 16 December.

Key challenges to date: Allocation of the Section 106 funds are utilised

NEV Business case successfully awarding Lambeth with funds to

develop the affected practices

Utilisation of Section 106 funds before they time expire

Engagement with other providers to develop co-location plans

Unsuccessful ETTF Application, plans for alternative funding

Securing a value for money rent at Lower Marsh or alternative

location

Key risks 2016-17: 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 estates within Lambeth within competing resources

Clapham Park Practice lease expiry

Lower Marsh Lease expiry

Estates

111

5.7.6 Workforce


Clinical Lead Dr. Adrian McLachlan

Programme Lead Fiona Stirling , HR Business Partner, South London CSU

IAF Indicators 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.

NHS Lambeth CCG’s Human Resources services are provided by South Commissioning Support Unit

and the organisation’s named Business Partner is 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.

Our workforce profile as at October 2016 is as follows:

Staff in Post As at 31 October 2016 the CCG has a headcount of 77 and a FTE of 67.34. Over the past 12 months there has been a general increase in staffing numbers, with an increased headcount of 11 from 1 November 2015 to 31 October 2016.

112

Staff turnover

The overview of the last 12 months is inconsistent and increases and decreases each month with a peak in August 2016. Generally speaking the CCG has a higher turnover rate than the national average (which may be attributable to the London factor) although the position improved from April to June 2016 where the CCG has a lower rate than the national CCG average rate (the national CCG average turnover rate for July 2016 was 1.55%, this is the latest data that can be retrieved from Iview).

Starters - Rolling 12 Months (Headcount & FTE) There has been 3 starters in October 2016, and 23 starters in total through-out the preceding 12 months.

Leavers - Rolling 12 Months (Headcount & Fte) There has been two leavers in October 2016 and 12 leavers over the preceding 12 months. Each month has been fairly consistent with either none or 1 or 2 employee's leaving each month with a peak in August 2016.

113

There has been 12 leavers in total over the preceding 12 months. Each month has been fairly consistent with either none or 1 or 2 employee's leaving each month with a peak in August 2016.

Sickness absence figures are currently available as at 30th September 2016. The sickness absence percentage rate for Lambeth CCG at 30th September was 3.33% which shows a slight increase in absence over the previous 2 months. The target is 2.50%. The national CCG average for July 2016 was 2.59%, 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 no employee relations cases progressing to a formal hearing stage.

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0

1

2

3

43

1

4

2

1

4

2 2

1

0

3

2

4

2

3

2

3

2

2015/2016

2016/2017

Complaints

0

2

4

6

8

10

129

4

7

43 3

11

3 3

7

4

2

87

10

24 4

2015/2016

2016/2017

PALS

6 QUALITY ASSURANCE

6.1 PALS and Complaints Quarter 2 report (latest available report)

6.1.1 New Complaints

There were seven new complaints in this quarter. This is the same number of new complaints received in the same quarter of 2015-2016. Of the new complaints received three were for the CCG to respond to and four were for other providers to provide a response to. Overall, so far in 2016/2017, there has been a 6% increase in complaints compared to 2015/2016.

6.1.2 New PALS There were ten new PALS in this quarter. This is equal to the figures for new PALS received in the same quarter of 2015-2016. Of the new PALS cases recorded, five were for the CCG to provide a response to and the other five were for other providers to action. On the whole, compared to the same period in 2015/2016, there has been neither an increase nor decrease in the number of PALS cases recorded in 2016/2017. Please note that the overall figure for PALS cases in this quarter also include MP related PALS cases.

115

6.1.3 Complaints per Quarter

The table below highlights the number of complaints, whether the CCG was required to respond and if the complaint originated from an MP.

6.1.4 Number of MP Cases

There were two MP PALS and MP complaint cases recorded between July to September 2016. There were no specific themes or trends of note. The MP’s in particular communicating in this quarter were: Helen Hayes, Sarah Newton, Kate Hoey and Councillor Jackie Meldrum

6.1.5 Number of Open Complaints and PALS cases

There are currently three cases that remain open – two PALS received on 2 and 5 September 2016 respectively as well as one complaint received on 29 September. The other eight PALS cases and six complaint cases received between July to September 2016 have all been dealt with and closed. Complaints Closed during Quarter There were nine complaints closed during Quarter Two. These are detailed in the table below. Where appropriate, or where the information has been provided, lessons learnt and the outcome are included in

the report.

116

There are no particular trends of note during this quarter. The joint highest number of complaints was split between Communication and Treatment/Care. The complaint subjects are further drilled down in to sub-subject. Each complaint could be categorised in several sub-subjects. For example if the main subject is Continuing Healthcare, the sub-subjects should be child related, assessment timescales, personal health budget and process. From this quarter complaints the main sub-subjects are:

Funding

GP

Provider

Access to Services

Appointments

Communication

Delayed/Late

Standard of Care

Trust/Hospital More details on the sub-subjects can be provided if required outside of this report.

Public Health Services Ombudsman (PHSO) Decisions

There are no complaints with the PHSO at present.

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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 2 2016/17 a total of 47 incidents were reported to the CCG via STEIS.

It is possible that SIs reported during this period may be de-escalated at a later date if found not

to meet the criteria following further investigation.

Forty four incidents required an investigation, as noted by provider in the following table. Two

SIs were de-escalated as on further investigation, they were not found to meet the SI criteria.

One further SI is being considered for de-escalation.

Table 1: Q2 2016/17 Serious Incidents requiring investigation reported by provider

Provider Jul-16 Aug-16 Sep-16

GSTFT 8 11 8

KCH 0 1 1

SLaM 3 6 6 NOTE: GSTFT = Guy’s and St Thomas’s NHS Foundation Trust; KCH = King’s College Hospital NHS Foundation Trust; SLaM = South London and Maudsley NHS Foundation Trust; PRUH = Princess Royal University Hospital

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 15 incidents reported by SLaM, one

concerns a non-Lambeth patient receiving services in Lambeth where NHS Lambeth CCG

retains oversight of the SI and two concern Lambeth patients receiving services in a

neighbouring CCGs, who retains oversight of the SI.

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Table 2: Serious Incident categories by Provider for SI’s requiring investigation, Quarter 2 2016/17

Of the incidents reported by GSTFT, all 27 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, 58% of reports from GSTFT and

14% 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 41.4% 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 2 by GSTFT. These included one wrong site surgery and two retained foreign objects post procedure. 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.

STEIS Category GSTFT KCH SLaM

Surgical/invasive procedure incident meeting SI criteria 9 0 0

Apparent/actual/suspected self-inflicted harm meeting SI criteria 1 0 8

Treatment delay meeting SI criteria 6 1 0

Disruptive/aggressive/violent behaviour meeting SI criteria 0 0 5

Slips/trips/falls meeting SI criteria 4 0 0

Maternity/obstetric incident meeting SI criteria: mother only 2 0 0

Pressure ulcer meeting SI criteria 1 1 0

Confidential information leak/IG breach meeting SI criteria 0 0 1

Diagnostic incident incl delay meeting SI criteria 1 0 0

Environmental incident meeting SI criteria 1 0 0

Maternity/obstetric incident meeting SI criteria: baby 1 0 0

Medical equipment/devices/disposables incident meeting SI criteria 1 0 0

Pending review 0 0 1

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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 to which South East CSU provides a Freedom of Information (FOI) service, 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 slight decrease in the total number of requests received for the year to date when compared to the same point in 2015/16. Figures for Quarter 3 are correct as at 24/11/2016.

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 Quarter 3 so far. Figures for 2015/16 have been provided for comparison.

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The CCG has a 100% response compliance rate for Quarter 3 to date. This is an excellent achievement and far exceeds the current good practice guidance suggested by the ICO. The CCG’s overall compliance rate for the year to date is 97%. South East CSU’s FOI Team continues to work hard with the CCG’s 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 CCG · 2017. 1. 10. · January 2017 Our Mission: ......

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