Governing Body Agenda – Part 1 Thursday 4 February 2016 ... · 5.2 Governing Body Assurance...

Governing Body Agenda – Part 1

Thursday 4 February 2016 Green Rooms 1&2, Ventnor Town Council,

1 Salisbury Gardens, Dudley Road, Ventnor, Isle of Wight PO38 1EJ

Governing Body

AGENDA

Thursday, 4 February 2016, 10:30-13:00 Green Rooms 1&2 Ventnor Town Council, 1 Salisbury Gardens, Dudley Road, Ventnor, Isle of

Wight PO38 1EJ 1. 1.1

1.2 1.3

Apologies for absence: Declaration of interests Confirmation that the meeting is quorate

JR JR JR

GB15-059

10:30

2. Minutes of the last Governing Body Meeting 5 November 2015 JR GB15-060 3. Matters Arising

3.1 Schedule of Actions from the 5 November 2015

JR

GB15-061

10:35 4. Chair / Chief Officer Report JR/

HS Verbal 10:40

5. Items for Assurance 5.1 Performance Report LO GB15-062 10:50 5.2 Governing Body Assurance Framework HS GB15-063 11:00 5.3 Risk Register Summary HS GB15-064 11:10 5.4 Emergency Preparedness, Resilience and Response HS GB15-065 11:20 6. Items for Approval 6.1 Policy Recommendation 004: Complex decongestive therapy (CDT) for

Lymphoedema HS

GB15-066

11:30

6.2 Transforming Care Programme HS GB15-067 11:40

7. Items for Discussion

7.1 CCG Allocation 2016/17 (RW/LO)

LO

To Follow GB15-068

11:55

7.2 Planning 2016/17 (GB) HS Presentation 12:10 8. Items to receive

8.1 Commissioning Intentions (GB) 8.2 Delegated Commissioning of Primary Care (CM) 8.3 MLAFL Update (LO)

HS HS HS

GB15-069 GB15-070

Presentation

12:25 12:40 12:50

9. Minutes to Receive 9.1 Audit Committee 26.11.15 LO GB15-072 9.2 Clinical Executive Minutes 19.11.15, 10.12.15 and 21.01.16 HS GB15-073 9.3 Quality and Patient Safety Minutes 24.9.15, 26.11.15 IR GB15-074 9.4 Joint Committee for Primary Care 1.10.15, 3.12.15 HS GB15-075 12:55 10. Urgent Business JR 11. Motion to exclude the Press and Public JR 13:00 - that representatives of the press, and other members of the public, be

excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest’, (Section 1 (2), Public Bodies

Dr John RIVERS Chair, Clinical Executive Member

John is: A GP Partner at Shanklin Medical Centre, Shanklin, Isle of Wight. Shanklin Medical Centre is a shareholder in One Wight Health GP collaborative. John undertakes private medicals and reports with general practice. President of Cruse Bereavement Care IW

Last Updated / Noted: August 2015 Helen SHIELDS Chief Officer

Helen’s husband is Head of Podiatry and Orthopaedic Triage at IW NHS Trust.

Last Updated / Noted: September 2015 Laurence TAYLOR Governing Body Lay Member

Laurence is: Director of Bembridge Airport Ltd and Bembridge Farm Ltd. He is employed by EU & FT Taylor Ltd

Last Updated /Noted: January 2016 Lindsay VOSS Governing Body Nurse

Lindsay is: Lay member for National Catholic Safeguarding Commission Lindsay’s husband is employed in Pharmaceutical industry (Eli Lilly and Company)

Last Updated / Noted: May 2015

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Governing Body Declaration of Governing Body Members’ Interests Sponsor: Helen Shields, Chief Officer

Summary of issue:

This paper sets out the relevant and material interests of the members of the CCG Governing Body. It represents the Register of Interests as required by the Standing Orders in accordance with the NHS Code of Accountability.

This paper supports the CCG Governing Body to fulfil its Standing Orders in accordance with the NHS Code of Accountability.

Action required / recommendation:

The CCG Governing Body is being asked:

• To receive and note the register of interests of members and ensure that members play no part in discussion or decision where a conflict of interest is established.

• To receive any oral updates on the interests of members.

Principle risk(s) relating to this paper:

There are no risks relating to this paper.

Other committees where this has been considered:

This paper has not been considered at any other committee.

Financial / resource implications:

There are no financial or resource implications arising from this paper.

Legal implications / impact:

There are no legal implications arising from this paper.

Public involvement /action taken:

There has been no public involvement or action taken.

Equality and diversity impact:

This paper does not request decisions that impact on equality and diversity

Author of Paper: Rebecca Berryman, Governance Support Officer

Date of Paper: November 2015

Date of Meeting: 4 February 2016

Agenda Item: 1.2 Paper number: GB15-059

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Declaration of Interest

1. Introduction

1.1 The NHS Code of Accountability requires the Governing Body to declare interests which are

relevant and material to the Governing Body of which they are a member.

1.2 Interests which should be regarded as “relevant and material” are:

• Directorships, including non-executive directorships held in private companies or PLCs (with the exception of those of dormant companies);

• Ownership or part-ownership of private companies, businesses or consultancies likely or

possibly seeking to do business with the NHS;

• Majority or controlling share holdings in organisations likely or possible seeking to do business with the NHS;

• A position of authority in a charity or voluntary organisation in the field of health or social

care;

• Any connection with a voluntary or other organisation contracting for NHS services;

• Research funding/grants that be received by an individual or their department;

• Interests in pooled funds that are under separate management (any relevant company included in this fund that has a potential relationship with the CCG must be declared);

1.3 Any Governing Body Member who comes to know that the CCG Governing Body has entered

into or proposed to enter into a contract in which he/she or any person connected with him/her (as defined in the Standing Orders) has any pecuniary interest, direct or indirect, the Governing Body member shall declare his/her interest by giving notice in writing of such fact to the CCG Governing Body as soon as practicable.

1.4 The Chief Officer will ensure that a Register of Interests is established to record formally declarations of interests of Governing Body Members. Interests will be declared at Governing Body meetings to ensure they are known to the public.

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2. Register of Interests

Name Relevant and Material Interests Martyn DAVIES Governing Body Lay Member

Martyn has no declarations of interests.

Last Updated/Noted: November 2015 Dr Joanna HESSE Clinical Executive Member

Joanna is: A GP Partner at Esplanade Surgery, Ryde, Isle of Wight. Joanna undertakes private practice within Esplanade Surgery, Ryde, Isle of Wight. Esplanade Surgery is a member of the One Wight Health IOW GP collaborative. The surgery has one share in the GP collaborative. Joanna has a contract with Isle of Wight GP Out of Hours (OOH) service to work in OOH on the Bank.

Last Updated /Noted: January 2016 Loretta KINSELLA Director of Quality and Clinical Services

Loretta has no declarations of interest. Last Updated / Noted: December 2015

David NEWTON Governing Body Lay Advisor

David is: Director of Social Enterprise Foundation CIC and Social Enterprise Foundation Members Ltd. A Senior Partner at Corporate Impact. Contracted by Priory Asset Management. A facilitator for the Patient and Public Involvement Lay Member Network. Member of the NHS England Board Level Task and Finish Group on Patient and Public Involvement. Board member of Vectis Housing Association.

Last Updated / Noted: November 2015 Loretta OUTHWAITE Chief Finance Officer

Loretta is a School Governor at the Island Free School. Last Updated / Noted: July 2015

Dr Ian RECKLESS Secondary Care Doctor

Ian is: Consultant physician and clinical director, Oxford University Hospitals NHS Trust. Honorary senior clinical lecturer, medical sciences division, Oxford University Clinical Advisor, Parliamentary and Health Services Ombudsman. Specialist advisor (clinical inspector) CQC. Author, Oxford University Press and Blackwell-Wiley (royalties)

Last Updated / Noted: September 2015

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Dr John RIVERS Chair, Clinical Executive Member

John is: A GP Partner at Shanklin Medical Centre, Shanklin, Isle of Wight. Shanklin Medical Centre is a shareholder in One Wight Health GP collaborative. John undertakes private medicals and reports with general practice. President of Cruse Bereavement Care IW John works occasional (up to 5 hours a week) sessions for Beacon (OOH GP Service)

Last Updated / Noted: January 2016

Helen SHIELDS Chief Officer

Helen’s husband is Head of Podiatry and Orthopaedic Triage at IW NHS Trust.

Last Updated / Noted: September 2015 Laurence TAYLOR Governing Body Lay Member

Laurence is: Director of Bembridge Airport Ltd and Bembridge Farm Ltd. He is employed by EU & FT Taylor Ltd

Last Updated /Noted: January 2016 Lindsay VOSS Governing Body Nurse

Lindsay is: Lay member for National Catholic Safeguarding Commission Lindsay’s husband is employed in Pharmaceutical industry (Eli Lilly and Company)

Last Updated / Noted: May 2015

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Governing Body Minutes of the Governing Body 5 November 2015

Sponsor: Helen Shields, Chief Officer

Summary of issue: Minutes of the previous Governing Body Meeting 5 November 2015.

Action required/ recommendation: To approve the minutes of the Governing Body 5 November 2015.

Principle risks: There are no risks relating to this paper.


This paper has not been considered at any other committees.

Financial /resource implications: There are no financial or resource implications.

Legal implications/ impact: These minutes form a formal public record of the previous meeting.

Public involvement /action taken: The Governing Body was held in public.

Equality and diversity impact: There is no equality and diversity impact relating to this paper.

Author of paper: Rebecca Berryman, Governance Support Manager

Date of Paper: 6 November 2015


Agenda Item: 3 Paper number: GB15-060

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NHS Isle of Wight Clinical Commissioning Group: Governing Body

Minutes of Part 1 of the CCG Governing Body held on 5 November 2015 at 10:30 at East Cowes Town Hall, York Avenue, East Cowes, Isle of Wight PO32 6RU

PRESENT: Dr John Rivers (JR) – CCG Chairman (Chair) Helen Shields (HS) – Chief Officer Joanna Hesse (JH) – CCG Clinical Executive Andrew Heyes (AH) – Head of Performance and Contracting (For LO until Item 5)

Loretta Kinsella (LK) – Director of Quality and Clinical Services David Newton (DN) – Governing Body Lay Advisor Loretta Outhwaite (LO) – Chief Finance Officer Dr Ian Reckless (IR) – Secondary Care Doctor Lindsay Voss (LV) – Governing Body Nurse

IN ATTENDANCE: Andrew Heyes (AH) – Head of Performance and Contracting (Item 5.2) Linda Rann (LR) – Head of Secondary Care Hospital Commissioning (6.1 & 6.2)

Gillian Baker (GB) – Deputy Chief Officer (6.2) Eleanor Roddick (ER) – Head of Urgent and Community Commissioning (6.3)

MINUTED BY: Rebecca Berryman (RB) – Governance Support Manager

15-057 Apologies for Absence Apologies for absence were received from Frederick Psyk (FP) – Governing Body Lay

Advisor. Andrew Heyes, Head of Performance and Contracting deputised for Loretta Outhwaite, Chief Finance Officer until item 5.

15-058 Declarations of Interest The Governing Body received and noted paper GB15-043 Declaration of Interests. DN

highlighted that he was a Member of the NHS England Board Level Task and Finish Group on Patient and Public Involvement. It was confirmed that a new declaration of interest form had been completed to this effect. There were no declarations of interest made in relation to any of the items on the agenda.

The Governing Body noted the Declaration of Interest. 15-059 Confirmation the Meeting is Quorate Confirmed. 15-060 Minutes of the Last Governing Body Meeting 3 September 2015 The Governing Body received paper GB15-044 Minutes of the last Governing Body

Meeting 3 September 2015. The minutes were approved as accurate, with the following exceptions: • 15-052 – Clinical Executive Minutes – should read ‘it was proposed that the Beacon

Contract should be extended until 31 March 2017.’

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• 15-041 – IR’s comment in relation to the Joint SIRI panel should read ‘IR queried the purpose of the Joint SIRI panel.’

• 15-044 – Assurance Framework – should read ‘IR commented that this is not consistent with the previous 5 assurance categories.’

Discussion took place regarding the draft minutes of sub-committees. It was confirmed that the draft minutes of sub-committees that are approved by the Chair will be reported to the Governing Body. If there are any ammendments to the minutes once these have been to the relevant committee, these will be updated and reported within the next set of sub-committee minutes. The draft and final versions will be clearly marked on each set of minutes.

The Governing Body approved subject to the above changes the Governing Body Minutes

of the 3 September 2015.

15-061 Schedule of Actions

The Governing Body received and noted paper GB15-045 Schedule of Actions from 3 September 2015. No further comments were made.

The Governing Body received the Schedule of Actions. 15-062 Chair and Chief Officers Report

Chair/Chief Officer Update The Governing Body received a verbal update from the Chair and Chief Officer. HS confirmed that two new Governing Body Members have been appointed subject to references. It is anticipated they will commence in shadow form from December 2015, and formally start in January 2016. The nominations for two Clinical Executive Members are due to go out on Friday 6 November 2015. The Wessex LMC will be administering the Election process on the CCG’s behalf. It is anticipated the new members will commence in shadow form from January 2016, with their term commencing from 1st April 2016. The next Wessex Assurance meeting for Quarter 2 is due to take place on Monday 9 November. The formal position for Quarter 1 has not yet been received from NHS England. HS and JR recently attended a meeting for Chairs and Chief Officers from all Commissioning and Provider organisations across Wessex. It was highlighted at the meeting the need to plan at scale, whilst maintaining the local context. DN queried if Hampshire Devolution had been discussed at the meeting. HS confirmed that discussion had not taken place regarding Hampshire Devolution, but the CCG have attended other meetings in relation to it. It is currently uncertain as to what the implications will be, currently an expression of interest has been submitted.

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The Governing Body noted the Chair and Chief Officers Report. Items for Assurance 15-063 NHS England Emergency Preparedness Resilience and Response The Governing Body received presentation GB15-046 NHS England Emergency

Preparedness Resilience and Response (EPRR), presented by HS. The CCG is required to complete a self-assessment template and to review the same template completed by the IOW NHS Trust (IOWNHST) to understand and improve the system’s ability to respond to emergencies and incidents according to the core standards set down by NHS England. HS commented that in relation to Business Continuity Plans, for them to be fully compliant they need to be challenged and tested in more detail. Therefore this should be updated to partially achieved. LV commented that there should always be a Pandemic Flu plan in place. It was confirmed that an old plan is available; however a Wessex-wide plan is expected from the Wessex Area Team. LK commented that there should be no material change between the plans. The old plan would be adequate if a Pandemic Flu plan needed to be put in place. IR queried if the CCG On-Call Rota was sustainable and whether there had been an increase in calls. It was confirmed that the number of calls have increased mostly in respect of the IOWNHST, the CCG experiences peak times usually over Bank Holidays when reporting is required to NHS England. However the rota of 9 was felt sustainable. HS confirmed that that the CCG is a Category 2 responder, and any member of staff on a grade 8C and above is part of the rota. A training exercise has recently taken place for all members of the rota. As a Category 2 responder CCG’s do not regularly need to be called in and can deal with issues remotely or over the phone. The issue for being on-call on the Island is the mobile phone signal. There is a buddy system in place and if the individual on-call cannot be reached the next individual on the list will be contacted.

The Governing Body noted the NHS England Emergency Preparedness Resilience and

Response Self-Assessment and Isle of Wight NHS Trust position and approved the CCG Work Plan.

ACTION: Business Continuity Plan to be updated to partially achieved on the NHS England

Emergency Preparedness Resilience and Response paper. CM

15-064 Performance Report

The Governing Body received paper GB15-047 Performance Report, presented by LK and AH. The report highlighted the following: Quality • C.Difficile – the IOWNHST has 14 C.Diff cases against a 15/16 trajectory of 7. The IOW

CCG has 23 C.Diff cases against a 15/16 trajectory of 28.

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• MRSA – the IOWNHST have had no reported cases in 15/16. The CCG have two reported cases against a 15/16 zero trajectory.

IR highlighted that he was not assured regarding the processes in place at the CCG and the IOWNHST in relation to C.Difficile. He requested for a C.Difficile report to highlight the systems and processes that are currently in place to be taken to the next Quality and Patient Safety Committee. IR also expressed his concern regarding Infection Prevention and Control practice. LK confirmed that there is an external Infection Prevention and Control panel, and she was in the process of setting up an Island one. The CCG has not had a dedicated Infection Prevention and Control lead, but as posts in the Quality Team have been recruited to this area will now be covered. • Pressure Ulcers - there has been an improvement in the numbers of pressure ulcers,

particularly grade 4. • Serious Incidents Requiring Investigation (SIRIs) – the IOWNHST has reported 20 SIRIs

as of August 2015. One SIRI is subject to external review. • Deprivation of Liberty Safeguards (DoLS) – 61 applications have been submitted as of

August 2015. A new Adults Safeguarding Lead has now been recruited at the IOWNHST. • There have been 11, 52 week waiters and 47 mixed sex accommodation breaches at

the IOWNHST. All mixed sex accommodation breaches have the patients consent.

JH queried if it was recorded how many mixed sex accommodations requests were turned down. It was confirmed that the information was recorded and reported at the Clinical Quality Review Meeting (CQRM) and that no requests had been turned down by patients. It was asked if a deep dive in relation to patient choice and mixed sex accommodation could be completed. LK agreed to do this at CQRM. • Friends and Family - patients report a high percentage of satisfaction with care; staff

report lower percentage rates of satisfaction as a place to work and for recommending care.

DN highlighted that the clinical incidents resulting in harm trend is more variable than it was. LK commented that she would be concerned if there was a low level of reported incidents. Incidents reported indicate openness and transparency. Granular data is needed to understand the clinical incidents; this is reviewed at SIRI panels. The area of current concern is the number of falls. Constitution Targets • Referral to Treatment <18 weeks – the waiting list continues to be under pressure due

to available bed capacity. The IOWNHST, University Hospital Southampton, Portsmouth Hospital Trust and Salisbury NHS Foundation Trust all failed target in month.

• A&E – the IOWNHST was on red alert for all of August with 11 days at Black Alert. • Cancer – The IOWNHST achieved all cancer pathway targets in month.

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• 111 – Continues to perform well. • Cancer Oncology review has commenced. • Community nursing out of hours and community mental health services business cases

have been approved. Finance • As at the end of August the CCG’s year to date position is £937k better than plan. The

contributing factors to the year to date underspend are: - The Service Level Agreement (SLA) with the IOWNHST planned care is £628k

underspent. This is due to the backlog of elective activity and fines have been applied which will be re-invested as part of the Operational Resilience planning.

- A predicted increase in the numbers of Continuing Healthcare patients with complex needs, which will generate increased costs in the year.

• The CCG is forecasting achieving a planned surplus of £2.5m. Discussion took place regarding the impact to the prescribing budget as a result of turning Script Switch off. LO confirmed that there had not yet seen any impact due to report timing, but this was being monitored. LK highlighted that the standard operating procedures have been reviewed and assurance gained that Script Switch can be turned back on.

The Governing Body noted the Performance Report. ACTION: C.Difficile report to highlight systems and processes to be presented to the next Quality

and Patient Safety Committee. A deep dive in relation to patient choice and mixed sex accommodation to be reported to CQRM.

LK

LK

15-065 Governing Body Assurance Framework

The Governing Body received paper GB15-048 Governing Body Assurance Framework, presented by HS. It was highlighted that progress is being made in various areas. A new addition to the GBAF since the last meeting is a Joint Safeguarding Nurse post is to be recruited to. The paper was taken as read and opened up for questions.

IR highlighted that on p.5 the likelihood had changed but the colour had not been amended. He also queried if the potential Junior Doctor Strike Action will be added to the GBAF if this became a risk. It was confirmed it would be picked up by the System Resilience Group but would be added if it became a risk.

DN commented that the ticks to say an action is complete are not consistent. It was agreed this would be sense checked more thoroughly in future.

DN also highlighted Risk 1.11 was rated green, but felt that the CCG were still very behind in the delivery of target. It was agreed however that more progress had been made in recent months and the rating should remain as green.

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The Governing Body noted the Governing Body Assurance Framework. 15-066 Risk Register Summary

The Governing Body received paper GB15-049 Risk Register Summary, presented by HS. One new medium risk has been added to the Risk Register, risk Y2/20 – both designated safeguarding nurses have indicated that they will be leaving the CCG. The posts are shared posts with Portsmouth and it had been agreed that the shared post will no longer exist. The CCG has therefore decided to advertise for a combined adult and children’s safeguarding nurse on a full time basis.

The Governing Body reviewed the Risk Register Summary. 15-067 Safeguarding Annual Report

The Governing Body received paper GB15-050 Safeguarding Annual Report, presented by LK. The paper was taken as read and opened for questions. IR highlighted that this was not discussed at the Quality and Patient Safety Committee (QPSC) due to time constraints; however LV confirmed she has met with both Safeguarding Nurses to discuss the report. LV suggested that a discussion was held at the next QPSC regarding the future of how reports will be presented in relation to assurance around meeting safeguarding responsibilities.

The Governing Body noted the Safeguarding Annual Report. ACTION: Discussion to take place regarding future Safeguarding Reports at the QPSC LK Items for Approval 15-068 Policy Recommendation 005: Functional Electrical Stimulation in the Management of

Drop Foot of Central Neurological Origin (Specifically Post Stroke and Multiple Sclerosis) The Governing Body received paper GB15-051 Policy Recommendation 005: Functional Electrical Stimulation in the Management of Drop Foot of Central Neurological Origin (Specifically Post Stroke and Multiple Sclerosis), presented by LR. It was noted that the whole SHIP Priorities Committee report was distributed with the papers, LR apologised for this, as it should have just been the policy and the CCG template. LR highlighted that Functional Electrical Stimulation (FES) was a second line of treatment, with a small number of patients receiving the treatment. It was therefore recommended that the Governing Body approved the policy. With regard to the new template provided with the policy, it was agreed it was useful however would be reviewed again if a more controversial issue arose. Discussion took place regarding some of the treatments that went to the SHIP Priorities Committee. It was confirmed that the committee was currently being reviewed. DN commented that it would be beneficial to see within the template how patient and public involvement has been included within the process.

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The Governing Body approved the Policy Recommendation 005: Functional Electrical

Stimulation in the Management of Drop Foot of Central Neurological Origin (Specifically Post Stroke and Multiple Sclerosis).

15-069 System Resilience – Non Urgent GP Referrals The Governing Body received paper GB15-052 System Resilience – Non Urgent GP Referrals, presented by GB and LR. The IOWNHST has been under considerable pressure since July 2014, which has resulted in failure of the 18 week Referral to Treatment admitted target. It was proposed that temporary suspension of ‘non urgent’ referral to the IOWNHST for General Surgery, Urology and Orthopaedics to improve waiting times at the Trust. Discussion took place regarding the CCG’s responsibility to provide quality, timely treatment to patients, as well as offer patients choice. It was identified that since August the number of patients choosing to be treated off-island has increased, along with the IOWNHST outsourcing some elective activity. The IOWNHST have opened up additional bed capacity within the Trust and Poppy Ward at Solent Grange. As a result, encouraging data from the Trust has been received indicating that for October elective capacity is close to plan. JR queried if the Trust continue to deliver to plan when waiting lists will be reduced to a manageable size. LR confirmed that the Trust suggest they will be back on track by March 2016, however HS indicated this figure is optimistic, particularly as the implications of winter have not yet made an impact. JR highlighted that the pressure experienced at the IOWNHST is not a failure of the hospital; it is an Island-wide system issue. What the CCG need to be responsible for is a quality service to its patients, and this needs to be done collaboratively with what is best for the patient. It was queried if ‘non-urgent’ referrals were temporarily suspended what the selection criteria would be for patients to be treated on the Island. It was agreed that this would have to be carefully managed and patients considered urgent would be treated on the Island. A panel would need to be set up to make a decision regarding other patients who could be treated on the Island. Concern was raised that this would not give patients the choice that the CCG was responsible for providing. It was agreed a more robust plan would need to be put in place regarding who should be treated on the Island if referrals were suspended. After discussion as to whether ‘non-urgent’ referrals to the IOWNHST for General Surgery, Urology and Orthopaedics should be turned off. It was agreed that the waiting lists at the Trust should be closely monitored to see if there is any improvement, before a decision is made to turn off referrals. In addition to monitoring waiting lists, it was also agreed that the message regarding the pressures and patient choice continues to be communicated to GPs and the public. The public and GPs will also be supported by a

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Referral Support Centre set up in the CCG to assist with referrals off Island. As the next Governing Body meeting isn’t until February 2016, if a decision needs to be made to turn off ‘non-urgent’ referrals, the Governing Body agreed to delegate the decision to the Clinical Executive.

The Governing Body agreed to actively promote and support patient choice as to options

for hospital treatment. It was also agreed waiting lists at the IOWNHST to be monitored for improvement before a decision to suspend ‘non urgent’ referrals to the IOWNHST for General Surgery, Urology and Orthopaedics. The Governing Body agreed to delegate the decision to suspend referrals to the Clinical Executive if a decision in future is required.

15-070 End of Life Strategy

The Governing Body received paper GB15-053 End of Life Strategy, presented by ER. The paper was taken as read and opened up for questions. JR complemented this as an exemplar piece of work in relation to public and stakeholder engagement. DN agreed highlighting this as an excellent example of process.

The Governing Body approved the End of Life Strategy. 15-071 Delegated Primary Care Commissioning

The Governing Body received paper GB15-054 Delegated Primary Care Commissioning, presented by HS. Delegated Commissioning has been discussed at the Joint Committee for Primary Care where any initial concerns have been ironed out. The Membership Council have also given their support to apply for Delegated Commissioning. It was noted that accountability for Primary Care will still be with NHS England. IR queried who would be the Chair of the Isle of Wight Primary Care Committee, it was confirmed that it has to be chaired by a Lay Member, but not the Lay Member for Governance. It was confirmed the Independent Lay Member will chair the meeting.

The Governing Body approved the submission of a Delegated Primary Care

Commissioning application.

Items to Receive for Discussion 15-072 My Life a Full Life Update

The Governing Body received a verbal My Life a Full Life Update, by LO. LO reported that £3.4m of funding has been released and £2.3m has currently been deployed. A further Value Proposition will need to be submitted for 16/17. DN queried if there was any indication of the further resource for 16/17, LO confirmed that there was commitment that funding for 15/16 would be honoured going forward. There is a risk that funding may not be released as there are now 50 Vanguard sites. To mitigate the risk £700k of existing My Life a Full Life funding has been frozen, this has been Board approved and all partners are signed up. The next steps are to continue to get the Programme Management Office set up as well

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as further communications and engagement. With regard to the Whole Integrated System Review (WISR), everything is in place and is currently awaiting NHS England to approve the tender for consultancy.

The Governing Body noted the My Life a Full Life Update.

Items to Receive for Information 15-073 Audit Committee 24.9.15

The Governing Body received and noted paper GB15-055 Draft Audit Committee 24.9.15.

The Governing Body noted the Audit Committee 24.9.15. 15-074 Clinical Executive Minutes 20.8.15, 17.9.15 & 15.10.15

The Governing Body received and noted paper GB15-056 Clinical Executive final minutes 20.8.15, 17.9.15 and draft minutes 15.10.15. IR queried why some procurement had been paused. It was confirmed as a result of WISR some services may require a different model, therefore have been paused until more details are known from the review.

The Governing Body noted the Clinical Executive Minutes 20.8.15, 17.9.15 & 15.10.15. 15-075 Quality and Patient Safety Committee Minutes 23.7.15

The Governing Body received and noted paper GB15-057 Quality and Patient Safety Committee final minutes 23.7.15.

The Governing Body noted the Quality and Patient Safety Committee Minutes 23.7.15. 15-076 Joint Committee for Primary Care 1.10.15

The Governing Body received and noted paper GB15-058 Joint Committee for Primary Care Summary 1.10.15.

The Governing Body noted the Joint Committee for Primary Care Summary 1.10.15. 15-077 Urgent Business

There was no urgent business.

15-078 Motion to exclude the Press and Public

JR read the following statement: “that representatives of the press, and other members of the public, be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest’, (Section 1 (2), Public Bodies (Admission to Meetings)”

15-079 Date of Next Meeting: Thursday 4 February 2015, 10:30 – 13:00 – Green Rooms 1&2 Ventnor Town Council, 1

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Salisbury Gardens, Dudley Road, Ventnor, Isle of Wight PO38 1EJ

Circulation: Members In attendance:

For Information (Agenda):

Dr John Rivers – CCG Clinical Executive (Chair) Fredrick Psyk – Lay Member (Deputy Chair) Dr Joanna Hesse – CCG Clinical Executive Helen Shields – Chief Officer Loretta Outhwaite – Chief Finance Officer Loretta Kinsella - Director of Quality and Clinical Services David Newton – Lay Member Dr Ian Reckless – Secondary Care Doctor Lindsay Voss – Governing Body Nurse

Rebecca Berryman, Governance Support Manager (Minutes) Caroline Morris, Head of Primary Care and Corporate Business.

For Information (Minutes): Karen Morgan, Head of Quality Linda Rann, Sue Lightfoot, Rachael Hayes, Dawn Berryman, Eleanor Roddick - Heads of Commissioning, Teresa Day, Acting Deputy Head of Medicine’s Management, Caroline Morris – Head of Corporate Business Rebecca Wastall – Deputy Chief Finance Officer Lucy Savill, Information Governance Manager

Invited: Gillian Baker

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Governing Body

Matters arising: Schedule of Actions – Part 1


Summary of issue: Actions identified from previous meeting together with updates on progress to date and expected completion dates

Action required/ recommendation:

To gain assurance that the actions requested by the Governing Body are in train

Principle risks: There are no risks associated with this paper.


This paper has not been considered at any other committee.

Financial /resource implications:

There are no financial or resource implications in relation to this paper.

Legal implications/ impact:

There are no legal implications or impact relating to this paper.

Public involvement /action taken: There has been no public involvement in this paper.


Author of paper: Rebecca Berryman, Governance Support Manager




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Isle of Wight Clinical Commissioning Group: Governing Body SCHEDULE OF ACTIONS TAKEN FROM THE MINUTES: 5 November 2015

Date of Meeting

Minute No

Action Lead Update Due Date Status

5.11.15 15-063 Business Continuity Plan to be updated to partially achieved on the NHS England Emergency Preparedness Resilience and Response paper.

CM Actioned. November 2015 Closed

5.11.15 15-064 C.Difficile report to highlight systems and processes to be presented to the next Quality and Patient Safety Committee.

LK Actioned, reported to Quality and Patient Safety Committee 26.11.15.

November 2015 Closed

5.11.15 15-064 A deep dive in relation to patient choice and mixed sex accommodation to be reported to CQRM.

LK Actioned. November 2015 Closed

5.11.15 15-067 Discussion to take place regarding future Safeguarding Reports at the QPSC.

LK Discussed at Quality and Patient Safety Committee 26.11.15.

November 2015 Closed

2

Governing Body: Performance Report February 2016

Sponsor: Loretta Outhwaite, Chief Finance Officer

Summary of issues:

1. The Governing Body is presented with a CCG Performance Report in a format that seeks to provide assurance on key performance indicators associated with Quality; NHS Constitution; CCG Outcomes Framework and Financial performance to note and comment upon.


The Governing Body is invited to:

Note and comment on the content of the Performance Report.

Principle risks:

Key Risks for the Performance Report include: Complexity and wide range of metrics and indicators with differing measurement for different purposes (eg COF, Quality Premium, CCG Assurance process) – systems in development and embedding – risk of missing vital information on all indicators continuously. Availability of data due to Health & Social Care Act compliance with Patient Identifiable Data for CCGs. New systems not yet agreed at NHS England level.


Information contained in the report has been considered at: Clinical Executive Quality & Patient Safety Committee Contract Review Meetings Internal Performance Review Meetings


Over-performance on contract activity could result in financial pressure where contracts are PBR based.

Legal implications/ impact: There are no significant legal issues within the Report.


Report is publicly available and provides patients and public with information on the CCG’s financial position and use of resources.


Requirement of providers and CCG to ensure all patients are treated in line with rights set out the in the NHS Constitution.

Author of Paper: Andrew Heyes, Head of Performance and Contracts

Date of Paper: 25 January 2016

Date of Meeting: 04 February 2016 Agenda Item: 5.1 Paper number: GB15-062

Governing Body

Summary Performance Report

February 2016

(Performance Information up to November 2015)

Governing Body, Performance Report (February 2016)

Content

Part 1 – Quality and Safeguarding- Outcomes for the Quality KPIs

Part 2 – Provider Management - Performance Summary

Outcomes for the NHS Constitution with further detail on performance exceptions only.

Part 3 – Commissioning update

Part 4 – Financial Management - Financial report M8 Finance Position

Purpose of report - This is the Isle of Wight Clinical Commissioning Group (CCG) Governing Body Performance

Report for February 2016.

- The report includes information for Month 8 – November 2015, where available.

- For SIRIs and Complaints results for December are available and have been included.

- Financial Reports for November 2015 (M8) have been included.

- This Performance Report describes the performance for the nationally reportable performance measures which are the responsibility of CCGs as set out in the NHS England documents of “Everyone Counts: planning for patients 2014/15”; the “CCG Quality Premium Guidance” and the “CCG Assurance Framework 2014/15” covering both quality and access measures.


Quality and Safeguarding


Quality and Safeguarding – Key Points

C-Diff – IWNHST: 17 cases against 15/16 trajectory of seven (one patient = two cases).

IWCCG: 47 cases against 15/16 trajectory of 28 (up to December 2015).

CCG is establishing a local C.Diff panel and an IPC Joint Group - Terms of

Reference have been drafted with membership to include: Public Health; Trust Development Agency, IWNHST and IWCCG.

MRSA – IWNHST: three reported cases in 2015/16 (up to December 2015).

IWCCG: seven reported cases against a 2015/16 zero trajectory (four CCG

attributable/two Holiday makers potential 3rd party) – mandatory PIRs undertaken.

Pressure ulcers – IWNHST: All grades (1-4) Hospital 192 : Community 219

Never Event – Retained swab (Maternity) – SIRI in progress

Serious Incidents Requiring Investigation (SIRIs) –

IWNHST report 36 SIRIs up to December;

Neonatal death – SIRI process has commenced.

Multi-Agency learning event (held 13.01.16 external facilitator) –

Involved reviewing Cancer and End of Life care pathways


Quality and Safeguarding – Key Points

Deprivation of Liberty Safeguards (DoLS)/Adult Safeguarding –

IWNHST report 93 DoLs applications up to November 2015

Trust has appointed to Adult Safeguarding post (commenced January 2016).

Performance Breaches; impact on quality:

IWNHST – up to November 2015:

52 week waiters x 11

Mixed Sex Accommodation x 61

All are investigated to determine clinical and quality impact on patients.

Friends & Family test – IWNHST – Patients report a high percentage of satisfaction

with care; staff report lower percentage rates of satisfaction as place to work and for recommending care.

• External Service Reviews Independent review of Oncology Service completed. A draft report is with the

IWNHST, UHS and PHT for their CEO’s to review and agree next steps.

Urology Review - to commence with external consultant in January 2016.

Medicines Management Review – to be undertaken in February/March 2016


Part 1 – Quality and Safeguarding

• Performance Summary – Quality Dashboard This Section provides exception reports and key highlights for quality outcomes. The dashboard provides a summary of outcomes by month, Year to Date and Trend (December 2014 – November 2015).


Part 1 – Quality and Safeguarding - commentary continued…

Serious Incidents Requiring Investigation

In December, the Trust reported a total of one new SIRIS occurring in month, compared with four for November. By comparison the CCG had reported no (zero) new SIRIs in month for either November or December.

As at 31 December 2015:

• IWNHST: o For SIRIs that occurred in 2015/16, there were four for which the CCG has not received a final RCA

• IWCCG: o For December, there were no (zero) SIRIS from 1st April 2014 that had breached the timescale to complete investigation, which

remained open.

NB: While an RCA may have been received, these cases may still be under review and answers to queries referred to the Trusts have not been resolved.



Action:

The CCG continues to hold SIRI Review panel meetings every other month, to review and close IWNHST SIRIs. Joint Panel Meetings with the IWNHST will be held every other month following the CCG SIRI panel. This will provide the CCG with additional assurance on the robustness of the Trust’s SIRI process and most importantly the lessons learnt arising from SIRIs to mitigate the risk of recurrence of incidents. It also provides an opportunity for more complex SIRIs to be discussed between Commissioner and provider; to follow-up SIRIs which require additional assurance before closure by the CCG and a forum for the Trust to negotiate additional time for investigations in extenuating circumstances.

Following the unexpected death of a patient in receipt of Inpatient Mental Health services, which was subject to both internal and external review, the Trust has reviewed all unexpected deaths and mental Health/Learning Disability SIRIs between 2012-2015, to identify and learn from themes and trends.

A meeting was held on 25 November 2015, with CCG attendance to discuss the outcome of the review and the Action Plan arising. The Action Plan will be reviewed again at CQRM on 4 March 2016.

The CCG SIRI, outstanding from 2014/15, was the focus of a learning event organised by the CCG and held on 13 January 2016. Representatives from organisations involved in the patient’s healthcare pathway attended. The outcomes from the event are currently being analysed and will be shared with the relatives.



Pressure Ulcers: Local target: Reduce total numbers (Hospital / Community) against IWNHST 2015/16 target reductions.

Local Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD

Actual Annual Target

Reduction in Pressure Ulcers - Hospital

Grade 2 30% reduction ≤5 monthly) 11 9 9 15 14 29 20 18 125 40

Grade 3 50% reduction ≤ 0.5 monthly 0 1 0 0 2 2 1 4 10 4.0

Grade 4 Zero cases 1 0 0 0 0 0 0 1 2 0

Reduction in Pressure Ulcers - Community

Grade 2 30% reduction ≤8 monthly 15 17 14 20 13 24 14 15 137 64

Grade 3 50% reduction ≤ 1 monthly 1 4 1 1 1 0 0 0 8 8

Grade 4 50% reduction ≤ 1 monthly 1 2 0 1 2 0 0 1 7 8

Total numbers for reported Pressure Ulcers in November had increased when compared with the adjusted total number for October. An increase was reported for the numbers of Grade 3 PUs both in an Acute setting together with a Grade 4 PU, the first in seven months.

The targeted reductions are currently being achieved for the more severe Grade 4 PUs in a Community setting.

At the end of November, the combined total numbers for both Grade 3 and Grade 4 PUs across both settings, were marginally fewer than at the same point in 2014/15, while for Grade 2 PUs the total numbers were significantly higher. This would indicate earlier identification of ulcers and a move towards prevention rather than management of more severe ulcers.

In the Trust:

o Trust wide Pressure Ulcer Prevention Group meets monthly. o Deep dives for each directorate going ahead to look at why expected reductions were not achieved last year. o Action plans for pressure ulcer reduction have been reviewed and are being amalgamated into a single master planfor coming year. o Local monthly Tissue Viability and MUST audits will be established by Tissue Viability Service. o Pressure Ulcer Reporting has been handed to Matrons and Locality leads to supervise to develop local ownership of reporting and

understanding the scale of the issue. o Work is also ongoing to identify where patients are admitted from their home address who have been receiving non NHS care assistance.

The Pressure ulcer Collaborative has been operating to do a weekly review of all pressure ulcers that occur in the IW NHS care. This has focussed further attention on this issue and raised awareness in the directorates.

NB: Figures for previous months will continue to change as validation occurs during the process of investigation.

Action:

Reviews of Pressure Ulcers continue with the move, under new guidelines, to a cluster review approach. Pressure Ulcers continue to be monitored on a monthly basis at CQRM with updates from the Trust’s Safety, Effectiveness and Experience Lead. Non-recurrent funding up to the end of March 2016 has been agreed by the CCG and the Trust have appointed to a fixed-term Tissue Viability post in the community. The post is expected to support Primary Care and Care Homes.



HCAI: MRSA – CCG: National Target Zero tolerance

A further case of MRSA was identified at the IWNHST in October, and has been confirmed subject to investigation and a PIR. This was a known MRSA positive patient who went on to develop the bacteraemia.

This represents an additional case for the IWCCG bringing the YTD total to four and a first case in year for the IWNHST.

Work continues to raise awareness and highlight actions, including intranet and poster campaigns regarding bowel management with action plans for rapid isolation of suspected cases. Reconfiguration of the Medical Assessment Unit is now complete and will facilitate isolation of suspected cases being admitted although bed pressures continue to present challenges.

MRSA - IWCCG Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD

2014/15 – Number in month 0 0 0 0 0 0 0 1 0 0 0 0 1

2015/16 – Number in month 0 2 0 0 0 1 1 0

2015/16 - Cumulative total 0 2 2 2 2 3 4 4 4

Wessex Area (Cumulative totals as at November 2015)

CCG Nov 2015

Variance to projected total. at

Nov 2015

CCG Population

YTD Total as ratio per 100,000 population

West Hampshire 2 4 549,353 0.73

Isle of Wight 1 4 142,297 2.82

Southampton 0 3 270,353 1.11

North East Hampshire & Farnham 1 2 222,931 0.90

South Eastern Hampshire 0 2 211,593 0.94

Dorset 1 1 782,692 0.13

Fareham & Gosport 0 1 202,312 0.50

Portsmouth 0 0 218,809 0.0

North Hampshire 0 0 220,801 0.0

Source: Public Health England (via South Commissioning Support Unit, Performance Portal) (Population Numbers – Health and Social Care Information Centre)



Action: Provisional results for December are for an additional three cases assigned to the IWCCG – one (IWNHST) and two (potential third party).

Post Infection Reviews (PIRs) have been undertaken in 2015/16 for five MRSA cases: two attributed to the CCG; One re-assigned to the IWNHST as the Trust failed to inform the GP of the patient’s MRSA status and two cases are currently being arbitrated by NHS England with the CCG requesting to assign to Third party (unknown), as in both case the patients were holidaymakers with no previous Island healthcare contact.

The CCG and the IWNHST continue to work together and concerns have been raised and discussed at the Clinical Quality Review Meeting (CQRM).



Healthcare Acquired Infections – C.Difficile: National Target: 28 maximum

Wessex Area (Cumulative totals as at November 2015)

Source: Public Health England (via South Commissioning Support Unit, Performance Portal) (Population Numbers – Health and Social Care Information Centre)

CCG Nov 2015 YTD (2015/16)

Variance to projected total. at Nov 2015 CCG

Population

YTD Total as ratio per 100,000 population

No. %

Dorset 28 156 25 19.1% 782,692 19.9

West Hampshire 13 84 14 20.0% 549,353 15.3

Isle of Wight 4 45 26 136.8% 142,297 31.7

Portsmouth 3 38 4 11.8% 218,809 17.4

Southampton 2 32 3 10.3% 270,353 11.9

Fareham & Gosport 2 25 5 27.8% 202,312 12.4

North Hampshire 3 37 -7 -15.9% 220,801 16.7

South Eastern Hampshire 2 28 -5 -15.2% 211,593 13.2

North East Hampshire & Farnham 3 18 -5 -21.7% 222,931 8.1

CCG: There were four reported cases for November, none of which was indicated to have occurred at the IWNHST (Acute). The total number exceeded the projected total for November (one) and the cumulative total of 45* exceeds the target number for the year. Provisional results for December, suggest an additional two cases against the CCG. Public Health England recently revised upwards the total number of cases for October from seven to thirteen.

IWNHST: There were no (zero) cases reported for November. The cumulative total for the year remains at 17 for the IWNHST. This number exceeds the annual target of seven cases for 2015/16.

Action: The CCG and IWNHST continue to work together to review C.Difficle cases island wide, to identify areas where additional focus could impact on the numbers of cases. Patient anonymised C.Difficle cases have been shared with the CCG Medicines Management team, to review occurrences across GP Practices in the first instance. A RCA tool for use in Primary Care is under development locally to enable C.Difficile cases to be individually reviewed and trends, themes and learning to be clustered into a Primary care Health Care Associated Infection (HCAI) Action Plan. The CCG is currently establishing a local C.Difficile appeals panel and IPC group with an Island-wide focussed approach. Terms of Reference have been drafted and an inaugural meeting has been arranged to include the CCG, Trust, Public Health and Trust Development Agency. A first meeting is scheduled for 16 March 2016.



Friends and Family Test: National Targets: Response rates improvement Q1-Q4 / Score Improvement Q1-Q4

It has been advised via the NHS England website (Statistics pages) that: ’Following a review undertaken by NHS England the Lead Official for Statistics has concluded that the characteristics of the Friends and Family Test (FFT) data mean it should not be classed as Official Statistics.’ It remains, however, the principal mechanism for capturing the rating of the services being offered by hospital trusts and which can provide a benchmark at both regional and national levels.

The following is a summary for the results achieved by IWNHST for the last four months up to and including November 2015:

IWNHST Aug Sep Oct Nov

Q4 14/15 Average

Q1 15/16 Average

Q2 15/16 Average

Q3 15/16 Average

Trend

A&E

Response rate 9.87% 4.32% 10.55% 7.93%

16.99% 12.81% 9.86% 9.30% Total Eligible/Responses 3,193/315 2,754/119 2,740/289 2,483/197 6,234/1,059 8,509/1,090 9,328/920 5,223/486

% Recommending 93.65% 88.24% 89.27% 93.91%

89.95% 93.04% 91.49% 91.59% -

% Not recommending 1.90% 4.20% 3.81% 3.05%

4.97% 3.75% 3.34% 3.43% -

Inpatients

Response rate 23.46% 22.05% 19.42% 23.97%

54.13% 31.17% 23.08% 21.83% Total Eligible/Responses 1,172/275 1,238/273 1,318//256 1,485/356 1,720/931 3,301/1,029 3,778/872 2,803/612

% Recommending 95.27% 94.14% 98.05% 96.35%

95.94% 97.22% 95.75% 97.20% -

% Not recommending 0.73% 1.47% 0.78% 1.12%

1.20% 0.98% 0.94% 0.95% -

Maternity Question 2: Birth

Response rate 10.00% 18.87% 21.21% 14.58% 24.92% 26.47% 18.10% 17.95% Total Eligible/Responses 120/12 106/20 99/21 96/14 309/77 306/81 348/63 195/35

% Recommending 100% 100% 100% 100% 95.40% 99.10% 100% 100% - % Not recommending 0% 0% 0% 0% 1.15% 0% 0% 0% -

NB: The NHS England review of the patient FFT, published in July 2014, recommended a move away from the Net Promoter Score (NPS) and the introduction of a simpler

scoring system in order to increase the relevance of the FFT data for NHS staff, patients and members of the public. Based on the findings of the review, NHS England is now calculating and presenting the FFT results as a percentage of respondents who would/would not recommend the service to their friends and family. This change was introduced with the release of the results for September and user testing of the presentation of the FFT results is being undertaken on the NHS Choices website.

A&E The response rate achieved in November of 7.93% was down on that achieved in October but improved on September’s result of 4.32%, the lowest reported for 2015/16. The poor rate of response achieved in month, may be a reflection of the continued pressures being experienced by that department.

For November a rate of 93.91% was attributed to A&E for those ‘Recommending’, an improvement on the previous two month’s results of 88.24% for September and 89.27% for October. The rate for November is comparable with the outcomes being achieved in the months at the beginning of the year and up to August although the numbers responding as ‘Extremely unlikely to recommend remained the same across the three months September to November.

Inpatients The response rate for Inpatients returned to being at around the 23% mark in November (23.97%) following a dip in the rate for both September (22.05%) and October (19.42%).

By comparison, the rate for percentage recommending, fell marginally in November (96.35%) from the rate achieved in October (98.05%), which had been the second highest reported rate in 2015/16.



Maternity As previously reported, the only response rate available is the published rate for ‘Births’, numbers for the other three elements captured under this process not being reported by NHS England.

The response rate for ‘Births’ has been in decline since June although there was a slight rally seen in the rate for October (21.21%). The rate for November (14.58%) was the third lowest reported for 2015/16 but was influenced by a low level of individuals eligible to respond in that month, a total of 96.

In contrast, the percentage rate for those ‘Recommending’ has remained at 100% for each of the last three months while the rate for those responding ‘Not Recommending’ the service remained at zero percent in the same period. (November - National average: 96.25%/1.42%).

Action:

Overall, there has been a fluctuation in response rates in both the A&E and In-patient settings over the last few months, although the percentage recommending services remain fairly consistent and in line with National figures.

The Friends and Family Test is monitored at the Clinical Quality Review Meeting (CQRM) on a monthly basis. It has been noted for Maternity (Births), that there has been a significant reduction in the response rate. This has been highlighted at CQRM.

The Friends and Family Test response rates for Mental Health and Learning Disability services has also been challenged by the CCG. In response, the MH/LD service have modified the Test in collaboration with Mental Health service users, to be more service user friendly, enabling volunteers to support completion through a semi-structured interview method. This was presented to the Clinical Quality Review Meeting on 15 January 2016.



Improving Access to Psychological Therapy (IAPT): National Target for Isle of Wight 22% (Annual)

IAPT – Entering treatment (performance in month) IAPT – The proportion of people who complete treatment who are moving to recovery (performance in month)

IAPT – Entering treatment (Cumulative position)

Indicator Target 2015/16

Performance against target by month: Apr 15 May 15 Jun 15 Jul 15 Aug 15 Sep 15 Oct 15 Nov 15 Dec 15 Jan 16 Feb 16 Mar 16

Improved access to psychological services:

The proportion of people that enter treatment against the level of need in the general population.

22%

Numerator: No. of people who receive psychological therapies

262 164 196 249 231 288 272 256

Denominator: No. of people who have depression and/or anxiety disorders

1,087 1,087 1,087 1,087 1,087 1,087 1,087 1,087 1,087 1,087 1,087 1,087

Percentage 24.10% 15.09% 18.03% 22.91% 21.25% 26.49% 25.02% 23.55%

Cumulative YTD:

Numerator: No. of people who receive psychological therapies

262 426 622 871 1,102 1,390 1,662 1,918

Denominator: No. of people who have depression and/or anxiety disorders

13,043 13,043 13,043 13,043 13,043 13,043 13,043 13,043 13,043 13,043 13,043 13,043

Percentage 2.01% 3.27% 4.77% 6.68% 8.45% 10.66% 12.74% 14.71%

Cumulative target (%) 1.83% 3.66% 5.50% 7.33% 9.16% 11.00% 12.83% 14.06% 16.5% 18.33% 20.16% 22%



Entering treatment:

The annual target for patients entering treatment is 22%. For the three months September to November performance had returned to achieving the target rate, although there has been some gradual reduction in the rate achieved over the three months with 23.55% having been achieved in November.

The cumulative position at the end of September provided a rate of 14.71% which was marginally above the predicted rate required to achieve the annual target of 22%. This represents a stepped improvement in the past two months from being a percentage point below the predicted rate required for the preceding months.

NB: Bank Holidays and the pattern by which weekends can fall within a month, both have an impact on the number of clinics that can be held, directly influencing the performance rate achieved.

Moving to Recovery:

In comparison, the rate for ‘The proportion of people who complete treatment and who are moving to recover’ recovered to achieve the target rate of 50% in November.

It should be noted that in respect of the performance rate being achieved for those patients moving to recovery, the outcome is impacted by the inclusion of patients from clusters that imply those with more complex issues which extend the period of recovery needed.

Action:

Performance for these indicators and the outcomes achieved will remain a focus for scrutiny by commissioners via the monthly Contract Officer Level Meetings.


Provider Management – Performance Summary


Performance Outcomes – Key Points

Constitution Targets:

The CCG met 10 out of 17 constitution targets for November 2015 including all bar three cancer targets.

Those not met were:

• Referral to Treatment <18weeks: • Incompletes (Target 92%- 89.70% achieved)

Comment: - Current trajectory is to meet the target by the end of March 2016 based on a revised activity plan from Oct 15-March 16 monitored through weekly meeting. GP referrals are significantly lower than plan due to increased referrals to mainland providers.

• A&E: <4 hour wait: • Department (Target 95% - 86.33% achieved)

Comment: - All regional providers are failing A&E targets. The IW Trust has instigated a revised action plan in December based on delivering recommendations from a TDA/ECIST event. Trust projecting recovery of target by the end of Feb 2016.

• Cancer: • <31 day wait for subsequent treatment – Surgery

(Target 94% - 92.00% achieved, 2 patients from 25) • <31 day wait for subsequent treatment – Drug Treatment

(Target 98% - 97.37% achieved, 1 patient from 38) • <62 days urgent referral to treatment

(Target 85% - 84.78% achieved, 7 patients from 46) Comment: - The IWNHST has an action plan in place to improve 62 day target and recover the target by the end of Feb 2016 which included revised pathway timings across the Trust and Cancer Centres.


Performance Outcomes – Key Points

Constitution Supporting Measures: In respect of the Key supporting measures performance is summarised below:

Met

• Mixed sex accommodation (zero breaches in November against a target of zero)

• Mental Health (Care Programme Approach) (Target 95% within 7 days, achieved 100%)

• A&E trolley waits, patients awaiting admission (zero breaches in November against a target of zero)

• Referral to treatment over 52 weeks (Target Zero, zero events in November)

• Urgent operations cancelled a second time (zero breaches in November against a target of zero)

Not Met

• Cancelled Operations Re-booked within 28 Days (Target 100%, achieved 46.67%) Comment: For November the rate currently reported fell further to 46.67% representing eight patients from a total of fifteen (4 x

General Surgery; 1 x Urology; 1 x ENT; 1 x T&O and 1 x Administrative error).

Outcomes not available

• Ambulance Handovers to A&E within 15 minutes (Target 100%)

• Ambulance then ready to accept new calls (Target 100%) Comment: Ambulance performance is under review, including data capture issues.


Part 2 – Performance Outcomes – NHS Constitution Dashboard


Part 2 – Performance Outcomes commentary

RED – Target missed; AMBER – Performance achieved within 5% of meeting target; GREEN – Target achieved.

The failure to achieve the target for Admitted continues, with performance having dipped to its lowest level in twelve months in November at 56.16%. Non-Admitted returned to missing target in October which continued through to November with a further diminishment to the rate achieved. More significantly has been the performance for Incompletes, now the principal measure for RTT performance employed by NHS England, which slipped below target in September with performance continuing to be below 92% for both October and November.

IWNHST - A similar pattern of achievemet has continued to be demonstrated with the IWNHST reported outcomes over the same three month period. The Trust has advised that elective activity had reduced significantly during the autumn period as system wide pressures impacted on the elective bed capacity available, leading to the waiting list increasing. A system wide plan had been agreed and was being implemented to secure non elective and elective capacity. This should enable elective activity to begin to resume normal levels and improve performance against target. The Trust Deevelopment Agency guidance given for the Christmas Season, had seen a reduction in elective bed availability with only Urgent and Cancer work being undertaken during this time, which it should be anticipated, will have an impact on December's performance.

Mainland Trusts The inconsistencies in performance achieved by each of the three mainland trusts monitored continues to be a feature, particulary with the performance given by both UHS and PHT. In respect of performance for November:

• UHS – Performance for UHS fell back in month for both Non-Admitted and Incompletes, with the target being missed for each. Performance for Admitted saw some very marginal improvement but with the target continuing to be missed.Capacity issues have continued to impact on the performance being achieved.

• PHT – PHT performance for Admitted fell for a second month, as did the rate achieved for Non-Admitted. There was some marginal improvement in the rate for Incompletes in month although the target continued to be missed.

18 week Referral to Treatment: National Targets: Admitted 90%; Non-Admitted 95%; Incompletes 92%

2015/16

IWCCG IWNHST UHS PHT Salisbury

Admitted Non-Adm Incompletes Admitted Non-Adm Incompletes Admitted Non-Adm Incompletes Admitted Non-Adm Incompletes Admitted Non-Adm Incompletes

December 88.04% 95.98% 96.03% 88.14% 95.99% 96.49% 96.30% 95.00% 93.48% 66.67% 93.48% 86.43% - - 90.24%

January 84.97% 96.83% 95.86% 85.05% 96.92% 96.47% 84.91% 96.97% 91.06% 64.29% 98.11% 86.16% 75.00% 100% 88.89%

February 84.70% 96.76% 96.25% 85.27% 97.18% 96.74% 82.35% 86.96% 92.11% 74.19% 93.18% 88.40% 66.67% 75.00% 88.89%

March 83.31% 96.44% 93.71% 81.68% 96.52% 93.94% 91.53% 94.34% 90.23% 72.41% 94.34% 91.06% 100% 100% 85.00%

April 69.75% 96.06% 92.99% 65.83% 96.30% 93.07% 81.25% 91.11% 93.00% 82.05% 89.66% 90.57% 66.67% 75.00% 80.49%

May 68.18% 96.55% 94.00% 65.01% 96.69% 94.32% 80.85% 97.62% 90.12% 93.75% 93.48% 88.83% 66.67% 50.00% 87.23%

June 66.01% 94.58% 94.05% 62.29% 94.71% 94.33% 86.00% 88.64% 92.26% 82.61% 91.84% 90.10% 66.67% 50.00% 83.72%

July 62.75% 94.09% 93.34% 57.34% 94.14% 93.41% 88.33% 100% 93.71% 86.21% 91.18% 90.76% 100% 66.67% 86.84%

August 67.45% 96.11% 92.85% 62.94% 96.32% 93.01% 82.22% 90.70% 91.86% 84.38% 92.42% 87.56% 83.33% - 87.10%

September 69.86% 95.72% 90.59% 65.02% 95.88% 90.77% 80.77% 92.73% 87.32% 94.12% 88.33% 84.91% 75.00% - 83.78%

October 63.90% 93.89% 89.29% 58.45% 94.16% 89.29% 79.55% 93.88% 83.88% 74.47% 88.24% 88.10% 100% 100% 86.11%

November 56.16% 92.74% 89.70% 51.71% 92.87% 89.63% 80.95% 90.91% 83.60% 66.67% 88.14% 90.28% 50.00% 80.00% 92.31%

506/901 2,415/2,604 6,273/6,993 379/733 2,239/2,411 5,395/6,019 51/63 50/55 311/372 26/39 52/59 195/216 3/6 4/5 24/26


Part 2 – Performance Outcomes commentary continued…

Salisbury – Salisbury returned to missing the targets for both Admitted and Non-Admitted, a reversal to the outcomes achieved in the previous month. Similarly, the rate for Incompletes went from failing in October to achievement of target in November. The first time the target has been met in 2015/16. Again the performance rates achieved were exaggerated by the low numbers of patients involved.

Actions:

IWNHST:

The System Resilience funded schemes in place, have offered the opportunity to increase service capacity to support the recovery of RTT performance and return waiting lists to a manageable position.

A Referral to Treatment Recovery Plan has been in place since October 2015, which has concentrated on transferring patients from the IWNHST waiting list backlog to mainland hospitals, and encouraging GPs to offer choice to patients regarding treatment at these providers if eligible.

Mainland Trusts: Contract Query Notices via lead Commissioners for RTT performance remain in place with University Hospital Southampton (UHS).

Commissioners continue to raise with the Lead Commissioner and Trusts to highlight patient waiting times and resolve any issues relating to specific specialities.

Patients waiting >52 weeks – National Target: Zero

For September through to November, there had been no further reported breaches for individuals having had to wait 52 weeks plus for treatment:



Cancer: Nine National Targets

RED – Target missed; AMBER – Performance achieved within 5% of meeting target; GREEN – Target achieved.

IWCCG – 2015/16 Target Q1 15/16 Q2 15/16 Sep 15 Oct 15 Nov 15 Year to

Date

Seen within 2 weeks of referral 93% 96.32% 97.36% 96.04% 95.35% 96.41% 14/390 96.62%

Seen within 2 weeks of referral - Breast Symptoms 93% 98.64% 97.83% 95.71% 98.68% 98.57% 1/70 98.32%

Treated in <31 days of diagnosis 96% 96.02% 98.26% 98.06% 96.94% 98.84% 1/86 97.26%

Treated in <31 days - Surgery 94% 92.73% 96.00% 95.00% 95.83% 92.00% 2/25 94.08%

Treated in <31 days - Drug Treatment 98% 100% 100% 100% 100% 97.37% 1/38 99.70%

Treated in <31 days - Radiotherapy 94% 96.77% 100% 100% 91.18% 100% 0/34 97.22%

Treated in <62 days - urgent referral to treatment 85% 79.66% 80.60% 77.27% 73.08% 84.78% 7/46 79.55%

Treated in <62 days - Consultant upgrade 86% 0.0% 100% <<N/a>> <<N/a>> 100% 0/2 60.67%

Treated in <62 days - Screening service 90% 94.74% 96.43% 90.91% 71.43% 100% 0/12 93.33%

Mainland Trusts – performance for island registered patients

IWNHST – 2015/16 Target Q1 15/16 Q2 15/16 Sep 15 Oct 15 Nov 15 Year to Date

Seen within 2 weeks of referral 93% 96.27% 97.50% 96.24% 95.25% 96.40% 14/389 96.65%

Seen within 2 weeks of referral - Breast Symptoms 93% 98.63% 97.82% 95.71% 98.67% 98.57% 1/70 98.31%

Treated in <31 days of diagnosis 96% 98.34% 99.13% 98.70% 100% 100% 0/62 99.08%

Treated in <31 days - Surgery 94% 100% 100% 100% 100% 89.47% 2/19 98.17%

Treated in <31 days - Drug Treatment 98% 100% 100% 100% 100% 97.22% 1/36 99.68%

Treated in <31 days - Radiotherapy 94% <<N/a>> <<N/a>> <<N/a>> <<N/a>> <<N/a>> 0/0 <<N/a>>

Treated in <62 days - urgent referral to treatment 85% 82.94% 84.71% 82.89% 73.96% 87.65% 5/40.5 82.75%

Treated in <62 days - Consultant upgrade 86% 0.0% 100% <<N/a>> <<N/a>> <<N/a>> 0/0 33.33%

Treated in <62 days - Screening service 90% 97.14% 100% 100% 76.92% 100% 0/6 96.33%

2015/16 UHS PHT

Q2 15/16

Sep 15 Oct 15 Nov 15 Year To

Date Q2

15/16 Sep 15 Oct 15 Nov 15

Year To Date

Seen within 2 weeks of referral 50.00% 50.00% 100% <N/a> 0/0 90.91% 100% <N/a> 100% 100% 0/1 100%

Seen within 2 weeks of referral - Breast Symptoms <N/a> <N/a> <N/a> <N/a> 0/0 100% 100% 100% <N/a> <N/a> 0/0 100%

Treated in <31 days of diagnosis 92.86% 92.86% 100% 92.86% 1/14 94.67% 96.00% 100% 72.73% 100% 0/9 84.13%

Treated in <31 days - Surgery 100% 100% 66.67% 100% 0/4 95.83% 66.67% 50.00% 100% 100% 0/1 64.71%

Treated in <31 days - Drug Treatment 100% 100% 100% 100% 0/2 100% 100% 100% <N/a> <N/a> 0/0 100%

Treated in <31 days - Radiotherapy 100% 100% 86.96% 100% 0/17 97.83% 100% 100% 100% 100% 0/16 96.43%

Treated in <62 days - urgent referral to treatment 57.14% 50.00% 33.33% 57.14% 1.5/3.5 62.96% 42.86% 33.33% 75.00% 75.00% 0.5/2.0 48.39%

Treated in <62 days - Consultant upgrade 100% <N/a> <N/a> 100% 0/1 100% <N/a> <N/a> <N/a> <N/a> 0/0 <N/a>

Treated in <62 days – Screening service <N/a> <N/a> <N/a> <N/a> 0/0 <N/a> 100% 100% 0% <N/a> 0/0 77.78%



Current year to date status for the CCG, demonstrates two pathways failing to achieve target. The more significant of these is the performance for ‘Treated in <62 days - urgent referral to treatment’, which is currently under National scrutiny but performance in November has brought this to below a 5% variance from target. By comparison, the outcome for ‘Treated in <62 days - Consultant upgrade’ was impacted by a failure in May involving two patients and due to the infrequent basis with which outcomes occur is less likely to recover by the year end. The one outcome that has a bearing on the Quality premium reward ‘Seen within 2 weeks of referral’ currently looks likely to achieve target at year end.

Performance in November demonstrated improvement for six of the nine treatments monitored, this despite the targets being missed for three treatment types. The failures in achievement of target for both ‘Treated in <31 days – Surgery’ and ‘Treated in <31 days - Drug Treatment’ might be attributed in part to the low numbers of patients involved in the case of ‘ Surgery’ two breached from a total of 25 patients and for ‘Drug Treatment’ one breached from a total of 38 patients. Additionally, in the case of one breach, due to patient choices about the consultant and anaesthetist to undertake the procedure. In the case of ‘Treated in <31 days - Drug Treatment’, this was the first failure to achieve target for 2015/16 and the margin of failure was less than one percentage point.

Performance by the two principal mainland trusts demonstrated some improvement with the results for November with those areas where target rates were not achieved being impacted by the low numbers involved. Capacity appears to be an on-going issue at University Hospital Southampton and is indicated to have resulted in two of the reported breaches.

Breach Report - IWNHST:

Treated in <31 days – Surgery – (Admitted) Tumour type 2 x Urological – (Wait time 1x 49 days) – Surgical admission cancelled to accommodate more urgent case.

(Wait time 1x 35 days) – Patient requested specific consultant to perform procedure and required specific anaesthetist in attendance.

Treated in <31 days – Drug Treatment - (Non-Admitted)

Tumour type Urological – (Wait time 1 x 36 days) – Patient required orthopaedic surgery following a fall.

Treated in <62 days urgent referral to treatment – Non-Admitted: (first seen/first treated IWNHST) – Tumour type: 1 x Haematological (Excluding Acute Leukaemia) – (Wait time 1x 81 days) – Complex histology and multiple MDT discussions in addition to patient requesting thinking time regarding treatment options. 1 x Lung – (Wait time 1x 84 days) – Inconclusive histology – required Tertiary Centre investigation. 1 x Lung – (Wait time 1x 69 days) – Patient deferred endoscopic investigation due to holiday

1 x Urological (Excluding testicular) – (Wait time 1 x 94 days) – Patient referred to Tertiary Centres for opinion and management

Breach Report – Mainland Trusts:

Treated in <31 days – Surgery – (Admitted) UHS: 1 x Surgery – Tumour type: Gynaecology (wait 46 days) – Capacity Breach

Treated in <62 days - urgent referral to treatment – (Admitted) – All patients first seen at the IWNHST PHT: 1 x – Tumour type: Urological (excluding testicular) (wait 84 days) – 98 – Other reason UHS: 2 x – Tumour type: 2x Gynaecological (wait 1x 84 days) – Capacity Breach; (wait 1x 87 days) referral past breach date, day 64 from the IW.



Action:

Performance is subject to active ongoing monitoring and discussion by secondary care hospital commissioners with all providers.

The IWCCG has failed the 62 day target recently, predominantly due to issues with the performance achieved at the mainland cancer centres in Portsmouth and Southampton with which the IWCCG has associate contracts with other CCGs. The IW NHST has submitted a RAP (Remedial Action Plan) to the IWCCG in relation to the 62 day pathway, which will be monitored by the Systems Resilience Group (SRG) and contract monitoring meetings.

Contract Penalties have been applied.



Category ‘A’ Ambulance Calls: National targets: Red 1 and Red 2 75%; 19 minutes 95%

Performance in November saw the targets for all three categories being achieved for a third consecutive month.

The decline in performance reported for August was seen to recover in September and the rates while fluctuating across all three categories in the subsequent two months have continued to achieve the target rates. For October and November the rates achieved across each of the three categories have been broadly similar to those achieved in 2014/15.

Provisional performance for December suggests that targets were met for a further month for both Red 2 and 19 minutes, while Red 1 fell short of target in month. It should be noted that these outcomes are unconfirmed and the final outcomes may vary from these initial indications.

Target April May June July Aug Sept Oct Nov Dec Jan Feb Mar YTD

Category A – Red 1 75% 75.00% 77.08% 66.67% 69.64% 68.63% 78.57% 79.49% 78.05% % % % % 74.04%

Category A – Red 2 75% 74.39% 75.65% 76.60% 75.32% 68.45% 75.77% 75.43% 76.05% % % % % 74.62%

Category A – 19 mins. 95% 96.03% 95.40% 90.22% 94.87% 94.70% 95.21% 96.43% 96.43% % % % % 94.90%

Action:

Additional support to improve patient flow, as well as specific Ambulance initiatives, is in place through the investment of System Resilience funds. The service continues to operate well despite on-going staffing challenges.

Provisional indications suggest that Red 1 performance was challenging for December.



A&E <4 hour wait for admission, treatment or discharge – National target 95%

Performance for the IWCCG and the IWNHST has remained below 90% since July, fluctuating between months by one to two percentage points over the six months to November. For November the rate fell to 86.33% with total numbers attending A&E having also fallen to the lowest reported number in 2015/16 at 4,860, a reduction of 476 on October’s total, although YTD the total number is marginally below the number reported for the same period in 2014/15. By comparison the numbers breaching the four hour waiting time was broadly similar between the two months of October and November, while the Year to Date total is significantly higher than was reported in the same period for 2014/15 .

The Trust had been on Red Alert for the majority of each of the two months, but with no (zero) at Black Alert. There has been some reduction seen in the numbers of Delayed Transfer of Care over the two months and Poppy Ward had been re-opened as a part of the Strategic Resilience plans.

Provisional results from the Trust for performance in December suggest a further failure to achieve the target rate of 95% in that month (at c.91%) although with an improvement in performance over the Christmas and New Year contributing to raising the overall rate achieved. The Trust had returned to Green Alert for much of the month being at Red Alert for around ten days day in the early part of the month, while numbers for the IWNHST attending A&E in December (5,356) were up on those reported for November (5,098).

IWCCG Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD

A&E <4 hour wait

14/15 96.15% 94.23% 95.96% 96.39% 97.05% 95.44% 93.85% 91.58% 92.54% 88.19% 85.73% 94.29% 93.6%

15/16 91.90% 92.67% 92.12% 88.90% 88.97% 86.27% 87.42% 86.33% % % % % 89.42%

No Attending 14/15 5147 6481 5301 7158 5352 4891 5712 4523 4904 5495 4777 4953 44,565

No Attending 15/16 6,502 4,952 5,545 5,850 5,830 5,090 5,336 4860 43,965

Breaches 14/15 198 374 214 259 158 223 351 381 366 649 682 283 2,158

Breaches 15/16 527 363 437 649 643 699 671 664 4,653

IWNHST Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD

Beacon WIC 100% 100% 100% 100% 100% 100% 100% 100% 100%

Emergency Dept. 87.4% 88.6% 88.1% 83.1% 82.6% 78.4% 79.7% 77.8% 83.4%

A&E <4 hour wait 91.89% 92.65% 92.05% 88.74% 88.85% 86.05% 87.24% 86.17% % % % % 89.3%

12 hour trolley waits – National target zero

For both October and November there have been no reported cases for patients having had to wait twelve hours or more on a trolley and provisional results for December suggest that this trend had been maintianed.

However, the final number of occaisions such waits occurred in September was revised up to 29 in month. These occurred across six days each of which coincided days the IWNHST was at Black Alert. The Year to date total currently stands at 42. .

Action:

Following a formal Contract Performance Notice being raised, the Trusts have developed a Recovery Action Plan aimed at returning performance to the National Standard (95%) by February 2016.

Actions include internal process improvements within the Emergency Department, as well as wider system improvements to aid the flow of patients. Many actions included were recommended by the National Emergency Care Intensive Support team that visited the Trust in November.



Ambulance Handover: National Target 100% for Handovers and Crew Green-Up time

For September and October performance rates continued to fluctuate at a monthly interval, failing to achieve the target rates for both Handovers and Green-up time

o Handovers completed within 15 minutes (National Target: 100%) – Performance in September 62.36% and October 68.14% a stepped improvement from August’s rate of 61.87%.

o Crews ready to accept new calls within 15 minutes of handover (National Target 100%) – Performance in September 71.19% and October 69.28%. There has been a diminishing trend seen since August when 77.10% was achieved.

The IW NHST Trust has advised that for the immediate future and commencing with the outcomes for November 2015, they will not be supplying outcomes for Ambulance Handovers. The IWCCG remain in discussion going forward over this approach.

Action:

A new Computer Aided Dispatch System was installed in mid-November to improve known data quality issues.

Due to the data quality issues being expereinced by the IWNHST, from October onwards the Trust has not been providing the IWCCG with performance data, until they are assured of its accuracy and reliability. As a result, the CCG has formally rasied an Information Breach Notice and a Contract Performance Notice.

A full Recovery Action Plan is now required from the IWNHST, demonstrating how data quality and performance will improve to an acceptable level.


Part 2 – Performance Outcomes continued…

Other Key Metrics

Diagnostics – National Target: >99% Performance for Diagnostics in September was 99.46%, an improvement on August’s rate of 99.20% and represented a total of seven patients having waited longer than six weeks. Performance for October improved marginally to 99.50%, again with a total of seven patients affected but against a larger waiting list.

The result for November demonstrated further improvement, achieving 99.83% with a total of two patients having experienced waiting times greater than 6 weeks, with both failures having occurred at mainland trusts.

Cancelled Operations – National Targets: 100% / Zero For September there were four cases (from 18) for ‘cancelled operations rebooked in 28 days’, representing a rate of 77.78%%, (2 x General Surgery and 2 x Urology.)

The rate fell in October achieving 72.22%% (five from eighteen) 1 x General Surgery (delay in theatre); 1 x Urology (no bed available) and 3 x T&O (2x no bed available and 1 x ran out of theatre time).

For November the rate currently reported fell further to 46.67% representing eight patients from a total of fifteen (4 x General Surgery; 1 x Urology; 1 x ENT; 1 x T&O and 1 x Administrative error).

(NB: Adjustments to reported occurrences may be made in subsequent months following investigation and review of occurrences).

In September there was one reported case of a ‘cancelled operation being cancelled for a second time’ (1 x Ophthalmology – due to another patient on the list having had more complicated surgery), while for October and November there have been no events reported.

Mixed Sex Accommodation – National Target: Zero Performance for September saw an additional eight breaches in month, all occurring at the IWNHST. These occurred across two events, both involving four-bedded bays on MAAU. In each case the breach was a decision taken as a result of excessive bed pressures during a Black Alert. All patients were kept informed and staff made every effort to maintain the patients’ privacy and dignity at all times and the situation was rectified at the earliest opportunity

For October the number of breaches fell to six, again all occurring at the IWNHST across two separate events on different days. One occurred in CCU and the other in MAU. In each case the decision to breach was planned and information was given to patients and their consent gained.

Financial penalties have been applied for the breaches incurred in both September and October.

Performance reported for November was for zero events having occurred.

Mental Health Care Programme Approach – National Target: 95% The performance rate achieved in the months September to November has demonstrated a stepped improvement: September: 95.24% (40 from 42); October: 95.56% (43 from 45) and November 100% (49 from 49).


Part 2 – Performance Outcomes continued…

Contract Query notices

The following Contract Query Notices are currently in place:

University Hospital Southampton (UHS) – RTT 18 week performance levels achieved – Unsatisfactory remedial plan received. (Oct 2013 - On-going). IWCCG letter sent to CEO, to which a response has been received.

Commissioning Support Unit (CSU) – Information Technology Performance Notice. (Dec 2014 - On-going).

PHT – Diagnostics (6 week wait failure re Ultrasound and MRI). (Sept 2014 - On-going).

PHT – Electronic Discharge Summaries (Failure of dataset / Method of delivery and timescales). (July 2014 - On-going)

IWNHST – A&E Performance (issued 16.10.15 On-going)

IWNHST – RTT 18 Weeks Incompletes (issued 27.10.15 On-going)

IWNHST – Cancer 62 day Urgent referral to treatment (issued 25.11.15 – On-going)

IWNHST – Ambulance Handovers (issued 11.01.16 – On going)


Commissioning


Commissioning – Key Points

Systems Resilience has continued to be challenging, a plan was commenced in October to increase capacity across the system and improve key process issues:

The CCG identified a total of £3.47m to support system resilience plan including £1.12m allocated to the CCG for this purpose.

An additional 21 acute medical beds and 30 step-down beds with staffing were opened.

The Escalation planning and discharge processes are being improved.

A key challenge has been the ability to recruit the additional staffing.

There has been a significant improvement in the volume of elective activity since implementation. However, the impact on ED (4 hour waits) has been less successful. This highlighted issues in operational process which were also identified by a TDA/ECIST review in November 2015. The recommendations are being taken forward in a Trust action plan.


Commissioning – Key Points

The Whole System Integrated Review (WISR) scope was agreed and procurement for consultancy services has now been completed.

The exercise commences in February 2016, is expected to last one year and is funded through NHS England’s New Models of Care programme.

The outcomes will inform options for the island’s sustainability and Transformation Programme.

Planning Guidance for the 2016/17 planning requirements was released at the beginning of January. A first draft submission is due on 8 February 2016 with the final submission due 11 April 2016.

A Services review of Urology Services has been commissioned in January 2016 and the Cancer Oncology Review options and recommendations are being shared with shareholders.


Financial Management


Finance – Key Points

• As at the end of November the CCG's year to date position was £1,550k better than plan (compared to the £1,535k reported position for October).

• The major contributing factors to the year to date underspend are:

o The SLA with the IW Trust Planned Care SLA is £1,942k underspent. This is due to backlog of elective activity and fines have been applied which will be re-invested as part of the Operational Resilience planning.

o Children’s Services are £119k underspent as a consequence of children’s continuing care being below plan.

• The CCG is forecasting achieving a planned surplus of £2.5m which will deliver an in-year break even position against the allocation.


Finance – Key Points

• Prescribing inflation (YTD £517k underspent) has been funded for 2015/16 at net 3%. A QIPP target has been included within the budgets of £1.8m – which will be monitored throughout the year.

• The net QIPP target for 2015/16 is £2.1m. The year to date position is £67k better than plan.

• The running cost allocation for 2015/16 has been reduced by £357k which is a national requirement. The CCG is forecasting to remain within the allocation.

• The Better Care Fund between the CCG and Local Authority is £22m. The CCG’s contribution to the fund is £14.6m in 2015/16.

• Key risks are around system resilience and recovery of the constitutional targets. Prescribing remains an area of risk as does Continuing Care and Mental Health Special Placements from potential higher overspends than currently forecast based on additional patients being eligible between now and the year end.


Part 3 – Financial Report M8

This Part provides details of the current financial position of the CCG. A forecast outturn position is included. In-month cost and activity variance is also illustrated.

<< Insert>>

• ‘Income & Expenditure: Financial Review’ – M8

a

Financial Review

MONTH 8– November 2015

MONTH 8 – November 2015

Rebecca Wastall|Deputy Chief Finance Officer FCCA

&

Wendy Marshall| Financial Controller FCCA, PGCE

NHS South, Central & West Commissioning Support Unit

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Financial Review

MONTH 8– November 2015

INCOME & EXPENDITURE POSITION

YTD Budget (£000)

YTD Actual (£000)

YTD Variance

(£000)

Annual budget (£000)

Year End

Forecast £000

Variance £000

Notified Resource limit 137,683 137,683 0 212,082 212,082 0

Application

Acute 66,788 65,345 1,443 101,407 102,300 (892)

Mental Health 14,429 14,599 (170) 21,722 21,924 (202)

Community 10,704 10,673 31 15,955 15,935 20

Better Care Fund 9,540 9,541 (1) 14,591 14,591 0

Children's 1,309 1,190 119 1,867 1,752 114

Continuing Care 7,975 8,326 (352) 11,965 12,496 (531)

Primary Care 22,771 22,254 517 34,056 33,677 380

Other Programme Staff Costs/ Project Costs 401 417 (15) 602 602 0

Vanguard funding 134 134 0 1,085 1,085 0

Reserves 0 0 0 2,433 1,612 822

2% Headroom 0 0 0 746 456 290

Total 535 551 (15) 4,867 3,754 1,112

Running Costs 1,944 1,966 (22) 3,121 3,121 (0)

Total Application of funds 135,995 134,445 1,550 209,550 209,550 0

Surplus 1,688 3,238 1,550 2,532 2,532 0

As at the end of November the CCG’s year to date position is £1,550k better than plan

(compared to the £1,535k reported position for October). The major contributing factor to the

year to date underspend is the underperformance of the IW Trust’s Planned Care SLA, and as

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per the national rules fines have been applied. Continuing Care and Special Placements are

overspending.

Acute Services – YTD £1,443k underspent. - IOW Planned SLA underspend of £1,942k – the

majority of the underspend relates to £1,425k in-patients (mostly T&O), Day cases £80k (again

mostly T&O). The IOW Unscheduled Care SLA is over-performing by £754k. This is mainly

relating to General Medicine excess bed days and cardiology. In terms of the year end forecast

the forecast for the planned SLA (£950k under) assumes that the revised plan will be achieved

from now till the year end but the under-performance at the start of the year will not be

recovered. The Unscheduled Care forecast (£1,180k over) assumes that over-performance will

continue. The Southampton contract is forecast overspend of £277k is due to increased

activity. As at the end of November fines imposed totals £620k. The forecast position £840k

assumes that targets will not be met until the last quarter of the year so fines will still be

imposed.

Mental Health Services – YTD £170k overspent- Special placements are overspending due to

an increase in patients compared to last year. The year-end forecast overspend is £202k which

takes into account the increase in patients.

Community Services – YTD £31k underspent - Community NHS ECR’s (extra contractual

referrals) are underspent year to date. The year -end forecast is an underspend of £20k.

Children’s Services YTD £119k underspent – The major contributing factor to the year to date

underspend is an underspend on children’s continuing care. The year-end forecast is £114k

underspent.

Continuing Care YTD £352k overspent – The overspend relates to an increase in patients

and high cost complex packages, especially in Mental Health over 65’s and physical disabilities.

The year-end forecast is an overspend of £631k, slightly off-set by a forecast underspend on

Funded Nursing Care of £100k.

Prescribing/Primary Care YTD £517k underspent - Inflation has been funded for 2015/16 at

net 3%. A QIPP target has been included within the budgets of £1.8m. Of the YTD

underspend £317k relates to PPA prescribing. This is using 6 months actuals and an estimate

for 2 months, based on the average spend for the year, based on YTD prescribing days.

Prescribing still remains an area of risk, but to date the ability not to be able to script switch is

not showing up in the year to date expenditure – but if seen it will be later in the year.

Running costs – from 1st April 2015 the allocation was reduced by £357k (10%). The CCG has

a statutory responsibility to stay within the allocation. The forecast is that the CCG will deliver

this. Currently there is a small contingency remaining.

Other/Reserves – The balance within general reserves is £2.4m; the contingency has been

committed to support systems resilience. Other reserves include investments with the IW and

non-recurrent QIPP funding for investments. The year-end forecast is slippage on reserves of

£822k, which will support the cost pressures in the areas described above.

The balance of the 2% headroom (£746k) mainly consists of non-recurrent QIPP investments.

These are being reviewed in light of the Vanguard priorities.

The CCG is forecasting achieving planned surplus of £2.5m, which will deliver and in year

break-even position against the allocation.

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RESOURCE LIMIT – (Month 8)

2015/16

Month Recurrent Non-

Recurrent Total

£'000 £'000 £'000

Funding

Programme Allocation 196,935 196,935

Growth funding 3,821 3,821

Running Cost Allocation 3,121 3,121

S256 Social Care Funding 3,513 3,513

ETO/DTR Funding 595 595

Winter Funding - Ambulance 49 49

Previous Year surplus 2,550 2,550

Total Opening Funding 207,390 3,194 210,584

In Year Allocations

GMS IT Allocation M3 364 364

Vanguard: PACS - Isle of Wight M4 150 150

Collaborative Fees M4 2 2

Waiting list validation and improving operational processes

M4 4 4

Initial allocation of funding for eating disorders and planning in 2015/16

M5 76 76

Slit lamp bio-microscopy (SLB) M6 6 6

Diabetic Retinal Screening (DS) M6 (35) 5 (30)

Vanguard funding M6 935 935

Tier 3 Neurology Commissioning Responsibility Transfer - NHS England

M7 266 266

High Cost Drugs at Frimley Healthcare M7 3 3

Prosthetics - Commissioning responsibility transfer - NHS England

M7 (314) (314)

Liaison Psychiatry - Mental Health M7 36 36

Total Funding 207,312 4,770 212,082

There has been no adjustment to allocations in November.

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QIPP SCHEMES

2015/16

PLAN AREA Annual Savings target Year to date

Savings £000

Investment £000

Total £000

Net Budget

Net Actuals

Variance Forecast

(+) (-) (Formula)

Planned Care 200 (10) 190 127 193 67 290

Unscheduled Care 1,245 (1,084) 161 107 107 0 161

Mental Health 128 (105) 23 15 15 0 23

Children & Young People 0 (20) (20) (13) (13) (0) (20)

Medicines management 1,790 0 1,790 1,193 1,193 0 1,790

Total 3,363 (1,219) 2,144 1,429 1,496 67 2,244

The net QIPP target for 2015/16 is £2.1m. The year to date position is £67k better than plan.

The schemes are either the full year effect of last year’s schemes or are an expansion of those

in place last year. A substantial proportion of the QIPP savings relate to prescribing savings

which are at risk of not being achieved due to senior posts within the medicines management

team being vacant and one post holder currently under suspension. QIPP plans are being

closely monitored. The forecast is £100k better than plan.

5 | P a g e

FINES AND PENALTIES

Section A - Contract Penalties 2015/16 (£'000) £'000 £'000 £'000 £'000 £'000

Quality Requirements Q1 Q2 Q3 Q4 Total

Operational Standard - RTT (E.B.3) 0 14 88 10 112

Operational Standard - Diagnostic Waiting Times (E.B.4) 1 2 3

Operational Standard - A&E Waits (E.B.5) 56 149 120 26 351

Operational Standard - Cancer Waits - 62 days (E.B.12 - E.B.14) 1 0 1

Operational Standard - Mixed Sex Accommodation Breaches (E.B.S.1) 3 11 4 18

Operational Standard - Cancelled Operations (E.B.S.2) 11 0 11

National Quality Requirement - MRSA (E.A.S.4) 0 10 10

National Quality Requirement - RTT Waits over 52 weeks (E.B.S.4) 10 5 15

National Quality Requirement - Ambulance / A&E Handovers (E.B.S.7 - E.B.S.8)

57 112 72 20 261

National Quality Requirement - Trolley Waits (E.B.S.5) 0 26 2 28

National Quality Requirement - Cancelled Op 2nd time (E.B.S.6) 0 30 30

Total 139 359 286 56 840

The actual position for the end of the November for fines applied was £602k, an increase of

£114k from quarter 2. These relate to diagnostic waiting time, A&E waits, Mixed sex

accommodation breaches, Ambulance/A&E Handovers, trolley waits and operations cancelled

for the second time. The forecast value is £840k, this assumes that the creation of additional

capacity will mean fines will be lower in quarter 4, but only slightly lower in quarter 3 mainly due

to the provider still failing A&E waits and Ambulance/A&E handovers.

Re-investment of fines is being considered as part of the system resilience planning. Fines will

be reinvested to create additional capacity - this will support recovery of the constitutional

targets.

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RISKS & OPPORTUNITIES – (Month 8)

Risks

Full Risk Value

£m

Probability of risk being realised

%

Potential Risk Value

£m

CCGs

Acute SLAs 0.40 50.00% 0.20

Community SLAs 0.00

Mental Health SLAs 0.80 50.00% 0.40

Continuing Care SLAs 1.00 55.00% 0.55

QIPP Under-Delivery 0.00

Performance Issues 0.00

Primary Care 0.00

Prescribing 0.70 50.00% 0.35

Running Costs 0.00

Other Risks 0.00

TOTAL RISKS 2.90 1.50

Please enter the probability of success of mitigating action

Mitigations

Full Mitigation

Value £m

Probability of success of

mitigating action %

Expected Mitigation Value

£m

Uncommitted Funds (Excl 2% Headroom)

Contingency Held 0.00 100.00% 0.00

Contract Reserves 0.00

Investments Uncommitted 0.00

Uncommitted Funds Sub-Total 0.00 0.00

Actions to Implement

Further QIPP Extensions 0.00

Non-Recurrent Measures 0.70 100.00% 0.70

Delay/ Reduce Investment Plans 1.60 50.00% 0.80

Other Mitigations 0.00

Mitigations relying on potential funding 0.00 0.00

Actions to Implement Sub-Total 2.30 1.50

TOTAL MITIGATION 2.30 1.50

NET RISK / HEADROOM 0.00

Key risks are around system resilience and recovery of the constitutional targets. Prescribing

remains an area of risk. Continuing Care and Mental Health Special Placements are at risk of

potential higher overspends than currently forecast based on additional patients being eligible

between now and the year end. These risks are being off-set by un-used balance sheet items

relating to 2014/15 and slippage in investments.

7 | P a g e

RUN RATE

Month 8

Surplus

YTD Expenditure

Run rate

CCG Population

£000

2014/15 Surplus/ (Deficit)

£m

2015/16 Surplus/ (Deficit)

£m

Plan £m

Actual £m

Variance £m

F'Cast Plan

£m

Extrapolated YTD £m

Variance

142 2.6 2.5

136.0 134.4 1.6

209.5 201.7 7.9

The extrapolated run-rate value for the CCG as at month 8 is showing that the CCG could be

£7.9m underspent against plan. The predominant reason for the underspend against run rate is

the significant level of under-performance against our IW Trust planned SLA and operational

resilience funding (£3.3m) being spent in latter part of the year. The Operational resilience

funding is being used to support recovery of constitutional targets. The Trust has increased

bed capacity by 51 – the CCG has agreed to support the premium costs as these beds will have

to be staffed with agency, as part of this the CCG is supporting step-down beds at Solent

Grange.

OTHER I&E RELATED UPDATES

There are no other matters to report

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Detailed I&E Position - November (M8) 2015

YT D

B udget

(£000)

YT D A ctual

(£000)

YT D

Variance

(£000)

A nnual

budget

(£000)

Year End

F o recast

£000

Variance

£000

R eso urces T o tal So urce o f F unds 137,683 137,683 0 212,082 212,082 0

A pplicat io n

A cute IOW NHS Acute Planned Care 26,581 24,639 1,942 39,928 38,978 950

IOW NHS Acute Unscheduled Care 20,503 21,257 (754) 30,802 31,982 (1,180)

IOW NHS Interim Support 3,400 3,400 0 5,100 5,100 0

IOW NHS N/R 401 401 0 401 401 0

IOW Ambulance 4,982 4,982 (0) 7,398 7,398 0

Fines & penalties 0 (620) 620 0 (840) 840

Ambulance 56 58 (2) 117 142 (25)

University Hospitals Southampton Acute SLA 2,929 2,984 (55) 4,394 4,671 (277)

Portsmouth Acute SLA 2,444 2,550 (106) 3,631 3,789 (158)

Salisbury Acute SLA 272 188 84 408 283 125

Acute CQUIN 0 0 0 22 22 0

Dermato logy 586 614 (28) 880 930 (50)

Non-Contract Activity 1,182 1,222 (40) 1,800 1,800 0

Other NHS 219 226 (7) 329 329 0

Winter Pressures 793 793 0 2,444 3,284 (840)

Non Pbr Drugs 1,660 1,688 (28) 2,475 2,525 (50)

Independent Treatment Centres 406 420 (14) 514 561 (47)

Acute Non-Nhs 374 542 (168) 763 944 (181)

T o tal 66,788 65,345 1,443 101,407 102,300 (892)

M ental H ealth IOW NHS M ental Health 12,306 12,306 0 18,445 18,445 0

Other NHS M ental Health 51 24 27 77 50 27

M H CQUINS 283 283 0 454 454 0

Winter Pressures M ental Health 0 0 0 0 0 0

Physical Disablilities Contracts 191 181 10 287 272 15

Special P lacements Learning Disabilities 330 427 (97) 495 595 (100)

Special P lacements M ental Illness 1,213 1,312 (99) 1,883 2,028 (145)

Non NHS M ental Health 54 64 (10) 81 81 1

T o tal 14,429 14,599 (170) 21,722 21,924 (202)

C o mmunity IW Community SLA Planned 4,171 4,171 0 6,214 6,214 0

IW Community SLA Unscheduled 4,105 4,105 (0) 6,153 6,153 0

IOW NHS Physiotherapy 306 306 (0) 458 458 (0)

Community NHS 47 16 31 70 32 38

Community CQUINS 7 7 0 11 11 0

Community Rehab Beds 0 0 0 0 0 0

Hospice 1,783 1,783 0 2,620 2,620 (0)

Community Non NHS 285 285 (0) 428 446 (18)

Other 0 0 0 0 0 0

T o tal 10,704 10,673 31 15,955 15,935 20

B etter C are F und Section 256 Allocation 2,395 2,395 0 3,592 3,592 0

BCF - Community Services 6,053 6,052 1 9,358 9,358 0

BCF - M ental Health Services 1,092 1,094 (2) 1,641 1,641 0

T o tal 9 ,540 9,541 (1) 14,591 14,591 0

C hildren's Children Community P lanned SLA 214 211 4 293 293 0

Children Community Urgent SLA 153 156 (4) 229 229 0

Child Continuing Care 350 248 102 525 430 95

Children NHS 18 21 (2) 27 36 (9)

Children Non NHS 573 554 20 792 764 28

T o tal 1,309 1,190 119 1,867 1,752 114

C o ntinuing C are Continuing Care 6,281 6,640 (359) 9,424 10,055 (631)

Free Nursing Care 1,275 1,275 0 1,913 1,813 100

Continuing Care Admin Support 419 411 8 628 628 (0)

T o tal 7 ,975 8,326 (352) 11,965 12,496 (531)

P rimary C are Prescribing 19,079 18,762 317 28,384 28,210 173

Enhanced services 1,541 1,467 74 2,447 2,401 46

Out of Hours 1,618 1,481 137 2,426 2,266 160

M edicines M anagement 533 544 (11) 799 799 0

T o tal 22,771 22,254 517 34,056 33,677 380

Other Project Costs 0 21 (21) 0 0 0

Programme Staff Costs 401 396 5 602 602 0

Vanguard funding 134 134 0 1,085 1,085 0

Commissioning Schemes 0 0 0 0 0 0

Reserves 0 0 0 2,433 1,612 822

2% Headroom 0 0 0 746 456 290

T o tal 535 551 (15) 4,867 3,754 1,112

R unning C o sts Running Costs 1,944 1,966 (22) 3,121 3,121 (0)

T o tal A pplicat io n o f funds 135,995 134,445 1,550 209,550 209,550 0

Surplus 1,688 3,238 1,550 2,532 2,532 0

9 | P a g e

Financial Review MONTH 8– November 2015

BALANCE SHEET POITION

Assets 2014/15 Outturn

£k

2015/16 Plan

Aug £'000

Sept £'000

Oct £'000

Nov £'000

Current Assets:

Inventories 0

0

0 0 0 0

NHS Trade and Other Receivables 972

550

77 141 55 127

Non NHS Trade and Other Receivables 729

850

193 420 878 205

Deferred Expense / Prepayments 0

0

11,150 10,570 11,240 9,650

Cash 57

124

7,300 5,448 2,610 3,280

Total Current Assets 1,758

1,524

18,719 16,578 14,784 13,261

Total Assets 1,758

1,524

18,719 16,578 14,784 13,261

Liabilities 2014/15 Outturn

£k

2015/16 Plan

£k

Aug £'000

Sept £'000

Oct £'000

Nov £'000

Current Liabilities:

Provisions (current) (109)

(130)

(105) (103) (102) (105)

NHS Trade and Other Payables (3,979)

(3,900)

(2,950) (959) (2,137) (2,212)

Non NHS Trade and Other Payables (7,830)

(7,900)

(7,752) (7,665) (7,285) (7,474)

Total Current Liabilities (11,918)

(11,930)

(10,807) (8,726) (9,525) (9,791)

Total Liabilities (11,918)

(11,930)

(10,807) (8,726) (9,525) (9,791)

Total Assets Employed (10,160)

(10,406)

7,912 7,852 5,259 3,470

Equity 2014/15 Outturn

£k

2015/16 Plan

£k

Aug £'000

Sept £'000

October £'000

November £'000

General Fund (10,160)

(10,406)

(90,582) (106,565) (122,471) (137,914)

Retained (Surplus) / Deficit 0

82,671 98,713 117,212 134,445

Total Equity (10,160)

(10,406)

(7,912) (7,852) (5,259) (3,470)

There are three areas of significant movement this month – cash, prepayments and Non NHS receivables.

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Cash held at month end - There is a £670k increase in cash held at month end compared to the previous month due to the remittance of cash from the local authority from the Better Care Fund (BCF) which had remained unpaid at October month end. NHS Payables – There was £674k reduction in Non NHS receivables this month due to the extra remittance received from the Local Authority as mentioned above. Prepayments - There was £1.6m reduction due mainly to the phasing of remittances back to the CCG under the BCF (£1.22m) but also due to the timing differences of expenses incurred for non-acute services such as continuing care and mental health.

MONTHLY KPI DASHBOARD

Balanced Scorecard - Monthly Target Aug-15 Sep-15 Oct-15 Nov-15

Finance Efficiency: Invoice payment: Paid with payment terms 30 days - % achievement - value

95% 99.95% 98.62% 99.99% 99.93%

Finance Efficiency: Invoice payment: <Paid within payment terms - % achievement - volume

95% 97.76% 93.59% 99.85% 98.39%

Finance Efficiency: Debtors outstanding for more than 30 days

<=5% 39.55% 3.45% 1.24% 74.44%

Finance Efficiency: Creditors outstanding for more than 30 days

<=5% 6.11% 3.09% 0.08% 0.00%

Finance Efficiency: Liquidity cash balance % of drawdown

<1.25% 56.93% 39.11% 19.33% 29.34%

BETTER PAYMENTS PRACTICE CODE

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

NHS 100.00% 99.43% 99.95% 100.00% 99.99% 99.98% 100.00% 99.98%

NON NHS 99.93% 99.77% 97.59% 95.44% 99.61% 92.58% 99.95% 99.63%

TOTAL 99.99% 99.62% 99.47% 99.21% 99.95% 98.62% 99.99% 99.93%

11 | P a g e

BETTER PAYMENTS PRACTICE CODE (CONT’D)

99.98% NHS invoices and 99.63% of all non NHS were paid with in terms (total value of £3K NHS and £7k of non NHS invoices failed the BPPC this month, mostly Choice Pathways Ltd £7k due to incorrect cheque payment method set up by SBS. The remaining failed invoices are due to either invoices being received or scanned late or SBS not scanning invoices correctly and then falling under dummy suppliers.)

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

NHS 100.00% 95.00% 98.48% 99.25% 97.97% 98.22% 100.00% 97.73%

NON NHS 99.54% 98.93% 96.89% 95.12% 97.65% 92.24% 99.81% 98.60%

TOTAL 99.62% 98.15% 97.27% 95.90% 97.76% 93.59% 99.85% 98.39%

97.73% of NHS invoices and 98.60% of all non NHS were paid with in terms (A total of 3 NHS & 6 non-NHS invoices failed BPPC this month due to invoices received late or scanned late by SBS)

88.00%

90.00%

92.00%

94.00%

96.00%

98.00%

100.00%

102.00%

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

NHS NON NHS TOTAL

85.00%

90.00%

95.00%

100.00%

105.00%

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

NHS NON NHS TOTAL

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AGED CREDITORS

CREDITORS £'000'S Total less than 30

days less than 60

days less than 90

days more than 90

Days

£ £ £ £ £

NHS (37) 51 (88)

NON NHS (255) 2,843 (534) (70) (2,494)

total (292) 2,894 (534) (70) (2,582)

At the month end there were £2.8k of invoices outstanding all current period and £3.1k in

credits due back to the CCG, all of which have been outstanding for longer than 30 days. The

supplier owed the highest value related to a current period invoice and has since been paid.

The highest value credit balance was in relation to a care home (£2.4k), as the supplier is in

administration. The other credit balances are awaiting further invoices currently in the system

but yet to be approved for the credit to offset.

-100%

-50%

0%

50%

100%

AG

E O

F D

EBT

Apr May Jun Jul Aug Sep Oct Nov

Over 30 days 230 17 (29) 22 9 17 (3) (0)

Current 1,571 96 24 236 143 537 174 0

Aged Creditors

(1,000)

0

1,000

2,000


Current Over 30 days TOTAL

13 | P a g e

AGED DEBTORS

Debtors £'000's total Current 31-60 Days 61-90 Days 90 DAYS +

£ £ £ £ £

NHS 68,439 3,750 58,371 0 0

NON NHS 21,082 18,537 350 0 8,513

total 89,521 22,287 58,721 0 8,513

The largest debtor at month end was an NHS Trust (£58k), which is still outstanding due to

awaiting a M6 invoicing to be signed off. There is 1 material debtor outstanding for more than

30 days - the Department of Health £6k for recharges. There are a number of small balances all

relating to training income/GP practice closures and all balances remain owing due to either

debtors awaiting copy invoices from SBS or SBS cannot contact the relevant person to chase for

payment.

0%

50%

100%

AG

E O

F D

EBT


Over 30 days 62 16 15 15 9 11 10 67

Current 125 14 28 56 14 297 787 23

Aged Debtors

0

500

1,000


Current Over 30 days TOTAL

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CASH

CASHFLOW

The physical cash balance at month end was £3,969k compared to the reconciled ledger

balance of £3,280k – the difference between physical cash and reconciled cash being due to

£8k unpresented cheques and the BACs run of £681k released on 26th November which won’t

fully clear the bank until the 3rd December 2015. The cash holding is higher than anticipated

due to unexpected timing differences on budgeted payments and also the mechanics of

administering the BCF.

2015/16 Nov Dec January February March Total

£000 £000 £000 £000 £000 £000

Receipts

CHAPS 1,625 1,800 1,100 1,100 1,725 13,500

CCG-Drawdown 13,500 13,500 14,500 14,500 10,534 185,534

Other 651

VAT 2 1 1 1 1 28

Total Receipts 15,127 14,602 14,602 14,602 13,024 197,876

Payments

Creditors NHS 12,317 11,551 11,560 11,555 12,500 149,064

Creditors CHAPS & Cheque 1,838 3,600 3,900 3,000 3,850 34,186

Salary CHAPS 172 172 172 172 172 2,009

Pensions 51 51 51 51 51 607

Tax & NI 69 69 69 69 69 825

Standing Orders /Direct Debits 1 33

Other 13,001

Total -Expenditure 14,448 15,443 15,752 14,847 16,642 199,725

Balance b/fwd 3,288 3,969 3,827 3,676 4,430 60

Balance c/fwd 3,969 3,827 3,676 4,430 48 48

15 | P a g e

SALARY OVERPAYMENTS

REF Balance

Remaining Expected Recovery

End Date Comments

1 54.76 TBC Late leaver - sales invoice raised and sent on 16.11.15

WRITE OFFS

There have been no write offs during the period to date, however the executive committee

need to formalise the treatment for Fairhome Care Group (W L) Ltd. We have received

confirmation from the administrators that there will be no distributions to unsecured creditors

and therefore the debt of £3k is unrecoverable and needs to be written back to the I&E account

(see creditors above). This figure represents funds paid for services that have not been

received.

PROVISIONS

Column1 YTD Actual

Open bal Brought Forward-Cont Care<1Yr

108,643

Utilisation-Cont Care<1Yr (3,439)

105,203

Utilisation-Cont Care<1Yr – Payment of retrospective care fees

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BETTER CARE FUND: CASH

Pooled budgets held by Local Authorities

Deposits Made Funds returned

£000s £000s

Apr-15 May-15 13,500 586

Jun-15 1,091 3,062

Jul-15

1,216

Aug-15

1,216

Sep-15

1,216

Oct-15

1,216

Nov-15

1,216

14,591 9,728

BALANCE AS AT 30/11/15

4,863

The table above shows amounts invoiced to the local authority not physical cash received.

CAPITAL

The CCG currently has no capital assets.

OTHER BALANCE SHEET RELATED UPDATES

There are no other matters to report

Governing Body Governing Body Assurance Framework Sponsor: Helen Shields, Chief Officer

Summary of issue:

As this Governing Body is the penultimate meeting of the year, this report looks at the likelihood of achieving each of the critical success factors by the end of the year. Objective 1: CSF 1: Temporary posts are now being filled within the CCG and wider Vanguard Project which is supporting existing staff to be released from day to day business to work on transformation programmes. This is being achieved within running costs, however ongoing funding relies on further investment from central government via the vanguard project. As a consequence of this work, the likelihood of some of these risks occurring has been downgraded turning these into low risks. It is now likely that KSF1 can be reported as achieved at the end of the year. KSF 2: Progress towards joint commissioning with the local authority has been made with useful Commissioning Officer Group set up. Agreement on the additional capacity to lead the programme has now been agreed; however physical colocation will not now take place this year. Despite this the intention will be to report this KSF as achieved at the end of the year. CSF3: Risks against the Better Care Fund are categorised as low and will be reported as achieved at the end of the year. CSF4: While the absolute risk associated with this area is low, a considerable amount of progress is predicated on the success of the WISR programme in the last few weeks of the year. It is unlikely that a fully formed programme will be in place by the end of the financial year. It is intended therefore to report this area as partially achieved with progress being made. Objective 2: CSF1: It is increasingly unlikely that IWNHST will meet all CQUINs by the end of the year, however the IWNHST has increased capacity particularly in relation to capacity and demand planning. It is intended therefore to report this as partially met at the end of the year. CSF2: The CCG is awaiting an audit to understand whether the Quality Indicators in the Contract have been achieved by IWNHST. We cannot therefore anticipate whether this is likely to have been met at the end

of the year CSF3: Additional resources are in place to support achievement against the quality indicators for the quality and safeguarding team, however no assessment has yet been made to determine whether this objective has been realised or not. Objective 3: CSF1: It is now highly unlikely that the Better Care Fund will achieve savings in this financial year. However the CCG will meet the running cost and Programme Cost targets. This will therefore be reported as partially achieved at the end of the year. CSF2: CCG will not meet the NHS Constitution targets by the end of the financial year despite the mitigating actions put in place. The cost base review will not be completed and although extensive work has been undertaken with NHS England in relation to the CCG Allocation, and a “sparcity” adjustment has been made this will not be sufficient to meet the needs of the island. This will therefore be reported as not achieved at the end of the year. Objective 4: CSF1: The CCG has been approved for delegated commissioning of primary care and is on track to ensure the Constitution is approved by the end of the financial year. This will therefore be reported as achieved. CSF2: The MLFL programme continues to develop and a new Programme Director has been appointed. Programme Support is in place; however the overarching governance remains an issue. It is likely that sufficient progress will be made by the end of the year to report this as achieved. Objective 5: CSF1: Further work is required with the membership to ensure that the localities and Clinical Executive are connected and communicating. However, there is no evidence currently to suggest that the relationship has deteriorated as we have moved towards delegated commissioning. It is possible to achieve this by the end of the financial year, but further work is required. CSF2: The Stakeholder Strategy has been written and progress towards metrics for governing body is being made, although this is likely now to fall short of a first report in this financial year. A communications manager has been recruited and the WISR project will support increased engagement activities. This will therefore be reported as partially achieved. CSF3: The OD plan has been shared across the MLFL partners and is now part of the wider Leadership Organisational Development and

Workforce workstream. Funding has been requested as part of the value proposition but at this stage it is not clear whether this will be forthcoming. In any event, the CCG will be working towards the OD plan and so this will be described as achieved at the end of the year.


The Governing Body is asked to consider whether there are any further actions that are required between now and the end of the financial year that may materially improve progress against the objectives.

Principle risks:

It is now certain that the CCG will not meet the NHS Constitution targets in year and this is resulting in the CCG receiving a lower level of assurance from NHS England that would otherwise be available. The Number of Healthcare Acquired Infections attributed to the CCG in year means that a proportion of the Quality Premium has not been achieved. There is continued uncertainty regarding the ability of the MLFL programme to deliver the required efficiency savings.


• The MLAFL Programme Board is overseeing the issues in relation the Vanguard;

• The Clinical Executive has detailed oversight of the key risks. • The Better Care Fund Board is reviewing progress against that fund


Risks around capacity of staff to undertake work as reported last time have eased in the last two months with the appointment of a number of temporary posts.

However risks in relation to the CCG Allocation are more acute with the publication of the allocation for next financial year with a very low level of growth and increasing costs within the system. Funding deficits within the local NHS Trust and Local Authority will exacerbate the potential impact of this low growth level.


There are no immediate legal implications inherent in this document.


A comprehensive engagement plan is in development to support the achievement of the CCGs objectives through the vanguard programme.

A separate programme of work to support public understanding of the measures that will need to be put in place to achieve NHS Constitution targets is also underway


Equality impact assessment will be required for all projects identified within this document.

Author of Paper: Caroline Morris


Governing Body Risk Register Summary Report Sponsor: Helen Shields, CCG Chief Officer

Summary of issue:

Then number of high risks identified by the CCG has increased since the last report with six new risks identified between early December and January. Three of these relate to the sustainability of service on the island in the light of recruitment issues both locally and within the wider NHS and indicate how important it is to undertake the Whole System Integrated Review to seek to resolve issues related to very small teams and lone experts on the island. Risks concerning the capacity of the system to transform remain of concern although as discussed within the GBAF the CCG has been able to recruit to a number of positions to relieve pressure in places. The safeguarding situation on the island continues to improve, although as discussed below, further issues have come to light recently which require an investigation which is now ongoing. There have been six new risks added to the risk register since the last report: • Y3/21 – IT Security and Capability in relation to the CCG’s ability to

achieve “level 2” against the Information Governance Toolkit. This is a mandatory achievement for CCGs, and an action plan is now in place to upgrade obsolete PCs urgently prior to the year end. Rated as high risk.

• Y3/22 – Retirement of Community Stoma Nurse. This service relies on a single individual who has indicated that she will be retiring. The service will be recommissioned during 2016, however this work plan has not progressed sufficiently yet to feel secure in the service. Rated as medium risk

• Y3/23 – Clinical Sustainability of Urology Service on the Island. The IW NHS Trust is experiencing ongoing difficulties recruiting Urology consultants and as a consequence waiting timings are increasing and the single consultant is under increasing pressure. Rated as high risk.

• Y3/24 – Partner Resilience – Increasing financial constraints and performance issues is leading to reduced management capacity at both the IW NHS Trust and the Local Authority putting at risk achievement of joint plans in the agreed timescales. Rated as a medium risk.

• Y3/25 – Inability to provide safe spinal MPTT and surgery pathway. UHS have given notice that the Spinal Consultant will not attend the Island, putting at risk the GPwSI service that relies on this consultant

support. Patients may need to travel to mainland. Rated as high risk.

• Y3/26 – Safeguarding issues have come to light in relation to Learning Disabled patients at a particular home which are now being investigated. Rated as high risk.

In addition to these new risks, four high risk areas remain identified by the CCG including: • Care home closures and bed reductions • Failure to meet A&E and RTT targets • Adult Safeguarding capacity within IOW NHS Trust • Achievement of prescribing QIPP schemes NHS Constitution targets will not be achieved this financial year despite the action plans in place and so will remain high risk for the remainder of this year. In relation to prescribing QIPP schemes, the current data suggests that targets will be achieved; however as the data lags three months behind this will remain an area of concern until the year end. Adult safeguarding capacity is improving at the IW NHS Trust, however the Clinical Executive have agreed to monitor progress before downgrading this as a risk.


The Governing Body is asked to review the summary report and determine whether it is assured that the CCG is capturing and managing risks appropriately.

Principle risks:

Failure to produce a meaningful risk register could result in the CCG failing to take the required actions to ensure that it meets its targets and statutory duties.


All changes to risk are discussed at the Commissioning Officer’s Group as they arise. In addition, the risk register is reviewed in detail monthly at the Clinical Executive and the outcomes of that review are detailed within the Clinical Executive minutes. Individual risks are discussed with teams during performance review meetings.


As we come towards the end of the financial year a number of short term investments, particularly in beds to support system resilience will require review and could impact significantly on next year’s financial position. The overall financial situation of the CCG is discussed in the Performance Report.


Y3/21 – failure to ensure secure IT services could lead to a breach of the CCG’s duty to ensure adequate data protection procedures are in place, particularly in relation to the disclosure of personal data. A serious breach of the Data Protection Act results in criminal sanction and the potential of fines of up to a maximum of £500,000.


The CCG has undertaken a number of communication and engagement exercises to support patients to make choices regarding mainland treatment as part of the action plans supporting system resilience.


Further issues in relation to Equality of access to services for patients are raised in the light of the concerns about service sustainability for the Island and will be addressed as part of the programme of work to resolve these problems.

Author of Paper: Caroline Morris, Head of Primary Care and Corporate Business.




Governing Body February 2016

GB15-064 Risk Register summary

Months >12 >6 >3 New

Risks 9 5 3 6

Risks added to register

1 Ref Score1 Y3/21 16

Y3/22 12Y3/23 16Y3/24 12Y3/25 15Y3/26 TBC

Risks removed from the register

Y3/8 12/

Risks with Increased Score

Ref Score

Increased Scores

Reduced Scores Risks with Reduced Score

Ref ScoreY3/4 8Y3/6 12

High RisksCommissioning

Corporate Care home closures and bed reductions

Quality Safeguarding adults capacity within IOW NHS Trust

Inability to provide safe Spinal pathways for the Island

IT - Security and Capability does not meet IG Toolkit requirements

23

Title

Title

TitleIT - Security and capability does not meet IG toolkit requirementsRetirement of Specialist Community Stoma Nurse

DOLS applications - now combined into single risk re: safeguarding capacity

Clinical Sustainability of Urology Service at IW NHS Trust

Clinical Sustainability of Urology Service at IW NHS Trust

System Resilience an failure to me A&E and RTT TargetsAchievement of Prescribing QIPP targets

Safeguarding concerns regarding LD Patients

Partner Resilience in light of poor performance and financial constraintsInability to provide safe spinal pathways for island residents Safeguarding concerns for LD patients

Progress with CQC Action Plan IW NHS Trust Better Care Fund schemes

Summary Risk Register

Risk Distribution by Objective

Activity

Total Time on Register

0

2

0123456

Comm Fin Qual Corp

High

Medium

Low

Governing Body Emergency Preparedness, Resilience and Response Sponsor: Helen Shields, Chief Finance Officer

Summary of issue: Letter to summarise Emergency Preparedness, Resilience and Response Assurance teleconference.


To note the Emergency Preparedness, Resilience and Response (EPRR) Assurance from NHS England.

Principle risks: Outstanding areas for compliance outlined within the paper.


The EPRR Action plan was discussed by the Governing Body on 5 November 2015.


There are no financial or resource implications associated with this paper.


Legal requirement to have EPRR action plan in place.


There has been no public involvement or action taken in relation to this paper.

Equality and diversity impact: There is no equality and diversity impact associated with this paper.

Author of Paper: NHS England

Date of Paper: January 2016



High quality care for all, now and for future generations

Dear Helen, Wessex Assurance of Emergency Preparedness, Resilience and Response (EPRR) 2015/16 This letter is to summarise our EPRR assurance teleconference on 4th December and to thank you for your work on EPRR assurance with NHS Isle of Wight Trust. Isle of Wight Clinical Commissioning Group During our teleconference we discussed how EPRR in the CCG has developed since the 2014 round when we agreed a ‘partially assured’ assessment rating. In 2015 the CCG has gained an improved understanding of its role in emergencies and has put in place most of the arrangements described in the core standards. In all of our discussions with CCGs this year we have sought more detail on board level engagement. We heard how the CCG’s EPRR paper generated a board level discussion on business continuity and informed a re-assessment of the initial rating against the relevant core standard. In our teleconference on the 4th we agreed the value of a consistent assurance process and acknowledged that the scope could be broadened to include contracted and primary care providers, particularly in the context of recent and planned changes to the NHS landscape. Over the last year we have seen greater attendance from AEOs and their deputies at LHRP meetings and we welcome continued LHRP engagement from the Isle of Wight CCG. The 2015 core standards template had 30 EPRR core standards applicable to CCGs, with an additional four ‘deep dive’ pandemic flu standards. We agree that in common with many commissioners and providers there is more work to be done on pandemic flu planning including participation in a LRF exercise now scheduled for July 2016. The CCG’s EPRR work plan highlights some key areas for development in 2016:

Core standards 8, 34, and 37

This work will include the development of a consistent training plan for staff with a key role in emergencies and an exercise programme that involves those staff. Following on from the work done in 2015, some plans need further work and we agree with the CCG’s view that updated business continuity plans should be completed in the forthcoming year.

Sent by email: Helen Shields, Chief Officer, Isle of Wight Clinical Commissioning Group

NHS England Wessex Area Team

Oakley Road Southampton

SO16 4GX

5th January 2016


Compliance Assessment of Isle of Wight Clinical Commissioning Group

In accordance with the NHS England EPRR assurance guidelines and with fewer than five core standards not met, we agree that Isle of Wight CCG is substantially compliant with the 2015 core standards. The move from partial to substantial assurance in 2015 is welcome and we appreciate the work that you and Caroline Morris, supported by colleagues, have done to make this progress. NHS Isle of Wight of Trust During 2015 the CCG worked with NHS Isle of Wight to monitor the implementation of the trust’s 2014 EPRR improvement plan and to prepare for the 2015 assurance round. In our teleconference we discussed the challenges presented to the EPRR agenda in NHS Isle of Wight and also heard how the trust has maintained a focus on EPRR and responded to planned and unplanned events and incidents in 2015. In November the trust’s board received a paper summarising its assurance self-assessment as well as the trust’s involvement in a number of significant incidents, a major incident, and large scale public events. A Business Continuity Manager had recently left their post after working to improve the trust’s BCM arrangements in 2015. We agree with the CCG that the appointment of a successor would allow the trust to maintain the progress seen over the last year. We also discussed the challenges that the Trust has found in attending LHRP meetings in 2015 and we look forward to more engagement in 2016. There has been work to formally agree and record how NHS Isle of Wight gets support from South Central Ambulance Service NHS FT, and we understand that finalising this depends on a shared understanding of financial implications; however we are keen to see to progress early in 2016. As discussed earlier in the year, we identified that NHS Isle of Wight does not receive central funding for some specialist capabilities that other ambulance services have. We will work together to develop and exercise that supports your risk assessment and helps to identify any capability gap. The 2015 EPRR core standard template had 35 EPRR core standards applicable to ambulance and acute hospital trusts, with an additional four ‘deep dive’ pandemic flu standards. The trust has worked to develop its arrangements for an influenza pandemic and meets 3 of the four pandemic deep dive standards, participation in a LRF exercise this summer will meet the demands of the fourth. At the time of its submission to the CCG in September the trust reported ongoing work against six EPRR core standards:

Core standards 8, 20, 21, 34, 36, and 37.

Core standard 37 requires a training portfolio for key staff and was complete by the time of our meeting. Completion of work linked to standards 20 and 21 requires clarification of arrangements with SCAS as described earlier in this letter and we believe should be a priority for action in 2016. Actions linked to core standard 8 require the review and sign off of plans and arrangements, some of which depend on external factors, such as finalising the trust’s lockdown plan while the capital building program is ongoing.


Compliance Assessment of NHS Isle of Wight Trust With the completion of work linked to core standard 37, Isle of Wight NHS Trust has work on five core standards outstanding which we expect to see on its EPRR Improvement Plan for 2016. Isle of Wight NHS Trust is therefore substantially compliant with the 2015 EPRR core standards. We welcome the progress made since last year’s partial rating and appreciate the work done by Alan Sheward, Keith Morey and their colleagues that brought about this improvement. Yours sincerely,

Jacqueline Cotgrove Director of Operations and Delivery NHS England (Wessex)

Extract from Hampshire & Isle of Wight LHRP Meeting Presentation, 8 December 2015

EPRR Assurance Summary Slides

Slide 1

Slide 2

Governing Body Policy Recommendation 004: Complex Decongestive Therapy (CDT) for Lymphoedema


Summary of issue:

Guidance has been received from the SHIP Priorities Committee that each CCG needs to make its own decision about the treatment of Lymphoedema. The SHIP Priorities Committee is an advisory body of representatives of Clinical Commissioning Groups (CCG’s) across Hampshire, Southampton, the Isle of Wight, Portsmouth and Surrey. The Committee provides CCG’s with evidence-based, carefully considered recommendations that inform the commissioning policies of the constituent SHIP Clinical Commissioning Groups. The Committee makes recommendations based on available clinical and cost effectiveness evidence that each CCG can consider. Clinicians from local hospitals are given the opportunity to contribute to the policy as part of the process. This advice and support ensures that clinical policy remains fit for purpose, up-to-date and rigorously responsive to challenge and assists the CCG to choose how to allocate their resources to promote the health of the local community.


The Governing Body is asked to agree the Priority Statement about the treatment of Lymphoedema.

Principle risks: None noted. Local clinicians are in agreement with this Priority Statement.


The Clinical Effectiveness Committee debated the use of Manual Lymphatic Drainage (MLD), an element of Lymphoedema treatment, in October 2015 and agreed that it was not opposed to its use.

The Clinical Executive recommended for approval to the Governing Body the SHIP8 Policy 004: Patients with Lymphoedema Priorities Statement at the meeting on 19th November 2015. As this meeting was not quorate the decision was ratified by Dr John Rivers, CCG Chair on 25.11.15


None noted


None noted


None required


No implications noted, treatment available to anyone with Lymphoedema

Author of Paper: Alison Geddes, Commissioning Manager

Date of Paper: 27th November 2015



SHIP8 Clinical Commissioning Groups’ Priorities Committee

Policy Recommendation 004: Treatments for patients with lymphoedema Date of issue: June 2015

The Priorities Committee recommends that assessment and treatment (particularly skincare, compression, remedial exercise, and self-management education) should be available for patients with lymphoedema within existing NHS services, for all patients who have lymphoedema irrespective of the cause. Patients, who receive treatment which may cause lymphoedema in the short or medium term, should be properly informed about the risk of lymphoedema (through consent arrangements) and educated in its management.

Supporting information:

• Lymphoedema presents as persistent tissue swelling caused by impairment of the lymphatic system. It is a chronic, progressive condition that is sometimes painful, causes psychological distress, impairs mobility and joint movement, adversely affects the ability to undertake activities of daily living and lowers quality of life.

• Lymphoedema most commonly results from iatrogenic damage or problems with the movement and drainage of fluid in the lymphatic system, often due to treatments for cancer, including surgery and radiation therapy. Other causes include decreased mobility related to obesity and age.

• Complex decongestive therapy (CDT) usually has three main components: • compression bandages and garments – to move fluid out of the affected limb

and minimise further build-up • skin care – to keep the skin in good condition and reduce the chances of

infection • exercises – to use muscles in the affected limb to improve lymph drainage

Also sometimes used are specialised massage techniques – known as manual lymphatic drainage (MLD) – to stimulate the flow of fluid in the lymphatic system and reduce swelling.

CDT usually begins with an intensive phase of therapy to help reduce the volume of the affected limb. This is followed by the maintenance phase, when patients are encouraged to take over their care by wearing compression garments, continuing to exercise and carrying out simple self-massage techniques in order to maintain the reduced size of the affected limb.

NOTES: Exceptional circumstances may be considered where there is evidence of significant health impairment and there is also evidence of the intervention improving health status. This policy may be reviewed in the light of new evidence or guidance from NICE.

Governing Body CCG Allocation 2016/17

Sponsor: Rebecca Wastall, Deputy Chief Finance Officer

Summary of issue: 2016/17 to 2020/21 CCG Allocations

Action required/ recommendation: For information

Principle risks:

To note that the CCG has received a limited level of growth, as its allocation is >5% above target. For the 5 year period this means that the CCG will receive c£15.6m less than it would have done had it received the national level of growth. This will impact on the CCG’s ability to respond to increasing demand and therefore requires major health and care transformation (via My Life a Full Life).


None. The information will be presented to the next Clinical Executive meeting.


See risk section above.


The CCG will ensure that there is full consultation in relation to any proposed service reconfigurations that are part of the transformation programme.


The CCG will ensure that there is full consultation in relation to any proposed service reconfigurations that are part of the transformation programme. The My Life a Full Life Communications and Engagement Strategy includes co-production, which will mean working in partnership with the public to design services and make decisions around them.


The CCG will ensure that equality and diversity are fully considered in relation to any proposed service reconfigurations that are part of the transformation programme.

Author of Paper: Loretta Outhwaite, Chief Finance Officer

Date of Paper: 3rd February 2016

Date of Meeting: 4th February 2016


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National allocations overview

The following paper is based on the NHS England Board paper (PB.17.12.15/04) and the NHS England CCG allocations guidance for 2016/17 National overview Last autumn, the NHS published the 5 Year Forward View, which set out the shared strategic vision for the development of the service to 2020/21 and the need to transform the current approach to delivering care. On 25 November’15, the government announced a five year funding settlement for the NHS. Annual funding will rise in real terms by £3.8bn in 16/17 and £8.4bn by 2020/21. Table 1 provides an overview of the national NHS funding growth. Table 1: National NHS Funding growth Real growth year on year 2016/17 2017/18 2018/19 2019/20 2020/21 % 3.6% 1.3% 0.4% 0.7% 1.4% £ £3.8bn £1.4bn £0.4bn £0.8bn £1.6bn This front-loaded funding settlement gives the NHS the platform to begin delivering the vision set out in the Five Year Forward View at a local health economy level. The NHS is, however, facing significant financial challenges during 2015/16, and therefore a key focus in 2016/17 will need to be upon stabilisation of the commissioner and provider sectors in order to create a sustainable footing for transformation. The national allocations process aims to enable the NHS to use the Spending Review funding to achieve:

• Greater equity of access through pace-of-change: o In 2016/17 all CCGs no more than 5% under target for CCG commissioned

services; o In 2016/17 all CCG areas no more than 5% under target for the total

commissioning streams for their population; o Three year transition to a similar position for primary medical care allocations.

• Closer alignment with population need through improved allocation

formulae: o A new inequalities adjustment for specialised care and more sensitive

adjustments for CCGs and primary care

• A new sparsity adjustment for remote areas.

• Faster progress with strategic goals through: o Higher funding growth for GP services and mental health; o Introduction of a Sustainability and Transformation Fund, with a focus in

2016/17 on restabilising the NHS and a priority in subsequent years of accelerating transformational investment.

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• Stronger long-term collaboration between commissioners and providers stimulated and supported through: o Shared strategic planning supported by visibility of projected commissioning

resources by locality for the next five years, couple with forward guidance on key tariff parameters in the planning guidance;

o Aligned incentives for effective integrated strategic planning; o Opportunities to pilot shared financial control totals.

As set out in the business rules for commissioners published in the forthcoming NHS planning guidance, the real terms element of growth in allocations from 2017/18 onwards for CCGs, as well as their access to the Sustainability and Transformation Fund, will be contingent upon the development and sign off of a robust Local Health Economy Strategic plan during 2016/17. Providers will be similarly incentivised, as the proposed criteria to access sustainability and transformation funding include sign off of Local Health Economy plans. Allocation period A five year funding settlement gives NHS England the opportunity to set five year allocations for commissioners, providing greater planning certainty in order that commissioners can now develop robust local health plans to deliver the Five Year Forward View. NHS England has published three years of firm allocations (2016/17 to 2018/19) and two further years of indicative allocations. Place-based funding allocations To enable a more integrated approach to be taken to planning for and delivering healthcare, NHS England is moving to place-based allocations. This includes:

• CCG core programme • Primary Care • Specialised

For 2016/17 the CCG will only be commissioning CCG core programmes and Primary Care (under its new delegated commissioning arrangements). In relation to Specialised Commissioning, the CCG will be working closely with NHS England to establish how interim and future arrangements will work. The NHS is requiring all systems to produce a five year Sustainability and Transformation Plan (STP), place-based and driving the Five Year Forward View. The plan must cover all areas of CCG and NHS England commissioned activity including specialised services, primary medical care. The national approach to distribution of funding between commissioning streams is based upon:

• Setting a reasonable level of efficiency challenge for each commissioning stream; • Directing funding towards Primary Care (GP services) in line with the strategic

intent of the Five Year Forward View; and • Within central budgets reducing day to day expenditure whilst prioritising funding

for transformation.

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There is a set of existing commitments regarding allocation of funding at commissioning stream level. The two principal commitments are:

• Parity of esteem, where there is not a set a specific allocation of funds, but rather through assurance processes hold commissioners to account for allocating growth in funding to mental health at a rate at least in line with general growth in their allocation; and

• The Better Care Fund, where contributions will increase in line with inflation. Funding growth There are two key drivers behind differential growth funding for a CCG:

• The progressive reduction of the distance between current funding and the target allocations

• Ensuring that all areas are funded appropriately for their expected population growth.

These objectives are subject to further protections designed to ensure that allocation changes do not destabilise individual local health economies. Table 2 below shows the funding growth at commissioning stream level. Table 2: Funding growth (%) at commissioning stream level 2016/17 2017/18 2018/19 2019/20 2020/21 % % % % % CCGs 3.4 2.1 2.0 2.2 3.8 Primary Care 4.2 4.0 4.5 4.8 5.4 Specialised 7.0 4.8 4.5 4.5 5.0 Total Place 4.0 2.7 2.6 2.8 4.1 Sustainability/ Transformation 69.5 33.9 2.9 16.5 -0.8 Direct commissioning -0.6 0 -0.5 -1.2 -1.0 NHS England central budgets -4.2 -4.8 -10.0 -6.5 -6.4 Use of drawdowns -16.7 60.0 0 0 0 Total 5.5 3.2 2.3 2.8 3.6 Note Drawdown includes utilisation of prior year cumulative surpluses, primarily by CCGs, to fund non-recurrent investments and funding for in-year deficits agreed as part of a multi-year recovery plan. Key changes in the national funding formulae methodology There have been a number of key changes made to the formulae which determine target allocations.

• Inequalities: o NHS England looks to meet some of its legal requirement to reduce inequalities in healthcare provision through its approach to allocations. This year, a comprehensive literature review has been undertaken to investigate whether the evidence base has changed. The conclusion is that the inequalities adjustment will be kept at current levels for CCGs and for primary care.

o The methodology has also been reviewed. ACRA has recommended that the application of the inequalities adjustment moves from a 10 tier to a 16 tier approach that better targets areas with the highest levels of deprivation. The

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impact of moving to 16 groups is to increase the target allocations to the areas with the very worst SMR<75.

• Population

o Population figures for all programme allocations continue to be based on GP list sizes, now updated to October 2015. Increases for future years are based on the Office of National Statistics1.

o Using GP lists as a basis for the allocations requires these lists to be materially accurate. Following the allocation of funds in 2015/16, further list updating activity has been undertaken in all regions and is reflected in this allocation setting process.

• CCG formula

o For this round of allocations the core structure of the CCG formula remains the same, but all underlying data has been updated. This means that the activity data used in the model has been brought forward by 4 years and model parameters re-estimated.

o There have been the following changes to the formula: Introduction of a sparsity adjustment; Refresh of the emergency ambulance cost adjustment (EACA); and Revision to application of inequalities (as above).

• Primary Medical Care

o The key change to the primary medical care formula is the inclusion of new estimates of stratified workload per patient for GPs based on 2 million patient records from the Clinical Practice Research Datalink 2014.

o The workload has been considered in detail to identify if there should be adjustments to the mapping of workload required (i.e. time spent per patient) based on a patient’s age and sex, the relative deprivation in the area and the volume, number and impact of new registrations in a practice.

o ACRA has endorsed these changes but has been clear that this is for allocation purposes only and does not in itself, at this time, imply any particular adjustments to GMS contracts.

• Non-medical primary care

o Only primary medical care is included in the place based commissioning allocations by locality, as other areas of primary care (principally community pharmacy, dentistry and optical services) are not currently within the scope of collaborative commissioning, and the allocation formulae are not yet sufficiently robust to use for individual CCG geographies.

• Specialised Services

o To support the development of a “place-based” approach, NHS England has developed a formula for specialised services, which will promote equitable allocations, support greater understanding and transparency and facilitate collaborative commissioning between CCGs and NHS England.

1 Whilst many local authorities compile more detailed future population projections, the methodology is not consistent and this means they cannot be brought into a national formula. Hence areas of disproportionally high anticipated growth may be adversely impacted if the ONS does not fully capture this in its assumptions. To mitigate this risk, actual changes in population will be reviewed annually to see if any CCG is given an unfair or disproportionate challenge for this reason, and an adjustment made if required.

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o It is a needs-based specialised formula, using a similar approach to the CCG formula (Person Based Resource Allocation). This covers c50% of all specialised services spend. The remaining services have been included within the target for each CCG geography based on historic expenditure.

Pace of change policy In previous years the NHS England Board has agreed a pace-of-change policy that has sought to:

• Bring all CCGs to target funding over time and specifically bring all CCGs within 5% of target as quickly as possible (in 2015/16 we halved from 34 to 17 the number of CCGs who were more than 5% below their target funding); and

• Bring all primary care geographies to target funding over time. Key considerations for the Board have included:

• The minimum floor growth any geography can be expected to manage without short term destabilisation of service provision;

• The pace at which over target geographies can adjust their spending to their needs based target; and

• The maximum growth that any geography can invest in a value for money way in a given year.

To date, discussions regarding pace-of-change have predominantly focussed upon CCG allocations. With the development of primary medical care and specialised formulae at CCG level a more holistic view of pace-of-change is now being taken, at a place (or local health economy) based level. NHS England has selected an approach which focuses on alignment with holistic place-based targets, but subject to applying rules to limit the volatility and unintended consequences in individual commissioning streams. The following high-level steps are taken to implement the hybrid approach:

• Apply funding at each commissioning stream level to meet specific rules for minimum growth and caps where appropriate;

• Any funds that are not needed to meet these commissioning stream aims are then used to support pace-of-change for the place-based allocation;

• Any additional funding which a CCG area accrues in step ii. is then redistributed back to the allocations for the CCG and primary medical care commissioning streams.

Better Care Fund Better Care Fund projections at CCG level for 2016/17 have been included in CCG allocations. Information regarding years after 2016/17 will be published alongside the strategic planning guidance in due course. CCG administration CCG administration allowances at an overall level will remain flat to 2020/21, as determined by HM Treasury’s Spending Review settlement.

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Individual CCG allowances will be rebased to adjust for changing share of population. Further details on the changes in formulae are provided in Appendix 1. Implications for NHS Isle of Wight For 2015/16 the CCG’s allocation consisted of CCG programme (healthcare), which was 18% DFT (distance from target), and CCG running costs. In line with the move to a place-based allocation and changes/updates to the allocation formulae, the CCG’s new allocation (place-based) has a 2015/16 closing DFT of 12.2%. Table 3 below, provides an overview of the CCG total place-based allocation for the next 5 years. Table 3: CCG total place-based allocation: 2015/16 to 2020/21

For Wessex, the 2016/17 average opening distance from target (DFT) is -0.5%, with the range of DFTs being from -5.1 to 13.0%. For the South of England the average DFT is -0.1%. The Island’s opening DFT is 13.0%. Nationally, the Island has the 5th highest DFT. Therefore, for the CCG’s total place-based services, the Island is considered to be spending £31.1m more than its population should need. The average growth for Wessex in 2016/17 is 5.0%. The Island’s growth, at 2.3%, is lower, due to the fact it is, in total (place-based allocation) 13.0% DFT and growth to any CCG above 5% DFT has been limited. By limiting growth, NHS England is moving the CCG closer to target allocation, so by 2020/21 it will only be 5.6% DFT. The limited growth will mean that by 2020/21, the CCG’s allocation will be £15.6m lower than had it received the national level of growth. As the CCG is >5% over its allocation target its growth has been fixed at the minimum rates for the next 5 years. This can be seen by comparing the per capita growth below to the growth shown in Table 2 above. As an example, for 2016/17 the CCG’s per capita growth is 1.9%, compared to national growth of 4.0%. The CCG was one of six CCGs to receive the new sparcity adjustment. This has increased the CCG’s allocation for 2016/17 by £4.9m, and is the main factor in the CCG’s reduction in its distance from target (DFT). It should be noted that the methodology behind the adjustment only looks at a certain set of services, and therefore

Total 15/16 16/17 17/18 18/19 19/20 20/21Allocation £'000 255,146 261,010 263,257 265,273 268,803 277,279Allocation per capita £ 1,824 1,832 1,838 1,854 1,904Growth 2.3% 0.9% 0.8% 1.3% 3.2%Per capita growth 1.9% 0.5% 0.3% 0.9% 2.7%Target £'000 236,324 241,703 247,040 252,901 262,595Target £ 1,651 1,682 1,712 1,745 1,803Opening DFT 13.0% 11.2% 9.7% 8.1% 7.0%Closing DTF 12.2% 10.4% 8.9% 7.4% 6.3% 5.6%

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is unlikely to fully compensate for all of the diseconomies of scale within the Island’s current healthcare services.

Other factors affecting the CCG’s DFT are:

• The CCG’s population growth of 0.6% is lower than the national average population growth of 0.84%. As the allocation is on a fair shares basis, the CCG’s share of the national allocation has decreased.

• The new primary care allocation is -0.2% DFT, which has had a favourable impact

• The new specialised services allocation is 8.2% DFT, which has had an unfavourable impact

The tables below provide an overview of each allocation element. The 2015/16 positions in all of the tables below have been updated by the national team for the formula changes explained in the sections above, to provide a comparator year/start position. Table 4 below shows the CCG’s core programme allocation. This and the CCG administration allocation are the two allocations the CCG has historically received. The 2015/16 positions in all of the tables below have been updated by the national team for the formula changes explained in the sections above, to provide a comparator year/start position. Table 4: CCG core programme allocation: 2015/16 to 2020/21

Note: 2015/16 to 2018/19 are firm allocations; 2019/20 and 2020/21 are indicative For Wessex, the 2016/17 average opening DFT is -2.2%, with the range of DFTs being from -7.0 to 14.9%. For the South of England the average DFT is -0.8%. The Island’s opening DFT is 14.94%. Therefore, for CCG commissioned services, the Island is considered to be spending £28.8m more than its population should need. The average growth for Wessex in 2016/17 is 4.7%. The Island’s growth, at 1.4%, is lower, due to the fact it is, in total (place-based allocation) 13.0% DFT and growth to any CCG above 5% DFT has been limited. The CCG’s DFT for 2015/16, for the core programme allocation, prior to the allocation adjustments was 18.2%. It is now 14.1%. The main reason for this is the sparcity adjustment of £4.6m.

CCG 15/16 16/17 17/18 18/19 19/20 20/21Allocation £'000 204,191 207,027 207,365 207,483 208,845 214,622Allocation per capita £ 1,447 1,443 1,438 1,441 1,474Growth 1.4% 0.2% 0.1% 0.7% 2.8%Per capita growth 1.0% -0.2% -0.4% 0.2% 2.3%Target £'000 185,014 188,404 191,765 195,527 202,662Target £ 1,293 1,311 1,329 1,349 1,392Opening DFT 14.9% 12.7% 10.8% 8.9% 7.5%Closing DTF 14.1% 11.9% 10.1% 8.2% 6.8% 5.9%

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Table 5 below shows the primary medical services allocation. From 2016/17 the CCG has been delegated the commissioning of these services by NHS England. Table 5: Primary Medical Services allocation: 2015/16 to 2020/21

Note: 2015/16 to 2018/19 are firm allocations; 2019/20 and 2020/21 are indicative For Wessex, the 2016/17 average opening DFT is 0.4%, with the range of DFTs being from -7.3 to 7.6%. For the South of England it is 1.6%. The Island’s DFT is -0.1%. Therefore, for the primary medical services, the Island is considered to be spending £0.36m less than its population should need. The average growth for Wessex in 2016/17 is 3.7%. The Island’s growth, at 3.6%, is lower, due to the fact it is, in total (place-based allocation) 13.0% DFT and growth to any CCG above 5% DFT has been limited. Table 6 below shows the specialised services allocation. For 2016/17 the CCG has no formal responsibility for the commissioning of these services. The CCG and NHS England will be working together to develop how, in the future, these services will be commissioned. Table 6: Specialised Services allocation: 2015/16 to 2020/21

Note: 2015/16 to 2018/19 are firm allocations; 2019/20 and 2020/21 are indicative For Wessex, the 2015/16 average closing DFT is 8.4%, with the range of DFTs being from -6.5% to 18.2%. The Island’s DFT is 9.1%. Therefore, for specialised services, the Island is considered to be spending £2.7m more than its population should need. The average growth for Wessex in 2016/17 is 7.55%. The Island’s growth, at 7.3%, is lower, due to the fact it is, in total (place-based allocation) 13.0% DFT and growth to any CCG above 5% DFT has been limited.

Primary Medical 15/16 16/17 17/18 18/19 19/20 20/21Allocation £'000 18,301 18,954 19,303 19,676 20,243 21,038Allocation per capita £ 132 134 136 140 144Growth 3.6% 1.8% 1.9% 2.9% 3.9%Per capita growth 3.2% 1.4% 1.5% 2.4% 3.4%Target £'000 18,950 19,498 20,066 20,687 21,488Target £ 132 136 139 143 148Opening DFT 0.6% 0.7% -0.3% -1.3% -1.5%Closing DTF -0.2% 0.0% -1.0% -1.9% -2.1% -2.1%

Specialised 15/16 16/17 17/18 18/19 19/20 20/21Allocation £'000 32,655 35,029 36,589 38,114 39,715 41,619Allocation per capita £ 245 255 264 274 286Growth 7.3% 4.5% 4.2% 4.2% 4.8%Per capita growth 6.9% 4.0% 3.7% 3.7% 4.3%Target £'000 32,360 33,801 35,209 36,687 384,445Target £ 226 235 244 253 265Opening DFT 9.1% 9.0% 9.0% 9.0% 9.0%Closing DTF 8.2% 8.2% 8.2% 8.3% 8.3% 8.3%

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Table 7 below shows the CCG’s running cost allocation. Table 7: Running cost allowances: 2015/16 to 2020/21

Note: 2015/16 to 2018/19 are firm allocations; 2019/20 and 2020/21 are indicative All CCG’s receive the same running cost allocation per head of population. As can be seen in table 8 above, this is decreasing in real terms by about 0.1% per annum.

Total 15/16 16/17 17/18 18/19 19/20 20/21Allocation £'000 3,100 3,090 3,081 3,074 3,067Population 140,480 141,052 141,648 142,276 142,936£ per head of popn 22.07 21.91 21.75 21.61 21.46

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Appendix 1: Rationale for growth applied to each commissioning stream Overall CCG programme spend is projected to grow above the GDP deflator in all 5 years. Growth is above 3% in 2016/17, mainly due to the funding pressure associated with the changes to pensions payments for employers, and above 3% in 2020/21, when the full rollout of 7 Day Services is completed. To support CCG investment the contribution required from CCGs in respect of Continuing Healthcare Provisions has been reduced from £250m in 2015/16 to £100m in 2016/17 and nothing in subsequent years. It should be noted that whilst the CCG has completed its retrospective Continuing Healthcare claims and therefore is not anticipating a call on this provision, it is still expected to make its contribution to the national provision. Primary care (GP services), which covers the core GP contract as well as other primary care medical services, grows at 4% per annum or greater in all years in line with the stated policy intent above. The NHS is experiencing significant and growing financial pressures due to the licencing of an increasing volume of effective but expensive new drugs and devices. This is a particular challenge for the specialised commissioning budget, towards which most NICE appraisals are aimed, thereby placing a legal limit on the funding discretion we have as between funding streams. There are specific legally binding pressures in 2016/17 regarding the introduction of new drugs for Hepatitis C and Cystic Fibrosis. As part of the Spending Review settlement there is, nationally, £2.1bn in 2016/17 to invest in the Sustainability and Transformation Fund.

• The Transformation element of the Fund is intended to support the ongoing development of new models of care along with the investment identified to begin implementation of policy commitments in areas such as 7 day services, GP access, Cancer, Mental health and prevention.

• In 2016/17, a Sustainability element of the Fund is being introduced, the purpose of which is to support NHS Improvement to bring the provider trust sector back to financial balance in year. Existing provider support funding held by NHS England (included within central programmes) will be added to the fund to create a single process. The Sustainability element of the Fund will have two elements:

o A general element which will be distributed to relevant providers to support the sustainability of emergency services and the achievement of agreed control totals; and

o A targeted element which we will use to support relevant providers to go further faster through additional efficiency gains.

£1.8bn of funding will be allocated at the beginning of 2016/17 to the Sustainability element of the Fund. Funding will be released on a quarterly basis subject to agreement by NHS Improvement and NHS England based on individual providers’ performance against financial, access and transformation eligibility criteria. Over the five year period the split between sustainability and transformation requirements for local health economies will change. As the provider sector comes back into underlying balance under NHS Improvement’s supervision, the share of the funding available for transformation and new policy commitments will increase in subsequent years.

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Other direct commissioning (includes primary care (other) which covers dentistry, community pharmacy and ophthalmology services, public health, health and justice and armed forces). There is some growth in public health funding in 2016/17 and 2017/18 which is a result of the planned transfer from Public Health England to NHS England of responsibility for the bowel scope screening programme with a staged rollout programme and the expansion of previously agreed programmes, such as Meningitis B vaccination and the childhood flu programme. Overall there is a reduction in funding for this area over the period as a result of the efficiency requirements agreed as part of the Spending Review. Changes in the national funding formulae methodology There have been a number of changes made to the formulae which determine target allocations. NHS England looks to meet some of its legal requirement to reduce inequalities in healthcare provision through its approach to allocations. In previous years, the methodology and the criteria underpinning the approach has been developed in line with the recommendation of the Advisory Committee on Resource Allocation (ACRA). This established that the Standardised Mortality Ratio for those aged under 75 (SMR<75) is the best indicator of unmet need, and thus current inequality in the provision of healthcare services. It was also previously agreed that there would be a 15% adjustment within primary care and a 10% adjustment within CCG funding to meet these requirements. This year a comprehensive literature review has been undertaken to investigate whether the evidence base has changed. Whilst work by Ben Barr from the University of Liverpool and colleagues show the benefit of targeting investment at areas with high levels of deprivation, evidence about the impact of additional investment based on inequalities is inconclusive, particularly in relation to the scope for marginal return and thus how much to invest. Therefore the inequalities adjustment will be kept at current levels for CCGs and for primary care. In introducing a new target formula for specialised services a 5% unmet need adjustment for specialised services will be introduced, on the basis that we would expect unmet need and the potential to impact on inequalities to be lower in this area. The methodology has also been reviewed, and whilst recommending that SMR<75 continues to be used, the application of the inequalities adjustment will be changed. ACRA has recommended that the application of the inequalities adjustment moves from a 10 tier to a 16 tier approach that better targets areas with the highest levels of deprivation. ACRA is planning to recommend a similar change to the public health formula used by Public Health England. The impact of moving to 16 groups is to increase the target allocations to the areas with the very worst SMR<75. Population figures for all programme allocations continue to be based on GP list sizes, now updated to October 2015. Increases for future years are based on the Office of National Statistics. Whilst many local authorities compile more detailed future population projections, the methodology is not consistent and this means they cannot be brought into a national formula. Hence areas of disproportionally high anticipated growth may be adversely

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impacted if the ONS does not fully capture this in its assumptions. To mitigate this risk, actual changes in population will be reviewed annually to see if any CCG is given an unfair or disproportionate challenge for this reason, and an adjustment made if required. Using GP lists as a basis for the allocations requires these lists to be materially accurate. Following the allocation of funds in 2015/16, further list updating activity has been undertaken in all regions and is reflected in this allocation setting process. This programme of work will continue over the next three years and potentially inform any update to the proposed allocations for 2019/20 and 2020/21. Before any adjustment is made to reflect unexpected population growth in future years NHS England will require a full analysis of the reasons for the growth to ensure confidence in the local list updating procedures. For this round of allocations the core structure of the CCG formula remains the same, but all underlying data has been updated. This means that the activity data used in the model has been brought forward by 4 years and model parameters re-estimated. It is useful to understand how the CCG formula is constructed: % General & Acute, A&E, Community & Ambulance

65

Prescribing 12 Mental Health 10 Maternity 3 Unmet need 10 There have been the following changes to the formula:

• Introduction of a sparsity adjustment; • Refresh of the emergency ambulance cost adjustment (EACA); and • Revision to application of inequalities (as above).

These adjustments have been reviewed and agreed by ACRA. The Emergency Ambulance Cost Adjustment (EACA) takes account of the differential cost of providing ambulance services in different parts of the country, principally the higher costs of providing these services in sparsely populated areas. It is included in the formula to provide funding to commissioners to meet the differential costs. The current formula, unchanged since its inception in 1998/99 apart from mapping to the different commissioning organisations over time, is based on the volume of activity, the case-mix of activity and a measure of rurality. NHS England has modelled the times by ambulances to reach incidents, provide treatment and convey patients to hospitals by MSOA across the combined data set from four of the 10 Ambulance Trusts to derive a new adjustment. ACRA supports the view that this is an improvement on the current EACA, which is more than 15 years old and was originally estimated for the then 100 or so Health Authorities. The impact of the EACA on target allocations is very small (range of +0.7% to -0.4% across CCGs). The updated CCG formula for 2015/16 increases the number of CCGs more than 5% below target from 17 to 24 CCGs and the number more than 5% above target from 27 to 28.

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Future developments are expected to include looking at community service provision, where lack of reliable robust data currently prevents detailed needs-based modelling, as well as continuing our analysis of the impact of sparsity and updating the mental health services component of the model. The purpose of the new remote provision (sparcity) adjustment is to provide funding to CCGs to meet the unavoidably higher costs of remote hospital sites, where the costs are higher because the level of activity is too low for the hospital to operate at an efficient scale. Three criteria have been developed that a hospital providing Type I A&E services must meet for its commissioning CCG to be considered eligible for the uplift to its target:

• There must be 200,000 or fewer population within a one-hour travel time. A population served of 200,000 is the estimated scale at which a hospital can achieve close to national efficiency levels. This ensures that large providers that are geographically remote but operating at efficient scale are excluded;

• The next nearest provider must be one hour or more by normal road travel times (including ferry times where relevant). This is a measure of whether or not consolidation of services on to fewer sites is feasible; and

• For at least 10% of the population in the hospital’s catchment area, this must be the closest provider, with the next nearest provider over an hour away. An adjustment to target allocations for the relevant CCG is only made when this percentage is 10% or higher. This avoids giving very small (immaterial) adjustments to very many providers.

Ony six CCG, in relation to eight hospital sites, were identified to receive a sparcity adjustment. The total adjustment for these CCGs is £31m and ranges from £2.6m to £14.2m per CCG. To calculate the sparcity adjustment, NHS England analysed the costs of all hospital sites, relative to their size, as measured by their activity levels. The estimated relative costs were adjusted to compensate to remove the impact of different case mix and in costs that are already compensated for through the market forces factor (e.g. differential staff pay and premises costs across the country). The difference between the costs of hospitals with a population of less than 200,000, and the average cost of hospitals was used as the expected cost premium. The existing allocation model for primary medical care is based on the contractual formula that is at the heart of the General Medical Services (GMS) contract, usually referred to as the Carr-Hill formula. This model has been frequently criticised in this context because it was developed more than ten years ago and is based on data that are around fifteen years old. The key change to the primary medical care formula is the inclusion of new estimates of stratified workload per patient for GPs based on 2 million patient records from the Clinical Practice Research Datalink 2014. The previous data were based on information from 1999-2002. This has allowed the re-estimation of the importance of key drivers of primary medical care activity. The way these updated estimates are used to model the consequential cost variation has not been changed. The workload has been considered in detail to identify if there should be adjustments to the mapping of workload required (i.e. time spent per patient) based on a patient’s age

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and sex, the relative deprivation in the area and the volume, number and impact of new registrations in a practice. ACRA has endorsed these changes but has been clear that this is for allocation purposes only and does not in itself imply any particular adjustments to GMS contracts. Work is underway to update the formula to influence such payments for subsequent years while ensuring that any future change to payment formulae is synchronised with the allocation formula developed here. The key impacts of the changes are to reveal an increase in the relative need for primary medical care in London and to reduce the range of the most extreme relative needs in the model, two of the most common criticisms of the Carr-Hill model. To support the transparency of comprehensive place-based expenditure, NHS England has taken the actual allocation at a local geography level for non-medical primary care services (principally community pharmacy, dentistry and optical services) and apportioned to CCGs on a per capita basis. The current non-medical primary care formula is not robust in isolation for a CCG geography, and this disaggregation is therefore indicative only. As part of our future work programme further work will be undertaken on the allocation methodologies for these services, but there are no current plans to move to delegated commissioning in these areas, and these have therefore been excluded them from the place-based pace-of-change calculations described later in this paper. In order to support the development of a “place-based” approach to understand the current and future utilisation of all healthcare resources at the CCG level of geography, NHS England has developed for the first time, a formula for specialised services. The analysis of the specialist service budget at a CCG level is not, in itself, intended to result in the transfer of responsibility for commissioning, but it will promote equitable allocations, support greater understanding and transparency and facilitate collaborative commissioning between CCGs and NHS England where appropriate, by influencing the overall balance of allocations through pace-of-change (see below). A needs-based specialised formula has been developed, using a similar approach to the CCG formula (Person Based Resource Allocation). Specialised services are represented variably in the source data used for modelling (SUS-PbR). Only categories of care with a reasonable level of coverage are used in estimating or applying the target formula. This covers c.50% of all specialised services spend. The remaining services have been included within the target for each CCG’s geography based on historic expenditure. This historic expenditure analysis has been strengthened over the last 18 months, including a number of detailed reviews and updating procedures designed to build confidence in its validity for use as part of the allocation process. The inclusion of a historic spend element within the formula also at this stage dampens some of the issues identified in the current pattern of specialised service utilisation and needs-based projections of utilisation. Of particular note is the issue that some specialised services in certain locations may be influenced by supply side variables (proximity to a hospital will increase the likelihood of a service being provided, an impact which needs to be eliminated in coming to a needs-based allocation) and demand side

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variables (where a particular individual, family or patient group specifically moves to a specialist centre for access purposes). ACRA will have an opportunity to carry out a full review of the methodology in due course. In the meantime, our internal review indicates that the formula generates valid target allocations, and NHS England therefore recommends proceeding with utilising the formula given the benefits in terms of supporting co-commissioning and the place-based approach. Potential risks have been sought to be mitigated by adopting a cautious approach to pace-of-change, and work will continue with ACRA over the coming months to enable them to complete their review. There is also potentially an opportunity to adjust any significant distortions in allocations in 2017/18 if required, as it is likely that elements of the sustainability and transformation funds will begin to move into local allocations in addition to the core allocations covered in this paper. In previous years the NHS England Board has agreed a pace-of-change policy that has sought to:

• Bring all CCGs to target funding over time and specifically bring all CCGs within 5% of target as quickly as possible (in 2015/16 we halved from 34 to 17 the number of CCGs who were more than 5% below their target funding); and

• Bring all primary care geographies to target funding over time. Key considerations for the Board have included:

• The minimum floor growth we can expect any geography to manage without short term destabilisation of service provision;

• The pace at which over target geographies can adjust their spending to their needs based target; and

• The maximum growth that any geography can invest in a value for money way in a given year.

To date, discussions regarding pace-of-change have predominantly focussed upon CCG allocations. With the development of primary medical care and specialised formulae at CCG level a more holistic view of pace-of-change is now being taken, at a place- (or local health economy) based level. This gives choices around how to operate a pace-of-change policy. NHS England has selected an approach which focuses on alignment with holistic place-based targets, but subject to applying rules to limit the volatility and unintended consequences in individual commissioning streams. The following high-level steps are taken to implement the hybrid approach:

• Apply funding at each commissioning stream level to meet specific rules for minimum growth and caps where appropriate (see paragraph 50);

• Any funds that are not needed to meet these commissioning stream aims are then used to support pace-of-change for the place-based allocation;

• Any additional funding which a CCG area accrues in step ii. is then redistributed back to the allocations for the CCG and primary medical care commissioning streams.

The rules for the initial allocations to individual commissioning streams (referred to as “minimum allocations below”) are set out in table X below.

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Table X: pace-of-change allocative decision rules by commissioning stream Allocative decision rules Allocative decision rules CCG • No CCG is more than 5% below target;

• All CCGs receive a minimum per capita growth that is equivalent to real terms cash growth at the average population growth (in 2016/17 this equates to 0.91%, being 1.66% GDP deflator less 0.75% average population growth)

• All CCGs receive a minimum cash growth equal to real terms growth plus specific non-routine policy pressures (predominantly relating to pensions and 7 day services); unless

• The CCG is more than 10% above target, when its cash growth is limited to the specific policy pressures. This cap is phased in between a DfT of +5% and +10%.

Primary Medical Care

• A minimum allocation is set that ensures maximum progress is made towards ensuring no locality is more than 5% below target, constrained by allowing no CCG area more than 10% per head growth in this step of the process;

• All CCG areas receive a minimum per head growth that is equivalent to real terms cash growth at the average population growth (as defined above); and

• All CCG areas receive a minimum cash growth equal to real terms growth plus specific policy pressures; unless

• The CCG area is more than 10% above target, when its cash growth is limited to specific policy pressures plus 1%. This cap is phased in between a DfT of +5% and +10%.

Specialised • All CCG areas receive the same per head uplift that utilises all the resources allocated to this stream, ensuring that at a national level the allocated funds for NHS England specialised services are maintained and to mitigate any risks relating to the target formula as described above.

Focus then turns to the total of these three streams. The total allocation to each locality must at least meet the sum of the three minimum allocations (CCG core, primary medical care and specialised). The remaining available growth is used to:

• Ensure that the total allocation to each locality is no more than 5% below target; • As for the individual streams, total allocations must in aggregate follow the

relevant minimum and maximum growth rules; and • Any remaining funds are channelled into pace-of-change.

The additional resources are distributed back across the CCG and primary medical care commissioning streams as follows:

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• Where the minimum CCG core allocation is below target and the minimum primary medical care allocation is above target, any available resources are used to bring the CCG allocation as close as possible to target. If the opposite applies, the resources are focused on the primary medical care allocation;

• If resources remain after this step, or if the minimum allocations are both above or both below target, resources are distributed to move both individual allocations the same number of percentage points towards their respective target allocations.

CCG admin allowances at an overall level will remain flat to 2020/21, as determined by HM Treasury’s Spending Review settlement. Individual CCG allowances will be rebased to adjust for changing share of population.

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Clinical and cost effectiveness of CDT

• Compared to no treatment at all, there is weak evidence that CDT reduces excess limb volume in the short term, but outcomes such as pain, function and quality of life are inadequately reported. The studies that were identified did not adequately describe the CDT maintenance regime, or follow up patients long enough, to be able to draw conclusions about the effectiveness of CDT longer term.

• There is evidence from two RCT’s that the addition of manual lymphatic drainage (MLD) to compression does not significantly decrease limb volume over skincare and compression alone.

• There is inadequate and in some cases conflicting evidence about the effectiveness of CDT, when compared to compression bandaging/compression garments, skin care and self-help alone.

• There is inadequate evidence to determine the most effective CDT regime.

• There is limited evidence from one small observational study that significant reduction in limb volume has a positive effect on physical and mental wellbeing.

• SPH found no studies which focused on the management of primary lymphoedema using CDT.

• SPH found no published studies about the cost effectiveness of CDT for lymphoedema. Given the poor quality of the evidence of effectiveness, the cost effectiveness remains unproven.

NOTES: Exceptional circumstances may be considered where there is evidence of significant health impairment and there is also evidence of the intervention improving health status. This policy may be reviewed in the light of new evidence or guidance from NICE.

Governing Body Commissioning Intentions Sponsor: Helen Shields - Chief Officer

Summary of issue:

The IOW CCG publishes Commissioning Intentions on its website each year to inform providers of its key commissioning intentions for the following year. This sets out to providers where it expects to see contractual changes and re-design of care pathways, where it plans to undertake reviews or it plans to undertake procurement exercises. The intentions are in line with the CCG Clinical Commissioning Strategy 2014-2019.

Action required/ recommendation: Governing Body are asked to note the contents of the paper

Principle risks: Changes to priorities and therefore commissioning intentions as a result of the My Life a Full Life (MLaFL) Programme and Whole Integrated System Re-design (WISR)


Clinical Executive (10.12.2015)


Any intentions outlined, will need to be subject to scrutiny in the operational planning process. Any Plans requiring investment will be subject to a prioritisation process and business planning process.


Transparency of process and intentions is important in reducing potential legal challenge i.e. procurements.

Public involvement /action taken: Consultation undertaken as part of Strategy Development.


Each individual scheme will be considered for equality and diversity impact. An equality impact assessment was undertaken prior to approval of the CCG Commissioning Strategy.

Author of Paper: Gillian Baker / Andrew Heyes / Heads of Commissioning

Date of Paper: 02 December 2015



ISLE OF WIGHT CLINICAL COMMISSIONING GROUP

COMMISSIONING INTENTIONS 2016-17

December 2015

K:\Corporate\Meetings\GOVERNING BODY & SUB-COMMITTEES\Governing Body\2016\A 4 February 2016\Documents\GB15-069 Commissioning Intentions 2016-17 v2 FINAL.docx

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C O N T E N T S 1. INTRODUCTION 2. STRATEGY CONTEXT 4. CONTRACTING FRAMEWORK

4.1 Contracting Principles 4.2 Contract Terms & Renewal and Duration 4.3 Contract Uplifts 4.4 Activity Planning 4.5 Performance and Quality Standards 4.6 Data Flows and Information

3. COMMISSIONING INTENTIONS


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1. INTRODUCTION

1.1 This document sets out the commissioning intentions and contracting assumptions for providers of contracts entered into by IW Clinical Commissioning Group (IW CCG) for 2016-17.

1.2 IW CCG is responsible for commissioning health services (where NHS England is not under a duty to do

so) for IW residents on IW GP Practice Lists, and for commissioning emergency care for anyone present on the Isle of Wight. The overall aim of the contracts is to enable implementation of the CCG’s strategy and policies, and to improve quality of services for patients within available resources.

1.3 Commissioning intentions are formed from the following components: CCG health services strategy;

Productivity benchmarks (including savings); changes to National Tariffs and cost pools; Joint Strategic Needs Assessment indicators; the financial envelope available; demand management and system reform schemes; and, national must-do imperatives contained in guidance and directives.

1.4 The aim of Commissioning Intentions is to enable commissioners and providers to go into contract

negotiations with a clear set of goals which align across health systems, deliver targets and enable clear activity and finance plans to be agreed which are deliverable and affordable, and ensure achievement of Quality, Innovation, Prevention and Productivity (QIPP) savings plans to balance health economy systems over time.

1.5 This document does not replicate the detail of the NHS IW Clinical Commissioning Group (CCG)

Commissioning Strategy but sets out how and where the service development and delivery contractual requirements will be interpreted into contracts for service changes, baseline and in-year investments, and planned savings.

1.6 The CCG will be responding to the proposals for co-commissioning of Primary Care services and

agreeing with NHS England any transfer of responsibility under joint or delegated commissioning arrangements. In addition, the CCG is expecting changes to the commissioning of agreed specialist services and these are currently not yet clarified, and the impact on contracting flows will be identified and shared with providers as a priority once the final arrangements are agreed. We will work with Providers to minimise any disruption to contracts already held. Supplementary Commissioning Intentions will be produced for both Primary Care and Specialist services where these will have an impact on the contracts held with Providers.

2. STRATEGY CONTEXT 2.1 The current IW CCG Clinical Commissioning Strategy 2014-2019 reflects the 5 year Health and Social

Care Vision agreed between the IW CCG, IOW NHS Trust and IW Local Authority; stakeholder engagement undertaken in the autumn of 2013; and wider public consultation. The strategy focuses on: • Self-Care and Self-Management. • Primary Care Services.


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• Integrated Care. • Urgent Care. • Supporting People to Improve their Mental Health. • Key Enablers (including Safeguarding, Information Technology, Workforce Development and

cultural change, Carers, and Patient engagement) and Service Pathways for Children and Planned Care.

2.2 This is in line with the Everyone Counts Planning Guidance detailing the emphasis on three Key Measures against which health economies are expected to make significant progress: • Improving Health (preventing ill health as well as treating ill health). • Reducing Health Inequalities (better care for vulnerable groups and integrated care). • Parity of Esteem (improving mental health as well as physical health and the physical health of

people with mental health problems).

2.3 CCGs are required to make improvement against seven Key Ambitions and these will be reflected in our plans: • Securing additional years of life for the people of England with treatable mental health &

physical conditions. • Improving health related quality of life of the 15 million plus people with one or more long term

conditions, including mental health conditions. • Reducing the amount of time people spend avoidably in hospital through better and more

integrated care in the community, outside hospital. • Increasing the proportion of older people living independently at home following discharge

from hospital. • Increasing the number of people with mental and physical experience of hospital care. • Increasing the number of people with mental and physical health conditions having a positive

experience of care outside hospital, in general practice and the community. • Making significant progress towards eliminating avoidable deaths in our hospitals caused by

problems in care. Innovation and Integration

2.4 Whilst improving quality of care, the IOW health & care system also continues to face a period of unprecedented change, and increasing financial challenge for all organisations. This focuses the need on innovation, productivity and performance within our agreements with providers to ensure that all of our resources are targeted effectively to maximise patient treatment and care, and to ensure the transparency of coding and charging across the health economy. We recognise that this will mean greater co-operation and collaboration across organisations to identify initiatives which will bring greatest benefit.

2.5 The CCG will explore opportunities to creatively utilise the commissioning funds available to us, and use

the flexibilities available to us to contract with providers in a way which increases the quality and safety


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of services for patients, drives us towards the goal of co-ordinated and integrated services, and gets as much out the Isle of Wight commissioning spend per pound as possible.

2.6 The CCG wholly support the models of care jointly developed by the IOW health & care system through

the Vanguard application and our intentions reflect that by recognising that the outcomes of current key initiatives such as the Whole Integrated System Redesign, Cost Base Review, and other schemes developing as part the New Models of Care and System Resilience Strategies will heavily influence commissioning decisions in the short to medium term impacting on the required pace of change.

2.7 Our strategy is in line with the recently published NHS England Five Year Forward View1 which focuses

care delivery options (which will be centrally defined). The CCG will therefore be working with local stakeholders on future provider configurations over the coming year on the implications for the future to be reflected in contracts, or procurements.

2.8 The Better Care Fund (BCF) which was implemented in 2015-16, has had an important impact on the

configuration of commissioning intentions. Plans are in place involving Community and Mental Health services delivery where the health economy can bring service elements together to increase integration. Health economies are also expected to make significant progress with regard to Seven Day a Week Working, improving Elective efficiency, and aspirations to reduce Hospital Emergency Activity linked to the implementation of the Better Care Fund. In general the vision for the BCF in 2016-17 is to continue with existing Health Act Flexibility Agreements (Section 75) adding additional schemes in accordance with the agreed BCF plan agreed.

2.9 The Isle of Wight Clinical Commissioning Group, NHS Trust, Council, One Wight Health (A collaborative

of Island GP practices) and the Voluntary Sector Forum have come together to form the My Life a Full Life (MLAFL) Partnership . MLAFL Partnership has built a joint vision of local health and care services at a high level to meet the challenges of the future and it has developed a new care model for the Island. http://www.mylifeafulllife.com/ . The My Life a Full Life Programme will continue to receive strong emphasis as it leads the key initiatives for integrated care on the Island. We now need to develop the more detailed care pathways in line with this model which will shape our future service provision. Our future model: • Builds on assets and mobilises social capital • Integrates services • Is based in the community/at home • Is a significant shift to prevention • Reduces reliance on statutory services

1Five Year Forward View - https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf


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http://www.mylifeafulllife.com/

https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf%C2%A0

2.10 In order to better understand the care needs of the people of the Isle of Wight and to support the system redesign in response to those needs for the next decade and beyond the MLAFL Partnership are commissioning a Whole Integrated System Review will be undertaken in 2015-16 and 2016-17. The first tranche of ‘quick wins’ will need to be implemented to realise efficiencies and to generate stakeholder buy-in. This will be a dynamic and fast-paced review, solution focussed, identifying some quick wins for early implementation which are not co-dependent on other work stream clusters. Co-dependent work will be implemented at the end of the review. The following high level outcomes are anticipated: • Quality care for all • Access to care for all • Sustainability and value for money • Sustainable workforce • Deliverability and implementation to ensure lasting value


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3. CONTRACTING FRAMEWORK

3.1 Contracting Principles

3.1.1 The CCG will expect to reflect appropriate measures described in the strategic context and commissioning intentions within its 2016/17 contracts.

3.1.2 The CCG will continue to use the contracts with providers to contribute to the transformation of

local health and social care services to implement the Health & Wellbeing Board Five Year Health & Social Care Vision for the Isle of Wight. Key initiatives will drive commissioning decisions throughout the next 2 years these include the Whole Integrated System Review, Cost Base Review, System Estates Strategic review, the System Wide Digital Roadmap / Interoperability Programme and other schemes developing as part the New Models of Care.

3.1.3 As we move towards the full integration of both health and social care services, in some cases as

new opportunities for improvement are developed the operation of a “shadow period” for activity in the contract may be appropriate. Consideration will also be given in year to the future contractual model for the integrated services and any transfer of services to the agreed model.

3.1.4 As part of the new models of care programme we also expect to continue exploring how new types

of contract can be implemented in future years to drive delivery of services in the direction of travel, and agree principles and timetables to move to other contracting methodologies. This may involve a move to “Outcomes-Based Incentive Contracts” and/or to implement a form of provider “Alliance” contract, bringing together a range of providers currently delivering services into a single contract with us, with common Key Performance Indicators and payment incentives.

3.1.5 Key implications for contracting over the next 1-2 years will fall from the transformation of local

health and social care services to implement the My Life A Full Life (MLAFL) Programme – enabling the local health system to move towards the emerging Vision of One Island-One Budget and the integration of care, with a focus on achieving the Locality Development, Crisis Management & Self-Help/Self-Management work-streams.

3.1.6 System Resilience. We are aware of the system-wide capacity issues experienced of the last year and in particular the deterioration in the IOW NHS Trusts performance in relation to key NHS Constitution targets. We will therefore be placing high emphasis on System Resilience actions that support return to achievement of these targets, particularly the Ambulance and AE targets, as well as supporting the RTT Incomplete target and waiting list reduction. This may involve amendment to specifications and budgets in year and the CCG would expect the IOW NHS Trust to comply with associated contractual amendments without adherence to notice periods, where actions are mutually agreed.

3.1.7 We therefore expect to conduct negotiations on our 2016-17 contracts with the providers which

allow all parties to: • Improve quality of patient and care and experience including choice

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• Improve performance • Reconfigure and re-specify services as appropriate to eliminate unnecessary clinical activity • Be financially sustainable and have a degree of certainty on contract expenditure • Deliver productivity improvements as mandated nationally • Agree shared strategic priorities and wholly support the system wide transformation.

3.1.8 The CCG is intent on aligning all the incentives across its contracts and any risk sharing agreements

to drive implementation of integrated services as a priority for the Contracts over the next 2-3 years. The CCG wish to pursue any contracting flexibilities and changes that enable the IW health economy to maximise resources and fulfil the Health & Wellbeing Board and CCG Strategies, and enable the implementation of the Better Care Fund.

3.1.9 The IW NHS Trust contract was agreed for three years 2014-2017; the CCG therefore expects to

enter into any National Contract Variation required if the NHS Standard Contract is revised in Planning Guidance, and a Local Contract Variation Agreement to update schedules including financial, activity, policy and local quality standards (including CQUINS), reporting and others as agreed.

3.1.10 The CCG wish to take full advantage of the revised Local Variations to Tariff methodologies that are

available to health economies within the NHS Standard Contract – this may involve reviewing both currency and price for specific pathways where a different approach will assist in fulfilling the MLFL vision.

3.1.11 The CCG will work with Providers to review any application for support for Local Tariff Modification where they can demonstrate an underlying structural cost pressure above benchmarked efficiency measures but this must be linked to the outcome of the Cost Based Review exercises.

3.1.12 The CCG will apply PBR Tariffs to all contracts where there is a National Tariff (including mainland and non-NHS providers), unless the CCG have agreed Local Variations and/or Local Modifications.

3.1.13 Whilst it may still be practical to have a single main contract with IW NHS Trust, commissioners wish to consider pursue implementing a more pathway-based approach to the components of the contract which in time will align with services contracted under the BCF Section 75. Steps towards this have already been made with the alignment of services under Unscheduled Care, Planned Care and Mental Health pathways.

3.1.14 Specific pathways are expected to be selected to pursue development of an “Outcomes-Based

Incentive Contract” and/or to implement a provider “Alliance Contract”, bringing together a range of providers currently delivering services into a single contract model, with common Key Performance Indicators and payment incentives. At the very least the CCG will want to continue development work on this type of contract to drive delivery of services in the direction of travel, and agree principles and timetables to move to other contracting methodologies including initially services for integrated localities and dementia (including community nursing).


3.1.15 The CCG will be reviewing the Local Quality Requirements within the Schedule 4 of contracts to ensure that all quality requirements, particularly any arising from any CQC inspection reports including improving quality management processes, are incorporated, along with any other areas of quality with which the CCG has any concerns.

3.1.16 Contractual amendments are expected in relation to the development of the Locality Model and the operation of a “shadow year” for the activity in the contract, as the CCG move towards the full integration of both health and social care services.

3.1.17 The CCG will continue to work with the Independent Sector nursing and residential homes to

understand the cost base.

3.1.18 The CCG will also continue to work with the voluntary sector to support the delivery of care pathways where appropriate, and will continue to utilise Health Act Flexibilities to enable agreements with third sector organisations, as part of integrated care pathways

3.1.19 To meet the cost-saving challenges facing the health economy, at the same time as these

commissioning intentions are being produced, IW CCG will be developing refreshed system-wide Quality, Innovation, Prevention and Productivity (QIPP) savings plans for 2016-17 which will impact on the commissioning intentions. The aim will be to:

• Investing in services that will support the containment of costs whilst improving quality. • Supporting providers to reduce demand for services to ensure the CCG can balance system

wide use of resources.

3.2 Contract Terms, Renewal and Duration 3.2.1 All contracts are expected to be issued or updated by variation in line with the prevailing National

Standard NHS Contract and associated Guidance when issued; and will be updated to reflect any nationally mandated changes in the NHS England Mandate and NHS Standard Contract. The CCG will issue Deeds of Variation where these are appropriate and new Contracts where contracts have expired on 31 March 2016, or during 2016-17.

3.2.2 The CCG expects to enter into contracts of up to 3 years duration, with options for extension in most services for contracts commencing on 1st April 2016. The CCG also wish to consider 6 month roll-over and subsequent 18-30 months contracts, where this enables the organisations to develop contracting across the annual cycle rather than concentrated in a short period of time annually.

3.2.3 It is likely that the IW CCG will remain an Associate to CCG Lead arrangements for multi-lateral

contracts with University of Southampton NHS Foundation Trust, Portsmouth NHS Trust, and Salisbury NHS Foundation Trust contracts and other mainland contracts as appropriate including independent providers. The CCG expects to hold its own bi-lateral contracts with all other providers.

3.2.4 Timeline: All contract renewals are expected to be negotiated and signed by 31st March 2016, by

the IWCCG and Providers, in line with the early indicative Planning Timetable from the tri-partite


bodies (NHS England and Monitor and the Trust Development Authority (NHS Improvement ), unless otherwise directed in planning guidance.

3.2.5 Contract Notices: Where Contract Notices have not been released following satisfactory action by

a Provider these will carry forward in any contractual agreement.

3.3 Contract Uplifts 3.3.1 Unless permissible Local Variations and Local Modifications to Tariff are agreed; the PBR Guidance

2016-17 and associated Tariffs will apply to all PBR activity, and non-PBR tariff activity will be uplifted in accordance with the NHS England Planning Guidance. The CCG also expects to receive guidance from the NHS England & Monitor on the net uplifts and efficiency savings expected to be included in Independent & Voluntary Sector contracts, including nursing and residential homes.

3.3.2 The CCG will consider changes to local tariff payments (local prices) where the required NHS Standard Contract notice periods for changes in counting, coding and tariff payments have been made to the commissioner within the required timeframes. The CCG may consider changes to local tariffs where this has not been complied with where there are exceptional circumstances to justify waiving the notice.

3.3.3 The CCG has received six-month notice of counting and coding changes to be considered from IW

NHS Trust and mainland acute Trusts (via the CSU) which will be worked through for agreement with Providers.

3.3.4 We will review the Local Prices chargeable in the contract to ensure that these meet the criteria for Local Pricing. We expect the IW NHS Trust Cost Base Review to inform the basis for future, local prices charging to be reflected in contracts.

3.3.5 The CCG will take the financial benefit of planned QIPP schemes which have been realised in 2015-16 in the 2016-17 financial schedule, where Business Cases have been approved.

3.3.6 Block contracts, based on provider cost pools with reasonable margins, will be agreed for service

lines with Providers where the commissioner is satisfied that the cost pool costing reflects reasonable costs.

3.3.7 NICE Technical Advisory Guidance (TAGs) will be implemented at the three month deadline date

and not before.

3.3.8 Terms will be in line with the detail of the Planning Guidance and the National Tariff Guidance.

3.4 Activity Planning 3.4.1 All contract activity will be uplifted to reflect projected changes to the population where activity-

based tariff contracts apply. This will be subject to negotiation for non-activity based contracts. PBR contract Acute activity will be modelled through a Demand Planning Tool and adjusted for


population growth, forecast outturn, trend adjustments, QIPP and other service development commissioning intention adjustments.

3.4.2 Acute contract service line adjustments and assumptions will be detailed in the associated Demand

Plan report (e.g. counting and coding corrections, activity transfers and new activity with prior agreements). Demand growth is expected to be offset by QIPP cost reduction plans, with the emphasis on cost containment. The final cuts of acute Activity Plans are due by end January 2016 in line with Commissioning Support Units timetable. For the IW NHS Trust this will form the basis of the revised Indicative Activity Plan for Year 3 (2016-17). Where a block approach is not in place for contracts the activity planning timetable will mirror that of the Acute Plan.

3.4.3 Commissioners will agree Acute Activity Plan Assumptions with Providers where relevant, upon which Activity Plans will be agreed, including health system indicators such as GP Referral Rates; Consultant to Consultant Referral Rates, Procedures of Limited Clinical Value Rates, Elective Length of Stay, Non-elective Length of Stay, Elective Day Case Admissions/1000 population; Out-patients/1000 population; Re-admission Rates, Conversion Rates, N:FU Ratios and especially focussing on Orthopaedic Hip and Knee Follow up ratios, etc. Consultant to consultant referrals rates are expected to remain at agreed outturn rates. New to Follow Up ratios are expected to remain better than national average and consideration will be given to non-payment of FU Out-patient appointments greater than national average.

3.4.4 The CCG are expecting at this stage that all BCF services under the Section 75 Pooled Fund

agreement currently contracted by the CCG as commissioner will continue to be commissioned under the current contractual arrangements, but amended to take into account any associated contractual requirements and development of the Alliance contract model.

3.4.5 Activity planning will be determined at GP Practice level where possible, but aggregated to IW CCG

level in all contracts.

3.4.6 Given the pattern of activity and red alerts in the hospital over the current year, it will be essential that Providers plan demand and capacity to ensure sustained achievement of the 18 Weeks Referral to Treatment Target (RTT), A&E, Cancer and other NHS Constitution Targets. Therefore the agreement of the Acute Trusts’ capacity plans will be an important part of the finalisation of contract negotiations.

3.4.7 The CCG will continue to work in partnership with the IW NHS Trust to support its delivery of the

cost base exercise. The key outputs of the exercise are: validation of the cost allocation and apportionment, development of a robust service level cost model; establishing sustainable capability to support costing.

3.4.8 Major service transformative requests for investments must be accompanied by robust business

cases for approval.


3.4.9 Mental Health Payment by Results. The Cost Base Analysis and shadow tariff-based activity is expected to have been finalised and tariffs agreed for 2016-17 with any associated Mental Health Memorandum of Understanding for risk sharing included in the mental health service contract.

3.4.10 Commissioners will agree an up-dated Community Activity Plan with the IOW NHS Trust based on

activity, unit refinements from shadow monitoring in 2015-16.

3.4.11 Where there is shadow tariff-based activity implementation for Mental Health and Community services, activity baselines must be agreed from the shadow activity outturn, adjusted for planned service changes, against which activity will be monitored.

3.5 Performance & Quality Standards 3.5.1 The CCG will expect to include in mainland contracts quality standards that ensure that IW patients

receive appointment times that are conducive with travelling from the Island (not early and late appointments), and that discharge arrangements are co-ordinated with primary, community or secondary care services, with discharge summaries received promptly. These may be negotiated to attach penalties for non-compliance with agreed standards.

3.5.2 All national Performance Indicators announced in the NHS England Planning Guidance are expected to be achieved within agreed demand, activity and financial plans. Providers should ensure their plans reflect capacity to achieve all the National Targets.

3.5.3 The CCG will review progress against the action plan from the Care Quality Commissioning Inspection of the IW NHS Trust and will agree any amendments to contractual clauses which reflect the quality improvements required. This will include requirements in respect of Emergency Department Triage, Stroke Rehabilitation and General Rehabilitation Wards, Ambulance Station equipment, Paediatric Emergency Admissions Pathway, Renal Pathway, Community services staffing levels, and Mental Health Services outcome measures.

3.5.4 All performance and quality schedules will be reviewed and updated before contract signature, including those where contract variations will apply.

3.5.5 Safeguarding and SIRI Policies. These will be amended in Year 3 of contracts where the local policies have been updated.

3.5.6 Seven Day Services. The CCG will be working with the Providers to implement 7 Day Services; agreeing where these are appropriate and the associated plans for implementation.

3.5.7 The CCG is expecting the Planning Guidance to include obligations for both Commissioners and Providers to engage with the Academic Health Science Networks’ Patient Safety Collaborative, and Quality Schedules may need to be updated to reflect this.

3.5.8 The CCG will welcome early discussions with Providers where CQUINS will apply to agree schemes as early as possible. Where CQUINS schemes have been agreed as two year schemes the CCG will work with Providers to review the success of Year One schemes and agree amendments to Year


Two of the Schemes where these may be required by the CCG. The CCG will also work with Providers to agree new CQUINS schemes and values of individual schemes where the CCG wishes to use this scheme to incentivise improvements in quality that have been identified through the quality governance process.

3.5.9 The CQUINS incentive payment value is expected to remain as 2.5 % of total contract values where

these apply. The CCG may develop other Local Incentive Schemes agreed with providers, to incentivise delivery of the CCG Commissioning Strategy.

3.6 Data Flows & Information 3.6.1 System-wide Information Technology and Data Sharing. In order to progress the integration of

services around the patient, we recognise that the IW strategic partners, including the Trust, now need to work more closely together to agree and implement a system-wide IT Strategy which will enable integration and the delivery of the My Life A Full Life Programme. This will include infrastructure development and funding; use of the NHS Number; and data-warehousing. We will work with system stakeholders to set up mechanisms to enable partnership working and agreements.

3.6.2 Information & Reporting Schedule. The CCG intends to include further reporting clarification in the Schedule 6:B of contracts. This will be necessary to ensure that any reporting requirements currently included in any service specifications are re-stated and also to ensure that, as the CCG moves to reviewing its provision of commissioning support services in preparation for the re-procurement requirements, that the contract is sufficiently robust to ensure that providers supply all the necessary reporting information to the CCG.

3.6.3 Focus will be given to improving the quality of data across the whole system including primary care, community services and public health to enable planning and integration of services

4. COMMISSIONING INTENTIONS

4.1 The following is a summary of commissioning intentions to be reflected in contracts.

4.1.1 Commissioners will expect all providers to comply with the Individual Funding Request policy and and/or Low Priority Procedures policy. The Isle of Wight CCG will be moving towards integrated commissioning with the Isle of Wight Council during 2016-2017, but we do not expect this to impact on contracts in the year. Any changes that do arise would only be in agreement with providers.

4.1.2 The CCG is deliberately not identifying many significant changes for 2016/17 to enable flexibility around the outcomes and delivery of quick wins from the Whole Integrated System Re-design (WISR) and the My Life a Full Life (MLaFL) Programme. All commissioning activities and intentions will align with the MLaFL vision which can be found on the MLaFL website (www.mylifeafulllife.com) and continue the implementation of the Health and Wellbeing Strategy and the CCG Strategy.


http://www.mylifeafulllife.com/

4.1.3 The following Commissioning Intentions are set out in accordance with the IW CCG Key Clinical

Pathways. Each Commissioning Intention is linked to the CCG’s relevant Strategic Objectives and Strategic Priorities.

• Urgent and Community Care Services • Secondary Care Hospital Services • Mental Health, Learning Disabilities & Dementia • Children & Young People • Primary Care and Medicines Management • Micro Commissioning and Commissioning for Individual People (Continuing Healthcare and

Individual Patient Care)


GROUPING: Urgent and Community Care Services Key Priorities: • System Resilience and the Achievement of Constitutional targets.

The key focus will be matching capacity to predicted demand and ensuring care pathways focus on the prevention of admission and the facilitation of discharge. Schemes supported via system resilience funds will be reviewed for effectiveness and consideration will be given to ongoing funding where appropriate.

• Developing the community model of service provision in line with MLaFL principles Encompassing locality working with integrated care. Alliance contracts will be developed where agreed with providers to focus on supporting integration across the system and improved outcomes.

• Urgent Care Strategy Consultation and agreement on the way forward for the possible reconfiguration of the Urgent Care pathways.

Commissioning Intention Expected Outcomes Providers

Affected System Resilience We will work with providers to ensure robust plans are in place and commissioned to support system resilience throughout the year and achievement of the NHS Constitution targets. We will review current SRG schemes and agree a plan to ensure resilience.

• NHS Constitution targets

achieved. • Reduced • No elective cancellations

IW NHS Trust Primary Care Voluntary Sector Independent Sector

Community Model of Service Provision We will work with partners to agree a new community Model and further develop the Integrated Localities as part of MLaFL. We will review Community beds provision.

• Improved co-ordination of

care. Right care at the right time in right place.

IW NHS Trust Primary Care Voluntary Sector

Urgent and Emergency Care Strategy We will review the Commissioning Standards for Urgent Care with Providers and the impact that implementation may have on the associated pathways.

• Right care at the right

time.

IOW NHS Trust Beacon



Affected We will undertake with providers a review of the baseline costs of the Hub, and the implications of the implementation of the Integrated Access Project on the contract specification and budget. We will discuss further the timetable and proposals for any re-procurement of the 111, GP Out of Hours and Walk In Centre delivery as part of the development of the Urgent and Emergency Care Strategy and WISR.

• Service users and providers clear on pathways of care.

Primary Care Mainland recovery hospitals for non-elective care e.g. Major Trauma

End of Life Strategy The EOL strategy implementation plan will require pathway development across the system. Our expectation is that partners will implement the pathway improvements and where appropriate these will be reflected in contracts.

• Improved quality of care. • Patients supported to die

in place of choice.

IOW NHS Trust Hospice Primary Care Beacon Domiciliary care providers

Older Persons Strategy An Older Persons Strategy will be jointly developed with the IOW Council including development of Frailty Pathways and a Market Position Statement.

• Comprehensive approach

to improving outcomes for older people (across organisations)

IOW NHS Trust IOW Council Primary Care Care Home Providers Domiciliary Care Providers

Rehabilitation and Reablement We wish to work with the Trust to review the current model of community beds to support better patient flow across the system. Discussion will include consideration of notice and procurement of the Rehabilitation Review Pathways, concurrent to the WISR Programme.

• Right care at the right

time in the right place. Service users and providers clear on pathways of care.

IOW NHS Trust Care Home Providers Primary Care ADRC

Community Nursing We may refocus the funding for one of the Community Matron posts (currently vacant) for the delivery of the community neurology nursing support. The specification may be included within any revised Rehabilitation Pathway specification. This will be considered alongside proposals for the re-

• Improved services and

better clinical outcomes for patients with specific

IOW NHS Trust



Affected organisation of Community Matron configuration as part of integrated locality working. neurological conditions.

Community Nursing Out of Hours The allocation of funding non-recurrently for this service in 2015-16 has been on the basis of developing a longer-term solution to the out of hours care. We intend to review the provision of this service to support particularly palliative care and catheter management.

• Reduced clinical

requirements for out of hours services.

IOW NHS Trust

Occupational Therapy (OT) We wish to review with the Trust and the Local Authority, the pathway for the provision of OT for patients who have undergone surgery at mainland providers, so that these providers are clear on responsibility within tariff and services to liaise with on Island. We also wish to clarify the pathway for patients who require subsequent rehabilitation or reablement and the associated referral processes. We will also review Pelvic, Obstetrics and Gynaecology OT provision.

• Access to consistency of

care post – operatively and improved recovery outcomes.

IOW NHS Trust Any mainland elective provider

Continence Service We expect to review non-pay costs of the continence service and ensure that efficiencies are in place to minimise waste and reduce consumables costs.

• Reduce costs pressures.

IOW NHS Trust

Wheelchair Service We will consider reviewing the criteria for provision of wheelchairs for adults and children with stakeholders. The service specification may be revised as a result of the review.

• Reduce costs pressures.

IOW NHS Trust Primary Care Providers of wheelchair services

Assistive Technology Development of a Joint Assistive Technology Strategy with Adult Social Care, as part of MLaFL Vanguard Programme.

• Clarity on the direction of

assistive technology for the Island.

Functional Restoration Programme The service specification will be redefines to support the delivery of the agreed Fibromyalgia pathway with the available budget.

• Improved services and

better clinical outcomes.

IOW NHS Trust

Outpatient and Home Parenteral Infusion Therapy (OHPiT) We expect to implement the cost per case funding from 1st April 2016.

• An increase in the level of

service with more people

IOW NHS Trust



Affected cared for in the Community.

Chronic Fatigue Syndrome (Adults) Following recent agreement on the care pathway, we intend to commission a Tier 2 service for the community treatment of patients with Chronic Fatigue Syndrome (Adults)

• An increase in the level of

service with more people cared for in the Community.

Mainland Provider


GROUPING: Secondary Care Hospital Service Key Priorities: • Cancer Oncology Review

The focus will be on implementing the outcomes from the review undertaken during 15/16. • Early Detection of Cancer

Implementation of the NICE Guidance for suspected cancer. • Delivery of the NHS Constitution Targets and Patient Choice

To include ensuring that no-one waits over 18 weeks from referral to treatment and that to facilitate this all patients are aware of the choice of provider.


Affected Cancer Oncology The CCG and NHS England Specialised Services are undertaking a review of the local Cancer Oncology Service which is due to be completed by January 2016. The recommendations from the review may require consideration of an alternative service delivery model for the Isle of Wight. This will also require exploration of innovative ways of delivery partnership working across hospital providers. NICE NG12 (2015) Suspected Cancer Guidelines NICE NG12 (2015) Suspected Cancer Guidelines –the national revision of the NICE Two Week Referral Guidance will require implementation of new referral processes and some tumour site care pathways, and capacity scoping and modelling for relevant services. The CCG will work with providers in both the Cancer Units, Cancer Centres, colleagues in Primary Care and the Wessex Cancer Strategic Clinical Network (WCSCN) to implement NICE compliant cancer care pathways.

• Improved, safe, sustainable and

resilient services to ensure that the population of the Isle of Wight have equal access to oncology services, and can expect the same health outcomes as the mainland population.

− A joined approach to imaging − Diagnosis for each referral − Improved appropriateness of

referrals

IOW NHS Trust UHSFT PHT Primary Care

Diagnostics Discussions have commenced between clinicians to improve GP access to CT and MRI scanning to aid early detection of cancer and timely access for other symptoms of concern i.e. headache

• Improved access to diagnostic and

better outcomes for patients.

IOW NHS Trust Primary Care



Affected or abdominal pain. The development of e-mail advice and guidance is also being explored and will require finalisation into the contract once agreed. Endoscopy Review Following the opening of the new Endoscopy Unit, and upon completion of capacity modelling, the CCG will reconsider the Endoscopy Review and recommendations to prioritise service developments and improvements, and to look for further opportunities. The CCG will also work with the IOW NHS Trust and GPs to clarify endoscopy pathways.

• Improved access to endoscopy,

earlier diagnosis and better outcomes for patients.

• Clarification of endoscopy pathways and the issuing of results to patients by the responsible clinician.

IOW NHS Trust Primary Care

Gastroenterology The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report ‘Time to Get Control’? A Review of the Care received by Patients who had severe gastrointestinal haemorrhage’ makes 26 recommendations for GI bleeds. The NCEPOD supply Trusts with a self-assessment checklist for compliance. The CCG will work with the Trust to consider their compliance against this report, and to identify and agree local actions as appropriate.

• Improved outcomes for patients. • Promote timely access and

effective treatment pathways.

IOW NHS Trust UHSFT

Ophthalmology To continue with implementation of recommendations from Ophthalmology review. Options are currently being explored for more cost effective delivery of Optical Computer Tomography (OCT) service which may lead to potential commencement of procurement for this service in 2016/17.

• Increased cost effectiveness and

potential savings.

IOW NHS Trust

Maternity Healthwatch Isle of Wight reviewed Maternity services in 2013-14, with a final report being published during 2014. Healthwatch Isle of Wight is currently considering the recommendations and suggested actions contained in that report with an up-date anticipated in January 2016. The CCG will consider this follow-up report, and work with partners in Public Health to identify priority areas for further improvement.

• To have developed a maternity

service that promotes normalisation of birth and meets the needs of the local population.

• Further outcomes to be determined on publication of Healthwatch report.

IOW NHS Trust

Urology Scope the potential for a service review of the Urology pathway to ensure service meets the needs of patients. In particular a review of out of hours cover.

• Improved urology pathway.

IOW NHS Trust PHT



Affected Multi-Professional Triage Team Spinal (MPTT) Scope the potential for a service review of the pain pathways to identify causes for increased volumes of referrals in 2015-16 and the improvement of the links to mainland specialist services.

• Improved spinal pathway.

IOW NHS Trust UHS

Dermatology Market re-test via open engagement to commence in quarter 4 2016-17. Retest the market to establish if competition exists to consider running a competitive procurement.

• Support patient choice. • Sustainable and resilient service. • Comply with recommends of

South of England Procurement and EU rules.

Beacon Dermatology


GROUPING: Mental Health, Learning Disability and Dementia Key Priorities: • Mental Health Crisis Concordat

Implementation of requirements. • Parity of Esteem

Improved access to services and outcome for people with mental health needs. • Winterbourne

Delivery of the Winterbourne requirements. • Delivery of NHS constitution targets. • Re-provision of Inpatient Dementia Unit Commissioning Intention Expected Outcomes Providers

Affected Dementia Recommissioning of the inpatient service following agreement of the business care in 2015/16. Inclusion of Admiral Nurses in the Dementia pathways and specifications.

• Improved access to support and

better outcomes for people with dementia.

IOW NHS Trust Possible other Dementia providers.

Community Mental Health Services Implement redesign of Community Mental Health Pathway- Improve access to services and outcomes for people with mental health needs. Improve crisis care to meet access and waiting time standards. Introduction of PbR. Implement Psychosis Pathway to meet new standards and target 50% access to assessment and NICE compliant treatment within 2 weeks.

• Improved access to mental health

assessments (right place, right time) for people presenting with a mental health crisis.

• Improved access to NICE compliant treatment pathways for people with mental health needs.

IOW NHS Trust IOW Council Adult Social Care Mental Health Services Third Sector



Affected Learning Disabilities Ensure Transforming Care Agenda (Winterbourne) for people with LD, Autism, Autistic Spectrum Disorder and Challenging behaviours is embedded within LD Services. Develop and implement clear integrated Transitions pathways. Market development ?

• Improved access to Learning

Disability assessments and care pathways for people with Learning Disabilities, Autism, Autistic Spectrum Disorders and Challenging behaviours.

IOW NHS Trust IOW Council Some LD care providers

ASD / ADHD Review ASD / ADHD provision and consider implementation of whole life pathway (from birth to adulthood) and transitions protocol.

Psychiatric Liaison To improve psychiatric care and provision of timely assessments and access to NICE Compliant pathways for people of all ages who present in Emergency Department ( ED) Increase mental health awareness in ED. Ensure compliance with crisis care concordat. Embed Parity of Esteem

• People presenting in ED with a

mental health crisis will be seen within an hour.

• Reduction of 4 hour breaches for people with SMI to meet constitution target.

• Reduction of admissions to mental health wards.

IOW NHS Trust


GROUPING: Children & Young People Key Priorities: • Paediatric Pathways • Learning disability, ASD, ADHD, Acute & Community Paediatrics (WISR) • Child & Adolescent Mental Health Services (CAMHS) • Children & Young People Improving Access to Psychological Therapies (CYP IAPT)


Affected Paediatric Pathways Review of Paediatric Pathways including LD, ASD, ADHD, Acute & Community paediatrics, CAMHS. Implementation of recommendations from whole integrated system review.

• Increase access to services • Reduction in non-elective

admissions • Increase community based care • Improve patient experience and

health and social care outcomes

IOW NHS Trust IOW Council Third Sector Independent Sector Primary Care UHSFT PHT

CAMHS Implementation of Local Transformation Plan to meet national standards and targets including Eating Disorder waiting time standards and Crisis Care Concordat to include psychiatric liaison in emergency department . CYP IAPT Reconfiguration of AQP Tier 2 Counselling service and possible procurement moving to a CYP IAPT model of care.


admissions

• Increase community based care • Improve patient experience and

health and social care outcomes

IOW NHS Trust Third Sector Independent Sector Primary Care

SEND Reforms Work with education and social care to jointly commission integrated services in line with the Special educational Needs and Disabilities (SEND) reforms


admissions

IOW NHS Trust Third Sector Independent



Affected • Increase community based care

• Improve patient experience and health and social care outcomes

Sector Primary Care


GROUPING: Primary Care & Medicines Management Key Priorities: • Delegated Commissioning

To include premises, PMS reviews, Directed Enhanced Services • Outcomes Based Commissioning with Prime contractor.

Formal re-procurements – anticoagulation, minor injury, phlebotomy, DVT Pathway • Clinical system migration for GP Practices services

Technical Migration & facilitation of record sharing • Over 75 innovation funding • Impact of Primary Care Transformation fund (premises and technology) • Practice Support • Maintain high quality low cost prescribing • Improve patient understanding of their medication • Embrace innovation to support improved outcomes for patients Commissioning Intention Expected Outcomes Providers

Affected Reprocurement of Point of care testing for Anticoagulation monitoring and dosing Commission a community wide service to include inpatient monitoring and dosing. The service will need to follow the procurement process which will be paramount to ascertain the need for full procurement and to enable a prime provider contract. Increase use of NOACs in patients unable to tolerate warfarin

• Develop an outcomes based

contract through market engagement.

• Explore the potential for using

alternative contract models. • Reduce incidence of strokes

amongst patients with AF and unable to tolerate warfarin

GP Providers NHS Trust

Prescribing of non -medicines Stoma Care Renewal of the community stoma care contract short term until the procurement of a new

• Prime Provider delivering a more

GP Providers



Affected stoma care provider is complete. The procurement will be in co-operation with the Trust who will hold the stoma care contract. SECSU to procure the service on behalf of the NHS Trust and Primary Care. Prescribing of non -medicines Nutritional Feeds Re-procurement of Nutritional Feeds, this will be a joint commissioned service with the Trust and CCG. South of England Procurement service will be commissioning the service on behalf of all interested parties. Review of all non-medicine prescribing to include dressings, continence, stoma, baby food, SIP feeds and parenteral nutrition.

cost efficient service whilst increasing the standard of care to patients in the community.

• A fair and equitable contract for

both the Trust and Primary Care • Delivering a clinically appropriate

cost efficient service for patients • Improved cost effectiveness for

the Island £ • Improved patient satisfaction

NHS Trust GP Providers NHS Trust IW Trust Community Pharmacy and Primary medical providers

Improve quality prescribing through the use of audit in areas – for instance – Long Term Conditions including self-management via technology

• Improved quality of prescribing

leading to better outcomes for patients promoting self-management.


Improve patient safety through the development of new safety schemes - for instance introduction of more specialised prescribing in primary care for denusomab and lucentis. Participation in NPSA audits regarding medication outcomes using Eclipse as a platform

• Improved patient safety and

convenience • Improved cost effectiveness • Contribution to national learning

on patient safety in medicines

Primary medical Care; IW Trust; community pharmacy

Cholesterol Management Improve cholesterol management in primary care, specifically implementing new guidelines on the prescribing of Statins.

• Increasing the number of patients

who achieve a total cholesterol of 5mmol

• Reduced events and admissions associated with cardiovascular




Affected disease over time.

Gluten Free Service Review gluten free service.

• Bring service in line with gluten

free prescribing nationally.

Pinnacle Health Partnership Pharmacy providers GP Providers

DVT Community Service Following a review during 15/16 of the community DVT pathway and service, a number of procurement/service options were identified which will support the recommissioning of the service. This includes the need to explore the lead provider/sub-contractor model for parts of the service.

• Redesign a new service pathway in

conjunction with the Trust. • Develop an outcomes based

contract. • Explore the potential for using

alternative contract models.


Community Phlebotomy Service Carry out a review of the current community Phlebotomy Service, highlighting any inequalities and gaps in the current service that need to be addressed. Following the service review a business case to be written to support the recommissioning of the service, exploring the lead provider/sub-contractor model for parts of the service.






Minor injuries Review of minor injury service in primary care and redesign in line with the strategic direction of the urgent and emergency care strategy to provide timely and local access in a primary care setting.



• Explore the potential for using alternative contract models.

GP Providers NHS Trust Beacon

Over 75 innovation funding Evaluate and review outcomes achieved for innovation funding and HCA for the elderly and

• Develop outcomes based

contracts.



Affected propose and implement long term commissioning options.



Affected Joint/Delegated Commissioning Review returning Directed Enhanced Services and link to locally commissioned schemes. Complete PMS reviews and commission services using PMS premium.

• Commission primary care services

meet the needs of the IOW population.

Reprocurement of Point of care testing for Anticoagulation monitoring and dosing Commission a community wide service to include inpatient monitoring and dosing. The service will need to follow the procurement process which will be paramount to ascertain the need for full procurement and to enable a prime provider contract.






Primary Care Quality Prescribing and Safety Care Home Quality & Safety Pathways (Medication Review Team) Improving quality & safety pathways with system communications via MRT, Care Homes and Primary Care via technology and integration reducing GP/Nurse visits by training programmes and systems implementation Patient Safety Alerts

• Improved patient safety and • Improved cost effectiveness and

continuity of care • Contribution to CQC standards in

Care Homes • Reducing GP/Community Nurse

interventions by training


Gluten Free Prescribing Review of Gluten Free Prescribing

• Improved optimisation prescribing

leading to better outcomes for patients promoting self-management

• Improved cost effectiveness

Medicines Optimisation in Primary Care Medicines Optimisation Group (MOG) – Progressing

• Improved optimisation for the

Island with cost effective safety priorities

• Improved patient satisfaction

PBR Drugs Review Non PBR Drug costs

• Cost Management in Primary Care



Affected PBR Drugs High Cost Drugs Funding approval process.

• Formal process to be put in place.

Monoclonal Antibodies Review of MABS

• Review of MABs (high cost drug)

due to come on to the Market 2016.

• Pending NICE Guidance.


GROUPING: Micro Commissioning – Commissioning for Individual People Key Priorities: • Care and Treatment Reviews (STR’s) for people with a Learning Disability • Increase the take up of Personal Health Budgets and Integrated Health and Social Care Personal Budgets (Adults and Children) • Improvement Planning for Young People in Transition Commissioning Intention Expected Outcomes Providers

Affected Learning Disabilities and Care and Treatment Reviews Ensuring all appropriate people with a learning disability get their needs reviewed appropriately and that sufficient provision is available. Market development of the LD supported living and residential sector to increase provision for those people with more complex needs.

• Increased choice of provision. • Care closer to home . • Improvements in the quality of

care and the ability to meet a diverse range of needs.

LD Providers of Care

Personal Budgets Develop the Market and set up process to ensure increased take up of personal budgets. Work with Adult Social Care to develop Health and Social Care budgets.

• People have increased

independence and control. • Provision in a more cost effective

way. • Improved choice of provision.

Range of Providers from independent and voluntary sector.

Transition Development of joint protocols which include law, regulations and national policy guidance, taking into account the views of young people, parents and carers. The Protocol will ensure that transition focusses on securing the best individual outcome for the young person. Essential to work across a whole system, whole family approach. Each young person to be supported from early teens into adult hood.

• Young people will have increased

control over services to meet the individual needs.

• Young people, family and carers will be included in planning services from an early age to reduce anxiety.

Adult Social Services. Independent voluntary sector. Education.


Governing Body Delegated Commissioning of Primary Care Sponsor: Helen Shields, CCG Chief Officer

Summary of issue:

The CCG’s application for delegated commissioning was approved in January 2016. Work is now underway to put in place the formal legal agreements to enact this decision. This paper outlines the content of the delegation agreement and a proposed approach to a single operating model across Wessex.


The Governing Body is asked to note the contents of the Delegation agreement and the scope/extent of what will be required of the CCG. It is asked to endorse the direction of travel in relation to a single operating model and management of the transactional aspects of primary care.

Principle risks:

Failure to enter into and then comply with the delegation agreement carries with it a number of formal sanctions which are outlined in the paper. The CCG Membership have increasingly high expectations of what delegated commissioning will mean to them, both in terms of their provider function and also their ability to make change as a commissioner. These expectations need careful managing and good communication during the transition process and beyond.


This issue has been discussed previously at the Governing Body, the Joint Committee for Primary Care and the application endorsed by the Membership Committee.


The CCG will receive a primary care allocation as part of this delegation agreement. There are a number of clauses in the delegation agreement which indicate that if these funds are not spent on primary care they will be returned to NHSE rather than retained within the CCG.


The delegation agreement is a legal agreement. NHSE retains accountability and liability under this agreement with the CCG taking responsibly for the strategic and operational management of primary medical care.


Not applicable at this stage of the process, although public support for this programme has previously be secured.


The delegation agreement has a specific requirement in it that the CCG seeks to reduce health inequalities. This will be actioned through the CCG normal processes in relation to Equality Impact Assessments .

Author of Paper: Caroline Morris, Head of Primary Care and Corporate Business.




Delegation of Primary Care

February 2016

A) Introduction

The CCG has been approved for delegated commissioning of Primary Care. A delegation agreement between NHS England (NHSE) and the CCG has been provided, with the advice that we should not seek amendment to it unless there are particular extenuating circumstances. This paper is to highlight to the Governing Body the implications of the delegation agreement and the remaining issues and risk faced by the CCG.

B) The Delegation Agreement

1) Services and Finance

The delegation agreement covers the commissioning, procurement and management of primary medical services contracts including:

• Enhanced services/Local incentive schemes • Establishment/closure/merger of practices • Discretionary payments (i.e. maternity and sickness payments for GPs) • Planning/reviews of services and needs assessments • Decisions about managing poorly performing practices including liaison with the CQC • Premises costs directions (i.e. rent reimbursements)

The agreement allows for additional delegation in the future via a variation process

The CCG is required to follow guidance and contractual notices and ensure that NHSE remains compliant with law in all its dealings with primary care. It also requires the CCG to undertake financial reporting as directed and allow NHSE access to the CCG ledger.

NHSE will notify the CCG of its allocation annually, including the relevant resource limits. This allocation is separate to the CCG main allocation. CCG receives money monthly using a revenue transfer process.

The CCG is required to keep a record of contracts and contractual sums payable.

NHSE remains responsible for:

• Administration of the Performers list • Administration of the revalidation and appraisal process for GPs • Capital expenditure • Complaints management (although the agreement allows for this to be delegated in the

future and requires us to cooperate with NHS England now) • Services delegated from Public Health England such as immunisation and vaccination

programmes (known as section 7a services)

• Determination of Prime Ministers Challenge Fund applications

However the CCG will administer payments under 7a and for capital processes including making payments as approved. Additional funds will be transferred to cover any costs incurred under this arrangement.

As part of the agreement, the CCG must produce a business plan, commissioning plan and annual report regarding primary care. This is intended to ensure that the CCG:

• Has in place controls over expenditure • Had plans in relation to the duty to improve quality • Can articulate how it intends to reduce inequalities • Has plans in relation to Public involvement and consultation

These duties are no different to those the CCG is already under in relation to all other commissioned services.

CCG will be monitored as part of CCG Assurance Framework

2) Staffing models

CCG May only use one of three staffing models

• Assignment – whereby staff remain in roles at NHSE and provide services under a SLA • Secondment – whereby staff are seconded from NHSE to the CCG • Employment – CCG may create new posts to undertake delegated functions but only if it

first offers existing NHSE staff employment

This must be agreed six months following delegation. In the absence of an agreement model 1 prevails. TUPE does not apply.

3) Sanctions and Termination of Agreement

Termination of delegation agreement can be requested any time prior to 30th September in any one year to come into effect from 31 March. A transition plan is then required from both parties. However NHSE may revoke the agreement without notice under certain circumstances such as persistent non-compliance with delegation agreement, changes in legislation or national variations to the agreement.

In the event of a CCG breach of the agreement NHSE may

• seek enforcement of agreement • sanction the CCG under the CCG assurance framework

In the event of a failure to remedy the breach NHSE may

• unilaterally waive the breach (following receipt of written report from CCG) • ratify any decision taken • revoke the delegation agreement

• escalate the issue (for instance by requiring a senior member of the CCG to attend a meeting)

• exercise any rights under common law.

There is a dispute resolution process within the document. The ultimate arbiter is the Secretary of State for Health.

4) Information Governance

CCG will enter into a personal data agreement that governs the processing of information between the parties as part of the delegation agreement.

The CCG will become responsible for the management of Information Governance Breaches reported by the GPs.

5) Complaints Management

The agreement sets out the way in which complaints handling will be conducted in the future and reserves the right to issue guidance and procedures to CCGs to handle these complaints.

6) Liability

NHS retains liability under the agreement and there are a number of provisions relating to the management and settlement of claims in relation to delegated functions which essentially require that the CCG act in a reasonable manner.

7) Freedom of Information (FOI)

In relation to FOI, NHSE will provide the CCG with guidance in relation to delegated functions, it is expected that the CCG will respond to FOI requests in relation to delegated functions.

C) Single Operating Model

It is proposed that a single operating model across Wessex be developed to support the transactional aspects of primary care commissioning. This would build on the historic cooperation across former PCTs in relation to primary care activities where a small number of individuals are able to act with greater efficiency and accuracy in relation to high volume small sum transactions. The CCG will be exploring the potential of this over the next few months with colleagues across Wessex and NHSE.

Governing Body

Minutes of the Audit Committee Meeting 26 November 2015

Governing Body Sponsor: Ian Reckless, Secondary Care Doctor

Summary of issue: Minutes of the Audit Committee 26 November 2015.

Action required/ recommendation: To note the minutes of the audit committee.

Principle risks: There are no principle risks relating to this paper.


This has not been considered at any other committee. Audit Committee minutes are reported to the Governing Body in public meetings.


There are no financial or resource implications associated with this paper.

Legal implications/ impact: There are no legal implications or impact relating to this paper.


Audit Committee minutes are reported to the Governing Body in public meetings.


Report Author: Rebecca Berryman, Governance Support Manager




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Audit Committee: Minutes of the Clinical Commissioning Group (CCG) Audit Committee held on 26 November 2015 at 13:00 in the Bembridge Room, Block A, The APEX, St Cross Business Park, PO30 5XW

PRESENT: Dr Ian Reckless (IR) – Secondary Care Doctor David Grist (DG) – Associate Lay Member

IN ATTENDANCE: Dr Peter Coleman (PC) – GP Membership

Heather Greenhowe (HG) – Counter Fraud Specialist (by phone for item 5) Paul King (PK) – Ernst and Young – External Audit Loretta Outhwaite (LO) – Chief Finance Officer Giles Parratt (GP) – TIAA Internal Audit Joanne Penney (JP) – TIAA Internal Audit Helen Shields (HS) – Chief Officer MINUTED BY: Rebecca Berryman (RB) – Governance Support Manager

15-033 APOLOGIES FOR ABSENCE Apologies were received from Martin Young. Giles Parratt, Head of TIAA Internal Audit was

introduced and welcomed to the meeting.

15-034 DECLARATIONS OF INTEREST

The Audit Committee received paper AC15-025 Declaration of Interests paper. This was agreed as accurate. The following declarations were made in addition to the interests outlined within the paper: • PC reminded the committee that he has a personal friendship with Dr David Turner, CCG

Prescribing Lead for Medicines Management. He also has a shared financial interest with Dr Turner, as he owns a share of a property with him. It was agreed that PC would leave the room if it was deemed necessary at the time discussion took place regarding

For the attention of the Governing Body:

The Audit Committee met on 26 November 2015 and discussed the following key issues:

• The committee emphasised the need for Directors to be involved with Audits relevant to their area, and in particular to be involved in the response to recommended actions. The committee agreed that it may be reasonable and appropriate for recommendations to be rejected on occasion as long as some narrative and explanation is provided.

• Final (internal) audit reports were received in relation to: o Medicines Management (no assurance level offered in view of co-existing investigations) o Performance and Data Quality

• Changes were discussed in relation to the process for contracting external audit going forward. It is likely that the CCG will wish to cluster with neighbours +/- engage the CSU.

• Discussion took place regarding Elective Surgery at the IOWNHST.

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Medicines Management on the agenda.

• JP reminded the committee that she is the Internal Audit Manager for the Isle of Wight NHS Trust. Should any conflicts arise she agreed to leave the room.

• PK reminded the committee he is the External Audit Engagement Lead for the Isle of Wight NHS Trust. Should any conflicts arise he agreed to leave meeting.

15-035

CONFIRMATION THAT THE MEETING IS QUORATE Confirmed.

15-036

MINUTES OF THE LAST MEETING 24 SEPTEMBER 2015 The Audit Committee received paper AC15-026 Minutes of the Last meeting 24 September 2015. The minutes of the meetings were noted and agreed as accurate.

15-037

MATTERS ARISING FROM THE LAST MEETING 24 SEPTEMBER 2015 Schedule of Actions taken from the meeting on the 24 September 2015 The Audit Committee received paper AC15-027 the Schedule of Actions from the Audit Committee meeting on 24 September 2015, the following comments were noted. • 15-008 Internal Audit Report Release Timescale – it was confirmed that this still needs

further work as the timescales are not being met. The committee emphasised the need for Directors to be involved with Audits relevant to their area, and in particular to be involved in the response to recommended actions. The committee agreed that it may be reasonable and appropriate for recommendations to be rejected on occasion as long as some narrative and explanation is provided.

• 15-020 Medical Exemptions – this was agreed to be a high risk area, as there are no longer any processes in place to review prescriptions for Medical Exemptions. However, it was also noted that the sums involved (prescription charge) are modest and that the risk / benefit of counter-measures needs to be considered.

• 15-023 – P11D Forms – LO confirmed she had not yet established whether staff needed to complete the forms, but would do this in the next month.

• 15-027 – IT Service Review – LO highlighted that the IT Service review was an interim piece of work before determining if the service needed re-commissioning. HS updated the committee to inform them that a contract notice had been served to the Commissioning Support Unit with an action plan. It was queried if there were other service providers available to provide the service. It was confirmed that there was, however on a short term basis as the vision for the Island’s future is to have a shared IT provider.

The Audit Committee noted the Schedule of Actions from 24 September 2015. 15-038 QUALITY AND PATIENT SAFETY & CLINICAL EXECUTIVE EXCEPTION REPORT

The Audit Committee received and noted paper AC15-028 Quality and Patient Safety and Clinical Executive Exception Report. Discussion took place as to whether this is still a useful format. PC and DG felt it was a useful summary and should be reported to every Audit Committee on a rolling annual basis. It was agreed to review this after the next two meetings, and to think about the title of the paper that is presented.

The Audit Committee noted the Quality and Patient Safety and Clinical Executive Exception

Report.

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ACTION: Audit Committee to review the format of the Quality and Patient Safety and Clinical

Executive Exception Report in May 2016 RB

15-039 LOCAL COUNTER FRAUD SERVICE

Counter Fraud Progress Report The Audit Committee received paper AC15-029 Counter Fraud Progress Report, presented by HG. The Local Anti-Fraud Bribery and Corruption Policy has been approved by the Clinical Executive. They delegated authority to the Audit Committee to approve Counter Fraud Policies in future. It was highlighted that as a result of the Conflicts of Interest Internal Audit that HG was liaising with LO to put together some training for managers and budget holders in relation to conflicts of interest. HG made the committee aware of a concern that was raised in relation to patients receiving calls and text messages regarding hospital appointments and it not being clear if these were from the NHS. It was confirmed that the calls and texts were from the NHS and the matter has now been closed. It was agreed that to cause concern there must have been a lack of clarity with the message received. HS agreed to feed this back to the Commissioning Managers to pick up with their services.

The Audit Committee noted the Counter Fraud Progress report. ACTION: HS to feed back to Commissioning Managers the issue with appointment phone and text

messaging. HS

15-040 INTERNAL AUDIT

Internal Audit Progress Report The Audit Committee received paper AC15-030 Internal Audit Progress Report, presented by JP. JP highlighted there were some errors within the report, the Payroll and HR Systems audit was expected to have been issued in draft, but this had not yet been issued. JP confirmed the sign off meeting was taking place on the 26 November 2015. IR queried if there were any capacity issues, either from the CCG or TIAA. It was confirmed that capacity was not an issue. Discussion took place regarding the Internal Audit Tracker, it was highlighted that not all actions had received responses. The Audit Tracker is presented to the Commissioning Officers Group (COG) and Directors take the lead on chasing the responses. HS suggested that a further column was added to the tracker with any updates and comments for clarity regarding how the action is progressing. As part of the Progress Report, an Information Governance Benchmarking report was also shared with the committee. It was requested that a table was produced to show how the Isle of Wight compares. JP agreed to share this with the committee outside of the meeting.

4

General discussion followed about the need for audit reports to be titled clearly such that it is immediately evident to the reader whether the report is a national review, a paper describing the performance of multiple organisations but where IOW performance cannot be discerned for the overall data set, or a paper where benchmarking is clear and transparent. Committee members expressed the view that the methodology employed in developing reports was not always clear. The Audit Committee also received a Mental Health Digest for information. It was queried whether the Isle of Wight NHS Trust (IOWNHST) was included in the report. JP agreed to confirm whether the IOWNHST was included. Discussion took place with regard to the Financial Control Environment Self-Assessments it was agreed that the self-assessment was a useful exercise to complete, and information is shared with Chief Finance Officers across Wessex. As part of the Progress Report, the following Audit Reports were received: • Medicines Management Final Audit Report – this report did not receive an assurance

level as there were some areas that couldn’t be looked at due to other investigations taking place. It was identified that there were some errors within the final report, in relation to specifying the brand of drugs. It was agreed if brands were specified this would be detrimental as costs are continually changing. Another error relates to prescribing generic drugs. HS requested that this report was taken back to draft to get the correct details within the report. HS asked JP to link with her in relation to this. DG queried whether the Island needs its own Medicines Management Team. It was confirmed that there is a need for an Island Team, however it was confirmed that their work would be reviewed.

Discussion took place as to whether pharmacists can change the brand of drug. It was confirmed this was not the case, and it was the responsibility of the Clinician regarding which drugs are prescribed. • Performance and Data Quality Final Audit Report – there was some confusion regarding

the actions outlined within the report. Some of the actions were from previous audits, it was requested the distinction was made clearer in future reports. IR queried the Performance in relation to Primary Care. It was confirmed that the Joint Committee for Primary Care now receive information from NHS England in relation to Primary Care Performance.

The Audit Committee noted the Internal Audit Progress Report ACTION: Additional comments column to be added to the Internal Audit Action Tracker.

JP to produce a table to show how the Isle of Wight benchmarks in relation to Information Governance and share with the committee outside of the meeting. JP to confirm whether the IOWNHST was included in the Mental Health Digest. JP to link with HS in relation to the errors within the Medicines Management Internal

JP JP

JP JP

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Audit Report.

15-041 EXTERNAL AUDIT

External Audit Progress Report The Audit Committee received a verbal External Audit Progress Report from PK. A paper titled Value for Money Audit was tabled at the meeting. The paper outlined that the Value for Money Conclusion was changing. PK informed the committee that a meeting was due to take place in December to understand the practical guidance and implications for the changes.

The Audit Committee noted the verbal External Audit Progress Report. 15-042 External Audit Contract 2017/18

The Audit Committee received paper AC15-031 External Audit Contract 2017/18. From 2017/18 onwards, Clinical Commissioning Groups and NHS Trusts must have an ‘auditor panel’ to advise on the appointment of their external auditors. As the 2017/18 appointment must be made by the end of the preceding year (i.e. by 31st December 2016), auditor panels need to be in place early in 2016. It was agreed that it would be sensible to set up an auditor panel with other CCG’s across Wessex. LO confirmed this would be discussed with Chief Finance Officers across the SHIP8 CCGs.

The Audit Committee agreed for the CCG to explore setting up Auditor Panels across the SHIP 8 CCGs.

15-043 Governance, Risk and Internal Control Report

The Audit Committee received and noted paper AC15-032 Governance, Risk and Internal Control, presented by HS. The report highlighted the following: • Year to date, the CCG is £1,742k better than plan. This is mainly due to the contract with

the IW NHS Trust for elective activity is £1,249k below plan, due to a backlog of activity. • LO highlighted that the National Team understands the Island’s financial position, the CCG

will be discussing the allocations at national level. • The CCG constitution changes have been submitted. • The CCG are discussing Emergency Preparedness Resilience Response (EPRR) with the

Trust and Area Team on the 4 December. A detailed EPRR was presented and an action plan approved at the Governing Body on the 4 November 2015. IR queried whether Marauding Firearms and Terrorism attack standards that the IOWNHST are not required to meet, should be reviewed in light of recent Terrorist attacks in Paris. HS agreed to discuss this on the 4 December call.

Discussion took place regarding Elective Surgery at the IOWNHST. The CCG have set up a referral support unit to advise GPs and patients regarding elective treatment on the mainland. There are ongoing media campaigns highlighting to patients that they have the right to choose where they have their treatment. It was confirmed that additional beds have been opened at the IOWNHST however the systems and processes at the Trust, particularly with regard to patient flow needs improving.

6

The Audit Committee noted the Governance, Risk and Internal Control Report. ACTION: HS to discuss Marauding Firearms and Terrorism attack at the 4 December EPRR call. HS 15-044 Any Other Business

There was no any other business.

DATE OF NEXT MEETING(S): Thursday 24 March 2016 – 13:00-15:00, Bembridge Room, Block A, The APEX, St Cross Business Park, Newport, Isle of Wight, PO30 5XW.

Circulation: Members: In attendance: David Grist – Associate Lay Member Dr Ian Reckless – Secondary Care Doctor

Peter Coleman – GP Membership Helen Shields – Chief Officer Loretta Outhwaite – Chief Finance Officer Rebecca Berryman (notes) – Governance Support Manager

Invited: Giles Parratt, TIAA Joanne Penney, TIAA Paul King, Ernst & Young Martin Young, Ernst & Young Heather Greenhowe, Hampshire & IW Counter Fraud

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Governing Body

Minutes of the Clinical Executive 19 November, 10 December 2015 and 21 January 2016


Summary of issue: Minutes of the Clinical Executive.

Action required/ recommendation: To note the minutes of the Clinical Executive.


Other committees where this has been considered: This will be considered at the Governing Body in public Meeting.


There are no financial or resource implications relating to this paper, other than the matters raised in the meeting.





Author of Paper: Rebecca Berryman, Governance Support Manager.

Date of Paper: November 2015 / December 2015 / January 2016



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Clinical Executive 19 November 2015

Minutes of the Clinical Commissioning Group (CCG) Clinical Executive held on 19 November 2015 at 12:30 in Carisbrooke Room, Block A, The APEX, St Cross Business Park

PRESENT: Helen Shields (HS) – Chief Officer (Chair) Gillian Baker (GB) – Deputy Chief Officer

Dr Benjamin Browne (BB) – Clinical Executive Dr Joanna Hesse (JH) – CCG Executive Andrew Heyes (AH) – Head of Performance and Contracting (for LO) Loretta Kinsella (LK) – Director of Quality and Clinical Services

IN ATTENDANCE: Sue Channon (SC) - Home Oxygen Contract Manager and Regional HOS Lead (Item

15-176) Alison Geddes (AG) – Urgent Care and Community Commissioning Manager (Item 15-176, 15-177 and 15-178) Caroline Morris (CM) – Head of Primary Care and Corporate Business (Item 15-174) Michaela Morris (MM) - Community Services and Long Term Conditions Commissioning Manager (Item 15-179) Joanne Penney – Audit Manager, TIAA Internal Audit (Item 15-174)


15-169 Apologies for Absence Apologies for absence were received from: Rida Elkheir (RE) – Associate Director of Public

Health, Dr John Rivers (JR) – CCG Chairman and Michele Legg (ML) – Clinical Executive. This resulted in the meeting not being quorate. HS agreed that items requiring a decision would be agreed in principle and finally ratified by JR when he returns from leave.


• Ambulance Handover delays – the IOW NHS Trust has informed the CCG that it will no longer provide data due to the level of inaccuracy. The CCG has stated this is unacceptable.

• System Resilience – all beds have been opened but improvement in A&E not been seen. This has highlighted internal patient flow issues at the IOW NHS Trust.

• Approved: - The extension of the current Regional Home Oxygen Service Contract - The MSK Physiotherapy Reprocurement and preferred provider - Extension of the assistive technology pilot - Extension of funding for 3 care navigators to match the scales for My Life a Full Life funded posts - The Information Governance Framework, Strategy and Policy - Reviewed the Atlas of Variation 2015 and required an action plan to be developed - Received the Delivery Plan Q2 update – noted slippage as a result of system pressures

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15-170 Declarations of Interest

The Clinical Executive received paper CE15-114 Declarations of Interest, presented by HS. The Declaration of Clinical Executive Members was agreed as accurate, with no changes.

15-171

Minutes of the Last Clinical Executive Meeting The Clinical Executive received paper CE15-115 Minutes of the last Clinical Executive Meeting, the minutes of the meeting on the 15 October 2015 were agreed as an accurate record.

15-172

Matters Arising i. Schedule of Actions from the CCG Executive 15 October 2015. The Clinical Executive received paper CE15-116 Matters Arising – Schedule of Actions, presented by HS. The following discussion took place: • 15-049 – Ambulance CAD System – it was confirmed that the CAD system is in place and live,

however there are still issues to be resolved. A letter has been received from the Isle of Wight NHS Trust (IOWNHST) informing the CCG that they would no longer be providing Ambulance Handover data. The CCG have responded stating that this is unacceptable as assurance is required with regard to Ambulance Handover. An audit has not been undertaken since January 2015; therefore a further audit has been requested from the Trust.

• 15-121 – Contract Details on Website – AH confirmed that the website has not yet been updated with contract information. A page is ready to go live; however the contract information may need to be reviewed due to the Whole Integrated System Review (WISR) programme slipping. AH is going to gain clarity from procurement with regard to exactly what needs to be published. In the meantime to be open and transparent, he will put a note on the website for individuals to contact him if they require any information.

• 15-144- Trust Structure – the IOWNHT Structure has not been shared with the Clinical Executive. RB to share the paper.

• 15-144 – DATIX – it was confirmed that GPs are aware they can still use DATIX. AH confirmed that a new system demonstration to replace DATIX is taking place on the 20 November 2015.

• 15-153 – Partial Knee Arthroplasty – no update was received. It was agreed that feedback was needed for the next meeting.

• 15-158 – System One – LK commented there is an impact on the Medicines Management Team in relation to the interface between systems. This is currently being looked in to.

• 15-166 – Clinical Executive Elections – the closing date for nominations is midnight on the 20 November 2015. 2 nominations have currently been received.

It was agreed that for future Schedule of Actions, each action would have an Executive lead and the member of staff leading on the action to be put in brackets.

ACTION: RB to circulate the new IOWNHST Structure.

Future Schedule of Actions to have an Executive Lead and the member of staff leading on the action to be put in brackets.

RB RB

The Clinical Executive received the Schedule of Actions. For Decision/Discussion

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15-173 Corporate/Governance Procurement Decisions There were no new procurement decisions.

The Clinical Executive noted the Procurement Decisions.

15-174 Risk Register The Clinical Executive received paper CE15-117 Risk Register, presented by CM. Joanne Penney; Internal Audit Manager for TIAA came to observe the Risk Register being presented as she would be undertaking an Audit in this area. CM highlighted that the organisation was carrying some high risks, with the risk thresholds staying the same for several months. The Clinical Executive discussed the following: • Y3/3 Care Home Closures or Bed Reductions / Service Specification Limitations due to

Negative CQC Inspections – the CCG have appointed a Care Home Quality Manager to commence in post February 2016. The Clinical Executive were asked if they were assured that the actions taken have started to mitigate the risk. In light of the recent report highlighting the Isle of Wight being ranked by the CQC as lowest in the country for care homes, it was agreed to keep the risk the same and review again in February 2016.

• Y3/6 Better Care Fund Section 75 Service Development Improvement Plan (SDIP) – it was agreed that this risk would need to be reframed, as the severity has reduced but the likelihood has increased. GB agreed to action.

• Y3/7 System Resilience – the CCG are assured that actions have been taken, but improvement has not been seen. All beds have now been opened, however this has highlighted that there are internal patient flow issues that need to be addressed at the IOWNHST. The Clinical Executive were asked if any further action should be taken in relation to System Resilience. It was confirmed that the Clinical Executive felt actions were being taken by the weekly monitoring undertaken by the CCG and that work was ongoing to improve System Resilience.

• Y3/8 Deprivation of Liberty Safeguards (DoLS) – LK highlighted that the IOWNHST have put together a Business Case for additional Safeguarding Support. It was agreed that the risk is reducing.

It was agreed that risks relating to DoLS and Adult Safeguarding be grouped together on the risk register in future. LK confirmed that the Quality and Patient Safety Committee are looking to strengthen reporting and assurance on Safeguarding. • Y3/18 Clinical Sustainability of Locums for Services at IOWNHST – it was agreed that the risk

in relation to Stroke and Haematology Consultants has reduced, however GB raised issues in relation to Urology. It was agreed the risk would be updated to reflect the concerns.

• Y3/15 Achievement of Prescribing QIPP Schemes – current indication highlighted that the QIPP is currently on target, however it was agreed to keep the risk as high until figures for September and October have been received.

JH highlighted concern regarding Adult Social Care in relation to staff shortages and the impact on system resilience. It was agreed to add Partner Resilience to the Risk Register. GB agreed to action.

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The Clinical Executive noted the Risk Register. ACTION: GB to reframe risk Y3/6 Better Care Fund Section 75 Service Development Improvement Plan

(SDIP) Risks relating to DoLS and Adult Safeguarding to be grouped together on the Risk Register. Risk Y3/18 to be updated in relation to concerns relating to Urology. GB to add Partner Resilience to the Risk Register.

GB

HS/CM HS/CM GB

15-175 The Local Anti-Fraud, Bribery and Corruption Policy Template

The Clinical Executive received paper CE15-118 The Local Anti-Fraud, Bribery and Corruption Policy Template, presented by AH. The paper was taken as read, there was no further discussion. It was agreed that decisions relating to Counter Fraud policies in future would be delegated to the Audit Committee.

The Clinical Executive approved the Local Anti-Fraud, Bribery and Corruption Policy Template.

The Clinical Executive also agreed that decisions relating to Counter Fraud policies would be delegated to the Audit Committee. This is subject to ratification from Dr John Rivers, as the meeting was not quorate.

15-176

Commissioning Home Oxygen Service Re-Procurement The Clinical Executive received paper CE15-119 Home Oxygen Service Re-Procurement, presented by SC and AG. Funding for the IOW Home Oxygen Equipment contract was passed from NHS IOW CCG to IOW NHS Trust to be administered by the Respiratory Department under a risk sharing agreement. The IOW CCG is part of the Regional Home Oxygen Equipment Contract and therefore needs input and agreement to the re-procurement and ongoing support. SC circulated a condensed paper, but highlighted this was not the final paper. The Clinical Executive were requested to extend the current contract for a further two years. It was confirmed that the Home Oxygen service has been exceptional after a few teething problems initially. The change to the current contract relates to savings as a result of putting more oxygen within the cylinder. It is for the CCG and Trust to discuss the additional savings that are made from the contract. It was highlighted that the Regional Home Oxygen Service Lead is hosted by North Hampshire CCG. Therefore CCG’s have been requested to pay £600 a year to support funding for the Service Lead in 2015/16. This was agreed. The final paper would be circulated once finalised.

The Clinical Executive approved the Home Oxygen Service Re-Procurement, subject to

ratification from Dr John Rivers, as the meeting was not quorate.

15-177 SHIP8 Policy 004: Patients with Lymphoedema Priorities Statement

The Clinical Executive received paper CE15-120 SHIP8 Policy 004: Patients with Lymphoedema

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Priorities Statement, presented by AG. This paper has been delayed as a result of the Clinical Effectiveness Committee needing to approve the continuation of a Lymphatic Drainage Service. This part of the policy needed to be agreed by CCGs on an individual basis. It was highlighted that the front sheet of the paper needs to be clearer when presented to the Governing Body to show the process.

The Clinical Executive recommended for approval to the Governing Body the SHIP8 Policy 004:

Patients with Lymphoedema Priorities Statement, subject to ratification from John Rivers, as the meeting was not quorate.

15-178 MSK Physiotherapy Procurement Ratification

The Clinical Executive received tabled paper CE15-121 MSK Physiotherapy Procurement Ratification, presented by AG. After a rigorous process a preferred provider has been chosen. Discussion took place with regard to self-referral and whether this would form part of the new contract. It was confirmed that it would be something to consider in the future. It was confirmed that the contract does include provision for patients being treated on the mainland coming back to the Island for Physiotherapy. As the decision is commercial in confidence, the providers do not know the outcome of the procurement until final ratification. A communication document will be circulated once finalised.

The Clinical Executive approved the MSK Physiotherapy Procurement Ratification, subject to

ratification from John Rivers, as the meeting was not quorate.

15-179 Assistive Technology Business Case

The Clinical Executive received paper CE15-122 Assistive Technology Business Case, presented by MM. The Respiratory and Heart Failure Telehealth pilot study in 2012 was funded through a CQUIN. The existing Isle of Wight service provides equipment and support to 50 patients with long term conditions or those who are able to be discharged earlier from hospital with the additional monitoring that telehealth provides. The current service has reduced 5 hospital admissions a month. It was highlighted that there was currently no vision across the Island for Assistive Technology and this needs to be agreed as part of My Life a Full Life. It was agreed that a strategy is required. Discussion took place that the pilot could not just cease due to the effect on patients. It was therefore agreed to extend the current pilot until March 2017, and review once an Assistive Technology strategy is in place.

The Clinical Executive approved the Option 2 of the Assistive Technology Business Case, to

extend the current service provision until March 2017, subject to ratification from John Rivers, as the meeting was not quorate.

15-180 Care Navigators Business Case

The Clinical Executive received paper CE15-123 Care Navigators Business Case, presented by GB. Currently Age Concern IOW is in receipt of funding to employ nine Care Navigators from three funding streams with three different end dates. It was proposed that the finding for three Care Navigators funded on a non-recurrent basis by the CCG is extended to June 2017 so that it matches funding for three Care Navigators recently obtained through Vanguard, which will end

6

in June 2017. It was highlighted that a full evaluation of Care Navigators will be completed and that approval is subject to a final review of costs by the CCG’s Finance Team.

The Clinical Executive approved the Care Navigators Business Case to extend CCG funding to

June 2017, subject to final review of costs by the CCG’s Finance Team and ratification by John Rivers as the meeting was not quorate.

15-181 Atlas of Variation Analysis 2015

The Clinical Executive received paper CE15-124 Atlas of Variation Analysis 2015, presented by GB. A further paper was distributed that highlighted key areas of concern. It was agreed that areas that needed a deep dive/need greater understanding are: • Percentage of re-admissions to hospital following an elective Caesarean section that occurred

with 28 days of discharge. • Percentage of people aged 65 years and over who were discharged from hospital into re-

ablement/rehabilitation services by upper-tier local authority. • Rate of council supported permanent admissions of people aged 65 years and over to nursing

home and residential care home settings per 100,000 population by upper-tier local authority. • It was not clear what rate of dual-energy Xray absorptiometry (DEXA) activity per 1000

weighted population by CCG meant. • Percentage of people discharged from hospital following a stroke who were ‘new

institutionalised’ by the CCG. • Percentage of people known to have atrial fibrillation (AF) who were prescribed

anticoagulation prior to stroke. • Relative risk of major lower limb amputation among people in the National Diabetes Audit

(NDA) with Type 1 and Type 2 diabetes when compared with people without diabetes by CCG. HS declared an interest in this item as her husband David Shields is Head of Podiatry and Orthopaedic Triage at the IOWNHST. She remained in the room. • Percentage of emergency admissions for excision colorectal surgery that have planned access

to adult critical care. It was discussed that there was not clarity regarding Childhood Immunisations. It was suggested that Rida Elkheir provides information on where we are now and what is happening to improve vaccination data for the next Clinical Executive meeting. AH agreed to provide an action plan from the summarised report.

The Clinical Executive noted the Atlas of Variation Analysis 2015. ACTION: RE to provide information on where we are now and what is happening to improve childhood

immunisation data for the next Clinical Executive meeting. AH to provide an action plan from the summarised Atlas of Variation report.

RE

AH 15-182 Performance and Contracting

Performance Report The Clinical Executive received paper CE15-125 Performance Report, presented by AH. The

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report highlighted the following: • The CCG is missing its key Constitutional Targets – A&E / Referral to Treatment / Ambulance • 111 targets are being met • All beds in Poppy Ward and Hospital are now open, internal processes at the IOWNHT need to

improve, particularly in relation to patient flow. • A contract notice has been issued for A&E at the IOWNHST. • Weekly System Resilience performance meetings are taking place. Information regarding

referrals has been cascaded and will continue to be cascaded to GPs. The referral support function has also been set up at the CCG.

• The format of the performance report will change in future. It will consist of 4 reports, performance, finance, quality and commissioning.

• The CCG continues to be £1.7m underspent with the IOWNHST contract. • There has been one reported Never Event. • There has been 3 MRSA cases reported, investigations are being carried out to determine if

there has been a fourth case. • Pressure Ulcers are reducing, particularly grade 4 ulcers. • Healthcare Acquired Infections are of concern; a report on C Difficile is being provided to the

Quality and Patient Safety Committee. Discussion took place regarding Junior Doctor Strike Action. Assurance is required regarding how the Trust will cope in the event of strike. AH confirmed he is receiving an action plan from the Trust on the 20 November 2015.

The Clinical Executive noted the Performance Report. 15-183 Contracts Report

The Clinical Executive received tabled paper CE15-126 Contract Report, presented by AH. The CCG currently has 148 providers, with over 200 contracts. A formal tracker is in process. There are 34 contracts still outstanding, these mainly relate to Continuing Healthcare (CHC) contracts. GB and AH agreed to meet and discuss the CHC contracts.

The Clinical Executive noted the Contracts Report. ACTION: GB and AH to meet to discuss Continuing Healthcare Contracts. GB/

AH 15-184 Delivery Plan Q2

The Clinical Executive received and noted paper CE15-127 Delivery Plan Q2, presented by GB. It was highlighted that some areas of the Delivery Plan have agreed to slip as a result of System Resilience.

The Clinical Executive noted the Delivery Plan Q2. 15-185 Information Management and Technology

CCG IT The Clinical Executive received a verbal CCG IT update, from AH. The CCG are issuing a contract letter to the CSU with regard to IT.

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The Clinical Executive noted the CCG IT update. 15-186 Information Governance Q2 Update

The Clinical Executive received and noted paper CE15-128 Information Governance Q2 Update, presented by AH.

The Clinical Executive noted the Information Governance Q2 Update. 15-187 Information Governance Policy

The Clinical Executive received and noted paper CE15-129 Information Governance Policy, presented by AH. It was taken as read, no further comments were made.

The Clinical Executive approved the Information Governance Policy. 15-188 Information Governance Framework and Strategy

The Clinical Executive received and noted paper CE15-130 Information Governance Framework and Strategy, presented by AH. It was taken as read, no further comments were made.

The Clinical Executive approved the Information Governance Framework and Strategy. 15-189 GP/GMS IT

There was nothing to report regarding GP/GMSIT.

15-190 For Noting

Clinical Effectiveness Minutes The Clinical Executive noted paper CE15-131 Clinical Effectiveness Minutes.

The Clinical Executive noted the Clinical Effectiveness Minutes. 15-191 CQRM Minutes October 2015

The Clinical Executive noted paper CE15-132 CQRM Minutes October 2015.

The Clinical Executive noted the CQRM Minutes October 2015. 15-192 Joint Adult Commissioning Board Minutes

The Clinical Executive noted paper CE15-133 Joint Adult Commissioning Board Minutes.

The Clinical Executive noted the Joint Adult Commissioning Board Minutes. 15-193 Locality October and November Minutes

The Clinical Executive noted paper CE15-134 Locality October and November Minutes.

The Clinical Executive noted the Locality October and November Minutes. 15-194 My Life a Full Life Minutes

The Clinical Executive noted the My Life a Full Life Minutes.


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15-195 Update Session Chair and Chief Officer Update HS gave an update with regard to Hampshire Devolution. She attended a meeting for all Chief Executives of Trusts and CCG’s across Hampshire with the Unitary Authorities. It was agreed at the meeting that health would need to have an input in to any future proposals.

The Clinical Executive noted the Update Session. 15-196 Any Other Business


15-197 Date of Next Meeting: Thursday 10 December 2015 12:30–15:30 Block A, The Apex –

Carisbrooke Room.

Post meeting note: All items for decision were ratified by Dr John Rivers, CCG Chair on 25.11.15.

Circulation: Members In attendance: For Information (Agenda): Benjamin Browne – CCG Executive Rida Elkheir – Associate Director of Public Health Joanna Hesse – CCG Executive Loretta Kinsella – Interim Director of Quality and Clinical Services Michele Legg – CCG Executive Loretta Outhwaite – Chief Finance Officer John Rivers – CCG Executive Helen Shields – Chief Officer (Chair)

Jade McCann (notes)

For Information (Minutes): Matthew Leek, CCG Commissioning Finance Mgr Shaun Sweatman, CCG Commissioning Finance Mgr Linda Rann, Sue Lightfoot, Rachael Hayes, Dawn Berryman - Heads of Commissioning, Eleanor Roddick – Head of Performance, Teresa Day - Acting Deputy Head of Medicines Management, Caroline Morris – Head of Corporate Business and Primary Care, Rebecca Wastall – Deputy Chief Finance Officer, Lucy Savill – Information Governance Mgr

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Clinical Executive 10 December 2015

Minutes of the Clinical Commissioning Group (CCG) Clinical Executive held on 10 December 2015 at 12:30 in Carisbrooke Room, Block A, The APEX, St Cross Business Park

PRESENT: Helen Shields (HS) – Chief Officer (Chair) Gillian Baker (GB) – Deputy Chief Officer (from item 7.4)

Rida Elkheir (RE) – Associate Director of Public Health (from item 7.4) Dr Joanna Hesse (JH) – CCG Executive (from item 7.4) Loretta Kinsella (LK) – Director of Quality and Clinical Services Dr Michele Legg (ML) – CCG Executive Dr John Rivers (JR) – CCG Chairman Becky Wastall (BW) – Deputy Chief Finance Officer (for LO)

IN ATTENDANCE: Russell Ball (RBa) – Senior Contracts Manager (IOWNHST) (Item 7.2)

Alison Geddes (AG) – Commissioning Manager (Item 7.1) Michelle Jones (ML) – Commissioning Manager (Items 7.3 & 7.4) Sue Lightfoot (SL) – Head of Mental Health and Learning Disability Commissioning (Items 7.3 & 7.4) Muriel Prager (MP) – Consultant Anaesthetist (IOWNHST) (Item 7.2) Steve Parker (SP) – Consultant Surgeon (IOWNHST) (Item 7.2 Linda Rann (LR) – Head of Secondary Care Hospital Commissioning (Item 7.2 & 8.1)


15-198 Apologies for Absence Apologies for absence were received from: Dr Ben Browne – CCG Executive.

Gillian Baker, Rida Elkheir and Joanna Hesse attended the meeting from item 7.4. Therefore the meeting was not quorate until item 7.4. All items that were approved in principle when the meeting was not quorate were ratified by JH when she attended the meeting.


• Approved: - funding to support a non-recurring reduction in the Orthotics waiting list - the increase of 1 HDU bed at IOW NHS Trust - the Children and Young Peoples Transformation Plan and national funding of £267k - a Learning Disability Transitions Nurse to work across health and social care - Commissioning Intentions 2016/17

• Reviewed the decision by the Governing Body not to turn off referrals to the IOW NHS Trust. Performance improving and referrals have decreased to the IOW NHS Trust, the Clinical Executive supported providing information to allow patient choice.

1


The Clinical Executive received paper CE15-136 Declarations of Interest. The Declaration of Clinical Executive Members was agreed as accurate, with no changes.

15-200

Minutes of the Last Clinical Executive Meeting The Clinical Executive received paper CE15-137 Minutes of the last Clinical Executive Meeting. The minutes of the meeting on the 19 November 2015 were agreed as an accurate record.

15-201

Matters Arising i. Schedule of Actions from the CCG Executive 19 November 2015. The Clinical Executive received paper CE15-116 Matters Arising – Schedule of Actions. The following discussion took place: • 15-049 - Ambulance CAD System – A letter has been received from the Isle of Wight NHS Trust

(IOWNHST) informing the CCG that they would no longer be providing Ambulance Handover data. The CCG have responded stating that this is unacceptable as assurance is required with regard to Ambulance Handover. Fines will continue to be implemented. An audit has not been undertaken since January 2015; therefore a further audit has been requested from the Trust. This is a high profile issue that has been discussed at the Overview and Scrutiny Panel. It was agreed for the action to remain open as it was still not clear whether the system is working.

• 15-153 – Partial Knee Arthroplasty – this was discussed at a recent Contract Meeting in relation to adherence to the partial knee arthroplasty policy. It was agreed the item could be closed.

• 15-158 – System One – it was agreed that an implementation action plan should be presented to the Clinical Executive in January 2016. JR commented that he was keen to highlight the way in which the programme can contribute to Integrated Working. It was agreed that a development plan should follow once the implementation action plan was received in January.

• 15-174 – Risk Register Actions – it was agreed that the Risk Register needed refreshing in January 2016 to take into consideration the actions.

• 15-181 – Atlas of Variation Action Plan – action plan update requested for next meeting. • 15-183 – Continuing Healthcare Contracts – a meeting has been planned. This action can now

be closed.

The Clinical Executive received the Schedule of Actions. ACTION: System One implementation action plan to be presented to the Clinical Executive in January

2016. HS (CM/LW)

For Decision/Discussion 15-202 Corporate/Governance

Procurement Decisions There were no new procurement decisions.

The Clinical Executive noted the Procurement Decisions. 15-203 Risk Register

The Clinical Executive received tabled paper CE15-139 Risk Register, presented by HS. Three

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issues were highlighted: • Y3/21 – CCG IT Security and Capability – a contract letter has been issued. It has been

requested that a plan is implemented for all CCG computers to be upgraded by the end of the financial year. The issue also has implications for the CCG’s Information Governance Toolkit.

• Y3/1 – Allocation Formula – it is expected that the CCG’s allocation will be published on the 20 December 2015. HS commented that at a recent National Spending Review Meeting, Simon Stevens indicated that a supplement for small hospitals will be received to support diseconomies of scale.

• Y3/11 – Quality Premium Target at Risk – it was noted that the Clinical Quality Review Meeting is not the right forum for this. It should stay with the Clinical Executive.

HS commented that the Risk Register will need updating to reflect the Clinical Executive Action Log. LK highlighted that risks in relation to quality are on track and she has no cause for concern. Discussion took place regarding concerns in Urology; HS confirmed that this would be picked up under the Performance Report.

The Clinical Executive noted the Risk Register. ACTION: Risk Register to be updated to reflect the Clinical Executive Action log. HS

(CM) 15-204 My Life a Full Life Update

The Clinical Executive received a verbal My Life a Full Life Update. This item was deferred until January 2016. HS commented that an update that was presented to the Health and Wellbeing Board would be useful to circulate.

The Clinical Executive noted the My Life a Full Life Update. ACTION: RB to circulate the My Life a Full Life paper that was presented to the Health and Wellbeing

Board. RB

15-205

Commissioning Orthotics Waiting List Proposal Business Case The Clinical Executive received paper CE15-140 Orthotics Waiting List Proposal Business Case, presented by AG. The demand on the Orthotic service rose 178% between 2006/7 and 2014/15 with a subsequent increase in waiting times. The business case outlined options for additional funding to either reduce the waiting list to 18 weeks or to 8 weeks within this financial year. It was highlighted that the CCG intends to review the Orthotics Service in 2016/17 to ascertain if it is value for money. The Clinical Executive agreed in principle to fund half of the proposed £90,334 for three months until March 2016 for a waiting list initiative to reduce waiting times to 8 weeks. When JH attended the meeting she confirmed her approval of the decision.

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The Clinical Executive approved to fund half of the proposed £90,334 outlined in the Orthotics

Waiting List Business Case for three months until March 2016.

15-206 ICU HDU Bed Configuration

The Clinical Executive received paper CE15-141 ICU HDU Bed Configuration, presented by LR, SP, RBa and MP. It was proposed that a change in the bed reconfiguration within the Intensive Care Unit (ICU) to 5 level 3 (ICU Level) and 2 high dependency beds (HDU) is made. This would be a formal increase of 1 HDU bed. Formal agreement is required to allow ICU to register the unit with the national and regional database of Intensive Care Beds and for ICNARC audit purposes. The change would allow patients to be formally charged for at HSU rates, which in turn would offset some of the additional support the Trust received to provide critical care services. The financial implications of this relate to £263k based on 321 bed days per year at 88% occupancy. It was agreed that the change would be a significant improvement from a clinical perspective. The Clinical Executive approved in principle the formal increase of 1 HDU bed. When JH attended the meeting she confirmed her approval of the decision.

The Clinical Executive approved the formal increase of 1 HDU bed. JH, GB and RE joined the meeting – therefore the meeting was now quorate. 15-207 Children’s Transformation Plan

The Clinical Executive received paper CE15-142 Children’s Transformation Plan, presented by SL. In May 2015 NHS England wrote to all CCGs to inform them of the requirement to submit local transformation plans for children and young people’s mental health and wellbeing. £267k of recurrent funding has been received following assurance of the IOW Transition Plan for Children and Young People. As a result 4 local priority work streams have been identified: • Reducing Perinatal and Infant Mental Health • Out of Hours Crisis and Inreach/Outreach Support • Improving Access to Support Children and Young People’s Mental Health Improving Access to

Psychological Therapies (IAPT) • Eating Disorder Service

The Clinical Executive approved the Children and Young People’s Transformation Plan. 15-208 Learning Disability Transitions Nurse Business Case

The Clinical Executive received paper CE15-143 Learning Disability Transitions Nurse Business Case, presented by SL & MJ. The Clinical Executive were requested to approve investment of £63k of a learning disability transition nurse to work across health and social care teams to ensure children and young people with learning disability and complex needs are identified early and supported to transition expediently into adult services. It was queried whether it was likely the post would be recruited to, MJ and SL confirmed they

4

were confident it would be.

The Clinical Executive approved the Learning Disability Transitions Nurse Business Case. 15-209 Prioritisation Process 2016/17

The Clinical Executive received paper CE15-144 Prioritisation Process 2016/17, presented by GB. It was agreed that the Clinical Executive would be given more time to review the paper and let GB have feedback by the 17 December 2015, for the paper to come back for approval in January 2016.

The Clinical Executive to review the Prioritisation Process 2016/17 approval will be sought in

January 2016.

ACTION: Clinical Executive to give feedback to GB re the Prioritisation Process by 17 December 2015.

Prioritisation Process 2016/17 to be presented to the January 2016 Clinical Executive. ALL RB

15-210 Commissioning Intentions 2016/17

The Clinical Executive received and noted paper CE15-145 Commissioning Intentions 2016/17, presented by GB. No further comments were made in relation to this paper.

The Clinical Executive approved the Commissioning Intentions 2016/17. 15-211 Performance and Contracting

Performance Report The Clinical Executive received paper CE15-146 Performance Report. The report highlighted the following: • The IOWNHST is still on red alert • The IOWNHST is failing the following targets – A&E, Ambulance, Referral to Treatment and 62

day cancer. • Contract letters have been issued.

Discussion took place regarding there being no improvement in A&E despite the opening of 51 additional beds. Discussion took place regarding the issues relating to systems, processes and culture within the Trust. A remedial action plan is expected on the 15 December 2015. It was agreed that a meeting should be proposed with the Trust’s Executive Team and the Clinical Executive. LR gave an Elective Plan Update the update highlighted the following: • Performance against the CCG plan have improved overall. • Day cases are achieving over target by 74 cases as at 6/12/2015. • Urology is the speciality that remains a concern. A Locum Consultant has now commenced

work and subject to clinical sign off internally, this should provide an additional 23 operating lists, plus improved senior locum cover for Tuesday evenings which will facilitate improved case mix potential on these lists. JH highlighted that patients she had referred to Urology had received a letter to say they could not be treated due to lack of Consultant cover. LR agreed to investigate this.

• A letter from Dame Barbara Hakin, National Director Commissioning Operations, NHS England

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has been received advising that Trust’s should curtail election admissions from the period 21/12/2015 to 15/1/2016 to provide greater resilience. This will put the elective plans further at risk and remodelling will be required.

• Total incomplete target not achieving and achievement has now been moved to March 2016. HS highlighted the decision in November 2015 by the Governing Body not to turn off referrals to the IOWNHST for Urology, Orthopaedics and General Surgery. The Governing Body requested that the position is reviewed by the Clinical Executive. It was discussed that the activity vs plan has improved, particularly in relation to day cases. It was agreed to keep communicating to the public and GPs about patient choice and encourage referrals off island. This would be reviewed again in January 2016.

The Clinical Executive noted the Performance Report and agreed that the system resilience plan

currently in place would remain and be reviewed again in January 2015.

ACTION: HS to write to KB regarding meeting the Trust’s Executive Team regarding systems, processes

and culture in the Trust. LR to investigate letters received from Urology patients regarding lack of Consultant cover. The Clinical Executive to review System Resilience in January 2016.

HS

GB (LR)

GB

15-212 Information Management and Technology

CCG IT The CCG update was discussed as part of the Risk Register.

The Clinical Executive noted the CCG IT update. 15-213 GP/GMS IT

The GP/GMS IT update was discussed at part of the Schedule of Actions.

The Clinical Executive noted the GP/GMS IT update. 15-214 For Noting

Joint Adult Commissioning Board November Minutes The Clinical Executive noted paper CE15-147 Joint Adult Commissioning Board November Minutes.

The Clinical Executive noted the Joint Adult Commissioning Board November Minutes. 15-215 Contract Monitoring and Service Review October and November Meeting

The Clinical Executive noted paper CE15-148 Contract Monitoring and Service Review October and November Meeting.

The Clinical Executive noted the Contract Monitoring and Service Review October and November

Meeting.

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15-216 My Life a Full Life Minutes

The Clinical Executive noted paper CE15-149 My Life a Full Life Minutes.


15-217 Update Session Chair and Chief Officer Update HS highlighted that there had been issues regarding the Clinical Executive Election. RB has been tasked with resolving the issue.

The Clinical Executive noted the Update Session. 15-218 Any Other Business


15-219 Date of Next Meeting: Thursday 21 January 2016 12:30–15:30 Block A, The Apex – Carisbrooke

Room.


Rebecca Berryman (notes) Russell Ball Alison Geddes Sue Lightfoot Caroline Morris Steve Parker Muriel Prager Linda Rann


7

Clinical Executive

Minutes of the Clinical Executive 21 January 2016


Summary of issue: Minutes of the Clinical Executive.

Action required/ recommendation: To note and approve the minutes of the Clinical Executive.



This will be considered at the Governing Body in public Meeting.







Author of Paper: Rebecca Berryman, Governance Support Manager.



Agenda Item: 3 Paper number: CE15-XXX

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Clinical Executive 21 January 2016 For the attention of the Governing Body:

• Still concern regarding Ambulance Handover delays and now lack of information from the isle of Wight NHS Trust.

• Approved: - Whole Integrated System Redesign ratification report. The chosen consultants are KPMG who

commence on 25 January 2016. - Standards of Business Conduct Policy. - In principle the Employment Support for People with mental Health. - Prioritisation process for 2016/17. - Medicines Optimisation Group (MOG) Standardised Operating Policy. - Home Oxygen Contract extension.

• Received high level project plan for GP GMS IT System One. • Appointed 2 new Clinical Executive members.

Minutes of the Clinical Commissioning Group (CCG) Clinical Executive held on 21 January 2016 at 12:30 in Carisbrooke Room, Block A, The APEX, St Cross Business Park

PRESENT: Helen Shields (HS) – Chief Officer (Chair from item 5.1) Dr Benjamin Browne (BB) – Clinical Executive Rida Elkheir (RE) – Associate Director of Public Health

Dr Joanna Hesse (JH) – CCG Executive Andrew Heyes (AH) – Head of Performance and Contracting (for LO) Loretta Kinsella (LK) – Director of Quality and Clinical Services (Chaired Items 1 -5.1) Dr Michele Legg (ML) – CCG Executive

IN ATTENDANCE: James Cotton (JC) – Commissioning Support Officer (Items 6.1 & 6.2)

Karen Kerley (KK) – Commissioning Manager (Items 6.1 & 6.2) Caroline Morris (CM) – Head of Primary Care and Corporate Business (Items 5.2, 5.3 & 10.2) Loretta Outhwaite (LO) – Interim MLAFL Programme Director (Item 8)

Tracy Richards (TR) – Business Administrator (Observer) Dr Peter Randall (PR) – Clinical Lead (Item 6.2) MINUTED BY: Rebecca Berryman (RB) – Governance Support Manager

15-220 Apologies for Absence Apologies for absence were received from Gillian Baker and John Rivers. Sue Lightfoot attended

on Gillian Baker’s behalf.


The Clinical Executive received paper CE15-150 Declarations of Interest. The Declaration of Clinical Executive Members was agreed as accurate. The following new declarations were made:

2

• JH declared she has signed a contract with Beacon Out of Hours to undertake shifts. She has

completed a new Declaration of Interests form. • ML declared she had put her name forward to undertake Out of Hours shifts, but had not yet

signed a contract. • BB declared he has a contract with the Council to undertake some work in Public Health. RB to

send a new form to BB. ACTION: RB to send BB new declaration of interests form. RB 15-222

Minutes of the Last Clinical Executive Meeting The Clinical Executive received paper CE15-151 Minutes of the last Clinical Executive Meeting. The minutes of the meeting on the 10 December 2015 were agreed as an accurate record.

15-223

Matters Arising i. Schedule of Actions from the CCG Executive 10 December 2015. The Clinical Executive received paper CE15-152 Matters Arising – Schedule of Actions. The following discussion took place: • 15-120 – Education and Healthcare Process – it was requested that a report it presented to

the Clinical Executive in February to outline progress and timelines, so the action can be closed.

• 15-049 – Ambulance Handover – there is still concern regarding Ambulance Handover and now the lack of data. It was requested that a comprehensive report was presented to the next Clinical Executive.

• 15-121- Contracts to Website – It has been agreed that next year’s contract is approved before anything is published on the website. There is a placeholder on the website directing queries to AH. AH confirmed that a paper would be presented to the Clinical Executive in March.

• 15-181 – Childhood Immunisations – RE confirmed that data had still not been received. It was noted that the Island continues to be an outlier.

• 15-211 – Urology Letters – JH confirmed that she could not track the letter down and hadn’t seen any further letters. It was agreed the action could be closed. ML commented that in relation to Urology she had concerns because the Isle of Wight NHS Trust (IOWNHST) only had one Urology Consultant. It was confirmed that a Urology review was due to start the week commencing 25 January 2016.

The Clinical Executive received the Schedule of Actions. ACTION: Education and Healthcare Process Update to include progress and timelines to be presented to

the Clinical Executive. Ambulance Handover Update to be presented to the next Clinical Executive meeting.

GB (RH) GB

(MF) For Decision/Discussion 15-224 Corporate/Governance

Procurement Decisions & Whole Integrated System Redesign (WISR) Ratification The Clinical Executive received paper CE15-153 Whole Integrated System Redesign (WISR)

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Ratification. It was confirmed that KPMG were the chosen Consultants for WISR, and they start work on the 25 January 2016. It was noted that a Procurement wash up meeting is to be arranged. There were no other procurement decisions.

The Clinical Executive approved the WISR Ratification. 15-225 Risk Register

The Clinical Executive received tabled paper CE15-154 Risk Register, presented by CM. The Risk Register highlighted the following: • Y3/1 – CCG Allocation – the allocation has now been received. The CCG will receive minimum

funding for the next 3 years. • Y3/3 – Care Home Closures – Workforce support is now in place and the Care Home Manager

has a robust Induction programme set up for when they commence post in February 2016. • Y3/4 – CQC Findings at IOWNHST – LK confirmed that she was assured the Trust had made

progress against the action plan and the risk can be downgraded. It is anticipated when the Risk Register is refreshed the risk can be taken off.

• Y3/5 & Y3/8 Safeguarding – The Safeguarding Nurse at the Trust and the Head of Safeguarding at the CCG have now commenced post. There is also now regular attendance at the Safeguarding Boards.

• Y3/6 Better Care Fund – the risk has now been re-specified and downgraded to medium risk. • Y3/7 System Resilience – continues to be high risk. • Y3/11 Quality Premium – this has now materialised as a risk as the CCG has failed to meet

some of the targets. HS commented that a review of the Quality Premium needs to take place in order to establish its position on the risk register.

• Y3/12 Looked After Children – there are currently no gaps in service, however the current post holder is due to retire, therefore succession planning needs to be considered. The Island is an outlier for the number of Looked After Children. The CCG Governing Body are due to receive a Looked After Children Update in February.

• Y3/13 Ambulance Handover – a contract notice and fines are in place. The Trust have been requested to undertake an Audit and Recovery Plan.

• Y3/15 Prescribing QIPP – is on track to achieve the targets, it is therefore no longer a high risk. The risk was agreed to be downgraded to medium.

• Y3/19 Medicines Management Reputational Risk - the CCG is still receiving Freedom of Information requests and stories continue to appear in the National News.

Four new risks have been identified since last month: • Y3/22 – Ability to continue service following retirement of community stoma nurse in 2016 –

Medium risk • Y3/23 –Clinical Sustainability of urology service – high risk • Y3/24 – Partner Resilience, particularly in relation to management capacity – Medium risk • Y3/25 – inability to provide safe spinal surgery pathway – high risk

The Clinical Executive noted the Risk Register. ACTION: Quality Premium to be reviewed to establish position on the risk register. AH

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15-226 Standards of Business Conduct Policy

The Clinical Executive received paper CE15-155 Standards of Business Conduct Policy, presented by HS. The Local Counter Fraud Service have reviewed the Standards of Business Conduct Policy and made a number of minor but clarifying statements to add to the policy.

The Clinical Executive approved the Standards of Business Conduct Policy 15-227

Commissioning Employment Support for People with Mental Health Problems The Clinical Executive received paper CE15-156 Employment Support for People with Mental Health Problems, presented by SL and KK. The paper proposed that the current Section 256 grant to OSEL Enterprises to continue to deliver an Employment Support Service for people with Mental Health problems until further strategic clarity is provided by the progress on development of Whole Integrated System Redesign (WISR). The Clinical Executive were requested to approve funding of £8,802 to be made available for the last month of the current financial year (March 2016) and a S256 funding of £105,623 for 2016/17. Discussion took place which highlighted that the number of those with Mental Health problems in employment had risen by 10% which was a significant achievement. HS commented that she would need assurance from finance that the funding has already been identified. If the funding has not been identified it will need to go through the prioritisation process.

The Clinical Executive approved in principle the Employment Support for People with Mental

Health Problems subject to assurance from finance.

15-228 IOW Psychosis Pathway

The Clinical Executive received paper CE15-157 IOW Psychosis Pathway, presented by SL, JC, KK and PR. The paper outlined proposals for the Isle of Wight Psychosis Pathway in order to meet new mental health access and waiting time standards which were published in February 2015. The Clinical Executive were requested to approve recurrent funding of £123k for two Band 6 RMNs to implement changes required for the Psychosis pathway to ensure the pathway reflects National guidance and meets the new standards and is NICE compliant. It was agreed that this was clinically the right thing to do, but as the funding is not currently identified it will have to go through the prioritisation process.

The Clinical Executive did not approve the IOW Psychosis Pathway, it was agreed this would

have to go through the prioritisation process as the funding is not currently identified.

ACTION: IOW Psychosis Pathway to go through the prioritisation process. GB/

SL 15-229 Prioritisation Process 2016/17

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The Clinical Executive received paper CE15-158 Prioritisation Process 2016/17 presented by HS. Feedback had been received since the last meeting that prevention should be given a greater weighting in terms of priority. The Prioritisation process was approved, but was noted that it could be fine-tuned at a later date if required.

The Clinical Executive approved the Prioritisation Process 2016/17. 15-230 Medicines Optimisation Group Standardised Operating Policy

The Clinical Executive received paper CE15-159 Medicines Optimisation Group Standardised Operating Policy, presented by LK. The paper outlines how decisions are made in relation to making recommendations to swap medications, whilst maintaining safety and quality. Discussion took place that there needed to be clarity regarding which GPs make up the virtual decision making panel. It was agreed that when a decision is required that the GP Prescribing Lead for each practice would be emailed and 3 responses would be required for a decision to be made. JH highlighted the yes and no’s on the Medicines Optimisation Decision Matrix needed to be amended. It was agreed that once amended this would need to go to the Clinical Effectiveness and would not need to go back to the Clinical Executive unless any further changes were made.

The Clinical Executive approved the Medicines Optimisation Group Standardised Operating

Policy pending approval at the Clinical Effectiveness Committee.

ACTION: Medicines Optimisation Group Standardised Operating Policy to be added to the Clinical

Effectiveness Agenda. RB

15-231 Home Oxygen Contract Extension

The Clinical Executive received paper CE15-160 Home Oxygen Contract Extension, presented by AH.

The Clinical Executive approved the Home Oxygen Contract Extension. 15-232 Care and Treatment Reviews

The Clinical Executive received and noted paper CE15-161 Care and Treatment Reviews, presented by SL. The Care and Treatment reviews briefing guidance has placed expectations on CCG’s ensuring they follow the care programme approach framework. This will be a cost pressure of £39,060 for 12 Community Treatment reviews.

The Clinical Executive approved in principle Care and Treatment Reviews, pending planning

guidance review.

15-233 Performance and Contracting

Performance Report The Clinical Executive received paper CE15-162 Performance Report. The report highlighted the following:

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• One new Serious Incident Requiring Investigation (SIRI) was reported for December. • There has been a reduction of Grade 4 Pressure Ulcers. • There has been an increase in Slips, Trips and Falls for November, with 6 resulting in serious

injury. • LK highlighted she had visited a Mental Health establishment on the Island in relation to

Safeguarding issues. • There are 2 new pathway managers in A&E. • The CCG is predicting a £1.3m underspend. HS commented that a decision needs to be made

regarding what to do with the underspend. • 7 cases of MRSA have been reported. 2 have gone to arbitration.

The Clinical Executive noted the Performance Report. 15-234 System Resilience

HS gave a brief System Resilience update that highlighted a new escalation process is now in place. There have been no recent black alerts. HS also highlighted the Isle of Wight NHS Trust had increased elective work and there are now a substantial number of referrals to mainland providers.

The Clinical Executive noted the System Resilience Update. 15-235 Q3 Delivery Plan

The Clinical Executive received and noted paper CE15-163 Q3 Delivery Plan.

The Clinical Executive noted the Q3 Delivery Plan. 15-236 My Life a Full Life Update

The Clinical Executive received a verbal update regarding My Life a Full Life from LO. Work is currently ongoing on the Value Proposition for 2016/17. LO highlighted that it needs to be clear what goes in to the value proposition and an evaluation criteria process is currently being put together. With regard to staffing James Seward has been appointed as the WISR Programme Director and Nicola Longson has been appointed as the My Life a Full Life Programme Director. The Project Management Office is currently running on interims, recruitment will be taking place imminently. ML commented that the various workstreams are requesting a lot of additional posts. She suggested that these posts could cover more than one area. LO confirmed she would be reviewing the posts to ensure there is no duplication. LO highlighted that the Guardian wrote a positive and balanced article on the Island’s Healthcare system, particularly focusing on the Hub. It was agreed that this was good for the Island’s national profile.

The Clinical Executive noted the My Life a Full Life Update.

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15-237 CCG Assurance

The Clinical Executive received and noted paper CE15-164 CCG Assurance, presented by HS. This assurance rating is currently provisional pending national ratification.

The Clinical Executive noted the CCG Assurance letter. 15-238 Information Management and Technology

CCG IT Update The Clinical Executive received paper CE15-165 CCG IT Update, presented by AH. AH confirmed that improvement is being seen with regard to IT. The CSU have stepped up their support and issues are being resolved.

The Clinical Executive noted the CCG IT Update 15-239 GP/GMS IT System One Implementation Plan

The Clinical Executive received a tabled GP/GMSIT System One Implementation Plan, presented by LW. LW highlighted that the circulated timetable is still currently provisional and emphasised that the CSU were the project managers. LW confirmed that practices were feeling confident and well supported in the migration process. Discussion took place regarding the implications for the CCG systems, particularly Script Switch integrating with the new GP System. LW agreed to look in to see if there are any potential issues in relation to this.

The Clinical Executive noted the GP/GMSIT Update ACTION: LW to look in to any potential issues with CCG systems and System One Implementation. LW 15-240 Information Governance Q3 Report

The Clinical Executive received and noted paper CE15-167 Information Governance Q3 Report, presented by AH. Lucy Savill, Information Governance Manager was praised for her continued hard work.

15-241 IT Policies

The Clinical Executive received and noted paper CE15-168 IT Policies, presented by AH. The Clinical Executive approved the following policies: • IOW NHS Trust – Information Technology Security Policy • IOW NHS Trust – Policy for the use of Portable Equipment and Media, capable of storing Trust

Data. These policies were retrospectively approved from last year.

The Clinical Executive approved the IT Policies. 15-242 Minutes to Note

The Clinical Executive noted the following: • Paper CE15-169 – Joint Adult Commissioning Board Minutes 2.12.15 & 6.1.16.

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• Paper CE15-170 – Contract Monitoring and Service Review Minutes 8.12.15 • Paper CE15-171 – Clinical Quality Review Meeting 6.11.15 & 4.12.15

15-243 Chief Officer Update

HS gave the following update: • John Rivers is currently interviewing for the WISR Lay Chair. • Two new Clinical Executive Members have been elected and will officially commence in April

2016, they are Dr Sarah Westmore from Cowes and Dr Timothy Whelan from Dower House. • The Clinical Executive Seminar in February will focus on allocations and planning. • Planning for the future will be completed at scale and the formal planning footprint was

agreed by the Clinical Executive at Hampshire and the Isle of Wight, within this there would be layers of planning at Isle of Wight level and localities.

The Clinical Executive noted the Chief Officers Update. 15-244 Date of Next Meeting: Thursday 18 February 2016 12:30–15:30 Block A, The Apex –

Carisbrooke Room.


Rebecca Berryman (notes)


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Governing Body

QPSC Minutes 24 September & 26 November 2015

Sponsor: Ian Reckless, Secondary Care Doctor

Summary of issue: Minutes of the Quality and Patient Safety Committee Meeting.


To note the minutes of the Quality and Patient Safety Committee Meeting


Other committees where this has been considered: This document has not been considered at any other committee.

Financial /resource implications: There are no financial or resource implications relating to this paper.



A member of Healthwatch is a member of QPSC. These minutes form part of the public record of events.


The Committee remains cognisant of equality and diversity issues in all matters it considers.

Author of Report: Jade McCann, Corporate Support Administrator

Date of Paper: 25 September 2015



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Quality and Patient Safety Committee Minutes of the Clinical Commissioning Group (CCG) Quality and Patient Safety Committee held on 24 September 2015 at 09:30 in Carisbrooke Room, Block A, The APEX, St Cross Business Park.

PRESENT: Dr Ian Reckless (IR) Secondary Care Doctor (Chair) Dr Benjamin Brown (BB) Clinical Executive Member

David Newton (DN) CCG Governing Body Lay Member

Loretta Kinsella (LK) Director of Quality and Clinical Services Lindsay Voss (LV) Governing Body Nurse

IN ATTENDANCE: Mark Fletcher (MF) Senior Commissioning Manager (Item 9) Dr David Isaac (DI) General Practitioner

Samantha Johnson (SJ) Quality Manager Sue Lightfoot (SL) Head of Mental Health and Learning Disability

Commissioning Karen Morgan (KM) Head of Quality Eleanor Roddick (ER) Head of Community and Urgent Care (Item 9)

Lorraine Smith (LS) Consultant Designated Nurse Safeguarding Children

MINUTED BY: Jade McCann Corporate Support Administrator

15-037 Welcome and Apologies for absence Apologies for absence were received from Anita Cameron-Smith, Tracy Keats and Joanna Smith.


The Quality and Patient Safety Committee received paper QPS15-038 Declarations of Interest, noting the following changes: David Newton is now on the NHS Board Level Task and Finish Group Standards for Public and Patient Involvement in Direct Commissioning.

15-039 Confirmation the Meeting is Quorate Confirmed.


• QPSC received a system resilience update (including plans for additional acute and step-down beds)

• QPSC discussed a response from the IOWNHST to a letter from the Chair of QPSC in relation to the Trust’s approach to mortality monitoring and review.

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15-040

Minutes of the Last Quality and Patient Safety Meeting 23 July 2015 The Quality and Patient Safety Committee received and approved paper QPS15-039 Minutes of the Last Quality and Patient Safety Meeting 23 July 2015, presented by IR.

15-041 Matters Arising

Schedule of Actions from 23 July 2015 The Quality and Patient Safety Committee received paper QPS15-040 Matters Arising - Schedule of Actions from 23 July 2015, presented by IR. The following discussion took place:

• 15-025 End of Life Care: It was proposed for KM to discuss with Eleanor Roddick, Head of Urgent Care and Community Commissioning quality metrics from the End of Life Strategy to be adopted into the Quality Dashboard. An update is expected by the November meeting.

• 15-025 Quality Indicators for Dashboard Targets: KM stated that a meeting is scheduled with the performance team to discuss and agree quality metrics to populate a new Quality Dashboard. They will be working together to meet the QPSC November paper deadline.

• 15-030 System Resilience Action Plan: A verbal update will be given by Eleanor Roddick, Head of Urgent Care and Community Commissioning and Mark Fletcher, Senior Commissioning Manager in relation to this plan.

• 15-031 Safety Netting: LK noted Alan Sheward, Director of Nursing at the Isle of Wight NHS Trust has assured a safety netting procedure was now in place to ensure timely response to patients who may be at risk of developing a cauda equina.

• 15-033 Workforce Data for District Nurses: DI stated that he felt there were problems with the length of shifts and the size of area covered by the district nurses. Mark Rawlinson, Locality Lead for Community Nursing will attend the November meeting to provide an update.

ACTION: To add Workforce for District Nurses to the November agenda. JM Items for Discussion/Decision Performance 15-042 Quality Dashboard

The Quality and Patient Safety Committee received paper QPS15-041 Quality Dashboard, presented by KM. Discussion was held around the access performance targets, which the IOWNHST are not meeting, it was noted that other CCG’s in Southampton and Portsmouth are in similar situations, however the Isle of Wight are seen as an outlier due to the high number of 12 hour trolley waits and mixed sex accommodation breeches. The Isle of Wight CCG (IWCCG) is working closely with the Isle of Wight NHS Trust (IOWNHST) to undertake a diagnosis of the key issues. LK stated that the IWNHST now understands that the primary issue is not an increase in demand from Primary Care but rather delays in discharge leading to a lack of beds. Bed shortages also result from a significant nursing deficit. SL further highlighted challenges within the community but explained the expectation that

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this would improve once Solent Grange is reopened. In regard to mixed sex accommodation breeches KM stated that all patients are consulted before a mixed sex breech move and the issue is handled in a dignified manner.

The QPSC noted the Quality Dashboard. 15-043

Mortality Data and Letter to IOW NHS Trust Medical Director 1.9.15 The Quality and Patient Safety Committee received paper QPS15-042 Mortality Data and Letter to IOW NHS Trust Medical Director 1.9.15, presented by IR. IR shared the response letter from Mark Pugh, Executive Medical Director at the Isle of Wight NHS Trust following a quality meeting in July regarding the decision to stop using Dr Foster as a mortality data analysis tool. IR stated he was reassured from the letter that the decision had been thought-through, however concern was raised that there is no assurance in regard to a tool to replace Dr Foster. The Summary Hospital-Ievel Mortality Indicator (SHMI) is nationally available to review quantitative data, but concern was raised that does not provide the qualitative data needed, nor that sufficient drill down to the granular data is feasible. KM stated Mark Pugh has set up a Multi-Disciplinary Mortality Group which LK has been invited to attend. This will be to gain further assurance regarding who in the Trust is responsible for reviewing in-patient deaths.

The QPSC noted the Mortality Data and Letter to IOW NHS Trust Medical Director 1.9.15. 15-044 Clinical Governance Report

The Quality and Patient Safety Committee received paper QPS15-043 Clinical Governance Report, presented by KM. KM highlighted the number of 12 hour trolley breeches and has asked for Root Cause Analysis (RCA) from an assurance perspective. The initial RCA report highlighted poor documentation whilst patients were waiting in A&E, this has been highlighted and will be monitored by the Quality Team. The Trust has reported 11 cases of C-Difficile. The panel have determined three cases to be unavoidable whilst eight have been deemed a lapse in care and therefore fines have been applied. LK stated that a meeting had been held with the Trust Development Agency (TDA) and the Infection Prevention and Control lead to discuss Infection Prevention and Control in the Trust. It was felt that robust antibiotic stewardship was in place, but further work was required around consistent hygiene practices. BB noted that Joanna Hesse, Clinical Executive Member, had communicated with other GP’s around antibiotic prescribing. The numbers of C-Difficile cases in the community are an area for concern for NHS England and the CCG. It was noted that no Root Cause Analysis takes place for community cases. KM will start to look at how to collect this data. A Root Cause Analysis

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tool had been trialled with GP’s for six months and this found no particular concerns around antibiotic prescribing. DN noted the rise in reported pressure ulcers, but noted he would rather see higher levels in grade 1 and 2, and reduced numbers of grade 3 and 4. KM explained the competency work done with GPs and practice nurses to manage pressure ulcers. As a result it is not known whether the increase is due to people reporting pro-actively, or indicative of a real increase within the system. LK stated the first joint SIRI panel with the Trust is due to take place at the end of September to explore the rise in pressure ulcers, with a proposal to cluster the investigation. LV queried the current position of the vacancy for the Safeguarding Adults Lead and it was confirmed by LK that this post had now been appointed to. It was noted that Alan Sheward, Director of Nursing (IOWNHST) has recognised additional staff are required to support this single post holder. IR highlighted the 47 Deprivation of Liberty Standards (DoLS) applications made as there is concern about the capacity within the Local Authority (LA) to process these applications in a timely manner. This has been escalated to the Health and Wellbeing Board, but LK suggested the Joint Adult Commissioning Board would be an appropriate forum to raise the issue. It was noted that DoLS is only one element of protecting vulnerable patients and awareness in the Trust needs to increase with people working together to meet patient needs. KM highlighted maternity as a concern in regard to having no SIRIs reported which is unusual and will therefore be closely monitored. Soft intelligence suggests there are issues with the early aspects of the maternity pathway but women are generally happy with the labour and delivery process. KM revisited the Healthwatch review of maternity services which found the Trust felt it was advantageous to rotate midwives, whereas women felt this was inconsistent as a midwife did not see the whole pregnancy process through. Women experiencing issues also highlighted the location of ante-natal classes not always being located near to home. However a small number of responses from the Friends and Family test reports 100% satisfaction rates. The 52 week waits were found to be related to the administrative management of waiting list. IR stated that further 52 week breaches may occur over the coming months as a result of the same problem if it is a systematic issue. The Chief Operating Officer at the Isle of Wight NHS Trust is investigating the process further.

The QPSC noted the Clinical Governance Report.

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ACTION: LK to raise the capacity requirements to assess DoLS at the Joint Adult Commissioning Board.

LK

15-045 CQUIN Quarter 1 Report

The Quality and Patient Safety Committee received paper QPS15-044 CQUIN Quarter 1 Report, presented by KM. DN queried the CQUIN ‘Urgent Emergency Care - Reducing the proportion of avoidable emergency admissions to hospital.’ It was explained that due to the system pressures and an increase in number of admissions, this had not been achieved. KM noted that all CQUIN schemes are on track to be completed by the end of the year.

The QPSC noted the CQUIN Quarter 1 Report. 15-046 SIRI Report

The Quality and Patient Safety Committee received paper QPS15-045 SIRI Report, presented by SJ. SJ noted the joint SIRI panel with the CCG and the Trust will take place next week to collectively review outstanding Root Cause Analyses (RCA) including using a cluster methodology to investigate these further. The Audit of Medical Involvement in RCA table showed the number of doctors involved in RCAs raising concern that there is not enough medical input into RCA. LK highlighted the expectation that there should be appropriate medical engagement for all RCAs. The Trust are actively being encouraged to use a multi-disciplinary approval in order to gain more robust assurance. Improvement in responding to SIRIs in a timely manner has improved but two external reviews were requested to gain further assurance. KM noted that the CCG has a duty of candour in articulating the information found to patients and the public.

The QPSC noted the SIRI Report. Safeguarding 15-047 Safeguarding Adults Quarterly Reports

The Quality and Patient Safety Committee received paper QPS15-046 Safeguarding Adults Quarterly Reports.

The QPSC noted the Safeguarding Adults Quarterly Reports. 15-048 Safeguarding Children Quarterly Reports

The Quality and Patient Safety Committee received paper QPS15-047 Safeguarding Children Quarterly Reports, presented by LS.

The QPSC noted the Safeguarding Children Quarterly Reports. 15-049 Draft Safeguarding Annual Report

The Quality and Patient Safety Committee received paper QPS15-048 Draft Safeguarding

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Annual Report, presented by LS. LS stated the report demonstrates work done in the past year through the strategy and delivery plan. Dr Ali Robins, Named GP for Safeguarding Children has been appointed and will work with the Safeguarding Leads on the island for one day a week. LV questioned what the key issues and priorities are for IOW, and also what level of assurance was available in relation to achievement against these priorities. However due to time constraints, it was agreed that questions to be e-mailed to LS in order obtain further assurance and explore the issues further. It was noted both Lorraine Smith, Designated Nurse for Safeguarding Adults and Tracy Keats, Designated Nurse for Safeguarding Children will both be leaving their posts in the near future and this should be raised as a risk on the CCG’s Risk Register.

The QPSC noted the Draft Safeguarding Annual Report. ACTION: LV to e-mail LS with questions regarding further assurance on the safeguarding policies. LV/

LS 15-050 Draft Safeguarding Policy

The Quality and Patient Safety Committee received paper QPS15-049 Draft Safeguarding Policy, presented by LS. DN raised concern that whilst this has been done well in identifying roles and responsibilities, there is less assurance on delivery of some of those responsibilities. He stated all CCG policy documentation needs to be compliant with the CCG’s Policy Management Policy. The discussion held was brief and LS had left the room.

The QPSC noted the Draft Safeguarding Policy. 15-051 Governing Body Assurance Framework

The Quality and Patient Safety Committee noted paper QPS15-050 Governing Body Assurance Framework, presented by LK. LK reiterated that the Adult Safeguarding Lead in the Trust has had now been appointed. Within the CCG the posts for Senior Quality Manager and Care Home & Home Care Quality Support Manager posts are currently out for advert. DN highlighted his concern in relation to missing NHS constitution targets prior to the meeting, but noted his assurance following the verbal update from MF and ER.

The QPSC reviewed the Governing Body Assurance Framework.

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15-052 Escalation Status Report Action Plan The Quality and Patient Safety Committee received a verbal Escalation Status Report Action Plan update, by MF and ER. MF noted the diagnosis of the situation focuses on two key areas: system process and staff capacity. Immediate work needs to be done by individual organisations and an intensive support team are involved to work on the discharge process and assessment criteria, however the demand levels are not high. System resilience money and CCG contingency will fund 30 step-down beds in the community and 21 acute medical beds in the hospital. The hospital bed capacity is anticipated to be in place by the end of October but this is dependent on recruitment, as agency staff recruitment needs to be achieved. ER highlighted that elective surgery will not be funded by the CCG until medical support is in place in A&E and ambulances are operating more efficiently. The community was commended on managing the demand well, as patients are only being admitted to hospital when it is appropriate to do so to ensure they are in the right place for treatment.

The QPSC noted the Escalation Status Report Action Plan update. Items to Note 15-053 Papers to Receive/Note for Information

Clinical Quality Review Meeting Minutes July and August The Quality and Patient Safety Committee received and noted paper QPS15-052 Clinical Quality Review Meeting Minutes July and August, presented by KM. It was noted that the July Clinical Quality Review Meeting Minutes were a draft version and the final version needs to be circulated.

The QPSC noted the Clinical Quality Review Meeting Minutes July and August. ACTION: KM to circulate the final version of the July Clinical Quality Review Meeting Minutes. KM 15-054 NHS 111 Clinical Governance Committee Minutes June and July

The Quality and Patient Safety Committee received and noted paper QPS15-053 NHS 111 Clinical Governance Committee Minutes June and July, presented by LK.

The QPSC noted the NHS 111 Clinical Governance Committee Minutes June and July. 15-055 Clinical Effectiveness Committee 25.6.15 & 27.8.15

The Quality and Patient Safety Committee received and noted paper QPS15-054 Clinical Effectiveness Committee 25.6.15 & 27.8.15, presented by LK.

The QPSC noted the Clinical Effectiveness Committee 25.6.15 & 27.8.15. 15-056 Any Other Business

SJ had brought tabled paper QPS15-055 NHS National Staff Survey for Acute, however it was decided this would be brought to the November meeting once additional

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information had been gathered from Mental Health and Ambulance. ACTION: NHS National Staff Survey for Acute, Mental Health and Ambulance to be an agenda

item for the November QPSC meeting. JM

15-057 Date of Next Meeting: Thursday 26 November 2015, 09:30-11:30, Carisbrooke Room,

Block A, The Apex, St Cross Business Park, Newport, IOW PO30 5XW.

Circulation: Members In attendance: Ian Reckless – Secondary Care Doctor David Newton – Vice Chair and CCG Governing Body Lay Member Dr Benjamin Browne – Clinical Executive Member Joanna Smith - Healthwatch Representative Loretta Kinsella - Director of Quality and Clinical Services Lindsay Voss – Governing Body Nurse

Dr David Isaac – General Practitioner Samantha Johnson – Quality Manager Karen Morgan – Head of Quality Dr Lorraine Smith - Consultant (Designated) Nurse Safeguarding Children Jade McCann – Corporate Support Administrator (notes)

Invited: Helen Shields – Accountable Officer

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Quality and Patient Safety Committee Minutes of the Clinical Commissioning Group (CCG) Quality and Patient Safety Committee held on 26 November 2015 at 09:30 in Carisbrooke Room, Block A, The APEX, St Cross Business Park.

PRESENT: Dr Ian Reckless (IR) Secondary Care Doctor (Chair) Dr Benjamin Brown (BB) Clinical Executive Member

David Newton (DN) CCG Governing Body Lay Member Loretta Kinsella (LK) Director of Quality and Clinical Services Joanna Smith (JS) Healthwatch Locality Manager

Lindsay Voss (LV) Governing Body Nurse IN ATTENDANCE: Samantha Johnson (SJ) Quality Manager

Karen Morgan (KM) Head of Quality

MINUTED BY: Jade McCann (JM) Corporate Support Administrator

15-058 Welcome and Apologies for Absence Apologies for absence were received from Anita Cameron-Smith, David Isaac and Lorraine Smith.


The Quality and Patient Safety Committee received paper QPS15-055 Declarations of Interest, noting the following changes: • DN stated he is an occasional guest lecturer at the University of Southampton


The Committee met on 26 November 2015 and discussed the following key issues:

• Further work is ongoing in relation to the reporting of quality and performance data. The pace of this work has been reduced by competing pressures and priorities.

• It was noted that there appeared to be a high infection rate following Caesarean Section. It was not clear whether this was real or a data error, and clarification would be sought.

• The purpose and operation of a new CCG SIRI panel was discussed.

• The committee had detailed discussions about patient experience and complaints.

• Benchmarked results from an IOWNHS Trust staff survey were concerning. The committee wished to be assured at a future date that the survey had been analysed and responded to appropriately by IOWNHST.

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• LV undertook training at the Royal College of GP’s which was funded by a pharmaceutical company

ACTION: JM to send DI and LV new Declarations of Interest forms. JM 15-060 Confirmation the Meeting is Quorate

Confirmed.

15-061

Minutes of the Last Quality and Patient Safety Meeting 24 September 2015 The Quality and Patient Safety Committee received QPS15-056 Minutes of the Last Quality and Patient Safety Meeting 24 September 2015, noting the following: • IR noted that the ‘For the attention of the Governing Body’ summary from the previous

meeting incomplete, he confirmed he would complete this as soon as possible. • It was queried as to why the Workforce Data for District Nurses had been removed from

the agenda, with LK stated that David Isaac had originally raised this issue and it was felt staffing establishments have changed recently within the community. LK asked what where the specific concerns the committee had so she could ensure the concerns were adequately addressed. A discussion was held in regard to dependency and acuity criteria. It was noted that whilst there is no national model for staffing establishments in the community setting, clarity around the methodology and capacity of the community nursing workforce is required, including assurance around how integration will work in the future. LK will speak to Mark Rawlinson (MR)– Locality Lead for District Nursing to raise these issues and request MR to attend a QPSC meeting. • DN highlighted that for the item Draft Safeguarding Policy, it should be noted that the

discussion held was brief due to time constraints and LS had left the meeting early due to another engagement.

ACTION: IR to complete the ‘For the attention of the Governing Body’ summary.

LK to contact Mark Rawlinson regarding the gaps in community nurse workforce and the proposed model of future care.

IR LK


Schedule of Actions from 24 September 2015 The Quality and Patient Safety Committee received paper QPS15-057 Matters Arising - Schedule of Actions from 24 September 2015, presented by IR. The following discussion took place:

• 15-024 Peer Review Survey – JS stated that this is no longer a Healthwatch project and David Sellars – Modern Matron for Acute Mental Health in the Trust will be facilitating. KM highlighted that a semi-structured interview template had been developed by the Trust and will be brought to the January Clinical Quality Review Meeting to review. KM will feedback at the QPSC in January.

• 15-025 Key Metrics for End of Life Care – KM stated that the new data collection tool is more focused on the comfort and experience of the patient. A discussion will be held with the Trust to establish how the metrics can aligned with data from the Earl

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Mountbatten Hospice.

• 15-025 Quality Indicators - KM noted that the metrics had been reviewed with the Performance Team at the CCG; however there is data which is not contractually obliged to be release from the Trust and is not included. A new Senior Quality Manager for the CCG will commence in January 2016, which will provide KM an additional resource to further develop the dashboard.

ACTION: KM to provide a progress update on the semi-structured interview template for

Mental Health. A revised draft of the dashboard to be brought to the January QPSC.

KM KM

Items for Discussion/Decision Performance 15-063 Quality Dashboard

The Quality and Patient Safety Committee received paper QPS15-058 Quality Dashboard, presented by KM. KM stated that the performance team are working towards having a Performance on a Page document which will be broken down into the various services, to ensure all aspects of services provided can be equally and easily monitored. It was noted that any gaps shown is where the Trust does not currently provide this level of detail and KM will work with the Trust to retrieve this data. IR highlighted the need to determine what data is available with a view of putting together an integrated report which can be commented on as a final product. It was noted that the use of trend indicators is positive but a glossary is important to define what certain terms mean. The Maternity Quality Indicators were discussed and the high figures for Caesarean section site infections were raised as a concern; KM stated she had spoken to the Head of Midwifery for further information. The Committee asked to be updated on this issue in January. BB noted that the emergency C-sections should be changed from ‘amber’ to ‘green’ as it is less than 12%. DN questioned why the Friends and Family Test did not have a target; KM confirmed that there are no fixed national benchmark requirements in general contracts, only to undertake the test.

The QPSC noted the Quality Dashboard. ACTION: KM to produce a revised performance report including a glossary for next meeting.

KM to establish details in relation to apparent high rate of Caesarean infections. KM KM

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15-064 Clinical Governance Report

The Quality and Patient Safety Committee received paper QPS15-059 Clinical Governance Report, presented by KM. IR asked for clarification regarding the issue with Incident Reporting in Primary Care and the CCG. KM stated that the Trust had served notice on the current DATIX system and would be withdrawing this imminently. This is as a result of the small capacity of administration staff, in addition to the GP’s having migrated to nhs.net e-mail accounts and therefore any information sent to the DATIX system is not encrypted. A new system called QUASAR will be considered for primary care reporting only as an alternative to reporting incidents. DN highlighted concern regarding the number of 12 hour trolley breaches in September and October. LK stated that the revised system resilience plan included an increase in beds at the hospital and the 30 bedded unit off site in Solent Grange with an expectation this will lead to a significant reduction in 12 hour trolley breaches. LK stated she was concerned at the level of 12 hour trolley breaches and would have this at the next Contract Review Meeting. LK requested KM to change the ‘should do’ action completion date from 2015 to 2016. Terms of Reference LK clarified that the CCG Serious Incidents Requiring Investigation (SIRI) panel will discuss all SIRIS prior to the Joint SIRI panel meeting held with the Trust. DN noted that the Terms of Reference should be more explicit in regard to how often the Trust is meeting.

The QPSC noted the Clinical Governance Report. ACTION: KM to change the ‘should do’ action completion date from 2015 to 2016. KM 15-065 Patient Experience Report

The Quality and Patient Safety Committee received paper QPS15-060 Patient Experience Report, presented by SJ. SJ clarified that in relation to complaint CCG64, patient consent had been received prior to the information being sent to NHS England. KM stated that a CQUIN had been set recognising the importance of improving communications to the structure of the quality department. DN highlighted that Whippingham Ward was mentioned more often with regard to complaints received compared to other wards. LK noted that high reporting for all quality intelligence will be triangulated and trigger clinical inspection visits by the quality team.

The QPSC noted the Patient Experience Report.

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15-066 Complaints Policy The Quality and Patient Safety Committee received paper QPS15-061 Complaints Policy, presented by SJ. SJ stated that this was a review of the current Complaints Policy and sets out the way in which the CCG will encourage feedback and respond to comments, concerns and complaints in respect of the services it commissions. This policy has been developed using National Guidelines but altered to reflect the Isle of Wight requirements. DN asked who was the Investigating Officer; SJ clarified that this is not a role for one person. Based on the complaint subject matter it is assigned to the most relevant manager who then assigns an Investigating Officer. KM noted that criteria had been created for vexatious and persistent complainants; whilst no complaint will ever be dismissed, there is a clear policy in place on how to manage these individuals. BB highlighted that the expression of gratitude should be made more explicit to state the quality of any service provided.

The QPSC approved the Complaints Policy. 15-067 Healthwatch Complaints Report

The Quality and Patient Safety Committee received paper QPS15-062 Healthwatch Complaints Report, presented by JS. JS stated that from April 2015 to June 2015, a survey on patient experience of complaints processes was conducted and Healthwatch asked the Trust to send surveys to everyone who had made a complaint from January 2015 to April 2015. 190 complainants were identified and 70 were returned directly to Healthwatch. 87% of these respondents stated they were unsatisfied with the response to their complaint and 64.5% reported they felt there would be adverse effects on their future care as a result of complaining. Enter and View visits were undertaken by Healthwatch to the majority of clinical areas at St Marys Hospital and these visits reported that complaints procedures are not well publicised and staff’s understanding of the complaints pathway was highly variable. JS highlighted that Healthwatch led a national complaints investigation and these results are not dissimilar to those nationally. JS is working with Alan Sheward – Executive Director of Nursing to look at change and is assured he is committed to improvement. The Overview and Scrutiny Committee will review after six months. LK stated that the Trust Development Authority also raised concern about patient experience in regard to the process of how to complain. Showing it should be made simpler and a complaint dealt with in a timely manner. JS noted that generally the GP surgeries display good material in their ‘How to Complain’

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procedures, but need to be more information about the role of Healthwatch and that they can conduct Enter and View visits.

The QPSC noted the Healthwatch Complaints Report. 15-068 Healthcare Acquired Infections

C-Difficile Review The Quality and Patient Safety Committee received paper QPS15-063 C-Difficile Review, presented by KM. KM stated that the CCG has regular discussions with the Trust microbiologist regarding cases of C-Difficile and although the increasing numbers are a concern, it does not appear to be a prescribing issue but associated with isolation and hygiene practices. A meeting is to be held on the 3rd December with regard to around island wide management of C-Difficile improving understanding of cases in the community and the acute sector. LK stated the requirement to look at recommendations of best practice and to explore cases in the community, which will be possible once the newly appointed Quality is in post releasing KM to take the lead on Infection Prevention and Control for the CCG. BB questioned were cases of C-Difficile higher on the Island compared nationally. It was confirmed that the Island does currently have a higher incidence rate, but this needs to be viewed in context i.e these figures include relapses. KM stated that a log is kept by the Trust of all community cases and this is shared with the Medicines Management tea to inform their work on antibiotic prescribing in Primary Care.

The QPSC noted the C-Difficile Review. 15-069 NHS National Staff Survey for Acute, Mental Health and Ambulance

The Quality and Patient Safety Committee received paper QPS15-064 NHS National Staff Survey for Acute, Mental Health and Ambulance, presented by SJ. SJ stated that a national staff survey had been conducted for employees within the acute, mental health and ambulance sector. It was noted that the response rate was lower from all sectors compared to the 2013 surveys. IR questioned what the Trust is doing in response to the data collected; SJ stated that an action plan has been requested from the Trust but has not yet been received. LK noted the importance of gaining assurance that appropriate action is taking place. The Committee wished to receive assurance at a future date as to the Trust’s response to this survey.

The QPSC noted the NHS National Staff Survey for Acute, Mental Health and Ambulance. ACTION: SJ to chase National Staff Survey for Acute, Mental Health and Ambulance Action Plan. SJ 15-070 Future Safeguarding Papers

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The Quality and Patient Safety Committee received a verbal Future Safeguarding Papers update, from LV. LV stated that it would be helpful to have a clearer understanding of intelligence that is for information purposes only, and what the risks and gaps are in safeguarding. LV suggested it would be useful to understand Safeguarding in Primary Care and how it applies for delegated commissioning. LK highlighted that currently it is not the responsibility of the Quality and Patient Safety Committee to have oversight of Primary Care as the CCG does not hold GP’s to account and delegated commissioning needs to go through an approval process via NHS England first. Oversight for adult and children safeguarding is provided through the local Safeguarding Boards and the SIRI process where the CCG is able to influence and has a mandatory role. LV noted she would like to have a clear vision of where the risks are and what the barriers are to good practice in relation to safeguarding. LK stated that this can be worked towards to further assure the Governing Body, but the key current risk is the CCG having no designated safeguarding nurses in place sue to resignation and retirement of current postholders. KM highlighted the challenge for the CCG but confirmed applications for a joint safeguarding nurse had been shortlisted and interviews would be taking place on 1st December. It was confirmed that there are Local Adult and Children Safeguarding Boards, therefore IR recommended that these Boards should be made aware of the imminent changes in commissioning arrangements for primary care, in order to take a view on current and future gaps in assurance and how best to bridge these. .

The QPSC noted the Future Safeguarding Papers update. ACTION: Future safeguarding reports to more clearly define the risks and gaps in regard to

Safeguarding for the CCG aligned with it’s roles and responsibilities. LK

Items to Note 15-071 Papers to Receive/Note for Information

Clinical Quality Review Meeting Minutes July and October The Quality and Patient Safety Committee received and noted paper QPS15-065 Clinical Quality Review Meeting Minutes July and October, presented by LK.

The QPSC noted the Clinical Quality Review Meeting Minutes July and October. 15-072 NHS 111 Clinical Governance Committee Minutes October and November

The Quality and Patient Safety Committee received and noted paper QPS15-066 NHS 111 Clinical Governance Committee Minutes October and November, presented by LK.

The QPSC noted the NHS 111 Clinical Governance Committee Minutes October and

November.

15-073 Clinical Effectiveness Committee October

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The Quality and Patient Safety Committee received and noted paper QPS15-067 Clinical Effectiveness Committee October, presented by LK.

The QPSC noted the Clinical Effectiveness Committee October. 15-074 Any Other Business 15-075 Date of Next Meeting: Thursday 28 January 2016, 09:30-11:30, Carisbrooke Room,

Block A, The Apex, St Cross Business Park, Newport, IOW PO30 5XW.

Circulation: Members In attendance: Ian Reckless – Secondary Care Doctor David Newton – Vice Chair and CCG Governing Body Lay Member Dr Benjamin Browne – Clinical Executive Member Joanna Smith - Healthwatch Representative Loretta Kinsella - Director of Quality and Clinical Services Lindsay Voss – Governing Body Nurse

Anita Cameron-Smith – Public Health Samantha Johnson – Quality Manager Karen Morgan – Head of Quality Jade McCann – Corporate Support Administrator (notes)

Invited: Helen Shields – Accountable Officer

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Governing Body

Minutes of the Joint Committee for Primary Care 1 October & 3 December 2015


Summary of issue: Minutes of the Joint Committee for Primary Care.


To note and approve the minutes of the Joint Committee for Primary Care.


Other committees where this has been considered: There are no other committees where this has been considered.







Author of Paper: Jade McCann, Corporate Support Administrator

Date of Paper: 2 October 2015



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https://upload.wikimedia.org/wikipedia/en/1/10/NHS_England_logo.png

Joint Committee for Primary Care 1 October 2015

Minutes of the Clinical Commissioning Group (CCG) Joint Committee for Primary Care held on 1 October 2015 at 14:00 in Hunnyhill Room, The Riverside Centre, The Quay, Newport, Isle of Wight PO30 2QR

PRESENT: Helen Shields (HS) – Chief Officer (Chair) Rida Elkheir (RE) – Associate Director of Public Health Dr Joanne Hesse (JH) – CCG Clinical Executive Caroline Morris (CM) – Head of Primary Care and Corporate Business Lindsay Voss (LV) – Governing Body Nurse Julia Bagshaw (JB) – Interim Director of Commissioning Wessex (NHS England) Martyn Rogers (MR) – Assistant Contract Manager for Primary Care (NHS England) Hab Singh (HSi) - Assistant Head of Finance (NHS England)

IN ATTENDANCE: Carol Giles (CG) – Assistant Contract Manager for Primary Care (NHS England) Matt Leek (ML) – Finance Manager Chris Orchin (CO) – Chair of Healthwatch

MINUTED BY: Jade McCann (JM) – Corporate Support Administrator

15-017 Apologies for Absence Apologies of absence were received from: Steve Gooch (SG) – Director of Finance at NHS England,

Loretta Outhwaite (LO) – Chief Finance Officer, Frederick Psyk (FP) – CCG Lay Member for Governance and Joanna Smith (JS) – Healthwatch Isle of Wight Locality Manager. ML attended the meeting in LO’s absence, he was delegated LO’s vote. HSi attended the meeting on Steve Gooch’s behalf. CO attended the meeting on Joanna Smith’s behalf.

For the attention of the Governing Body :

• First meeting in public of the Joint Committee for Primary Care. • Discussed CCG delegated commissioning for Primary Care. • Approved a proposal for a service to improved Primary Care quality prescribing and reducing the

cost of prescribing. • Received a report relating to CQC inspection at 8 practices. One rated as requires improvement,

remainder good.

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HS noted this was the first formal meeting to be held in public.


The Joint Committee for Primary Care received paper PC15-006 Declarations of Interest, presented by HS. JH declared she is a GP at Esplanade Surgery, which is a member of the One Wight Health Isle of Wight GP collaborative. JH noted a conflict of interest will arise in regards to agenda Item 6 – Primary Care Prescribing Quality Proposal. CG stated she had no interests to declare.

ACTION: JH and JS are to be added to the declarations of interest. JM 15-019 Minutes of the Last Joint Committee for Primary Care Meeting 9 July 2015

The Joint Committee for Primary Care received paper PC15-007 Minutes of the Last Joint Committee for Primary Care 9 July 2015, presented by HS. The following comments were made: • 15-005 Future Chair of Committee: HS stated the minutes should be made clearer, and she will

act as deputy chair in the absence of the CCG Lay Member. • 15-009 QOF Performance: The date should read 2014/2015. • 15-010 Primary Care Sign Up and Budget: The title of this paper should be changed to ‘CCG

Primary Care Sign Up to Enhanced Services and Budget.’


i. Schedule of Actions from 9 July 2015 The Joint Committee for Primary Care received paper PC15-008 Schedule of Actions from 9 July 2015, presented by HS. • 15-003 Removal of JH as a Member: HS stated this action is outstanding and not closed, as the

constitution has not been formally changed therefore the membership of JH cannot yet be agreed.

• 15-009 Non-Participating Practices Regarding Learning Disabilities: CM clarified that whilst practices are providing a healthcare service for learning disabilities, not all had signed up to the Directed Enhanced Services (DES) agreement. This action is to be left open as there is continuing action taking place at locality level.

• 15-011 Feedback for Finance Paper: HSi confirmed feedback had been received and Steve Gooch is continuing to develop the paper, however the content will focus mainly on financial transactions.

• 15-013 GP Patient Survey: CM noted there has not been the capacity to produce the overarching paper, however it was suggested the original could be shared with practices.

The Joint Committee for Primary Care received the Schedule of Actions from 9 July 2015. ACTION: CM to send out the GP Patient Survey to GP practices. CM Items for Decision/Discussion 15-021

Delegated Commissioning The Joint Committee for Primary Care received paper PC15-009 Delegated Commissioning, presented by CM.

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CM stated this paper was brought to the committee to explain the reasons for applying for delegated commissioning, the risks involved and the timeline of the process, in addition to discussing potential arising issues from the perspective of NHS England. JB noted the following: • The CCG will be able to make grants from revenue for primary care. NHS England retains the

capital powers. • While NHS England may agree changes to the national primary care contracts such as a

reduction of Minimum Practice Income Guarantee, the CCG would carry out the transactional elements of the change. JB also highlighted that NHS England are exploring how CCG’s could be more involved in market entry decisions for pharmacy and be involved in the discussion but not the decision. MR noted that the paper stated the CCG take over GP complaints management, however this had not yet happened. LK explained this is the intention, but additional resources will be required within the CCG once the legislative framework has been amended. HSi highlighted that the budget under delegated commissioning is the same as under co-commissioning; the CCG’s will receive the budget plus headroom and a contingency fund. Whilst this money is not technically ring-fenced, the expectation is that NHS England will be held to account nationally for reporting all delegated spend. JB has recommended that the steering group for delegated commissioning be extended so all CCG’s can discuss their experiences of the delegated commissioning process.

The Joint Committee for Primary Care discussed the Delegated Commissioning. ACTION: CM to take a decision regarding delegated commissioning to the Membership Council. CM 15-022 Primary Care Prescribing Quality Proposal

The Joint Committee for Primary Care received paper PC15-010 Primary Care Prescribing Quality Proposal, presented by CM. JH stated her conflict of interest and it was decided by the committee that she should stay in the room and contribute, however as she is not a voting member she will not participate in the decision. CM stated that this seeks approval for the ‘Platinum Points,’ which is an outcome based service that will deliver improved safety and quality in prescribing within Primary Care. There are two key elements to the scheme; the first is to ensure practices undertake the work necessary to reduce the rising cost of prescribing without compromising quality, and the second is aimed at driving improvement in the patient safety and quality of prescribing in relation to CCG objectives. MR queried as to why the contract was proposed as three years as this could be reviewed annually. He also asked for transparency in regards to the amount of practices who have achieved a level of prescribing cost effectiveness beyond the secondary target and what action plan is put in place for these practices. After discussion this was not supported. It was noted that Scriptswitch had been temporarily halted, but once this has reactivated it should result in better value. The committee approved the proposal on a one year basis, agreeing that the CCG Chief Officer’s Group can oversee the detailed specification, however clarity is required around arrangements to the dispensing practice and therefore needs to come back to the next Joint Committee for Primary Care.

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The Joint Committee for Primary Care approved the Primary Care Prescribing Quality Proposal for one year.

ACTION: Primary Care Prescribing Quality Proposal to be made clearer regarding dispensing practice

and be brought back to the Joint Committee for Primary Care. CM

15-023

Personal Medical Services Review The Joint Committee for Primary Care received a verbal update regarding the Personal Medical Services Review, by MR. MR stated that a review commenced in two island practices. A letter asking practices to review the information and submit any reasons why they are delivering services over and above the expectations of their current GMS contract. The deadline for these submissions is the 2nd November. Following an NHS England review, the submissions will be provided to the CCG to examine and determine services they wish to continue to fund. HS highlighted that two island practices that will be impacted by the national change, and will result in them receiving less income, but this money is reinvested into all primary care services. CM noted that the investment amount is low over each of the five years in which this will be phased, but as a whole is significant. This is likely to result in insufficient funds to commission new services over all the island practices unless the full value is available. It was agreed options will be discussed at the next Joint Committee for Primary Care.

The Joint Committee for Primary Care noted the PMS Review. ACTION: Options regarding the reinvestment into Primary Care from the Personal Medical Services

contract to be explored. CM

Items for Information 15-024 Finance Report

The Joint Committee for Primary Care received paper PC15-011 Finance Report, presented by HSi. JB commented on the totally balanced position was because Wessex have a requirement to use the reserve balance. It was agreed this would be shown separately in future to show variances.

The Joint Committee for Primary Care noted the Finance Report. 15-025 Healthwatch Enter and Review Reports

The Joint Committee for Primary Care received a verbal update regarding the Healthwatch Enter and Review Reports, by CO. CO stated that in May 2015, Healthwatch looked at how nine island practices manage their complaints. Each surgery has now been issued with a report which identifies good practice and recommendations for improvement to influence and guide direction. An overall report is currently being produced which is hoped to be able to share in the next month and it is anticipated for a review to take place again in November 2016 to measure any differences. CM highlighted that practices need to be aware that Healthwatch can carry out these investigations and need to understand the framework to do so; CM is to communicate this with

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practices. CO asked from a public engagement viewpoint what aspect of the GP service makes an impact and HS suggested this is discussed with CM using the GP Survey to gain an understanding.

The Joint Committee for Primary Care noted the Healthwatch Enter and Review Reports. ACTION: CM to communicate with GP practices regarding Healthwatch investigations. CM 15-026 CQC Report Outcomes

The Joint Committee for Primary Care received paper PC15-012 CQC Report Outcomes, presented by CM. CM noted a CQC inspection had taken place at eight practices, including the Beacon centre. One reported as requires improvement, the remaining good with three occasions reporting outstanding practice. It was noted that the CCG can support in three key areas: • A focus is needed on infection, prevention and control • Peer review cycles are not evidenced in some practices • Reinforce the importance of attending mandatory training

JB queried if the CCG would charge practices to provide the support needed, however it was confirmed this is not the case as it is a benefit of being a part of the membership. With respect to the practice which required improvement, it was stated that the practice will have to establish an action plan and CQC will monitor this.

The Joint Committee for Primary Care noted the CQC Report Outcomes. 15-027 Any Other Business

15-028 Motion to Exclude the Press and Public

HS read the following statement: “that representatives of the press, and other members of the public, be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest’, (Section 1 (2), Public Bodies (Admission to Meetings)”

15-029 Date of Next Meeting: Thursday 3 December 2015, 09:00-12:00 – Venue TBC.

Circulation: Members In attendance: For Information (Agenda): Helen Shields (HS) – Chief Officer (Chair) Rida Elkheir (RE) – Associate Director of Public Health Loretta Kinsella (LK) – Director of Quality and Clinica Services Caroline Morris (CM) – Head of Primary Care and Corporate Business Loretta Outhwaite (LO) – Chief Finance Officer Lindsay Voss (LV) – Governing Body Nurse Julia Bagshaw (JB) – Interim Director of Commissioning Wessex (NHS England) Carol Giles (CG) – Assistant Contract Manager for

Jade McCann (notes) Carol Giles Joanna Hesse Matt Leek Hab Singh Louise Wells

For Information (Minutes):

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Primary Care (NHS England) Steve Gooch (SG) – Finance Director (NHS England) Martyn Rogers (MR) – Assistant Contract Manager for Primary Care (NHS England)

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Joint Committee for Primary Care 3 December 2015

Minutes of the Clinical Commissioning Group (CCG) Joint Committee for Primary Care held on 3 December 2015 at 10:00 in The Restaurant, The Riverside Centre, The Quay, Newport, Isle of Wight PO30 2QR

PRESENT: Helen Shields (HS) – Chief Officer (Chair) Julia Bagshaw (JB) – Interim Director of Commissioning Wessex (NHS England) Clare Bryan (CB) – Deputy Director for Finance (NHS England) (for Steve Gooch) Rida Elkheir (RE) – Director of Public Health (until item 8) Carol Giles (CG) – Assistant Contract Manager for Primary Care (NHS England) Caroline Morris (CM) – Head of Primary Care and Corporate Business Dr Joanne Hesse (JH) – CCG Clinical Executive Martyn Rogers (MR) – Assistant Contract Manager for Primary Care (NHS England) Dr John Rivers (JR) – CCG Chairman and GP Lead for Primary Care (until item 9) Laurence Taylor (LT) – Governing Body Lay Member (observing) Lindsay Voss (LV) – Governing Body Nurse Becky Wastall (BW) – Deputy Chief Finance Officer

IN ATTENDANCE: Chris Orchin (CO) – Chair of Healthwatch Martyn Rogers (MR) – Assistant Contract Manager for Primary Care (NHS England)


15-030 Apologies for Absence Apologies for absence were received from Steve Gooch (SG) – Director of Finance (NHS England)

and Loretta Outhwaite (LO), Chief Finance Officer (CCG). CB attended the meeting on behalf of SG, BW attended the meeting on behalf of LO, she was delegated voting rights. Laurence Taylor (LT) was introduced as the CCG’s new Governing Body Lay Advisor – Independent. He observed


• Approved - The direction of travel for the Reprocurement of the CCG locally commissioned services. - The approach to determining the applications by practices for reinvestment of the Personal Medical

Services (PMS) premium. • Did not approve the dispensing practice prescribing scheme. Agreed revised proposal required and a

decision would be made by the voting members. • Discussed the Garfield Road, Ryde practice closure and the need to manage the migration of patients.

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the meeting, but would be taking over as Chair of the committee for future meetings. Martyn Davies was also introduced as the new CCG Governing Body Lay Advisor – Governance, he also attended in an observational capacity.

15-031 Declarations of Interest The Joint Committee for Primary Care received paper PC15-013 Declarations of Interest; there were no new declarations in relation to the paper. However in relation to agenda items both JR and JH as GP Partners of two Island GP Practices declared an interest in item 5 Locally Commissioned Services: Procurement Options 16/17. JH also declared an interest in item 8 Garfield Road Practice – Update, being a GP Partner of a GP Practice that is affected by the Garfield Road closure. It was agreed that both JH and JR would remain in the room for the items, contribute to discussion, but not be part of decision making.

15-032 Minutes of the Last Joint Committee for Primary Care Meeting 1 October 2015

The Joint Committee for Primary Care received paper PC15-014 Minutes of the Last Joint Committee for Primary Care 1 October 2015. These were approved as a true and accurate record, with no changes.


i. Schedule of Actions from 1 October 2015 The Joint Committee for Primary Care received paper PC15-015 Schedule of Actions from 1 October 2015. All actions were closed, however the following was discussed for clarity: • 15-003 JH Membership of Committee – JH commented that her membership status had not

been updated. It was confirmed that JH is a member of the committee but not a voting member.

• 15-013 / 15-020 GP Patient Survey Results – it was confirmed that the GP Patient Survey results original paper has been shared with practices via Locality Meetings and the CCG Extranet.

• 15-021 – Delegated Commissioning to Membership - it was confirmed this was discussed at the Membership Council meeting on 8 October 2015.

• 15-025 – Healthwatch Investigations – CM confirmed that GPs had been informed about Healthwatch Investigations at the November Locality meetings and shared via the CCG Extranet.

HS requested that more information was included in the update section of the schedule of actions in future for clarity.

The Joint Committee for Primary Care received the Schedule of Actions from 1 October 2015. Items for Decision 15-034

Locally Commissioned Services: Procurement Options 16/17 The Joint Committee for Primary Care received paper PC15-016 Locally Commissioned Services: Procurement Options 16/17, presented by LW. JH and JR declared an interest in this item, they participated in the discussion but not in the decision making process. The paper outlined the proposed work programme for recommissioning primary care local

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services between now and April 2016. HS queried the capacity in order to reprocure the services. LW confirmed that a meeting was due to take place with the reprocurement support services team the following week. MR queried whether a matrix will be used when determining the services, it was confirmed that a matrix would be used where applicable. It was discussed that April 2016 is not a lot of time to reprocure services, it was confirmed that once the meeting has taken place with the reprocurement support team it will be clear how ambitious the plans are. Any contracts that can’t be reprocured by April 2016 will be extended until March 2017. It was requested that a procurement plan and matrix was produced for the next meeting. HS queried in relation to 005 Primary Care Management of Deep Vein Thrombosis (DVT) what the risk is as a result of the D-dimer test strips no longer being available. JH commented that there is no patient risk, the change results in a blood test needing to be performed by the Pathology Department. If a patient is deemed high risk, treatment will commence and be reviewed once the blood test results have been received.

The Joint Committee for Primary Care agreed the direction of travel for the Reprocurement of

the IOW CCG Locally Commissioned Services.

ACTION: A Procurement Plan and Matrix in relation to the IOW CCG Locally Commissioned Services to

be presented to the committee on the 11 February 2016. CM/ LW

15-035 Personal Medical Services (PMS) Contracts Review and Reinvestment

The Joint Committee for Primary Care received paper PC15-017 PMS Contracts Review and Reinvestment, presented by CM. NHS England is undertaking a review of GP Practices holding PMS contracts. Historically practices that hold PMS contracts have been based on an inclusive price and included a financial premium. The intention of the exercise is therefore to identify the premium and remove it over a five year period so that unwarranted financial difference between practices has been eroded. The money released from this process will be made available to the CCG for reinvestment in primary care. The Isle of Wight has two PMS Practices, the CCG has been advised that the sum available for reinvestment will be in the region of £130k at the end of the 5 year transition period starting with £26k in 2016/17. CM has requested whether the money can be received from the CCG in a block rather than on an annual basis over five years. Both practices have been issued with paperwork and a template to complete so they can make a case outlining why they believe they are delivering services over and above core requirements. CM highlighted that the CCG has received a set of templates from both PMS practices and now needs to complete a review and consider whether a case is made by the practices. CM presented a process by which the CCG could review the paperwork. It was suggested that a one-off panel consisting of the Local Medical Committee (LMC), NHS England, CCG, a member of the Clinical Executive who is not a GP and a Lay Representative. JB suggested that an Independent GP should also sit on the panel to gain clinical input, this needs to be explored with the PMS Practices. It was agreed that a timeline needed to be put together to allow adequate time for discussion and to allow contracts to be finalised, with a recommendation paper presented to the February meeting for approval.

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The Joint Committee for Primary Care approved the approach to determining the applications by

practices for reinvestment of the PMS Premium.

ACTION: Timeline to be put to together for PMS panel and sign off. CM to explore clinical engagement on PMS panel with GP Practices.

CM/MR CM

15-036

Dispensing Practice Prescribing Scheme The Isle of Wight CCG Primary Care Primary Prescribing Quality proposal for the dispensing practice was not available in time for committee members to review prior to the meeting. The service is outcomes based to deliver improved safety and quality in prescribing within Primary Care, whilst tackling key Government health concerns such as antibiotic prescribing. CM identified the need that operationally she required a decision for what to do this year, but noted that the scheme needs to be re-negotiated for future years. It was agreed a decision could not be reached at the meeting; however one would need to be reached before the next committee meeting. It was agreed that the paper would be circulated to members; any comments should be fed back to CM by Friday 11 December. CM would then put a proposal together for voting members to make a decision.

The Joint Committee for Primary Care did not approve the Dispensing Practice Prescribing

Scheme. It was agreed the Primary Care Prescribing Quality proposal would be circulated to members for comments and a proposal would be put together for voting members to make a decision.

ACTION: CM to share the Primary Care Prescribing Quality Proposal with members for feedback then

put a proposal together for voting members to make a decision regarding the Dispensing Practice Prescribing Scheme.

CM

Items for Discussion/Assurance 15-037 Garfield Road Practice – Update

The Joint Committee for Primary Care received a verbal update regarding the Garfield Road Practice, by MR. MR confirmed that Drs Majumdar had given notice on their GMS Contract and their practice will close in March 2016. The patient list is 2500 and to date no decision has been reached as to what happens to that patient list. HS expressed concern that the migration of patients’ needs to managed quickly and that patients need to be informed regarding their options. It was agreed that a letter need to be shared with patients before Christmas outlining the change. This letter also needs to be shared with GP Practices and key stakeholders so the message is consistent.

The Joint Committee for Primary Care noted the Garfield Road Practice update. ACTION: JB and MR to share a letter regarding the closure of Garfield Road Surgery to patients, GP

Practices and key stakeholders. JB/ MR

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15-038 Review of Dispensing Patient Lists

The Joint Committee for Primary Care received paper PC15-019 Review of Dispensing Patient Lists, presented by JB. NHS England has a policy in place which requires local offices to carry out an annual validation exercise to ensure that dispensing practices only dispense to eligible patients. CM queried if the CCG are approved for Delegated Commissioning would this then become the CCG’s remit to complete. It was confirmed that it would be.

The Joint Committee for Primary Care noted the Review of Dispending Patient Lists. 15-039 Finance Report

The Joint Committee for Primary Care received paper PC15-020 Finance Report, presented by CB. The report highlighted the following: • The year to date month 7 position is reporting a break even across the main components of the

medical services budgets, in line with expectation. There are no commitments against the headroom giving an underspend of £104k year to date and a forecast underspend of £178k.

HS commented that the format of the report was not what had been requested at the previous meeting as it does not highlight any variances. It was agreed that BW would discuss the future format of the report with Hab Singh, Assistant Head of Finance (NHS England).

The Joint Committee for Primary Care noted the Finance Report. ACTION: BW to discuss the future format of the Finance Report with Hab Singh, Assistant Head of

Finance (NHS England). BW

15-040 Governing Body Assurance Framework

The Joint Committee for Primary Care received paper PC15-021 Governing Body Assurance Framework, presented by CM. The paper was taken as read, with no questions in relation to the paper. CM commented that she will put a proposal together for the next meeting in relation to the Governing Body Assurance Framework and Primary Care for discussion.

The Joint Committee for Primary Care noted the Governing Body Assurance Framework. ACTION: CM to put together a proposal for the new Governing Body Assurance Framework in relation to

Primary Care for the February 2016 meeting. CM

15-041 Forward Look

The Joint Committee for Primary Care received paper PC15-022 Forward Look, presented by JB. The Forward Look highlighted the following: • Clinical Pharmacists Pilot – a national pilot to introduce and evaluate new ways of working

with clinical pharmacists in general practices establishing a number of pilot sites across England. Three schemes submitted in Wessex have been successful in attracting funding.

• Transformation Fund – CCGs are to identify as part of emergency their emerging estates strategy those premises developments which are the highest priority for funding over the next

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three years.

• Winter Resilience – NHS England has made available a total transformation fund of £1m to support CCGs to commission services in primary care to assist in the delivery of system resilience over the coming winter.

• Workforce Data Collection – not all GP Practices have sent their completed workforce census return. It was suggested that the details of practices who have not completed the return should be sent to CM to chase.

JH queried if any feedback had been received regarding the recent Indemnity Workshop. It was confirmed that no feedback had been received.

The Joint Committee for Primary Care noted the Forward Look. ACTION: Details of practices who have not completed the Census data return should be sent to CM to

chase. JB

15-042 Any Other Business

HS highlighted that Quality and Performance is not currently reported to the committee. It was agreed that a position statement could be provided for a part 1 meeting, with a part 2 discussion regarding key metrics. LK agreed to have liaise with Sarah Mussett, NHS England to discuss how to take this forward.

ACTION: Primary Care Performance position statement to be presented to part 1 of the meeting in

February 2016. LK to liaise with Sarah Mussett reporting of key quality metrics.

CM

LK 15-043 Date of Next Meeting: Thursday 11 February 2016, 10:00-12:00 – Venue TBC.

Circulation: Members In attendance: (V) Helen Shields – CCG Chief Officer (Chair) Rida Elkheir – Associate Director of Public Health, Local Authority (V) Carol Giles- NHS England Commissioning Manager Joanna Hesse – CCG Clinical Executive Loretta Kinsella – CCG Director of Quality and Clinical Services Caroline Morris – CCG Head of Primary Care and Corporate Business (V) Loretta Outhwaite – Chief Finance Officer John Rivers – CCG Chairman & GP Lead for Primary Care (V) Laurence Taylor – Governing Body Lay Member Lindsay Voss – Governing Body Nurse (V) Julia Bagshaw - Director of Commissioning (NHS England) (V) Steve Gooch - Director of Finance (NHS England)

Rebecca Berryman, Governance Support Manager (CCG) (notes) Chris Orchin – Healthwatch Locality Manager Representative of the Health and Wellbeing Board Martyn Rogers - Commissioning Manager (NHS England)

(V) = voting member

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Governing Body Agenda – Part 1 Thursday 4 February 2016 ... · 5.2 Governing Body Assurance...

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Transcript of Governing Body Agenda – Part 1 Thursday 4 February 2016 ... · 5.2 Governing Body Assurance...