GOVERNING BODY MEETING – A meeting in public€¦ · MT reported that the CCGs QIPP challenge...

Agenda – Wirral Governing Body Meeting PUBLIC SESSION – 2ND May 2017 of 3

GOVERNING BODY MEETING – A meeting in public

Tuesday 2nd May 2017

Old Market House, Nightingale Room

1pm - 4pm

AGENDA

Ref No.

No Time Item Action Papers

GB17-18/0005 1. 1.00pm PRELIMINARY

BUSINESS/ADMINISTRATIVE ITMES (Chair)

1.1 Apologies for Absence 1.2 Chair’s Announcements To Note 1.3 Declarations of Interest 1.4 Welcome and

Comments/questions from members of the public (10 mins)

1.5 Minutes and Action Points of Last Meeting – 7th March 2017 Action Points

To Approve

2. DRAFT GB Minutes PUBLIC MEETING 07.03

3. MASTER - CORPORATE ACTION L

1.6 Matters Arising To Approve

1.7 Patient Story (Lorna Quigley)

To Note Presentation

1.8 Chief Officer’s Update (Simon Banks)

To Note Verbal

GB17-18/0006

2. 1.20pm RISK MANAGEMENT 2.1 Risk Register

(Paul Edwards) To

Discuss 4. MASTER Risk

Resgister -May GB me GB17-18/0007

3. 1.30pm FINANCE 3.1 Chief Financial Officer’s

Report (Mike Treharne)

• Finance Committee

To Note

To Note

5. Finance report cover sheet - May GB 2

6. Finance Report 16-17 - May GB 2017.d

7. Appendix 1 Governing Body - Finan

8. Finance Committee 21 March 2017 Chairs


Ref No.


Chair’s Report (Lesley Doherty)

• Turn Around Group Update Report (Mike Treharne)

To Note

9. Turnaround Group update reportGB.docx

GB17-18/0008

4. 1.50pm PERFORMANCE AND COMMISSIONING

4.1 Director of Commissioning’s Report (Nesta Hawker)

• Primary Medical Care Co-Commissioning Committee Chair’s Report

(Linda Roberts)

To Note

To Note

10. Cover Sheet Director of Commission

11. Director of Commissioning Report

11A. Copy of Copy of Operational Plan Dash

12. PMCCC Chair report 14.3.17.docx

GB17-18/0009

5. 2.20pm QUALITY & PATIENT SAFETY 5.1 Director of Quality &

Patient Safety’s Report (Lorna Quigley)

• Quality and Performance Chair’s Report

(Linda Roberts)

To Note

To Note

13. Director of Quality Cover sheet - May GB

14. Director of Quality and Patient Safety Rep

15. Wirral - Final NHSE return for 2016 E

16. wirral E+I annual report 2016.docx

17. Quality and Performance Chair rep

GB17-18/0010

6. 2.50pm GOVERNANCE AND ENGAGEMENT

6.1 Director of Corporate Affairs’ Report (Paul Edwards)

• Integration between NHS Wirral CCG and Wirral Council Commissioning

To Note

To Approve

18. Corporate Affairs Report cover sheet.doc

19. Director of Corporate Affairs Repo

20. Integration cover sheet.docx

21. Integration Update.docx


Ref No.


functions

• Governing Body Assurance Framework

• Audit Chair’s Report (Alan Whittle)

To Approve

To Note

22. Integration diagram.pdf

23. BAF cover sheet.docx

24. AF May Body narrative.docx

25. Wirral CCG Assurance Framework

26. Audit Committee Chairs Report 20 April

GB17-18/0011

7. 3.10pm MEDICAL 7.1

7.2

Medical Director’s Report (Dr Paula Cowan) Clinical Senate Chair’s Report (Dr Paula Cowan)

To Note

To Note

27. Medical Director GB Report - May 2017

28. Clinical Senate Chair Report GB May 2

GB17-18/0012

8. 3.30pm COMMITTEE REPORTS 8.1 Committee Meeting

Minutes

• Quality and Performance Minutes from January & February 2017

• Clinical Senate

Meeting of 14th February 2017 & 14th March 2017

• Audit Minutes from 26th January 2017

To Note

To Note

To Note

29. RATIFIED QP Minutes 31.01.2017.do

30. RATIFIED QP Minutes 28.02.2017.do

31. ratified clinical sentate minutes 14 2 1

32. RATIFIED Clinical Senate minutes 14.03

33. Ratified audit minutes 26 1 17.docx

GB16-17/0013

8.0 3.40pm ANY OTHER BUSINESS

Date and time of Next meeting: Tuesday 6th June 2017 – 1pm – 4pm Nightingale Room OMH Please forward any apologies to [email protected]

mailto:[email protected]

Minutes of the WCCG –Governing Body Meeting – PUBLIC SESSION – 7th March 2017 Page 1 of 7

WIRRAL CLINICAL COMMISSIONING GROUP GOVERNING BODY BOARD MEETING

Minutes of Meeting – Public Session

Tuesday 7th March 2017 1pm

Nightingale Room, Old Market House Present: Dr Sue Wells (SW) Chair Dr Paula Cowan (PC) Medical Director Jon Develing (JD) Chief Officer Mike Treharne (MT) Chief Financial Officer Nesta Hawker (NT) Director of Commissioning Paul Edwards (PE) Director of Corporate Affairs Lorna Quigley (LQ) Director of Quality & Patient Safety Dr Sian Stokes (SS) GP Lead – Long Term Conditions Dr Helen Downs (HD) GP Lead – Unplanned Care Dr Laxman Ariaraj (LA) GP Lead – Planned Care Dr Simon Delaney (SD) GP Lead – Primary Care Lesley Doherty (LD) Registered Nurse Alan Whittle (AW) Lay Member (Audit & Governance) Graham Hodkinson (GH) Director of Health and Care Richard Sturgess (RS) Secondary Care Doctor Mike Sowden (MS) Healthwatch In Attendance: Allison Hayes (AJH) Corporate Officer

Ref No. Minute

Action GB16-17/0038

Preliminary Business 1.1 Apologies for absence Apologies were received from: Richard Williams, James Sowery, Linda Roberts and Fiona Johnstone.

1.2 Chairs Announcements/Opening Remarks Chair welcomed Dr Helen Downs, GP Lead for Unplanned Care and Dr Richard Sturgess, Secondary Care Doctor as new members of Governing Body. She also welcomed the members of the public to the meeting. 1.3 Declarations of Interest Chair reminded the Governing Body members of their obligations to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of Wirral Clinical Commissioning Group. Declarations declared by members of the Governing Body are listed in the CCGs Register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link: https://www.wirralccg.nhs.uk/Downloads/AboutUs/WhosWho/Register%20of%20Interes

https://www.wirralccg.nhs.uk/Downloads/AboutUs/WhosWho/Register%20of%20Interests%20Version%20Updated%20June%202016.pdf


Ref No. Minute

Action ts%20Version%20Updated%20June%202016.pdf The following update was received at the meeting:

• With reference to business to be discussed at the meeting, LA declared that he works in Wirral University Teaching Hospital Foundation Trust as a GP with Special Interest in Endoscopy but that there were no decisions on the agenda that this represented a direct conflict with.

1.4 Comments/questions from members of the public There were 2 members of the public who attended the meeting. Mr D Stieber, Customer Liaison Manager with a provider organisation, addressed the Governing Body with regards to proactively identifying key areas of support that they could supply to the CCG. It was agreed that LQ would contact Mr Stieber after the meeting. 1.5 Minutes & Action Points from previous meeting held on 7th February 2017 The minutes of the previous meeting held on 7th February 2017 were agreed as a true and accurate record notwithstanding grammatical/typographical errors which will be rectified. Action Points: Members noted that the outstanding action. 1.6 Matters Arising There were no matters arising. 1.7 Patient Story In light of Prostate Cancer week, LQ read a transcript from a patient who had suffered with prostate cancer and the treatment he had received. Members recognised the positive aspects of the patient’s journey. Chair thanked LQ for the patient story. 1.8 Chief Officer’s update JD advised the Governing Body of discussions which have recently taken place with regard to the membership for the Healthy Wirral Partners Board and advised that the membership has now been amended to reflect Primary care, Children’s Services and Federations. JD reported that an independent chair has not yet been identified and therefore Clare Fish, Strategic Director at Wirral Borough Council, will act as the interim chair. JD reported that the CCG have received a ‘directions’ letter from NHS England (NHSE) as a result of the CCGs current and forecast financial position and advised that a response will be required within four weeks, incorporating an Improvement Plan and a Financial Recovery Plan. JD advised that a Turn Around Group has been established with Lay member support and it is expected these arrangements will improve the overall governance and grip around the recovery process and formalise the key

LQ



Ref No. Minute

Action linkages to operational performance and wider improvement. JD also advised that the CCG has received a letter from NHS England offering support in relation to Quality, Innovation, Productivity and Prevention (QIPP) and that the CCG will be looking to take up this offer. JD reported that the first Joint Health and Wellbeing Board across Cheshire and Wirral has taken place and was very successful. Members of the Governing Body noted the Chief Officer’s update.

GB16-17/0039

2.0 Risk Management 2.1 Risk Register PE highlighted the main risks recently reviewed at the Quality and Performance Committee and the Governing Body noted the updated to the risks and accepted the recommendation to keep the scores as they were. He suggested that the key risk for focus in relation to today’s agenda was the CCGs financial position.

GB16-17/0040

3.0 Finance 3.1 Chief Financial Officer’s Report MT introduced the finance report for the period 1st April 2016 to 1st January 2017. MT drew members’ attention to the following headlines:

• £11.366 YTD deficit against Resource Limit • The CCG forecast outturn remains at £12.00m deficit, but there remains risk of

£0.5m attached to this forecast. The risk relates to expenditure on prescribing. • The risk attached to the forecast has reduced by £1.0m compared to month 9

due to some favourable contract movements, in particular Spire. • The QIPP required to achieve this forecast will be full year £3.779m consistent

with the M9 reported figure. With regards to non NHS contracts MT stated that there is a contract over performance of £253k at the end of month 10 which represents a favourable movement in the position of £234k when comparing to the month 9 position. MT reported that the CCGs QIPP challenge started at £17.6m. However, since the start of the year, the forecast outturn has been revised from a surplus of £0.4m to a deficit of £12m and advised that the QIPP forecast has been reduced to £3.779m. As at month 10, the remainder of schemes are delivering against forecast and all schemes have started In conclusion MT asked the Wirral Governing Body to note the Month 10 Operational overspend of £11.366m and the current full year forecast outturn of £12m with £0.5m of net risk attached. Members of the Governing Body noted the financial update. 3.2 Chair of Finance Committee Report LD provided a brief from the Finance Committee held on 31st January 2017. Significant topics discussed at the meeting included the following:


Ref No. Minute

Action

• Month 9 Financial position • 2017/18 Financial Plan • Audiology service procurement options appraisal • Continuing Health Care (CHC)/Joint packages improvement plan • Establishment of the Turn Around Group

Members of the Governing Body noted the Finance Committee Report.

GB16-17/0041

4.0 Performance and Commissioning 4.1 Director of Commissioning’s Report NH reported the key activities undertaken by her and her team. Particular focus was given to:

• NHS RightCare programme • November’s performance data

NH advised that Wirral CCG has adopted the NHS RightCare improvement methodology which is used to maximise value and reduce variation, both from an individual patient perspective and at population level. NH reported that through using this methodology, opportunities to increase value, improve outcomes and reduce spend have been identified within the following areas:

• Cardiovascular Disease (CVD) • Gastroenterology • Neurology

NH reported that task and finish groups with key stakeholders and clinical involvement have met to begin to redesign local pathways. NH went on to report the performance against the NHS constitutional standards for November 2016 and highlighted to members the following:

• The 4 hour A&E target – continues to be challenged and performance has not achieved the 95%.

• Ambulance standards continue to be a challenge, with a weekly average ‘time to clear’ of 33 minutes which is above the 30 minute standard.

• The referral to treatment (RTT) 18 week wait for incomplete pathway was not met in November and the CCG has not met the 92% standard since December 2015.

• In terms of IAPT (Improving Access to Psychological Therapies) the implementation of the action plan for recovery is continuing and additional action plans and scrutiny have been implemented in order to improve performance and meet the trajectories.

Members noted the Director of Commissioning’s report.

GB16-17/0042

5.0 Quality & Patient Safety 5.1 Director of Quality and Patient Safety’s Report LQ provided a report updating Governing Body members of the activities that have been undertaken by the Quality and Patient Safety team. Key areas of focus included:


Ref No. Minute

Action • Performance against quality indicators (December) – Health Care Acquired

Infections • Mixed Sex Accommodation Breaches • Friends and Family • Serious Incidents • Care Quality Commission activities (CQC)

LQ asked Governing Body members to note the contents of the report and to be assured of the rigour in the process in relation to quality in nursing homes and domiciliary providers via the CQC inspection regime. 5.2 Quality and Performance Chair’s Report In the absence of LR, LQ provided a brief from the Quality and Performance Committee held on 20th December 2016. Significant topics discussed at the meeting included the following:

• Review of Risk Register • Performance of Wirral University Teaching Hospital Foundation Trust (WUTH)

in relation to the Constitutional Standards • Safeguarding Annual Report • Personal Health Budgets

Members of the Governing Body noted the Quality and Performance Report presented today.

GB16-17/0043

6.0 Governance and Engagement 6.1 Director of Corporate Affairs Report PE reported the key activities undertaken by the Corporate Affairs team and asked the Governing Body to note the following:

• Emergency Preparedness, Resilience and Response Core Standard Assurance – PE reported that the statement of compliance level was submitted as full compliance and this has now been confirmed by NHS England.

• Statutory and Mandatory training – PE reported that the target compliance rate for all training is 90% and overall the CCGs compliance rate is 94%.

• PE drew attention to the wide range of engagement activity undertaken recently. Members of the Governing Body noted and acknowledge the report and work carried out by the Director of Corporate Affairs. 6.2 Audit Chair’s Report AW provided a brief from the Audit Committee held on 26th January 2017. Significant topics discussed at the meeting included the following:

• Annual Audit Committee effectiveness review • CCG Annual Report 2016/17 – Month 9 Governance Statement Report • Conflicts of Interest quarterly assessment, January 2017 • Losses and Special payments • Review risks and controls around financial management • Review Information Governance compliance progress report • Review progress on implementation of internal Audit Report recommendations


Ref No. Minute

Action • Review Counter Fraud Progress report • Receive progress reports from internal audit and external audit

AW drew members’ attention to the internal audit review of Quality, Innovation, Productivity and Prevention (QIPP) leadership arrangements within the CCG, which had been designated as providing limited assurance. However, recent changes, such as the formation of the Turn Around Group, should improve this. Members supported AW suggestion that Governing Body should commend to each subcommittee that an annual effectiveness review should be conducted in line with the approach taken to review the effectiveness of the Audit Committee. AW also stated that the CCG’s external auditor has written to the Secretary of State in relation to the CCG’s breach of financial duty. Members of the Governing Body noted the Audit Chair’s report.

GB16-17/0044

7.0 Medical 7.1 Medical Director’s Report PC provided the Governing Body with an update on the clinical leads and delegated duties of the Medical Director. Members noted the update provided by the Medical Director. 7.2 Clinical Senate Chair’s Report PC provided a brief from the Clinical Senate Committee of 17th January 2017. Areas included:

• Antimicrobial Resistance • Medical Optimisation Pathway • 2 week referral for suspected Upper Gastrointestinal Cancer • Procedures of Low Clinical Priority

PC advised that the medical optimisation pathway is a process so that patients who have a raised Body Mass Index (BMI) and/or who are smokers be given the opportunity to optimise and improve their surgical outcomes. PC went on to report that the 2 week referral pathway for Upper Gastrointestinal Cancer has recently changed with a direct to scope pathway now in place. PC also advised members that the Clinical Senate were given further updates on additional areas for consideration within the Procedures of Low Clinical Priority (PLCP). The Governing Body noted the Clinical Senates update.

GB16-17/0045

8.0 Committee Reports

• Quality and Performance Minutes from 20th December 2016 • Clinical Senate Meeting of 8th November 2016 and 11th Jan 2017 • Audit Committee of November 2016 • Finance Committee meeting of 20th December 2016

Members agreed for the Turn Around Group to submit a regular monthly update from


Ref No. Minute

Action April onwards to the Governing Body.

JD GB16-17/0048

9.0 Any Other Business 9.1 Risk Register With regards to the financial position highlighted within today’s Finance report, members agreed that the risk rating remain the same on the Risk Register.

Date and Time of Next Meeting (informal meeting)

Tuesday 4th April 2017 1pm – 4pm Nightingale Room, OMH, Please forward any apologies to [email protected]

Board meeting ended at: 14:20pm.


Action Date of meeting Title of Item Agenda Ref ID Action Lead(s) Deadline Progress Update

1 10.01.2017 HWPB NA NA JD advised that the HWPB Change of membership details will need to be approved by the Governing Body in March

JD Mar-17 JD to update Governing Body as part of his Chief Officer's Report in March

4 10.01.2017 Director of Commissioning Report GB16-17/0028 4.1 NH to present final operational plan to Governing Body NH Jun-176 10.01.2017 Director of Quality Report GB16-17/0029 5.1 LQ to present more information on avoidable infections in

reports LQ Mar-17 Complete

7 07.02.2017 Service Review Report GB16-17/0036 4.1 NH to progress implementation of Service Review decisions NH Apr-17 Complete 8 07.03.2017 Comments and Questions from Public GB16-17/0038 1.4 LQ to contact Customer Lliasion Manager MHC LQ Apr-17 Complete 9 07.03.2017 Committee Reports GB16-17/0045 8 Turn Around Group to submit a regualr monthly update from

April onwards to GB MT/SB Apr-17 Complete

GB Formal Meetings Action Log

2017 Actions - GB Public Meeting

Master 16-17

Page 1 of 3

Risk ID Date added Source Division Risk Description Organisational Objectives (reference to detail)

Consequence

Likelihood

Matrix Score

Key Control Established Key Gaps in Control (reference to evidence)

Assurance on Controls (reference to evidence)

Gaps in Assurance (reference to evidence)

Consequence

Likelihood

Previous Risk

Rating

Owner Date of next review

Date of last review Last review Change narrative

Target Impact Target Likelihood Target Score Target Deadline

Risk Appetite

9

9

By end of quarter 1 - 2017

By end of March 2016.

3

3

3

4 4

5 20.00 On-going monitoring Target not being met by Wirral economy & rated high risk by NHS England and Monitor

Target continues to not be met.

414-15G Jun-14 CCG

14-15P January QPF CCG 3Minutes & monitoring of GB / QPF / Finance

Committee / QIPP Plan / Financial recovery plan.

Timeliness of reporting / ability it implement action

plans directly.

Ability to influence activity trends.

4Gov Body A&E 4 hour Target, including quality of care & standards provided to patients

Quality / Financial / Patient Safety

4

QPF Financial risk to CCG in achieving the planned circa £12 million deficit.

Financial 4 4 16.00 Regular financial reporting through QPF & GB.

Further detailed monitoring of contractual prescribing

& other commissioning expenditure areas as appropriate. Finance

Committee. QIPP Plan. Financial recovery plan.

16.00 NH April 2017 QP

Feb 17 QP - Additional narrative re quality review visits agreed.

Updated action plan reviewed at October QPF - Wirral economy is part of phase 1 ECIP and first meeting took place on 20th October 2015. Next due for review at QPF in January 16.Updated AP to be reviewed at Jan 16 QPF as weekly monitoring of the target continues.

Updated AP reviewed at Jan 16 QPF and agreed for the risk scores to remain the same. Noted that the ECIP report will be reviewed at Governing Body in March 16. Therefore action plan next due for review at March 2016 QPF.

Updated AP received for review at March QPF.

Reviewed at March 16 QPF and agreed that for 2015/16 the 4 hour target would not be achieved. QPF members recognised, however, that a range of measures are in place to address this risk and it was envisaged that performance would improve in quarter 1 2016/17.

Further update to be provided at QPF in April 2016.

Reviewed at April QPF and members agreed they would request specific assurances from the Systems Resilience Group around implementation of action plans and tangible improvement milestones.

Update provided at May QPF together with a review of the performance report and action plan to support patient flow. Next due for review at June QPF.

Some improvement following SAFER, new Chief Operating Officer appontment and improved internal processes. Score left as is to assess sustainablilty of improvement.

Reviewed at July 16 QPF - Agreed for next review at August 16 QPF. Agreed for scores to remain the same.

Current position and verbal update to be provided by NH at QPF in October 2016.

Discussed at QPF in October 2016 in line with the performance pack and agreed for the scores to remain the same. ECIP report to be received at the next QPF together with a verbal updae from NH in December 16.ECIP report presented at December 16 meeting. Recovery plan within the report to be closely monitored but scores to remain the same until tangible improvement is seen in performance.

Feb 17 - NH advised that performance has deteriorated and a formal letter is to be sent to WUTHsharing the concerns of the CCG. Assurance will be requested regarding the quality impact of the performance.

Feb 17 QPF - LQ reported that in light of repeated performance of below 80% quality review visits will be arranged to assure CCG that the actions outlined in correspondence have been undertaken.

Verbal update due for April QP meeting.

Oct 16 - Update provided from MT (plan lead) to update of the latest position for month 6 - Schemes are needed for £5 million to deliver the control deficit of £9 million. Scheme identified to the tune of £7.2 million which is a combination of new saving schemes and managing back operational overspend.

Oct 16 QPF - Noted financial position remains the same. Scores agreed to remain the same. Due for next review at Nov 16 QPF.

November 16 - Update from MT to advise that the risk to control decrease is estimated of £9 million is currently estimated at £3.5 million with known actions to mitigate further risk.

Finance Committee to provide report to QPF on a monthy basis until the approval of the Finance Committee as a sub-committee of Governing Body. Next due at QPF to be held in January 2017.

Jan 2017 - Year end planned deficit has now been moved, with agreement by NHS England, to circa 12 million. As a result, the Governing Body had increased confidence in achieving this position and hence reduced the likelihood score from 4 to 3.

Jan 17 QPF - Financial issue remains - Month 10 should provide a clear indication re position. Spire and Prescribng remain the two main issues

Feb 17 - Update from MC to advise that the full year forecast outturn remains at £12m, and there remains risk attached to this of £0.5m which has been discussed with NHSE. The risk will be reassessed for month 11 reporting.

March 17 QP - QP members agreed to increase the lieklihood score from 3 to 4.After Finance Committee consideration, it was felt that some of the potential financial risk was likely to materialise before year end,.Further verbal update to be provided at QP in April 17.

16.00 MT April 2017 QP

March 2017 QP 10th January 2017 - Year end planned deficit has now been moved, with agreement by NHS England, to circa 12 million. As a result, the Governing Body had increased confidence in achieving this position and hence reduced the likelihood score from 4 to 3.

February 2017 QP

Master 16-17

Page 2 of 3

16-17A Jul-16 CCG QPF Number of significant issues raised by MIAA report into Personal Health Budgets.

Commissioniong 3 3 9.00 Head of Partnerships to develop plan based on the management responses within the MIAA report.

Action plan still not developed.

Monitoring of action plan once in agreed and in

place.

Monitoring framework still not established.

3 3 9.00 LQ April 2017 QP

January 2017 QP Action Plan to be collated for review at July 2016 QPF.

Paper included within the agenda for July 16 QPF with MIAA Personal Health Budget Arrangements Advisory Report 2015/16 which also includes action plan. Agreed to leave risk on the register with the same scores.

Current position and verbal update to be provided by LQ at December 2016 QPF.

LQ deferred report until QPF in January 2017.

Verbal update to be provided in relation to the report at January 2017 QPF.

Jan 17 QPF - LQ advised that the report has not yet been received - LQ to follow this up via the joint CHC Committee and provide an update at QPF in February 2017 QPF.

Feb 17 - Update from LQ to advise that the need to increase PHB’s is a national drive for 2017/18, a system will be developed in order to achieve this which will fulfil the actions required in the MIAA report. Achievement against targets set will be reported upon via Q&P Committee.

LQ to provide verbal update at QP in April 17.

2 2 4 By end of quarter 1 - 2017

16-17C Nov-16 CCG QPF Increase in potential patient safety issues leading to moderate or severe harm at acute provider organisation.

Quality / Patient Safety 4 3 12.00 Monthly Serious Incident Review Group, of which

minutes are also reviewed at QPF Committee.

Awaiting outcome of the reviews.

Minutes of Serious Incident Review Group.

Potential patient safety issues.

LQ April 2017 QP

February 2017 QP Scores to be agreed at QPF to be held in December 2016.

08/12/2016 - Updates provided in relation to actions being taken in relation to this:

- 72 hour concise reviews being undertaken- External review of the Opthalmology service- Serious Incidents reported on the national reporting system (StEIS)- Contract meetings with provider organisation

Discussed at December 16 QPF and scores agreed as 4 for consequence and 3 for likelihood.

Next due for review at QP in February 2017.

Feb 17 - Update from SS to advise that the report from the external review of the Opthalmology Servuce was reviewed at Serious Incident Review Group and further questions were raised for clarification with WUTH - Therefore, awaiting action plan from the Associate Director of Risk at WUTH.

Feb 17 QP - Updated that all lists have now been suspended. Further verbal update to be provided at QP in April 2017.

Scores agreed as 4 for consequence and 3 for likelihood. TBC TBC TBC TBC

16-17D Feb-17 CCG QP Potential breach of Referral to Treat (RTT) targets

Quality / Patient Safety / Commissioning

3 5 15.00 NHS England have allocated funds for data validation which is being

monitored

Awaiting outcome of the data validation which is also in conjnction with

NHS Improvement

Data to be monitored and action plan to be

developed.

Potential patient safety issues.

NH April 2017 QP

February 17 QP April 17 - Data validation and cleanse being undertaken - Expecting for the situation to worsen before an improvement is seen. Action plan is to also be developed following the data cleanse exercise.Further update to be provided at May 2017 QP.

9 Update to be provided by the end of quarter 1 - 2017

3353Dec-15 CCG14-15U QPF Improving Access to Psychological Therapy (IAPT) service will not meet the targets related to access and treatment and performance will not improve with additional resource and will deteriorate with any claw back of resource by NHS England.

Quality / Patient Safety / Financial / Contracts

3 April 17 QP March 17 QP4 12.00 Wirral CCG Improving Access to Psychological Therapy (IAPT) Recover Plan 2015/16 in place.

15.00 The Recovery Standard has trajectory to be achieved by September 2016 (reported to NHS England in Feb 16 as part of the recovery planning). Currently on 45% from 40%, and the standard is 50%.

Risk to remain on the register until recovery standard is met, then all IAPT standards will be compliant (access, 6 and 18 week waiting times and recovery).

Update re IAPT performance provided at July and August 16 QPF - Noted (as above) to remain on the register until the recovery standard is met then all IAPT standrads will be compliant (access, 6 and 16 week waiting times and recovery).

Oct 16 QPF - Reviewed in line with the performance pack and noted that IAPT are not meeting the 6 weeks or recovery times. It was agreed for scores to remain the same but with close attention paid to improving performance. It was additionally noted that this risk was potentially affected by a local third sector provider' sustainability, but assurance was given by NH that contingencies were in place. Due for review further update at December 16 QPF.

LQ provided an update at December 16 GB to advise that a meeting will be held on 23rd December to discuss in depth the on-going risks associated with IAPT non-delivery. Scores to be re-assessed in January 2017.

Jan 17 - Verbal update to be provided and scores to be re-assessed in January 2017.

Jan 17 QPF - Update provided that IAPT is noted under performance at the contracy meetings. Noted no trends accross Cheshire and Merseyside. NHS England are supporting a Quality Meeting - currently awaiting date for this and following the meeting will outline the key lines of enquiry. CQC have held a meeting with the main provider but the CCG have received no feedback to date. Recovry has deteriorated 10% since last reporting period. Therefore, will continue to bemonitored / scrutinised.Further update to be provided at Feb 17 QPF.

Feb 17 - Update from SS to advise that a date has now been sent for 24th February 2017 to undertake the Quality Risk Profile with NHS England and further feedback will be provided once this has been completed.

March 17 QP - Update from SS at QP to advise that a quality risk profile has taken place in conjunction with NHS England resulting in an interim action plan, that will be monitored on a weekly basis.

Verbal update to be provided at April 17 QP.

NH

Master 16-17

Page 3 of 3

16-17E Mar-17 CCG Commissioning Introduction of primary care streaming mandated by NHSE – prescribed model is likely to have financial implications for the CCG

Commissioning 3 4 12.00 Whole system approach being adopted with

providers working together to develop economically

viable proposal

This is a recent directive so funding not identified

within CCG financial plan for 17/18

Agreement from all stakeholders to develop

sustainable solution

Level of financial risk currently unknown until

provider proposals submitted and reviewed

NH April 2017 QP

Not applicable April 17 - Awaiting submission of provider proposals.

Insert Rows Above This Line Only

Impact ValuesNegligible 1 Minor 2Moderate 3Major 4Catastrophic 5

Probability Values

Rare 1Unlikely 2Possible 3Likely 4Almost Certain 5

Green/Yellow/Red Threshold ValuesGreen - maximum score 4Yellow - minimum score 5Yellow - maximum score 12Red - minimum score 15

1/2

GOVERNING BODY REPORT COVER SHEET

Risk Please indicate Detail of Risk Description

High Medium Low YES

The figures in this report are subject to external audit but it is expected that the risk of any changes is low.

Clinical engagement taken place N

Patient and public involvement taken place N

Equality Analysis/Impact Assessment completed N

Quality Impact Assessment N

Chief Finance Officer’s Report Agenda Item: 3.1 Reference GB17-18/0007

Public / Private Public Meeting Date 2nd May 2017

Lead Officer/Author of paper

Mike Treharne, Chief Finance Officer

Contributors Mike Cunningham, Deputy Chief Finance Officer Emma Edwards, Senior Reporting and Planning Accountant

For Decision

For Information Yes

For Discussion Yes

Executive Summary Financial performance as at 31st March 2017 (full year outturn subject to external audit as referenced in the introduction section of the paper), and high level identification of risks for 2017/18.

Recommendations The Governing Body is asked to: • Note the contents of the report • Note the risks identified in the report

2/2

Strategic Themes To empower the people of Wirral to improve their physical, mental health and general well being Y

To reduce health inequalities across the Wirral Y

To adopt a health and well-being approach in the way services are both commissioned and provided Y

To commission and contract for services that:

• Demonstrate improved person centred outcomes • Are high quality and seamless for the patient • Are safe and sustainable • Are evidenced based • Demonstrate value for money

Y

To be known as one of the leading Clinical Commissioning Groups in the country Y

Provide systems leadership in shaping the Wirral health and social care system so as to be fit for purpose both now and in five years time

Y

This section gives details not only of where the actual paper has previously been submitted and what the outcome was but also of its development path i.e. other papers that are directly related to the current paper under discussion.

Governance route prior to Governing Body

Meeting Date Objective/Outcome

of 6

1) INTRODUCTION

1.1 This report sets out the headline financial position for NHS Wirral Clinical Commissioning Group (Wirral CCG) as at the end of March (Month 12) 2016/17. As this is a yearend position, all figures quoted are subject to a satisfactory audit of the statutory accounts. The 1% headroom which the CCG has been required to maintain during the year has been released reflecting a yearend position. Therefore performance is measured against a forecast outturn deficit of £7.130m (calculated as £12.000m less 1% headroom of £4.870m). The main headlines are;

• £7.128m full year actual outturn deficit compared to forecast outturn deficit of £7.130m. This means that the CCG has achieved its forecast outturn in line with NHSE expectations.

• The QIPP delivery was as forecast at £3.779m.

2) FINANCIAL POSITION

2.1 As at the end of March, NHS Wirral CCG has a reported deficit of £7.128m. The year to date operational overspend is shown below:

Wirral CCG Financial Position as at 31st March 2017 (Month 12)

Expenditure Area M12 YTD

variance £'000

M11 YTD

variance £'000

Movement £'000s

NHS 1,284 1,295 (11)Non NHS 487 581 (94)Prescribing (591) (503) (88)Commissioned out of Hospital

4,377 4,050 327

Primary Care (405) (178) (227)Better Care Fund (321) (175) (146)QIPP (incl reserves/ contingency)

2,909 7,546 (4,636)

Running costs (218) (222) 4Operational performance

7,522 12,394 (4,872)

Surplus (394) (361) (33)CCG YTD overall 7,128 12,032 (4,905)

Report Title Chief Finance Officer’s Report Lead Officer Mike Treharne, Chief Finance Officer Recommendations To note contents of M12 report and delivery of the CCG’s forecast

outturn in line with NHSE expectations.

of 6

2.2 This deficit position reported includes full year QIPP achieved of £3.779m, and a number of operational overspends as discussed (starting at paragraph 2.3) below. A full breakdown of the CCG position by contract and spend area is within Appendix 1.

NHS Contracts

2.3 NHS contracts £1,284k overspent which represents a favourable movement of £11k when compared to the month 11 YTD position. Of the £1,284k overspend; £193k is attributable to the Countess of Chester Hospital. This is predominantly due to critical care which is overspending by £319k, offset by underspends in electives and non-electives.

2.4 The Liverpool Heart and Chest Hospital contract also over performed by £255k for the year predominantly due to day cases including a biventriculuar pacemaker, percutaneous interventions and perc complex ablations.

2.5 Wirral Community Trust over performed by £278k. This was predominantly due to

physiotherapy overspending by £200k and an increase in CTS attendances.

2.6 Royal Liverpool & Broadgreen University Hospital over performed by £253k for the year which was predominantly due to non-achievement of QIPP.

2.7 The remaining overspend of £305k was due to increased performance across all other

NHS contracts.

2.8 The weekly activity management group (AMG) continues to look into significant contract variances and there is an activity log to monitor actions which is reviewed and task and finish groups set up to report back on items identified.

Non NHS Contracts

2.9 Non NHS contract over performance was £487k for the full year. This represents a favourable movement in the position of £94k when comparing to the month 11 YTD position.

Spire Murrayfield was £665k over the planned level of spend for the full year which represents a favourable movement of £141k when compared to Februarys YTD position. This is due to activity data having been received at the predicted lower levels. This overspend was partially offset by under performance against planned levels at Peninsula (£107k) and one to One Midwifery (£110k).

2.10 Monthly practice visits continue to take place in order to attempt to address the issue of over performance.

Prescribing 2.11 The month 12 financial position for prescribing has been informed by February’s data.

of 6

This shows a year to date position of £591k underspent, (favourable movement of £88k) of which £579k relates to practice prescribing, £39k against central drugs, but a pressure of £29k against Air Liquide.

Continuing Healthcare

2.12 As at the end of March, Joint/ Fully Funded and Children’s packages were overspent by £4,377k. This is an adverse movement of £327k when compared to the month 11 position. Of this, approximately £125k is the result of the FNC rate increase approved by government. The remaining pressure has been caused by a number of new packages, existing package price increases and also the impact of QIPP non delivery £92k.

2.13 The main movements however this month include the following:

Continuing Healthcare

• 26 new CHC eligible packages have been agreed totalling an estimated value of £496k (note this value also includes the impact of all YTD new packages), with an increase in existing package costs totalling £100k. 16 packages have ceased totalling £266k. We have also seen a number of new PHB packages with a total cost of £28k.

Joint Funded/Complex Care

• 12 new Complex Care packages have been agreed totalling an estimated value of £520k (note this value also includes the impact of all YTD new packages), with an increase in existing package costs totalling £79k. 8 Complex Care MH packages have ceased totalling £397k.

Funded Nursing Care

• The impact of the weekly rate increase has seen an in month impact of £125k.

Better Care Fund 2.14 BCF has reported a full year underspend of £321k, an improvement of £146k compared to the £175k underspend reported at month 11. This position reflects slippage on a number of schemes.

Running Costs

2.15 Running cost budgets were underspent by £233k for the full year. This reflects some pay & non pay underspends relating to vacancies and some staff not currently being part of the NHS pension scheme.

2.16 The savings referred to in 2.15 more than offset the non-recurrent expenditure which the

CCG has incurred as part of its financial recovery. 2.17 The outturn position includes costs pressures identified in earlier reports relating to

Property Services Limited for the vacant space within Old Market House. This relates to the space that the Community Trust used to occupy, as host tenant, the CCG is liable for the charges until the space is occupied.

of 6

3) QIPP

3.1 The CCGs QIPP challenge started at £17.6m (excluding BCF £0.6m). However since the start of the year the forecast outturn was revised from a surplus of £0.4m to a deficit of £12m. The QIPP requirement was consequently revised. The actual QIPP outturn for the year was £3.779m in line with the forecast made in recent months.

4) UNDERLYING POSITION

4.1 Due to the sizeable challenge the CCG faces, it must be noted that the underlying position

of the CCG finances is a significant deficit.

Wirral CCG Underlying Recurrent Position 2017/18 Revenue Resource Limit 493,944 Programme Costs 495,207 Running costs 7,099 Contingency - Total Application of Funds 502,306 Underlying Surplus /(Deficit) (8,362)

4.2 £8.4m deficit would mean contingency and headroom have been utilised. In order to

return to business rules (1% surplus/ 1% headroom and 0.5% contingency (£12.4m)), the underlying position could be closer to £21m deficit.

5) RISKS

5.1The risks previously identified pertaining to 2016/17 have been managed within the overall

position to achieve the forecast outturn. 5.2 However moving into 2017/18 the key risks facing the CCG include achievement of a QIPP

plan of £12.3m and ensuring operational/contract expenditure is managed in line with the financial plan set.

6) CASH MANAGEMENT

6.1 The recorded CCG cash book balance at the end of March was £16k. This is in line with

current NHSE guidance that CCGs aim towards 1.25% month end cash balance of the drawdown.

of 6

6.2 In total there is £1,778,450 of outstanding debt at 31st March 2017. The ageing profile is shown in the graph below.

6.3 The top 3 debtors by value greater than 30 days amount to £78,671.

Customer £ Invoice Date Comments NHS MIDLANDS AND LANCS CSU 29,308.53 11/02/2017 Update required. WIRRAL UNIVERSITY TEACHING HOSPITAL 25,719.74 11/02/17

Clarity sought on what further back up information is required 16/03..

WIRRAL METROPOLITAN BOROUGH COUNCIL 23,642.40 various Payment date requested 30/03

6.4 The BPPC monitors public sector organisations on the timeliness of its financial payments in terms of both volume and value. Guidance recommends 95% of payments within 30 days, the CCG performance was 99.32% for March. The following table shows the number of invoices paid against target.

of 6

6.5 Expenditure incurred above £25k is collected monthly and published on the CCG website.

7) CONCLUSION

7.1 The Governing Body is asked to note: • Full year actual outturn deficit £7.128m compared to forecast deficit of £7.130m (after

release of 1% headroom).

• QIPP actual outturn £3.779m.

• Risks pertaining to 2017/18 – achievement of QIPP plan £12.3m, and the need for vigorous control of operational/contractual expenditure in line with the agreed finance plan.

Month Period Number

Paid Year

Total Number

of Invoices

Paid

Total Paid

Within Target

No.

%age Total Value of Invoices Paid £

Value paid w ithin Target £

%age

APRIL 01 16 866 860 99.31% 33,456,211.22 33,444,805.71 99.97%MAY 02 16 1032 1014 98.26% 53,350,413.32 53,321,457.60 99.95%JUNE 03 16 1318 1298 98.48% 18,709,856.47 18,689,113.64 99.89%JULY 04 16 1031 1030 99.90% 40,173,367.99 40,120,156.39 99.87%AUGUST 05 16 1253 1244 99.28% 35,662,459.16 35,654,083.17 99.98%SEPTEMBER 06 16 1099 1090 99.18% 35,889,499.67 35,862,128.53 99.92%OCTOBER 07 16 1040 1033 99.33% 38,417,565.13 38,379,976.62 99.90%NOVEMBER 08 16 845 841 99.53% 33,905,551.55 33,843,665.90 99.82%DECEMBER 09 16 1264 1253 99.13% 37,471,119.61 37,450,927.03 99.95%JANUARY 10 17 1009 976 96.73% 39,241,694.88 38,871,692.69 99.06%FEBRUARY 11 17 1075 1061 98.70% 33,987,741.71 33,932,583.55 99.84%MARCH 12 17 1347 1295 96.14% 37,254,056.15 37,002,580.49 99.32%

13179 12995 98.60% 437,519,536.86 436,573,171.32 99.78%

Performance Against Better Payment Practice Code (BPPC) ALL

NHS Wirral CCG

APPENDIX 1 - Month 12 Breakdown of Expenditure By Contract & Spend Area

Cost Centre Expenditure Category Annual Budget Budget to Date

Spend to Date Variance Prior Mth YTD Variance

Change In YTD Variance

Prior Mth Forecast Variance Including

RiskWirral University Teaching Hospital NHS Foundation Trust Acute 228,177,000 228,177,000 228,162,153 (14,847) (15) (14,832) 0North West Ambulance Service Ambulance and Other 12,165,890 12,165,890 12,324,836 158,945 195,636 (36,690) 236,816West Midlands Ambulance Service Ambulance and Other 898,443 898,443 1,046,906 148,464 133,810 14,654 157,860Royal Liverpool & Broadgreen University Hospitals NHS Trust Acute 7,398,314 7,398,314 7,651,706 253,392 (27,353) 280,745 (9,592)Aintree University Hospitals NHS Foundation Trust Acute 2,786,886 2,786,886 2,966,097 179,211 122,548 56,663 145,038Countess of Chester NHS Foundation Trust Acute 4,214,294 4,214,294 4,406,827 192,533 316,767 (124,234) 311,892Liverpool Womens NHS Foundation Trust Acute 2,578,747 2,578,747 2,767,862 189,115 169,826 19,290 212,843Liverpool Heart & Chest NHS Foundation Trust Acute 1,297,932 1,297,932 1,552,941 255,009 223,770 31,239 244,106Alder Hey Childrens NHS Foundation Trust Acute 2,163,700 2,163,700 2,108,843 (54,857) (109,429) 54,572 (130,034)St Helen's & Knowsley NHS Trust Acute 1,046,464 1,046,464 880,589 (165,875) (141,546) (24,329) (166,924)CCC Diagnostics Other 168,188 168,188 123,664 (44,524) (36,737) (7,786) (41,940)Central Manchester University Hospitals NHS Foundation Trust Acute 223,955 223,955 284,094 60,139 49,218 10,921 60,139Warrington & Halton Hospitals NHS Foundation Trust Acute 96,821 96,821 97,683 862 7,002 (6,140) 7,401Wrightington, Wigan and Leigh NHS Foundation Trust Acute 147,347 147,347 124,931 (22,416) (13,456) (8,960) (16,388)University Hospital of South Manchester NHS Foundation Trust Acute 168,267 168,267 216,428 48,161 40,710 7,450 46,106Walton Centre NHS FT Acute 1,010,472 1,010,472 1,070,707 60,235 72,097 (11,862) 78,640Non Contracted Activity (various providers) Acute 2,660,510 2,660,510 2,507,065 (153,445) 1,336 (154,781) 0Cheshire & Wirral Partnership NHS Foundation Trust Mental Health 33,081,753 33,081,753 32,943,222 (138,531) (98,071) (40,460) (96,762)South Staffordshire and Shropshire Healthcare NHS Foundation Trust Mental Health 2,617,118 2,617,118 2,589,842 (27,276) (1,743) (25,533) (1,741)Greater Manchester West MH NHSFT - Military Vets Mental Health 30,000 30,000 30,302 302 (63) 365 0MH NCAs (Various Providers)/ Merseycare NHS Trust Mental Health 54,393 54,393 136,089 81,696 32,874 48,822 35,854Wirral Community NHS Trust Community 42,929,211 42,929,211 43,207,031 277,820 358,375 (80,555) 426,438Liverpool Community Health NHS Trust Community 47,897 47,897 47,376 (521) (473) (48) (521)Total NHS Contracts 345,963,602 345,963,602 347,247,193 1,283,591 1,295,083 (11,492) 1,499,231Spire - Murrayfield Acute 5,701,910 5,701,910 6,367,046 665,136 806,171 (141,035) 748,090Spa Medica Acute 1,447,599 1,447,599 1,382,649 (64,950) (50,203) (14,747) (47,017)One to One Midwifery Acute 934,426 934,426 824,792 (109,634) (114,818) 5,184 (124,945)Spire Liverpool Acute 86,765 86,765 136,386 49,621 20,145 29,476 21,971Extended Choice Network Acute 63,994 63,994 118,236 54,242 48,851 5,391 53,283Locally Commissioned Services - Minor Surgery (Wallasey&Bebington) Community 181,522 181,522 156,589 (24,933) (34,762) 9,829 (37,932)Peninsula Community 1,993,374 1,993,374 1,886,708 (106,666) (105,203) (1,463) (112,125)Locally Commissioned Services Community 2,867,508 2,867,508 2,908,919 41,411 23,868 17,543 34,431Stroke Association Other 135,829 135,829 135,829 0 1 (1) 0Specialist Care / IFR Panel Approvals Other 345,284 345,284 374,214 28,930 21,237 7,694 23,159Marie Curie Community 113,675 113,675 123,685 10,010 10,054 (44) 10,957End of Life Community 329,545 329,545 329,567 22 32 (10) 23St Johns Hospice (Wirral) Community 1,642,482 1,642,482 1,634,072 (8,410) (7,197) (1,212) (7,755)British Pregnancy Advice Service Community 196,327 196,327 225,237 28,910 31,381 (2,472) 34,230Patient Transport Other 37,706 37,706 18,994 (18,712) (15,606) (3,106) (17,039)Mental Health Services Mental Health 67,998 67,998 68,002 4 (928) 932 0Primary Care Advice Link Other 484,820 484,820 484,746 (74) (73) (1) 0CAMHS Mental Health 174,000 174,000 174,000 0 0 0 0Parenting & Prevention Other 87,500 87,500 30,000 (57,500) (52,711) (4,789) (57,500)Homeopathy Other 14,318 14,318 10,077 (4,241) (3,046) (1,195) (4,241)Looked After Children Other 0 0 3,372 3,372 3,583 (211) 2,000Total Non Acute Contracts 16,906,582 16,906,582 17,393,121 486,539 580,775 (94,236) 519,590Primary Care Prescribing Prescribing 59,201,241 59,201,241 58,621,870 (579,371) (522,848) (56,524) (716,930)Central Drugs Prescribing 1,728,388 1,728,388 1,688,547 (39,841) (29,030) (10,811) (23,619)Air Liquide Prescribing 527,608 527,608 556,204 28,596 49,214 (20,618) 56,446Total Prescribing 61,457,237 61,457,237 60,866,620 (590,617) (502,664) (87,953) (684,103)Continuing Healthcare/ Fully Funded Packages of Care Commissioned Out of Hospital 8,124,350 8,124,350 9,747,402 1,623,052 1,206,136 416,917 1,331,852Continuing Healthcare/ Fully Funded Packages of Care Personal Health Commissioned Out of Hospital 857,048 857,048 1,225,950 368,902 340,936 27,966 360,165Continuing Healthcare/ Joint Funded Packages of Care Commissioned Out of Hospital 19,242,408 19,242,408 20,132,870 890,462 836,228 54,234 1,219,641Continuing Healthcare/ Joint Funded Packages of Care Personal Health Commissioned Out of Hospital 0 0 40,918 40,918 38,716 2,201 39,022Children with Special /Safeguarding Needs Commissioned Out of Hospital 1,522,841 1,522,841 1,333,165 (189,676) 109,699 (299,375) 139,303CHC Childrens Personal Health Budgets Commissioned Out of Hospital 32,557 32,557 33,651 1,094 822 272 1,054Funded Registered Nursing Care Commissioned Out of Hospital 4,581,840 4,581,840 6,224,210 1,642,370 1,517,448 124,921 1,616,530Total Commissioned out of Hospital 34,361,044 34,361,044 38,738,167 4,377,123 4,049,986 327,137 4,707,567LES Budgets Other 2,260,691 2,260,691 1,924,585 (336,106) (130,694) (205,413) (142,907)Primary Care Development Other 170,000 170,000 163,165 (6,835) 0 (6,835) 0Think Pharmacy Other 200,000 200,000 125,894 (74,106) (65,527) (8,579) (74,103)WCCG Service Development Other 698,972 698,972 663,190 (35,782) (22,859) (12,923) (40,305)

Cost Centre Expenditure Category Annual Budget Budget to Date

Spend to Date Variance Prior Mth YTD Variance

Change In YTD Variance

Prior Mth Forecast Variance Including

RiskInterpreting Services Other 70,400 70,400 74,018 3,618 3,528 90 1,841Collaborative Fees Other 180,625 180,625 182,983 2,358 0 2,358 0Phlebotomy Other 121,029 121,029 168,253 47,224 43,067 4,157 31,920Prior approvals & exceptions (GPIT spend) Other 0 0 (703) (703) (703) 0 0PCTF Revenue Other 29,007 29,007 0 0 0 0Primary Care GPIT Other 860,000 860,000 855,589 (4,411) (4,485) 74 (4,492)Total Primary Care 4,590,724 4,561,717 4,185,981 (404,743) (177,672) (227,071) (228,046)Reablement Other 21,267,047 21,267,047 20,881,196 (385,851) (251,413) (134,438) (272,460)Acute Elderly Services Other 623,039 623,039 623,040 1 10 (9) 1Commissioning - Non Acute Other 127,057 127,057 127,057 0 12 (12) 0Community Services Other 48,633 48,633 33,914 (14,719) (13,674) (1,045) (14,925)Palliative Care Community 43,785 43,785 43,782 (3) 4 (7) 0Hospices Community 230,036 230,036 230,035 (1) 5 (6) 0Mental Health Services - Advocacy Other 16,521 16,521 53,415 36,894 33,224 3,670 36,243MH Services - Adults Other 471,996 471,996 471,996 0 8 (8) 0Dementia LES Other 53,000 53,000 72,587 19,587 17,960 1,627 19,587Dementia Other 221,290 221,290 221,292 2 11 (9) 0Intermediate Care Other 1,840,596 1,840,596 1,863,294 22,698 38,664 (15,967) 40,605Total BCF 24,943,000 24,943,000 24,621,608 (321,392) (175,189) (146,203) (190,949)Programme Projects (VANGUARD) Other 75,000 75,000 177,619 102,619 105,857 (3,238) 105,857CHC Admin Team Other 796,022 796,022 796,020 (2) 0 (2) 0CHC Admin Team - Other Other 187,374 187,374 187,378 4 () 4 0CSU MM Programme charges Other 873,125 873,125 873,122 (3) 1 (5) 0Winter Pressures (SRG) Other 198,684 198,684 134,493 (64,191) (3,535) (60,656) (64,191)Safeguarding Other 385,396 385,396 370,080 (15,316) (11,147) (4,169) (12,159)Safeguarding - other Other 194,082 194,082 191,562 (2,520) 96 (2,616) 0General Reserve - Programme Reserves 446,064 446,064 (1,572,301) (2,018,365) (1,719,867) (298,498) (2,091,961)Contingency Reserves 2,470,100 2,470,100 0 (2,470,100) (2,265,077) (205,023) (2,470,100)Rec QIPP Target Reserves (13,549,856) (13,549,856) 0 13,549,856 12,547,223 1,002,633 13,549,856Non recurrent Reserves Reserves 1,305,720 1,305,720 0 (1,305,720) (1,108,051) (197,669) (1,305,720)1% Headroom Reserves 4,867,000 4,867,000 0 (4,867,000) 0 (4,867,000) 0Total Other (1,751,289) (1,751,289) 1,157,973 2,909,262 7,545,501 (4,636,239) 7,711,582Total Programme Budgets 486,470,900 486,441,893 494,210,663 7,739,762 12,615,819 (4,876,056) 13,334,872Chair and Non Execs Running Costs 182,661 182,661 183,573 912 4,344 (3,432) 3,395CEO/ Board Office Running Costs 757,690 757,690 954,112 196,422 181,243 15,178 194,749Strategic Planning & Outcomes Running Costs 446,821 446,821 446,052 (769) (5,528) 4,759 (3,125)Clinical Governance Running Costs 469,954 469,954 345,177 (124,777) (123,062) (1,715) (134,723)Contracts Management Running Costs 552,422 552,422 423,755 (128,667) (123,629) (5,038) (130,513)Corporate Costs Running Costs 795,891 795,891 915,838 119,947 97,714 22,234 137,683CSU SLA Running Costs 444,580 444,580 411,895 (32,685) (30,089) (2,596) (32,685)Business Informatics Running Costs 445,218 445,218 423,212 (22,006) (14,242) (7,764) (21,850)Finance Running Costs 883,227 883,227 814,582 (68,645) (59,127) (9,518) (68,679)Commissioning Running Costs 553,767 553,767 564,519 10,752 6,935 3,817 2,152PALS Running Costs 34,000 34,000 34,000 0 2 (2) 0Reserves RC Running Costs 86,874 86,874 (81,740) (168,614) (156,731) (11,883) (169,150)Total Running Costs 5,653,105 5,653,105 5,434,975 (218,130) (222,170) 4,040 (222,746)

Total Wirral CCG Spend 492,124,005 492,094,998 499,645,638 7,521,633 12,393,649 (4,872,016) 13,112,126Surplus Offset 394,000 394,000 0 (394,000) (361,163) (32,837) (394,000)Total Wirral CCG Resource 492,518,005 492,488,998 499,645,638 7,127,633 12,032,486 (4,904,853) 12,718,126

* Running costs budget is vired non recurrently each year to cover programme spend - actual running costs expenditure against the original allocation is shown on the line below

Total Running Costs 7,099,000 7,099,000 6,865,555 (233,445) (233,314) (131) (234,905)

Wirral Clinical Commissioning Group

Briefing from the Deputy Chair of the Finance Committee, 21 March 2017

Purpose

The purpose of the committee is to provide assurance to the Governing Body in relation to the financial performance and plans of the CCG. This includes an assessment of the major risks to the delivery of the CCG’s statutory financial duties and the effectiveness of mitigating actions to manage the risks, the achievement of value for money in the use of resources, and the delivery of the annual Quality, Innovation, Productivity and Prevention plan, which is fundamental to the CCG’s ability to operate within the business rules determined by NHS England.

Significant agenda Items/Key topics discussed

• Month 11 Financial Position. The control total for the year of £12million deficit agreed by NHS England will be a major challenge to achieve, following a deterioration of £666,000 during Month 11.The committee focussed its discussion on the main areas of overspending, and efforts to improve performance.

• Cheshire and Wirral control total for 2017/18. NHS England has set a break-even control total for the CCG for next year, which will necessitate delivery of QIPP savings of over £12 million in the year, significantly more than the £3.8 million forecast achievement in 2016/17.

• Proposed Incentive Scheme for Primary Care Prescribing. The committee considered and supported a new prescribing incentive scheme, which if successfully implemented, will improve the quality, safety and cost effectiveness of prescribing, with shared benefit for the CCG and individual participating practices.

• Financial Recovery Plan. The committee reviewed the draft plan, which must be submitted to NHS England as part of the Capability and Capacity Action Plan, by 23 March 2017. Committee members made suggestions to strengthen the narrative of the plan, particularly in relation to proposals being considered to identify the full value of QIPP schemes required, and to address current overspending trends in key managed budgets such as Continuing Health Care and Physiotherapy Services.

Outcomes/actions/assurances/risks

• Based on the Month11 financial performance, there is a strong risk that the control total for 2016/17, set by NHS England may be breached. The CFO is reviewing all available options to avoid this position.

• In order to be released from formal Directions by NHS England in March 2018, the CCG must deliver a QIPP savings programme of over £1 2million in 2017/18, more than 3 times that achieved in 2016/17, as well as control spending within all managed operational budgets.

•

Any formal recommendations

The recommendations to the Governing Body from the meeting are as follows:-

• The Governing Body should take clear ownership for the successful delivery of the Capability and Capacity Action Plan, and in particular the Financial Recovery Plan.

Deputy Chair Name: Alan Whittle

Deputy Chair of Finance Committee

Date: 23 March 2017

1/2

1. INTRODUCTION 1.1 This report provides an update from the Turnaround Group meetings held on 28th February and the

21st March.

1.2 The Turnaround Group was established to improve the governance around Financial Recovery and to support the work of the Financial Recovery Group. The Turnaround Groups’ focus is on execution at Executive and Governing Body level, and it meets monthly to track the progress of the key programme themes and agree any mitigations or recovery activity necessary; it also tests the level of clinical ownership and confidence in the measures coming forward. Detailed scrutiny and development of individual QIPP projects takes place at the Financial Recovery Group, working to a new and more robust decision making process. The Finance Committee retains the key overview responsibility for financial recovery, to the Governing Body.

1.3 The terms of reference and scope of the Turnaround Group was approved at the Finance

Committee, and the first meeting was held on the 28th February.

2. KEY ISSUES / MESSAGES 2.1 The February meeting covered the following key areas:

• Agreement of terms of reference, scope of the group, and overall governance. • 2016/17 Financial plan and QIPP update. • 2017/18 Financial plan and QIPP update. • 2017/18 QIPP schemes requiring gateway review. • 2017/18/19 Operational plan. • Improvement Plan update.

2.2 The March meeting covered the following key areas:

• Requirements of the NHS England directions letter, • Discussion/Approval of the Improvement Plan, • Discussion/Approval of the Financial Recovery Plan 2017/18 – 2018/19.

2.3 The group strengthens the governance arrangements around the delivery of the QIPP programme

in terms of accountability, and provides a direct line of sight for governing body through the Accountable Officer who Chairs the meeting.

Report Title Turnaround Group Update Report Lead Officer Simon Banks, Accountable Officer

2/2

2.4 The 2017/18 QIPP plan has currently around 83% in total identified and this represents a considerable improvement on last year where very little was identified at the planning stage. The delivery of schemes now needs to be the key focus in terms of execution, and this represents a key challenge for the Executive Team, and for the CCG as a whole.

2.5 The Business case approach to QIPP scheme approval improves the governance and rigour

around schemes, ensuring we take forward those schemes that deliver the best returns. However, the identification of the business case outcomes in terms of both change and financial savings need further focus in terms of scale and pace to support improved delivery. It is important that cases are honed in on the key deliverables to gain traction, and that sufficient resource is supporting delivery.

2.6 The operational plan will need to support the financial recovery and QIPP requirements once this is

completed in May. 2.7 The Improvement Plan shows progress to date in terms of the implementation of key

recommendations, however there remains a significant challenge in terms of supporting the changes required to deliver the new ways of working.

2.8 The Financial Recovery Plan meets the requirements to deliver a balanced plan in 2017/18 through

a £12,275m QIPP, the challenges remaining around delivery. 2.9 The CCG expects to receive feedback on both the Improvement plan and the Financial Recovery

Plan from NHSE as part of its directions.

3. IMPLICATIONS

3.1 The delivery of the financial plan for 2017/18 and the supporting QIPP is critical to the CCG

achieving the requirements laid out in its directions.

3.2 The Executive Directors will need to ensure they have the appropriate focus within their teams to assure delivery.

4. CONCLUSION

4.1 The Turnaround Group provides a key assurance to the Governing Body in holding to account on delivery of QIPP and wider transformation.

Simon Banks Chief Officer

1/2

GOVERNING BODY BOARD REPORT COVER SHEET


High YES Medium Low

The exceptional performance is identified as a risk within the CCG Risk Register.





Director of Commissioning’s Report Agenda Item: 4.1 Reference GB17-18/0008



Nesta Hawker, Director of Commissioning

Contributors Tricia Clitheroe, Assistant Director of Contracts and Delivery, Andrew Cooper, Assistant Director of Planned and unplanned Care, Anna Coyle, Programme Management Office Lead

For Decision

For Information Yes

For Discussion

Executive Summary The report highlights key updates from the portfolio of the Director of Commissioning.

Recommendations The Governing Body is asked to: • Note the contents of the report

2/2






Y



Y




Report Title Director of Commissioning’s Report Lead Officer Nesta Hawker, Director of Commissioning

Recommendations • To note update on the implementation of the CCG Operational Plan

for 2016/17 • To note the update on the Better Care Fund to 2017/18 • Note the review of recent performance against constitutional

standards.

1 INTRODUCTION

This paper provides Governing Body with a report on the key strategic and operational issues and developments related to the delegated duties of the Director of Commissioning.

2 STRATEGY DEVELOPMENT AND REFORM IMPLEMENTATION

2.1 OPERATIONAL PLAN 2016/17

The CCG Operational Plan for 2016/17 had a number of milestones for achievement of the key priority areas of work. Against the key priority areas there were 115 milestones of which 73 have been achieved, 32 will be achieved during 2017/18 and 8 remain outstanding with mitigating actions identified against each of these. The detail of the milestones and achievements are shown in appendix 1 and the below is a summary of achievements against each of the priority areas.

2.1.1 Primary Care Transformation – notable achievements in this area include use of e-referral increasing to 78% from baseline of 56% and an increase to 90% of patients rating the experience of accessing GP service as very good or good. There is one unachieved milestone within this priority area related to the CCG achieving level 3 delegated commissioning for primary care. Further engagement work will continue during 2017/18 with our members with the aim of submit an application for level 3 with member approval.

2.1.2. Urgent Care Redesign – whilst achievements have been made during 2016/17, there are a number of milestones that will continue into 2017/18. In order to reduce low acuity presentations at the hospital, primary care streaming is now being undertaken at the emergency department at the hospital both for those brought via ambulance and also for those who walk into the department. During 2016/17 the CCG completed a value stream analysis of the urgent care pathway with key stakeholders which has resulted in the development of two proposed models for an improved urgent care pathway. Further engagement work will be undertaken prior to a full formal public consultation during 2017/18.

2.1.3 Care Closer to the Individual (Better Care Fund) – key achievements in this area include the success of intermediate care in supporting 90% of people to remain at home 91 days after discharge. However, overall the various schemes within the Better Care Fund have not achieved the target of 3% reduction in non-elective admissions (actual 2.7%) and there has been no reduction in bed occupancy.

2.1.4 Transforming of Diabetes Care – key milestones have been achieved during the year and there is only one milestone that will now be achieved during 2017/18 and this is due to the delay in launching the diabetes registry. Key achievements have included the introduction of specialist foot clinics in order to reduce waiting times and amputation rates.

2.1.5 Transforming Respiratory Care – progress has been achieved during 2016/17 with the development of more local services to improve access to patients. Work will continue on the development of the

registries which will enable identification of the impact of the improved access. Further work is required to develop increased use of self management and tele health for this patient group.

2.1.6 Parity of Esteem – progress has been made during 2016/17 in particular against achievement of constitutional standards for early intervention of care packages for patients with a new diagnosis of psychosis, and also the development of an integrated provider hub which is achieving efficiencies for reinvestment in mental health.

2.1.7 Transforming Care Programme – learning disability services – notable achievements in year is the development of a Joint All Age Learning Disability Strategy with the Local Authority and adoption of an outcome based specification across Wirral and Cheshire. Work will continue on the milestones and actions that are ongoing during 2017/18.

2.1.8 Children’s Mental Health – key achievements during 2016/17 include the implementation of a primary care mental health model in October with each school having a named primary health worker. A new eating disorder model has also delivered improved access to services. Work will continue on the milestones and actions that are ongoing during 2017/18.

2.1.9 Maternity – all milestones have been achieved during 2016/17. Notable achievements include the agreement of shared care pathways between providers and also Wirral securing funding to improve perinatal mental health care.

2.1.10 Older People – frailty pathways – all milestones have been achieved during 2016/17. Key achievements include the Community Rapid Response teams and Integrated Care Co-ordination teams managing 1,164 patients by supporting them to stay at home.

2.1.11 Cancer – there is one milestone that will be achieved during quarter one of 2017/18 in that the Cancer Strategy is to be formally adopted. Key achievements during 2017/18 implementation of new pathways for three major tumour sites in order to improve rapid diagnosis from GP referral.

2.1.12 Palliative and End of Life Care – key milestones have been achieved during 2016/17 which have included enabling more patients to receive care in their preferred place for end of life care. Work will continue into 2017/18 on outstanding actions, including the roll out of an Electronic Palliative Care Co-Ordination System which is linked to the development of the Wirral Care Record.

2.2 BETTER CARE FUND 2017/18

The Better Care Fund (BCF) continues to support transformational change in Wirral and has achieved a 2.7% non-elective admission reduction at month 10 of 16/17. However, this now stands at 0.9% increase against plan due to unprecedented demand over the winter months.

All existing schemes have been reviewed in order to identify priorities for development and potential areas for recommissioning. Key priorities for 2017/19 include:

o Drive integration & develop a robust 7 day community offer

o Better Health, Better Care, Better Value

o Support wider 5 year plan (Accountable care partnership) in line with (STP) sustainable transformation plan

o Support wider system redesign

The BCF plan for 17/19 will build on recent successes identified from the ongoing evaluation of existing schemes. The focus is to scale up the most successful schemes including:

o Rapid Community Service developed to include dementia crisis response and provide support for ‘Green Car’

o Green car – expansion of hours (16 hours per day, 7 days per week)

o Ensuring immediate access to wrap-around community support offer which includes:

• Reablement at home • Domiciliary care • Mobile nights

Key areas for transformational change in 2017/18 include:

o Discharge to assess (bed based)

o Home first (individual’s own home)

o Development of the single integrated gateway to ensure robust community interventions are offered to avoid an admission wherever possible

o Investment in tele-triage / tele-health

Recently published national guidance mandates the following four conditions:

1. Plans to be jointly agreed

2. NHS contribution to adult social care is maintained in line with inflation

3. Agreement to invest in NHS commissioned out-of-hospital services, which may include 7 day services and adult social care

4. Managing Transfers of Care (a new condition to ensure people’s care transfers smoothly between services and settings)

Beyond this, areas have flexibility in how the Fund is spent over health, care and housing schemes or services, but need to agree how this spending will improve performance in the following four metrics:

1. Delayed transfers of care;

2. Non-elective admissions (General and Acute);

3. Admissions to residential and care homes;

4. Effectiveness of reablement.

In addition, following the budget announcement relating to increased funding for social care, the national guidance also includes specific reference to the ‘Improved Better Care Fund’. This is additional resource aimed at supporting social care which is channelled through the Better Care Fund. For 2017/18 this equates to £8.3m, it is proposed by the Local Authority that this is allocated in the following way:

• £5m for the protection and stabilisation of social care • £1.3m for care provision outside of hospital to support timely discharge • £2m allocated to a local ‘innovation fund’ on a non-recurrent basis to support sustainable system

transformation – proposals will be developed from across the system which will be reviewed and approved / rejected via the BCF Board.

1. PERFORMANCE AGAINST THE NHS CONSTITUTIONAL STANDARDS (February 2017)

The full performance report for January has been reviewed and discussed in detail by the Quality and Performance Committee in its March meeting. The following dashboard demonstrates the exceptions only in performance against the NHS constitutional standards and includes a trend analysis from April 2016 to February 2017. A copy of the full performance pack is available on request.

A&E The 4 hour A&E target continues to be a concern and the trend in the dashboard above demonstrates the deterioration in performance. The Wirral A&E Delivery Board monitors the progress made against the action plan. Recent initiatives include primary care streaming, review and redesign of discharge pathway and initiation of additional Better Care Fund Schemes. Ambulance The performance of ambulance response times has shown some recent improvement in terms of red category 2 calls (not life threatening) and category A calls within 19 minutes. The Wirral A&E Delivery Board monitors the performance and progress against the action plan. A recent initiative has been a pilot of primary nurse triage of ambulance arrivals at the hospital. This has had a positive impact on reducing the handover time from the ambulance to the hospital and as a result the triage will continue. RTT The referral to treatment (RTT) 18 week wait for incomplete pathway was not met in February with performance at 84.51% for Wirral CCG and 83.69% for WUTH. The CCG has not met the 92% standard since December 2015. The performance at WUTH is a significant contributing factor to the CCG as WUTH has not met their STF target or the standard since July 2016. The CCG is receiving additional support from NHS England via the Demand Management Assurance Programme and has developed an action plan to support CCG recovery. The CCG, WUTH, NHSE and NHSI (via RTT Intensive Support Team) are working together to support WUTH’s recovery of the standard. WUTH has developed a revised RTT recovery plan with support from NHSI. The initial emphasis is on data cleansing of Patient Tracking Lists, data quality, training, and harm

reviews of patients waiting more than 52 weeks. WUTH have notified the CCG that they have identified 2 patients who have waited more than 52 weeks at this point and that there are more 52 week+ waiters in March and April. WUTH have confirmed that they will adhere to their Duty of Candor for all 52 weeks waiters. Following completion of the data cleansing/quality phase, work will commence to agree recovery trajectories. This will be overseen by the newly formed RTT Recovery Board which will include all key stakeholders and is yet to host its inaugural meeting. The continued poor performance in regards of RTT at WUTH is discussed at length at the Quality and Performance Committee. Cancer Wirral CCG closely monitors the 62 target on a monthly basis and liaises with WUTH in respect of breaches and action plans. A number of actions have already been implemented and improvements are now being realised, this has included additional resources and clinics being put in place in gynaecology and targeted action plans for Head & Neck, UGI and Urology. Pathways are continually being reviewed for improvement, for example, Lung is currently under review. A key area currently is robotic capacity, this is being looked at in detail by WUTH and we are awaiting a response in terms of their proposals and timescales. WUTH have introduced robust systems to review all patient progress weekly, and when breaches occur an investigation is always undertaken and the finding fed into an action plan which is agreed and monitored by the Chief Operating Officer. WUTH report their targets quarterly and in general meet their targets for 62 day referral. IAPT In terms of the performance for the Improving Access to Psychological Therapies (IAPT) the CCG has completed a quality risk profile with NHS England and NHS Improvement and have instigated enhanced performance monitoring. A formal performance notice has been issued with required actions to be delivered for improvement during April and also reduction of waiting list during April – June. NHS Improvement is due to undertake a review of the provider during May. 4. CONCLUSION

Governing Body is asked to:-

• To note update on the implementation of the NHS Right Care programme. • To note update on Better Care Fund • Note the summary review of recent exception performance against constitutional standards.

Priority Area

Logic Model Outcome RAG Update

Increase in the number of integrated out of hospital servicesPotential reduction in acute hospital activityReduction in unwarranted variation (movement to top quartile of NHS Right Care specialties)

Achieved (year to date) a 16.5% GP referrals reduction for Wirral University Teaching Hospital NHS Foundation Trust and Spire against the Primary Care Quality Scheme (PCQS) plan 2016/17.

Use of E-Referral has increased to 78% from a baseline of 56%.

Ambulatory Care Sensitive Admissions reduced by 13.3% against plan.

Enhanced Primary Care in ‘Care Homes’ service commencing April 2017 to deliver a 10% targeted reduction in admissions from care homes from 2016/17 baseline.

100% of Wirral patients are able to access routine GP services over 7 days The Wirral Primary Care GP Access Hubs will be operational from May 2017 in each of Wirral’s Parliamentary constituencies. The service will be delivered in addition to core GP contracted hours providing a minimum of 186 additional GP appointments each week over 6/7 days (subject to the outcome of the Pilot).

>85% of patients have a ‘good’ experience of accessing GP services or a 3% increase

90% of patients have rated their overall experience of their General Practice as ‘Very Good’ or ‘Good’. We continue to be above the England average for the percentage of patients who have a ‘Good’ experience of accessing GP services (National GP Patient Survey).

100% of Primary commissioning decisions with CCG involvement The CCG currently undertakes formal joint commissioning arrangements enabling it to locally determine the primary care delivery model and primary care service design in conjunction with NHS England. This is further supported by the establishment of the Primary Medical Care Co-commissioning Committee (PMCCC), a sub-committee of the Governing Body.

As part of our application for level 3 delegated commissioning of primary care, a survey was carried out in January 2017 with our members. The outcome of the survey was not to proceed with the application. In 2017 further work will be carried out with our members supported by a robust communications and engagement plan, which has been agreed with the PMCCC. The aim of this work will be to submit an application by December 2017 for level 3 - fully delegated commissioning. If successful, the change would be effective from April 2018.

100% of Wirral practices are a member of a GP Federation Two emerging GP Federations have been formed to represent unit GP practices as provider groups – Wirral GPW-Fed Limited and Primary Care Wirral Limited.

All Wirral practices are members of one of the Federations; we will continue to work with the two Federations in 2017/18.

At least maintain the overall number of the primary care workforce across all roles

100% of primary care staff are able to access training

2016/17 Operational Plan - Update Report

New out of hospital NHS RightCare Pathways are being developed for implementation in April 2017. These will aim to move Wirral to the top quartile range of RightCare CCGs.

All primary care staff are able to access training via Bluestream Academy, an online e-learning resource. 4 Protected Learning Time (PLT) half day events are held for GPs and Nurses annually.

Investment allocation of £29k provided to GP Federations for reception training.

23 practices embarked on the GP Improvement Programme.

Wirral Primary Care Workforce Strategy to be implemented from April 2017 detailing trajectory of programme implementation to mitigate impact of general practice staff leaving the service.

Primary Care Transformation

Tran

sfor

mat

ion

Priority Area


Deflection of 15% low acuity/primary care presentations away from A&E Streaming has been pushed over several keys dates, deflecting over 15% of presentations away from ED. This has overall supported capacity through the front door.

Estate that is fit for delivering new models of urgent careDelivery of care in the right place by the right professionalFeedback used to inform new care model developmentIncrease in low acuity trauma referrals Wirral Community NHS Foundation Trust's Minor Injuries Unit located at Victoria Central Hospital has piloted a pathway for the

management of low acuity trauma referrals to be managed away from the main hospital site. The findings of this pilot will be incorporated into the transformation for urgent care.

Improved patient flow through the healthcare system Wirral has focussed on improving patient flow through the hospital and recently instigated a transfer of care group to support seamless journeys for patients including the principle of Home First.

3.5% reduction in non-elective admissions Care closer to home schemes e.g. rapid response and ICCT have contributed to 2.7% reduction in non-elective admissions. A number of new schemes will be implemented in 2017/18 to ensure the 3.5% target is achieved.

Aligned, clinically consistent, cost effective services The Urgent Care Alliance has been superseded by the Urgent Care Transformation Group. A period of engagement will be undertaken from May 2017 with all key stakeholders to propose potential options for the future this will include a review of clinical governance, contracting and funding arrangements.

3% reduction in non-elective attendances Care closer to home schemes supported via BCF have contributed to reducing non elective admissions by offering pathways and services in the community which has seen a reduction of 2.7% in admissions at January 2017.

Individuals receive rapid assessment and intervention from services Rapid assessment and intervention for IV antibiotics in the community has avoided 225 admissions, providing treatment in the patient’s own home.

Enabling people to live independently at home – target of 90% of people still at home 91 days after discharge from reablement

Reablement has supported 90% of people to remain at home 91 days after discharge e.g. Intermediate Care.

People have a better experience of care – monitored via patient surveys Schemes include intermediate care beds and achieve key outcomes for patients and improve their experience. 80% of patients mostly improved. 77% of patients showed improvement in at least one therapeutic goal/outcome. 50% of patients required less support with their toilet use.

5% overall reduction in hospital bed occupancy Bed occupancy has fluctuated particularly in the early part of 2017 due to complexity of case mix and need for acute care in many patient groups.

Reduction micro and macro vascular complications We have been working collaboratively with orthotist and vascular consultants within the MDT foot clinics.Admission avoidance incl from care homes Following a review of care homes, a policy has been developed and agreed with social services to be included in care home contracts.

Optimisation of treatment plans (9 care processes) This has been developed within our community hubs resulting in a reduction in HbA1c levels.Reduction in length of stay A bid for DSNs based at Arrowe Park Hospital has been submitted to improve management of in-patients and reduce length of stay.

Improved diagnosis and case finding The launch of the diabetes prevention program (DPP), in October 2016, to support lifestyle change in patients at risk of developing diabetes has resulted in 229 patients being referred with 100% attendance at group sessions.

Improved data sharing across Wirral health and social care economy We have supported the development of the Wirral Care Record and registries.Consistent approach to care We have been working collaboratively with Wirral Universtity Teaching Hospital NHS Foundation Trust and Wirral Community NHS

Foundation Trust to develop an single education programme.Improved targeting of services to meet population need We have developed 5 day MDT foot clinics to reduce waiting times and amputation rates.Improved knowledge and awareness of population We have used QOF, NDA, JSNA and RightCare data to validate information and ensure all aspects of diabetes care has been reviewed

to support service transformation.Earlier identification of people with diabetes &/or at risk (pre-diabetes) We are identifying people with diabetes earlier by promoting health checks and referrals to the DPP service.

Improvement of lifestyle factorsIncreased self-managementImproved use of telehealth/digital approaches to manage conditions We have worked with Cerner to develop a registry for diabetic patients which will be launched across all practices in the coming year.

There has been a delay in lauching the diabetes registry - this will now be implemented in Summer 2017.

Tran

sfor

mat

ion

We have successfully promoted lifestyle changes as part of the DPP and the community hubs which has reduced HbA1c levels.

Following on from the successful VSA events, the CCG is now undertaking a process of engagement with key stakeholders to look at options for future delivery as part of the transformation of urgent care . This includes new models of care with right place, first time and replaces the urgent care alliance.

Care Closer to the Individual - Better Care Fund

Urgent Care Redesign

Tran

sfor

mat

ion

Tran

sfor

mat

ion

Transformation of Diabetes Care

Priority Area


Reduced admissions and length of stay; fewer hospital visits, fewer unplanned primary care visits

We are currently looking at capturing this information to report to the Healthy Wirral Partners Group

Easier and earlier access to care and support We have provided ‘Hot Slots’ for patients requiring urgent appointments with a consultant or GPwSI. We also now have a 7 day COPD service in place.

Earlier, evidence-based treatment e.g. pulmonary rehab We have an additional Pulmonary Rehab Group based at St Catherine’s which has provided easier access for patients and reduced waiting times.

Improved data sharing across Wirral health care economy We have supported the development of the Wirral Care Record and registries. We have worked with Cerner to develop a registry for respiratory patients which will be launched across all practices in the coming year. There has been a delay in lauching the respiratory registry - this will now be implemented in Summer 2017.

Improved diagnosis and case finding We have been waiting for the launch of the registries to provide analytics which will drive improved efficiencies and clinical outcomes.

Consistent approach to care We have presented an update on the service to GPs at a PLT event to develop a consistent approach across the system.Better case management We now review care plans for patients referred into the service and ensure GPs are provided with an update following discharge.

Improved targeting of services to meet population need We are now providing a service at St Catherine’s to provide easier access and reduce DNAs.Earlier identification of people with certain respiratory conditions We have reduced waiting times with implementing the pilots and having access to ‘Hot Slots’ which is helping with earlier

identification of patients with respiratory conditions.Improved knowledge and awareness of population We have used JSNA and RightCare data to validate information and ensure all aspects of respiratory care has been reviewed to

support service transformation.Improvement of lifestyle factors e.g. reduced smoking/higher quit rates The additional Pulmonary Rehab Group and consultant clinics include promotion of lifestyle factors and increased self-management.

Improved use of telehealth/digital approaches to manage conditions

Increased self-managementBetter understanding of determinants of poor respiratory health We have promoted the service to clinicians including the local factors that affect people’s health.Minimised duration of untreated psychosis>50% people with suspected psychosis will have access to a NICE approved care package within 2 weeks of referral>70% of our expected prevalence of dementia have a confirmed diagnosis This target has been met for Q1-3.

>95% of people referred to IAPT services are treated within 18 weeks of referral>50% people in treatment with IAPT services move to recovery>75% people referred to IAPT services will be treated within 6 weeks of referralPeople with suspected ADHD assessed within 18 weeks New model for ADHD is to be launched May 2017 to introduce a new shared care model to increase assessment rates. Compliance with NICE for adult ADHD

Compliance with NICE for schizophrenia and bipolar90% people with severe and enduring mental illness have a record of physical health check in the past year

JW New model for physical health monitoring and secondary care mental health interface with primary care in development. Each practice will have a named secondary care mental health worker, and patients will be discharged back to their GP who no longer require secondary care mental health services.

Outcomes based commissioning

Reduced duplication in contract monitoring and shared outcomes

Patients are in personalised packages that move them towards independence

Assurance that all out of area packages are appropriate

Compliance with NICE guidanceMental Health Act used when appropriate JW Info from Janet

Tran

sfor

mat

ion

Men

tal H

ealth

& L

earn

ing

Disa

bilit

y

Early Intervention Psychosis 2 week referral to treatment target has been met and surpassed for Q1-3.

We still need to look at how we can develop this aspect as part of the transformation with the limited resources we now have.

Transforming Respiratory Care Pathway

Parity of Esteem

Implementation of Integrated Provider Hub during 2016/17 delivering the following: -

- Outcomes will be reported across Mental Health providers with effect April 2017- Outcome based care plan in place for all new mental health packages of care- Collaborative commissioning across health and social care for individual care packages.

Integrated Provider Hub is reviewing mental health packages on behalf of CCG and for reinvestment of efficiencies within mental health.

Referral within 18 weeks to IAPT services target has started to be met in Q3 and is expected to be achieved by Q4.

IAPT targets for access and recovery are not on track to recover by end of year. We are working with the NHS intensive support team and the provider to develop a recovery plan.

Compliance is adhered to for schizophrenia, bipolar and adult ADHD current model.

Priority Area


Timely intervention

Reduction of A&T beds to 6 for 2016-17

Better experience of care

Support learning disability clients to live as independently as possible

9 core principles identified in person centred outcomes

Management of people living with a learning disability in a proactive and inclusive way

80% of people with a learning disability over the age of 14, will be offered an Annual Health Check and Action PlanReduce health inequalities60% of LD patients will have a Health Passport

Focus on outcomes not counting activity All commissioned LD services from our main mental health provider (Cheshire and Wirral Partnership Trust, (CWP) for Wirral now operate under one specification, which focus on outcomes and not just counting activity, this is also in line with the Transforming Care Programme (TCP).

Understanding of our population’s needsAccountability and transparencyReduced duplication in contract monitoring and shared outcomes

Outcomes based commissioningChildren and young people receive first contact within 4 weeks of referral to eating disorder services

Increase in number of children and young people referred to eating disorder services accessing a NICE-concordant care package within 4 weeks

School staff more confident in managing mild to moderate mental health concerns

Children and young people feel more supported within the school setting

Reduction in admissions for self-harm

Compliance with NICE guidance

Children and young people able to see a community paediatrician within 18 weeks of referral

Children's Mental Health

Men

tal H

ealth

& L

earn

ing

Disa

bilit

y

Transformation Care Programme (TCP) - Learning Disabilities (LD) - Cheshire & Wirral Delivery Hub

We have been working with the Local Authority to review existing data sources, and are developing a shared 'Future in Mind' dashboard for implementation in 2017/18.

Milestones have been agreed between CWP, Wirral CCG and East Cheshire CCG for a new eating disorder model which is delivering improved access and service to nice concordant eating disorders. Positive feedback has been received from parents accessing localised service.

We continue to improve our number of Annual Health Checks and Health Passports. In 2015/16 we achieved 63% for health checks; we are aiming for 80% for 16/17. The data for this will be available Autumn 2017.

For Health Passports in 15/16 we tasked our main mental health provider with a target of 60% of service users known to their service, required to have a Health Passport - We achieved 86%.

We have led a bid for additional funding to support the delivery of an intensive support service. As part of the Cheshire & Wirral footprint we have been successful in attracting under £1.5 million pounds in total to aid work on supported living, as well as the intensive care support service.

We have developed a Joint All Age Learning Disabilities Strategy with our local authority. This strategy aims to address inequalities in society that are often faced by people with learning disabilities and identified following reviews conducted by MENCAP in 2007 and 2012 and Winterbourne View. This strategy has the nine core principles in person centred outcomes at the heart of its delivery and was coproduced. Our Equality and Inclusion report for 2016 formally recognised our work on the Joint All Age Strategy.

We are continuing to reassess individual patient pathways to achieve our trajectory for year 1, 6 beds, we currently have 7 inpatients on A&T wards. Care and Treatment Reviews (CTRs) have been developed as part of NHS England’s commitment to improving the care of people with learning disabilities with the aim of reducing admissions and unnecessary length stays in hospitals and reducing the health inequalities.

In 2016 we undertook 12 inpatient CTRs in order to facilitate discharges and 10 blue light CTRs which resulted in 8 people not being admitted to hospital. As part of the TCP we are working towards, with our colleagues across Cheshire and Mersey, to maximise resource and standardise process in this area. This process also aims to ensure that care is delivered in the right place at the right time.

We are part of and working within the Cheshire footprint as a whole system approach regarding the reduction of these beds. This is in line with our TCP Cheshire and Mersey Plan.

Child

ren

and

Mat

erni

ty

A Primary Care Mental Health model was launched in October 2016, with each school having a named primary mental health worker.

Collaborative commissioning between Health, Social Care and Public Health commenced with the review of the CAMHS service specification.

Early indicators demonstrate reduced attendance at A&E for children and young people presenting in crisis and as a result of self harm.

A new parenting course model for ADHD and ASD has been launched.

Review of Community Paediatrics specification to improve referral pathways across paediatric services between the Acute

Priority Area


Personalised care centred on woman and her baby and the family We have been working collaboratively with other local CCGs to implement the recommendations included in the Better Births report.

Continuity of carer, to ensure safer careMulti-professional working breaking down barriers between clinicians

Safer self-care with professional working together to ensure rapid referral and access to services

Models of care and service delivery across Cheshire and Merseyside are being developed by the Maternity Vanguard Team, including input from all providers to assist in the shaping of future services.

Better postnatal and perinatal mental health care We have been mapping out resources available in Wirral for perinatal mental health, looking at a competency framework, identifying the gaps, and funding available for training.

Number of redesigned pathways We have developed a service specification for a caseloading 3 year contract model maternity service, awarded to One to One Midwives.

Compliance with NICE guidance Monthly dashboards received from WUTH and One to One allow us to monitor compliance. Working across boundaries to support personalisation We have been working across boundaries to support the implementation of the Better Births report at a local level.

Reduction in rate of still births Training is in place to help midwives identify women at risk of still birth (small babies) in line with national guidance.

Enabling people to live independently at home – target of 90% of people still at home 91 days after discharge from reablement

Reablement has supported 90% of people to remain at home 91 days after discharge e.g. Intermediate Care.

Reduction in unplanned hospital admissions for patients aged 74+ years (excluding surgical and stroke admissions)Reduced length of stay (no more than two nights where appropriate)Management of elderly people in a planned way Community Older People’s Service supports care to older patients in a planned way. This includes telephone line, home visits, and

older people’s rapid assessment clinics. Patients and carers have a better experience of care Carer experience - 3,100 carers on the carers register, short break beds commissioned for both residential and nursing which are 90%

occupied. 205 carers accessing carers grant and benefit from support such as counselling and groups. Rapid response and intervention Community Rapid Response Reams and Integrated Care Co-ordination Teams have managed 1,164 patients over the year providing

rapid response and intervention to support particularly older patients to stay at home and reduced admissions.

We have agreed pathways for shared care during pregnancy across both WUTH and One to One midwives .

Old

er P

eopl

e

Unplanned admissions have reduced over the last 12 month period. Older People’s Assessment Unit supports a reduced length of stay as consultant geriatricians, specialist nurses and therapists plan care and discharge patients as early as possible. Length of stay is gradually reducing to prevent deconditioning of patients.

Older People - Frailty Pathways

Child

ren

and

Mat

erni

ty

Maternity

Priority Area


Strategy to support all delivery partners to develop and deliver cohesive services (Measurement – Cancer Strategy 2017 – 2020 published Jan 2017)

We have developed a draft Wirral Wide Cancer Strategy for 2017 - 2020 with partner and patient input. This is aligned to national and regional activity, for example, the Cancer Transformation funding. The strategy will be monitored through the CCG operational plan on a monthly basis and, bi-monthly, progress will be considered by the Wirral Strategic Cancer Partnership.

Rapid and responsive care for those with urgent need presenting at ED (Measure – Patient Experience Survey shows 5% increase in satisfaction)Patients experience rapid diagnosis for suspected cancer from GP Referral (Measurement – 100% of patients are diagnosed within or less than target)

Improved communications and information sharing across delivery partners enabling delivery partners to make fully informed decisions utilising comprehensive patient data and access guidance and advise as required (Measure – Patient Experience Survey shows 5% increase in satisfaction)

A directory containing new email and phone hotlines is in place for GPs and partners to support early diagnosis.The Macmillan Cancer Information Centre is now established at Arrowe Park Hospital and Clatterbridge Cancer Centre.

Health & Well-being Events are in place for patients diagnosed with cancer.

An increase in the number of people adopting healthy lifestyle choices (Measure – 10% increase in the number of patients participating in health lifestyles)

A decrease in the next 5 years in diagnosed conditions relating to poor lifestyle choices (Measure – increase by 5% annually in the number of years people live with and beyond cancer)

Those living with and beyond cancer have access to the information and support they need (Measure – Patient Experience Survey show 5% increase in satisfaction)

The Macmillan Cancer Information Centre is now established at Arrowe Park Hospital and Clatterbridge Cancer Centre.

Health & Well-being Events are in place for patients diagnosed with cancer.

Holistic needs assessments have been introduced within the clinical setting to support patients to assess their priorities including their health and well-being.

All patients have access to a named Clinical Nurse Specialist.

Primary care professionals are aware of and able to guide and refer patients appropriately (Measure – GP practices develop Cancer Action Plans / increase in number of 2WW referrals by 10%)

A directory containing new email and phone hotlines is in place for GPs and partners to support early diagnosis.Regular communications are provided to GPs in respect of early diagnosis of cancer.

On the whole, we are attaining the target for 2 weeks from referral to first appointment, this has been supported by revised referral guidance and updated referral forms.

18 practices have engaged with CRUK to undertake the Cancer Self Assessment framework.

Canc

er a

nd E

nd o

f Life

New pathways are in place for three major tumour sites - Lung, Colorectal and Upper GI. This has accelerated diagnosis and increased capacity.

Referral to diagnosis is not monitored, however, we are just below the national average (2.36%) for cancers diagnosed at Stages 1 or 2 and screening rates are green for breast cancer at 75%, but amber for Bowel (55%) & cervical (72%) (Data - Q3 2015/16). A communications programme has been established to amplify national campaigns at a local level and a prevention sub group has been

The Macmillan Cancer Information Centre promotes health and well-being activities and provides information as to where patients can engage in activities.

Regular Health & Well-being Events provide support for patients to access health and well-being activities.Holistic needs assessments have been introduced within the clinical setting to support patients to assess their priorities including their health and well-being.

We are working with leisure services to introduce Lifestyle HNAs in the community setting.Staff at Wirral Leisure centres and a private gym has been trained through Macmillan funding on the Wright Foundation Cancer Module.

Communication plan to amplify locally national campaigns to raise awareness of cancer and cancer screening.

Cancer

Priority Area


Increased integration between providers We have developed a draft Wirral wide Palliative and End of Life Care Strategy with input from a range of providers, for implementation in 2017.

Timely, accurate information sharing between providers EPaCCS (Electronic Palliative Care Co-ordination System) is still mandatory but is still evolving as part of the Wirral Shared Care Record project.

Improved care pathways An upcoming procurement for a new Domiciliary Care contract for Palliative and End of Life patients which will ensure consistency ,quality and availability of care for all patients. Interim providers are already in place.

Established service model with clear budget and performance indicators In 2016/17, we held contract review/negotiation meetings with all our EoL/Palliative providers to ensure all services are providing a quality service within defined financial limits.

Effective management of complex needs for end of life patients ‘Six Steps’ training for care home staff is continuing to be rolled out by the End of Life Facilitators. However, as this is a voluntary arrangement with providers, there are challenges contractually to implement in all nursing homes even those who take CHC funded patients.

Patients receive care in their preferred place with dignity and compassion We have commissioned Wirral St John Hospice to provide a Hospice at Home Service, to enable patients to remain at home, if they wish, for as long as it is safe and appropriate.

Negotiations to establish a more robust future contractual model with the Hospice have started to strengthen existing relationships and help the provider to develop our on-going business model.

Canc

er a

nd E

nd o

f Life

Palliative and End of Life Care


Briefing Report from the Chair of the Primary Medical Care Co-Commissioning Committee

Purpose:

To report to the Governing Body on available levels of assurance and/or escalate risks and issues requiring action arising from the Committee’s meeting on 14th March 2017

Significant agenda Items/Key topics discussed:

• Review of Risk Register • Primary Care Transformational Plan - Noted • Paper re PCQS 17-19 & Practice Standards and Clawback terms • Primary Care Quality Scheme (PCQS) highlight report 16/17 – Noted • PCQS Payments & Appeals paper – Noted • Estates and Technology Transformation Fund update – Noted • Wirral Primary Care GP Access Hubs Highlight Report March 2017 – Noted • Primary Care Support England bulletin - Noted


• Primary Care Quality Scheme – Approved in principle, subject to outcome of Finance Meeting

• Framework of the Risk register for the committee to be updated to reflect the Master Risk Register

Formal recommendations

• That the Governing Body notes the report above.

Linda Roberts Chair of Primary Medical Care Co-Commissioning Committee 14th March 2017

1/2



High Medium Low Yes

No key risks are identified within the report itself; however any risks relating to the issues within the paper will be identified separately within the risk register.


Patient and public involvement taken place Y

Equality Analysis/Impact Assessment completed Y

Quality Impact Assessment Y

Director of Quality and Patient Safety’s Report Agenda Item: 5.1 Reference GB17-18/0009



Lorna Quigley, Director of Quality and Patient Safety

Contributors Jessica Rani Pathak, Equality and Inclusion Business Partner Midlands and Lancashire CSU

Rachel Musgrave, Consultant in Health Protection Wirral Council

For Decision Yes, approve the CCG’s self-assessment against the Equality and Delivery System 2.

For Information Yes

For Discussion

Executive Summary This paper provides Governing Body with a report on the statutory functions and duties that the Director of Quality and Patient Safety is responsible for. These areas also align to the external CCG Assurance Framework.

Recommendations The Governing Body is asked to: • Note report • Approve the CCG’s self-assessment against the EDS2 system • Note the CCG’s Equality and Inclusion Annual Report

2/2






Y



Y


Governance route prior to Governing Body Meeting Date Objective/Outcome

Report Title Director of Quality and Patient Safety’s Report Lead Officer Lorna Quigley, Director of Quality and Patient Safety Recommendations For Governing Body to:

• Accept the quality report. • To be assured of the processes in place to promote quality

and patient safety. • Approve the CCG’s self-assessment against the EDS2

system • Accept the CCG’s Equality and Inclusion Annual Report

1. INTRODUCTION

This paper provides Governing Body with a report on the statutory functions and duties that the Director of Quality and Patient Safety is responsible for. These reports also align to the external CCG.

2. KEY ISSUES / MESSAGES

• Performance against Quality indicators (January data)

Health Care Acquired Infections (HCAI)

C-Difficle – In January there were 9 cases attributed to Wirral CCG, cumulative score stands at 78 incidents, now 15 over the trajectory cumulative figure (63), however Governing Body are reminded that this is an annual threshold. This is an improvement from the 2015/16 performance. Of the cumulative total, 39 cases have been assigned to the CCG. The themes from these cases include:

• Delays in sampling • Inappropriate prescribing (antimicrobial and other medications) • Poor documentation

Year to date, 24 have been assigned to Wirral University Teaching Hospital; 12 of which were avoidable and 12 unavoidable. The remaining cases (15) where assigned to other trusts which the CCG is an associate to the contract.

MRSA - There was 0 new cases in January, cumulative score remains at 3. This is an improvement on last year.

All cases of Health Care Acquired Infections have a Post Infection Review undertaken to ascertain if these where unavoidable or due to lapse in care. Action plans are developed for any cases due to lapse in care. Following the Post Infection Review (PIR) process, all 3 cases of MRSA have been assigned to the CCG and have been assessed as avoidable. The key themes/learning points are:

• Appropriate antibiotic prescribing • Timely referral to specialist services • Recognition of the deteriorating patient

The NHS has made great strides in reducing the numbers of C- Difficle, but the rate of improvement has slowed over recent years and some infections are a consequence of

factors outside the control of the NHS organisation that detected the infection. Further improvement on the current position is likely to require greater understanding of the individual causes of C -Difficle cases, to understand if there were any lapses in the quality of care in each case, and if so, address any problems identified. To support this, in 2014/15 NHS England introduced a change in the methodology for calculating organisational C-Difficle objectives and encouraged commissioners to consider sanctions for breach of C-Difficle objectives only where those were associated with lapses in care. This approach remains unchanged for 2017/18. NHS Improvement is carrying over the

C- Difficle objectives for 2016/17 into 2017/18. Action; Governing Body to note the continuation of the C-Difficle threshold for 2017/18.

• Mixed Sex Accommodation Breaches

NHS organisations are expected to operate without having mixed sex accommodation except in very specific circumstances “sleeping accommodation” included areas where patients are admitted and cared for on beds and trolleys, even when they do not stay overnight. It is therefore includes all admissions assessment units (including decision making units) day surgery and endoscopy units. It does not include areas where patients have not been admitted such as Emergency Department cubicles.

There have been 4 breaches in month for CCG patients, of which all occurred within Wirral University Teaching Hospital. Despite using contractual levers, there has been no improvement against this quality requirement; a quality review visit is being undertaken as part of enhanced surveillance in order to gain assurance that patient’s privacy and dignity is being maintained. The outcome of this will be reported through the CCG’s Q&P committee.

• Friends and Family (FFT)

There is no specific target to achieve in relation to FFT; however, providers have set themselves performance thresholds with regard to the recommend scores (90% green).

• Serious Incidents (SI)

Serious incident are events in healthcare where the potential for learning is so great, or the consequences to patient’s families and carers, staff or organisations are so significant that the warrant using additional resources to mount a comprehensive response. Serious incidents can extend beyond incidents which affect patients directly and include incidents which may affect patient safety or an organisations ability to deliver ongoing health care.

https://www.england.nhs.uk/patientsafety/wp-content/uploads/sites/32/2015/04/serious-incidnt-framwrk-upd2.pdf

A SI requires a provider organisation to undertake a root cause analysis within 60 days of the incident occurring develop a remedial action plan and provide ongoing evidence of implementation of the action plan. This process is managed through the Wirral Serious Incident Review Group.

There was 41 SI’s recorded in January, this is a decrease from previous months. Governing Body is asked to note: • A change in reporting guidance in Pressure ulcers for WCFT which has led to an

increase in reported incidents for the organisation.

• Care Quality Commission (CQC)



The role of CQC is to monitor, inspect and regulate services to ensure they meet fundamental standards of quality and safety and publish findings, including performance ratings to help people choose care. Throughout the last year, Inspections have been undertaken in Primary Care including GP surgeries and Dental Practices. Inspections will only be undertaken in the year for those practices that have regulations in place or have undergone a change in registration. Action: Governing Body to note the inspection regime • Equality and Inclusion Equality Delivery System (EDS 2) ; Following the EDS2 scoring event in December 2016, taking into the evidence submitted and the opinions given by stakeholder the CCG has self-assessed against the goals and outcomes within the EDS2 standards. These are outlined in Appendix 1. The CCG with has developed an Equality and Inclusion strategy. This aligns with the existing strategies and plans (communications and engagement strategy and CCG improvement plan). The strategy outlines the ambition and direction for the CCG over the next 4 years. A report will be produced annually which will record progress towards achieving the objectives within the strategy; Appendix 2 The Equality and Inclusion annual report has been developed to demonstrate the work and the activity that has been undertaken by the CCG over the past year and identify areas of priorities; Appendix 3 Action Governing Body is asked to: • Approve the CCG’s self-assessment rating against the EDS2 and the uploading on the

CCG website. • Note the Equality and Inclusion Annual report. 3. CONCLUSION

Governing Body members are asked to note the contents of the report and the following actions:

• To be assured of the rigour in the process in relation to the quality in primary care services

• Approve the CCGs self- assessment rating against the EDS2 and the uploading on the CCG website

• Note the Equality and Inclusion Annual report.

Equality Delivery System for the NHS EDS2 Summary ReportImplementation of the Equality Delivery System – EDS2 is a requirement on both NHS commissioners and NHS providers. Organisations are encouraged to follow the implementation of EDS2 in accordance with the ‘9 Steps for EDS2 Implementation’ as outlined in the 2013 EDS2 guidance document. The document can be found at: http://www.england.nhs.uk/wp-content/uploads/2013/11/eds-nov131.pdf

This EDS2 Summary Report is designed to give an overview of the organisation’s most recent EDS2 implementation. It is recommended that once completed, this Summary Report is published on the organisation’s website.

Headline good practice examples of EDS2 outcomes (for patients/community/workforce):

Level of stakeholder involvement in EDS2 grading and subsequent actions:

Organisation’s EDS2 lead (name/email):

Organisation’s Board lead for EDS2:

NHS organisation name: Organisation’s Equality Objectives (including duration period):

Publication Gateway Reference Number: 03247

Date of EDS2 grading Date of next EDS2 grading

Goal Outcome Grade and reasons for ratingOutcome links to an Equality

Objective

Bet

ter

hea

lth

ou

tco

mes

1.1

Services are commissioned, procured, designed and delivered to meet the health needs of local communities

Grade

Undeveloped

Developing

Achieving

Excelling

Which protected characteristics fare well

Age

Disability

Gender reassignment

Marriage and civil partnership

Pregnancy and maternity

Race

Religion or belief

Sex

Sexual orientation

Evidence drawn upon for rating

1.2

Individual people’s health needs are assessed and met in appropriate and effective ways Grade

Undeveloped

Developing

Achieving

Excelling


Age

Disability

Gender reassignment



Race

Religion or belief

Sex

Sexual orientation


1.3

Transitions from one service to another, for people on care pathways, are made smoothly with everyone well-informed

Grade

Undeveloped

Developing

Achieving

Excelling


Age

Disability

Gender reassignment



Race

Religion or belief

Sex

Sexual orientation



ObjectiveB

ette

r h

ealt

h o

utc

om

es, c

on

tin

ued

1.4

When people use NHS services their safety is prioritised and they are free from mistakes, mistreatment and abuse

Grade

Undeveloped

Developing

Achieving

Excelling


Age

Disability

Gender reassignment



Race

Religion or belief

Sex

Sexual orientation


1.5

Screening, vaccination and other health promotion services reach and benefit all local communities

Grade

Undeveloped

Developing

Achieving

Excelling


Age

Disability

Gender reassignment



Race

Religion or belief

Sex

Sexual orientation


Imp

rove

d

pat

ien

t ac

cess

an

d e

xper

ien

ce

2.1

People, carers and communities can readily access hospital, community health or primary care services and should not be denied access on unreasonable grounds

Grade

Undeveloped

Developing

Achieving

Excelling


Age

Disability

Gender reassignment



Race

Religion or belief

Sex

Sexual orientation



ObjectiveIm

pro

ved

pat

ien

t ac

cess

an

d e

xper

ien

ce 2.2

People are informed and supported to be as involved as they wish to be in decisions about their care

Grade

Undeveloped

Developing

Achieving

Excelling


Age

Disability

Gender reassignment



Race

Religion or belief

Sex

Sexual orientation


2.3

People report positive experiences of the NHS Grade

Undeveloped

Developing

Achieving

Excelling


Age

Disability

Gender reassignment



Race

Religion or belief

Sex

Sexual orientation


2.4

People’s complaints about services are handled respectfully and efficiently Grade

Undeveloped

Developing

Achieving

Excelling


Age

Disability

Gender reassignment



Race

Religion or belief

Sex

Sexual orientation



ObjectiveA

rep

rese

nta

tive

an

d s

up

po

rted

wo

rkfo

rce 3.1

Fair NHS recruitment and selection processes lead to a more representative workforce at all levels

Grade

Undeveloped

Developing

Achieving

Excelling


Age

Disability

Gender reassignment



Race

Religion or belief

Sex

Sexual orientation


3.2

The NHS is committed to equal pay for work of equal value and expects employers to use equal pay audits to help fulfil their legal obligations

Grade

Undeveloped

Developing

Achieving

Excelling


Age

Disability

Gender reassignment



Race

Religion or belief

Sex

Sexual orientation


3.3

Training and development opportunities are taken up and positively evaluated by all staff Grade

Undeveloped

Developing

Achieving

Excelling


Age

Disability

Gender reassignment



Race

Religion or belief

Sex

Sexual orientation



ObjectiveA

rep

rese

nta

tive

an

d s

up

po

rted

wo

rkfo

rce 3.4

When at work, staff are free from abuse, harassment, bullying and violence from any source Grade

Undeveloped

Developing

Achieving

Excelling


Age

Disability

Gender reassignment



Race

Religion or belief

Sex

Sexual orientation


3.5

Flexible working options are available to all staff consistent with the needs of the service and the way people lead their lives

Grade

Undeveloped

Developing

Achieving

Excelling


Age

Disability

Gender reassignment



Race

Religion or belief

Sex

Sexual orientation


3.6

Staff report positive experiences of their membership of the workforce Grade

Undeveloped

Developing

Achieving

Excelling


Age

Disability

Gender reassignment



Race

Religion or belief

Sex

Sexual orientation



ObjectiveIn

clu

sive

lead

ersh

ip

4.1

Boards and senior leaders routinely demonstrate their commitment to promoting equality within and beyond their organisations

Grade

Undeveloped

Developing

Achieving

Excelling


Age

Disability

Gender reassignment



Race

Religion or belief

Sex

Sexual orientation


4.2

Papers that come before the Board and other major Committees identify equality-related impacts including risks, and say how these risks are to be managed

Grade

Undeveloped

Developing

Achieving

Excelling


Age

Disability

Gender reassignment



Race

Religion or belief

Sex

Sexual orientation


4.3

Middle managers and other line managers support their staff to work in culturally competent ways within a work environment free from discrimination

Grade

Undeveloped

Developing

Achieving

Excelling


Age

Disability

Gender reassignment



Race

Religion or belief

Sex

Sexual orientation


1

Equality and Inclusion Annual Report

2016/17

Introduction

2

This report outlines the CCG’s progress and work undertaken in 2016/17 in incorporating Equality and Inclusion in all its work. This public document ensures WCCG complies with the specific duty of the Public Sector Equality Duty to publish equality information annually. The report includes:

• The Legal duties for Equality and Inclusion. • The CCG’s in year progress with regard to Equality and Inclusion. • CCG’s Equality Delivery System Public Grading Assessment • The CCG’s Equality and Inclusion Strategy and Equality Objectives

Legal Duties for Equality and Inclusion There are a number of legal duties which underpins the Equality and Inclusion agenda including:

• NHS Constitution

The NHS Constitution Principles states that: ‘The NHS provides a comprehensive service, available to all irrespective of age, disability, sex (gender), race, sexual orientation, gender reassignment, religion, belief, pregnancy and maternity or civil partnership status. The service is designed to improve, prevent, diagnose and treat both physical and mental health problems with equal regard. It has a duty to each and every individual that it serves and must respect their human rights. At the same time, it has a wider social duty to promote equality through services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population.’

• The Equality Act 2010

The Equality Act 2010 replaced previous anti- discrimination laws and place key duties on statutory organisations that provide public services. The general equality duty is intended to accelerate progress towards equality for all, by placing a responsibility on bodies subject to the duty to consider how they can work to tackle systemic discrimination and disadvantage affecting people with particular protected characteristics. It protects people from unfavourable treatment and this refers particularly to people from the following categories know as protected characteristics:

• Age • Disability • Sex (Gender) • Sexual Orientation • Gender Reassignment • Race including national identity and ethnicity • Religion or belief • Pregnancy and maternity • Marriage and Civil Partnership

We additionally pay due regard to the needs of carers, homeless, and military veterans, when making commissioning decisions.

3

• General Duties

Section 149 of the Equality Act 2010 requires us to demonstrate compliance with the ‘Public Sector Equality Duty’ which places a statutory duty on the CCG to address:

• Eliminating unlawful discrimination, harassment, victimisation and any other conduct prohibited by the Equality Act 2010

• Advance equality of opportunity between people who share a protected characteristic and people who do not share it

• Foster good relations between people who share a protected characteristic and people who do not

• Specific Duties

Publish information to demonstrate their compliance with the Equality Duty, at least annually Set equality objectives, at least every four years

• Human Rights Act

The CCG has, through the Equality and Inclusion training and Equality Impact and Risk Assessment completion, ensured that we undertake Human Rights screening on our entire commissioning activity. All Human Rights Screening outcomes are embedded into the Equality Impact and Risk Assessment for the commissioner consideration.

• Public Sector Equality Duties (PSED)

The PSED consists of both general and specific duties, the broad aim of the general equality duty is to integrate consideration of the advancement of equality into the day-to-day business of all bodies subject to the duty. Achievements in 2016/17

• Workforce

The CCG has commissioned Midlands and Lancashire Commissioning Support Unit’s (CSU) Human Resources and Equality and Inclusion Team who support the CCG in ensuring that it has in place fair and equitable employment and recruitment practices in place. The CCG aims to fully understand the diversity of the workforce to ensure non-discriminatory practice, working with staff and staff representatives to identify and eliminate barriers and discrimination in line with the Public Sector Equality Duty, Equality Act 2010 and the Employment Statutory Code of Practice. The CCG has a small workforce and as such is not required under the Specific Equality Duty to publish its workforce data, however the CCG reviews its data on a quarterly basis through the Q&P committee and promotes transparency in all of its work aims to carry out regular reviews and analysis of the workforce profile in line with best practice.

• Training

4

Staff working within the CCGs undertakes annual equality and diversity training. The training is designed as an introduction to diversity and cultural awareness, and as a practical guide to making organisational culture an inclusive one. Staff training uptake is monitored by Electronic Staff Records. Equality and Diversity Training is mandatory for all CCG employees every three years. Programme/Commissioning leads within the CCG who are responsible for transforming health services have received one to one coaching on undertaking Equality Impact and Risk Assessments.

NB. At March 2017, 98% of CCG employees had undergone Equality and Diversity training.

• Communicating with People

In June 2016, the Governing Body approved the CCG’s Communications and Engagement strategy. The approach adopted within the strategy ensures that the CCG is meeting its obligations in relation to the Public Sector Equality Duty

• Workforce Race Equality Standard (WRES)

The WRES report sets out the CCG performance information profile and Board composition, by ethnicity, The CCG submits its WRES return to NHSE as required.

• Workforce Disability Equality Standard (WDES)

It has been recommended that a Workforce Disability Equality Standard (WDES) should be mandated via the NHS Standard Contract in England from April 2018, with a preparatory year from 2017-18. NHS England has agreed to do so. The EDC has also agreed to support a programme of work to support this

• Showing ‘Due Regard’ to the Public Sector Equality Duty

In order to deliver high quality inclusive health services, the CCG aims to ensure that protected groups have the same access, experiences and outcomes as the general population. A way of achieving this is through Equality Impact and Risk Assessments; in order to support the transformational and QIPP programme, The CCG has adopted an Equality Impact and Risk Assessment (EIRA). This enables the CCG to show ‘due regard’ to the Public Sector Equality Duty by ensuring that all requirements around equality, human rights and privacy are given advanced consideration prior to any policy decisions that the CCG’s Governing Body or Senior Managers make that may be affected by these issues. CCG Commissioners continue to ensure that the EIRA is integral to the decision making process.

https://www.england.nhs.uk/nhs-standard-contract/

5

Equality Impact and Risk Assessment Undertaken in 2016/17 Title Procedures of Limited Clinical Priority

• Dermatology Services (including acne vulgaris, benign skin lesions, desensitising light therapy)

• Musculoskeletal services (including Facet Joint Injections/Spinal injections, Spinal surgery for non-acute lumbar conditions, Dupuytren's Contracture, knee replacement)

• Urology and Uro-Gynaecology Services • Ophthalmology Services (including Photodynamic Therapy for Age Related Macular

Degeneration ARMD Multi-focal (non-accommodative) intraocular lenses) • Gynaecology services (including Vaginal/Uterovaginal prolapse Hysterectomy +/-

Oophorectomy for menorrhagia (heavy menstrual bleeding)

Service/pathway changes

• Medical Optimisation programme • Phlebotomy Services • Homeopathy and Iscador services

Medicines Management

• Over the counter policy • Products of Limited Clinical Value • Gluten Free •

Commissioning for Equality and Inclusion

EDS2 implementation by NHS provider organisations has been mandatory since April 2015 is part of the NHS standard contract. EDS2 implementation is included within the CCG Assurance Framework, and will continue to be a key requirement for all NHS CCGs.

As part of the contractual process All NHS Providers undertake the annual equality performance review using the NHS Equality Delivery System (EDS). Non achievement against the schedule results in the issuing of a contract performance notice.

6

Wirral CCG commissions services from the following providers

Equality Objectives

Published Equality Information in 2016/17

Undertaken EDS grading in 2016/17

Published WRES report in 2016

Cheshire & Wirral Partnership NHS Foundation Trust

Wirral University Teaching Hospital NHS Foundation Trust

Wirral Community Trust

The CCG has been working with providers of mental health services to look at pathways in order to promote Equality and Inclusion including; women who are pregnant who require additional support with their mental health, dementia diagnosis, care and treatment. The CCG has led the partnership work with other agencies to develop care for crisis care which has led to the development and the implementation of the crisis care concordat.

Work has commenced with regard to Learning Disabilities in 2016/17 which has included local implementation of the national Transforming Care for People with Learning Disabilities Programme (TCP). The TCP aims to improve services for people with learning disabilities and/or autism, who display behaviour that challenges, including those with a mental health condition.

In response to reviews conducted by MENCAP in 2007 and 2012 and Winterbourne view the CCG and Local Authority have co-produced an all age Learning Disability strategy with the aim of will drive forward planning and decision making for people with a learning disability in Wirral.

7

Assessing and monitoring the NHS Equality Delivery System (EDS2) The EDS2 process generates evidence of the CCG’s compliance with the PSED and this evidence is then reviewed by local people and stakeholders against the goals. EDS2 provides the local stakeholder group representatives and the CCG Governing Body with an assurance mechanism for compliance with the Equality Act 2010 and links our equality objectives with users of services, to ensure improvements in patient experience.

The four EDS2 goals are: 1. Better health outcomes for all

2. Improved patient access and experience

3. Empowered, engaged and included staff

4. Inclusive leadership at all levels A grading event to assess the CCG’s performance was undertaken in December 2016.The focus of the event was Goal 1 – Better Health Outcomes. Representatives from protected groups where invited to assess the evidence provided by the CCG (scores in appendix 1) Priorities 2017/18 A large number of work has commenced and been achieved in 2016/17, however a number of priorities have been identified in for 2017/18.

8

• To focus on areas within the EDS2 where it is “developing” with the aim to

moving to “achieving” level. • To strengthen communications and engagement as outlined in the

approved CCG communications and engagement strategy • To develop robust mechanisms to ensure that NHS commissioned services

comply with EDS2 and any non-compliance is reported and acted upon. • To ensure Equality and Inclusion is embedded within the values of the CCG

through the implementation of the CCG improvement plan. • To support the implementation of the all age Learning Disability strategy. • Continuation of pathway development in Mental Health services that are

inclusive and achieve the constitutional standard. Conclusion The report demonstrates equality developments and achievements that have been made during 2016/17. These achievements have supported the CCG in meeting their obligations under the Equality Act 2010 and PSED, in addition to working towards reducing health inequalities and improving health outcomes, access, and care for diverse patients.

This year has seen the development of structures and systems to enable the equalities agenda to become integral to the work and practices of the organisation. The report illustrates the CCG working practices are improving, with room for further development in some areas. A number of challenges however remain in tackling health inequalities and ensuring services respond to the needs of a very diverse population. The CCG aims to address these issues through the implementation of its equality objectives, along with priorities that have been identified through the EDS2 and EIA processes.

The CCG is committed to ensuring equality and human rights remain integral to the vision and values of the organisation, and will continuously demonstrate its progress against this agenda through the annual publication of the Annual Equality and Inclusion Report.

9

Appendix 1

EDS2 Goal 2 Equality Outcome Grade (2015)

Grade (2016)

Better health outcomes

1.1 Services are commissioned, procured, designed and delivered to meet the health

needs of local communities

Developing Developing

1.2 Individual people’s health needs are assessed and met in appropriate and

effective ways


1.3 Transitions from one service to another, for people on care pathways, are made

smoothly with everyone well-informed


1.4 When people use NHS services their safety is prioritised and they are free

from mistakes, mistreatment and abuse

Developing Achieving

1.5 Screening, vaccination and other health promotion services reach and benefit

all local communities

Not assessed in 2015

Developing


Briefing Report from the Chair of the Quality & Performance Committee

Purpose:

To report to the Governing Body on available levels of assurance and/or escalate risks and issues requiring action arising from the Committee’s meeting on 28th February 2017


• Review of Risk Register • Response of Wirral Hospital University Teaching Hospital Foundation Trust to letter

from CCG outlining concerns re performance • Continuing Health Care (CHC) report • Performance Pack • Risk re Referral To Treatment (RTT) performance • Noted: Serious Incident Review minutes 7.12.16; Individual Funding Request (IFR)

report; OFSTED Improvement Plan Outcomes/actions/assurances/risks

• Approved the Assessment for Autistic Spectrum Disorder in Adults Commissioning subject to a review of pathways and DNAs

• Approved the procurement of the Phlebotomy Service subject to further work with Sue Wells

• Approved the Procedure of Low Clinical Priority (PLCP) & Fertility Policy subject to minor amendments in consultation with Sue Wells

• Approved the Next Steps paper on Integrated Musculoskeletal Procurement subject to the review of contract value

• PE to update risk register re RTT

Formal recommendations

• That the Governing Body notes the report above.

Linda Roberts Chair of Quality & Performance Committee 28th February 2017

1/2



High Medium Low YES

The Board Assurance Framework and Risk Register are presented as separate reports on this agenda, but no key risks are identified within the report itself.





Director of Corporate Affairs Report Agenda Item: 6.1 Reference GB17-18/0010



Paul Edwards, Director of Corporate Affairs

Contributors

For Decision

For Information Yes

For Discussion

Executive Summary This paper provides Governing Body with a report on the statutory functions and duties that the Director of Corporate Affairs is responsible for. These areas also align to the external CCG Assurance Framework.

Recommendations The Governing Body is asked to: • Note report

2/2






Y



Y




Report Title Director of Corporate Affairs Report Lead Officer Paul Edwards, Director of Corporate Affairs

Contributors Laura Wentworth, Corporate Affairs Manager

Michael Chantler, Assistance Director of Communications and Engagement Recommendations Note key messages in report

1. INTRODUCTION This paper provides Governing Body with a report on the statutory functions and duties that the Director of Corporate Affairs is responsible for. These areas also align to the external CCG Assurance Framework.

KEY ISSUES / MESSAGES

o Emergency Preparedness, Resilience and Response (EPRR)

o Industrial Action • No industrial action planned (within the period of February and March 2017).

o Feedback from groups

• Local Resilience Forum (LRF):

• NHS England represents the NHS at the main LRF group. • No issues raised for the CCGs at the last meeting.

• Local Health Resilience Partnership (LHRP) meeting:

• No issues raised for the CCGs at the last meeting.

o EPRR Core Standards Assurance • Further to the submission of the CCG’s EPRR Core Standards documentation, the

statement of compliance level was submitted as full compliance. • The CCG received a letter from NHS England’s Regional Director of Assurance &

Delivery (North) and Regional Head of Emergency Preparedness (North) to express their gratitude for involvement in the EPRR assurance process over the last year.

• The letter also outlined that details of the formal process for EPRR assurance in 2017/18 and 2018/19 will be issued from NHS England’s national team in April / May 2017, however, the overall process is being moved to earlier in the year so that it is completed before winter.

o Commissioning Support

o The CCG contracts for the following elements from Midlands and Lancashire Commissioning Support Unit (MLCSU): End to End services (including areas such as Human Resources and Communications). Medicines Management, Individual Exceptional Funding Requests and Retrospective Continuing Health Care

o The Director of Corporate Affairs holds a monthly contract review meeting with MLCSU to monitor performance across the service lines.

o This is supported by the development of a CSU performance dashboard o CSU performance is also monitored across Cheshire and Merseyside via a ‘Collaborative

CSU/CCG’ meeting, with senior staff from CCGs and CSU discussing common areas of concern and collective opportunities

o As per the last report, there continues to be limited activity around Emergency Planning, particularly in regard to training support and a promised Business Continuity proposal. This has been raised with the CSU Service Director for attention and a response was provided by CSU, but did not address some of the fundamental lack of service delivery. The Director of Corporate Affairs will assess whether there is a viable offer for 2017/18 that could deliver the CCG’s requirements or whether alternative arrangements need to be found.

o Communications and Engagement

o Website redevelopment Phase 1 of the website redevelopment has had a ‘soft launch’, this is the main public facing website and a number of IT issues and interdependencies have been identified that should have been addressed by the CSU IT team prior to launch. This has been escalated to the senior leadership team within the CSU and assurances have been sought for the remaining parts of the project which relate to the members website and the staff intranet.

o Urgent Care Transformation

An engagement and consultation framework has been developed to support this programme which will ensure that the CCG meets its statutory duty as well as maximising the opportunities for stakeholders and the public to contribute to the review. The framework includes the development of a range of communications which explain the case for change and the proposed models prior to consultation.

o Member engagement The 360 stakeholder survey results have been received and are currently being reviewed. A resulting plan will be developed to address any improvements required. A review of member communications has also resulted in a gateway protocol being developed to manage the impact of information being sent to practices, this has included a revised format for the weekly bulletin.

o Staff newsletter The first staff newsletter has been produced and has received positive feedback from staff. The newsletter will continue to be developed to ensure it is relevant to staff and is utilised as a means for staff to share best practice and good news stories.

o Staff Recognition Scheme Supporting documents and process have been successfully launched.

o Step Challenge

The Birkenhead to New York step challenge has been completed and we successfully completed the trip to New York. A new challenge will be launched in conjunction with Merseyside Sports Partnership and will be a ‘Round the World’ challenge, this will also involve member practices to encourage participation and engagement.

o Policies

o There were no corporate policies due for review or approval at the QPF meetings held in

February or March 2017.

o Organisational Development

The Organisational Development (OD) Group continues to meet with the primary remit of overseeing the delivery of the CCG’s OD Strategy and Implementation Plan. Recent developments have included:

o Introduction of a Mentorship Scheme, with the support of North West Leadership Academy o A planned training event for April to support new Mentors o The development of a Coaching offer, with the support of Midlands and Lancashire CSU o A commitment to introduce a more flexible, web-based Personal Development Review system o This will incorporate a number of on-line course to support internal development beyond

Statutory and Mandatory Requirements o A survey on the method of allocating the CCG’s training budget

o Statutory and Mandatory Training

The training compliance as at March 2017 is as follows:

Training Module

Compliance (%) – (Target is now at 90% as agreed at QPF held in November 2016)

Counter Fraud 96% Equality & Diversity 98% Fire Safety 91% Health & Safety Awareness 96% Infection Prevention and Control 96% Information Governance 96% Safeguarding Adults 96%

Safeguarding Children 96%

The target compliance rate for all Statutory and Mandatory training is 90% and overall for the CCG the overall compliance rate is 96%, this is an increase of 2% from the previous reporting period. The new on-line training system continues to have the ability to provide reminder emails to staff one month prior to their courses expiring and reminder emails continue to be sent directly to staff members and copied to Line Managers from the Corporate Affairs team, to continue to address non-compliance.

o Complaints

Within the reporting period of 1st February 2017 to 31st March 2017, 39 new complaints were received, all off of which were acknowledged within 3 working days of receipt in line with national guidance. There have been a number of complaints received with regards to funding for spinal stenosis injections and a generic response was collated and is being issued for any concerns raised in relation to this. Further complaints were received about the lack of provision in the West Wirral area for a phlebotomy hub. During this reporting period, it has been confirmed that a new hub will be situated in West Wirral and a result of this, all previous complainants have also been sent a letter to provide details with regards to the arrangements for this additional hub. In response to the update letters being sent, the Corporate Affairs Team have received 2 compliments in relation to this hub. There were a number of complaints received about the treatment received by patients at Inclusion Matters Wirral, these have been shared with the contract lead the CCG and will continue to be monitored. There are currently 5 complaints being investigated by the Parliamentary and Health Service Ombudsman (PHSO). The CCG are awaiting the final outcomes and reports with recommendations in relation to these cases and further updates will be provided at a future meeting. There were 31 complaints closed within this reporting period (some of which were received in the previous reporting period). Full details of each investigation, outcome and lessons learned, where applicable, were provided in all complaint responses, in line with the national standards for managing complaints and National Health Service Complaints (England) Regulations 2009. A questionnaire feedback form is provided when a complaint is closed to determine how a patient feels their complaint has been managed. During this reporting period, of the 31 feedback forms sent, 0 were completed and returned to the Corporate Affairs Team.

o Patient Advice and Liaison Service (PALS)

The PALS is commissioned by Wirral CCG and provided by Wired to provide ‘on the spot’ help whenever possible, with the power to negotiate immediate or speedy resolution (within 48 hours) of problems. Where appropriate, the PALs service will refer patients to independent advice and advocacy support from local and national sources including HealthWatch.

There were 24 PALS enquiries received within the month of February 2017 and 31 received within the month of March 2017. The two dominant areas of these were related to Wirral University Teaching Hospital NHS Foundation Trust and GP Practices. Of the 55 calls received, 9 were formally raised as complaints with the relevant organisation, 6 were requests for information, 32 concerns were raised and 8 queries received. (Source: Monthly PALS report provided from Wired)

o MP Enquiries

Within the reporting period of 1st February 2017 to 31st March 2017; 16 new enquiries were received, all of which were acknowledged within 3 working days. There were 19 MP enquiries responded to and closed within this period. All of these enquiries were investigated and responded to within the CCG’s Key Performance Indicator of 20 working days and therefore the CCG was fully compliant in managing and responding to MP enquiries within this period.

o Freedom of Information (FOI) requests

Within the reporting period of 1st February 2017 to 31st March 2017, 57 new FOI requests were received (31 in February 2017 and 26 in March 2017). The subjects of the FOI requests received are detailed below (split by month):

Subject Number Received CCG Commissioning 24 CCG Structure / Intentions / Plans 1 Continuing Healthcare 3 Contracts and Procurement 1 Finance and Expenditure 3 HR 0 ICT 2 Medicines Management 5 Mental Health 6 Other 9 Primary Care 3 Total 57

The graphs below provide a breakdown of the subject of FOIs received by month:

February 2017: March 2017:

All FOI requests received during this period were responded to within 20 working days, in line with the Freedom of Information Act 2000 and the CCG’s Policy for Management of Freedom of Information requests. Therefore, the CCG were fully compliant in managing and responding to all FOI requests within this reporting period.

o Subject Access Requests (SARs)

There were 4 SAR’s received within the period of 1st February 2017 to 31st March 2017. The requests were responded to within 40 days, therefore the CCG was fully compliant in managing and responding to the request received within this reporting period.

2. IMPLICATIONS

The CCG will actively seek to ensure Statutory and Mandatory training targets are continued to be complied with by reiterating messages for new starters in regard to early completion of all training modules.

3. CONCLUSION

Governing Body members are asked to note the contents of the report.

1/2



High Medium YES Low

This paper supports managing Risk D6 on the CCG’s Assurance Framework which is defined as “Providers/ Health and Social Care fail to work together in partnership”

Integration between NHS Wirral CCG and Wirral Council Commissioning functions Agenda Item: 6.1 Reference GB17-18/0010



Paul Edwards, Director of Corporate Affairs Graham Hodkinson, Director of Health and Care, Wirral Council

Contributors

For Decision To support direction of travel and recommended next steps

For Information

For Discussion

Executive Summary When discussed by Governing Body members on 10th January 2017, various future commissioning arrangements were considered in the context of moving towards more effective collaborative approaches. Given the significant population size of Wirral, its discrete provider landscape and the co-terminosity between the CCG and Wirral Council (where there are already close working relationships), it was agreed that the move towards a closer integration of commissioning functions in a Wirral footprint was the most effective and practical way forward that would best serve the Wirral population. This development of a single integrated Wirral Commissioner also mirrors providers on Wirral coming together to formal a single entity. This paper outlines progress to date and next steps on the integration of Council and CCG commissioning functions.

Recommendations The Governing Body is asked to: • Note progress to date • Support direction of travel • Support a Financial Due Diligence Exercise • Support the development of Shadow Strategic Commissioning Board • Support an Options Appraisal on future Legal Vehicles

2/2










Y



Y




Report Title Integration between NHS Wirral CCG and Wirral Council

Commissioning functions Lead Officer Paul Edwards, Director of Corporate Affairs

Graham Hodkinson, Director of Health and Care

Contributors Recommendations The Governing Body is asked to:

• Note progress to date • Support direction of travel • Support Financial Due Diligence Exercise • Support development of a Shadow Strategic

Commissioning Board • Support Options Appraisal on future Legal Vehicles

Introduction

When discussed by Governing Body in January 2017, various future commissioning arrangements were considered in the context of moving towards more effective collaborative approaches. Given the significant population size of Wirral, its discrete provider landscape and the co-terminosity between the CCG and Wirral Council (where there are already close working relationships), it was agreed that the move towards a closer integration of commissioning functions in a Wirral footprint was the most effective and practical way forward that would best serve the Wirral population. This development of a single Wirral Commissioner also mirrors providers on Wirral coming together to formal a single entity. For clarity, the Council Commissioning areas would include Adult Social Care, Children and Young People, Public Health and some corporate functions these areas.

Key Issues/Messages

Following the support from Governing Body of closer integration between Wirral CCG and Wirral Council, an Integration Commissioning Project Board has been formed and meets fortnightly to support the development of a single commissioner on Wirral. It is made up of Executive Leaders from both NHS Wirral CCG and Wirral Council and from this, there have been several developments to date:

• A draft governance arrangement that describes how a new Strategic Commissioning Board could operate within the Wirral health and care system, whilst respecting the statutory functions of both the CCG’s Governing Body and the Local Authority Cabinet (Appendix A)

• A draft vision to be discussed with staff and senior teams • Agreed leadership portfolios so as to provide clarity and reduce duplication • Proposed aligned team structures, with a plan to engage staff on these prior

to implementation

• Some teams already co-located, with a forward plan for other teams to co-

locate in the coming months • The planned commissioning of a due diligence exercise to review pooled

budget arrangements

In addition to these, a common narrative that outlines the future ambition for a single integrated commissioner on Wirral has been developed. Key elements of this have been presented to Wirral Council’s Cabinet and are also presented in this paper. This narrative states that NHS Wirral CCG and Wirral Council aim to achieve the following from the integrated commissioning approach:

• A focus on better health outcomes for the people of Wirral • A greater ability to manage demand and secure efficiencies in service delivery • Care Market shaping and oversight • The commissioning of a range of provision of high quality, appropriate

services offering choice and control to residents • Continuity of care and prevention of market failure • Delivery of integrated health and care to benefit people that require support • Provision information to the public for making good decisions regarding care • Promotion of local access and ownership and drive partnership working • Promotion of social inclusion and wellbeing • The delivery of an integrated whole systems approach to supporting

communities It is envisaged that in creating a single integrated commissioner, this would offer the opportunity to deliver a unified and comprehensive commissioning plan, ensuring that commissioning decisions are in the interests of the whole system. A single governance structure will ensure that Health and Care services are effectively joined up into a single system that is sustainable, through using resources to best effect and to deliver improved outcomes for the people of Wirral. Whilst progress is advancing on aligning teams and agreeing leadership accountabilities, at a later stage it is proposed that the Council’s Adult Social Care budget and NHS Wirral Clinical Commissioning Group allocation would form the basis of pooling available resources, building on the existing Better Care Fund model, to use the collective resources efficiently and to maximum effect. The proposal is that pooled budgets will be apportioned so that integrated delivery providers have a fixed allocated care budget available for them to draw down against to meet the needs of local people who need services. Close monitoring of draw down against the pooled budget will ensure that commissioners have control and can work with providers to mitigate pressures where they arise. It should be noted, however, that the resource overall is currently under significant pressure which could increase potential financial risk. This does merit further exploration and to this end, both NHS Wirral CCG and Wirral Council are planning to

commission a ‘due diligence’ exercise so that both organisations fully understand any potential risks and the scope of this is being developed as part of the work of the Integration Commissioning Hub Project Board . In governance terms, it is anticipated that a Strategic Commissioning Board, as shown in Appendix A, led by the Cabinet Member for Adult Social Care and the Chair of Wirral CCG will make formally delegated health and care commissioning decisions on behalf of the Local Authority and CCG under a Section 75 agreement. The Strategic Commissioning Board will be directly accountable to the Health and Wellbeing Board, Cabinet and CCG Board. In the interim, these arrangements will be developed in shadow form to be followed by a further more detailed proposal in relation to statutory governance arrangements. This will be brought back to Council Cabinet and the CCG’s Governing Body in Quarter 3 2017, alongside the output from the Due Diligence exercise Implications

The Governing is asked to note that the integration of the Council and CCG’s commissioning functions does not represent an abrogation of each organisation’s statutory duties. In the shorter term, by aligining staff, co-locating teams, adopting joint governance arrangements and agreeing leadership roles across both organisations, there should be a more cohesive and effective approach to commissioning for the residents of Wirral. Opportunities for joint appointments will become the norm and this has already begun to happen, therefore reducing costs and improving collaboration.

Longer term (potentially to be operationalised in 2018/19), consideration will need to be given around a legal vehicle that will allow the Integrated Commissioner to act as a single organisation. The CCG’s Director of Corporate Affairs will lead an options appraisal of potential options in this regard.

Conclusion

The Governing Body is asked to:

• Note progress to date • Support direction of travel • Support Financial Due Diligence Exercise • Support development of a Shadow Strategic Commissioning Board • Support Options Appraisal on future Legal Vehicles

WIRRAL HEALTH AND CARE SYSTEM Integrated Commissioning Partnerships Integrated Provision

CCG Governing

Body

Wirral Council

Cabinet

Health & Wellbeing Board

High level strategy

Focus on health and care

outcomes

Healthy Wirral Delivery Group

Implementation of Healthy

Wirral

System Recovery Plan

Collective problem

solving/challenging ambition

of plans

Strategic Commissioning Board

Implementation of

strategy by determining

and commissioning

population outcomes

Key decisions regarding

use of Pooled Funds

Peo

ple

ove

rvie

w a

nd

Scr

uti

ny

Co

mm

itte

e

Healthy Wirral Programme

Partnership

Quarterly assessment of

progress against targets and

investment

Recommendations for

further investment

Pooled Funds Programme Board

Section 75 Management

and performance

The Wirral Partnership

2020 Outcomes

and Pledges

Delivery of

Strategy

Focus on Wirral

Level outcomes Provider Accountable

Care Organisation (ACO)

Board

1/2



High YES Medium Low

The Assurance Framework allows the Governing Body to consider the risks that may hamper the Clinical Commissioning Group from delivering its statutory duties and functions – these are the strategically significant risks facing the Clinical Commissioning Group. The Framework also outlines how the Governing Body is provided with assurance that these risks are being effectively managed and, as such, acts as a documented risk assessment

Governing Body Assurance Framework Agenda Item: 6.1 Reference Gb17-18/0010



Paul Edwards, Director of Corporate Affairs

Contributors Governing Body Members, Mersey Internal Audit Agency

For Decision To agree any potential changes

For Information

For Discussion To discuss risks

Executive Summary The Assurance Framework was developed by the Governing Body in conjunction with Mersey Internal Audit Agency and identifies key risks to NHS Wirral CCG’s Strategic Objectives. When presented at Governing Body in June 2013, key controls and assurances were identified against each risk, with any gaps identified as requiring an action plan to address them. The Assurance Framework has been reviewed a number of times since then (see Report History), with the whole structure of the Assurance Framework structure itself being reviewed at the Informal Governing Body session held on 1st March 2016 where risks were re-aligned to refreshed CCG Strategic Aims. This session also suggested the inclusion of ‘risk appetite’ and this was discussed at July 2016’s Governing Body and was incorporated in the October 2016 iteration of the Assurance Framework. The changes agreed at January 2017 are incorporated here and further proposed changes for consideration at Governing Body in May 2017 are outlined in the supporting paper.

Recommendations The Governing Body is asked to: • Discuss risks • Agree any potential changes

2/2










Y


Provide systems leadership in shaping the Wirral health and social care system so as to be fit for purpose both now and in five years’ time

Y




Governing Body 10th January 2017 Reviewed scores and agreed amendments

Governing Body 4th October 2016 Reviewed scores and added risks

Governing Body 5th July 2016 Reviewed scores and add ‘risk appetite’ section

Governing Body 1st March 2016 Updated to align to new refreshed Strategic Aims, facilitated by Mersey Internal Audit Agency

Report Title Assurance Framework Lead Officer Paul Edwards, Director of Corporate Affairs

Contributors Recommendations Governing Body members are asked to approve the

proposed changes, discuss new risks and assess whether any risk scores need to be modified.

Introduction

When presented at Governing Body in June 2013, key controls and assurances were identified against each risk, with any gaps identified as requiring an action plan to address them. The Assurance Framework has been reviewed a number of times since then, with the whole structure of the Assurance Framework structure itself being reviewed at the Informal Governing Body session held on 1st March 2016 where risks were re-aligned to refreshed CCG Strategic Aims. This session also suggested the inclusion of ‘risk appetite’ and this was discussed at July 2016’s Governing Body and is now incorporated with this iteration of the Assurance Framework, alongside the review of the risks.

Changes to the Assurance Framework agreed at January 2017 Governing Body

The following were agreed amendments to the Assurance Framework at January’s Governing Body:

• Engagement implantation plan approved at November GB as additional control on risks: A1, A2, C5, D1, D3, D4, D7 and E2

• Finance committee approval via NHS England added as a gap in control for risk: B3, C4, E3

• Need for approval of LDP and STP plans highlighted as a gap for risk: B1 • PMO added as control for risks: C4 and E3 • Clinical Senate added as a control on risk F4

The following score changes were agreed:

• Risks A1, A2, C5, D1, D3, D4, D7 and E2– Likelihood reduced from 3 to 2 following production in Engagement Implementation Plan

All other risks were deemed to be accurate in terms of scores and narrative.

Proposed changes at May 2017 Governing Body

• Extensive engagement exercises added as assurance sources on Risks A1, A2 and D7

• Establishment of Finance Committee and Turnaround Group as added control on Risks B2, B3 and C4

• Purchase of Browse Aloud as additional control on Risk D4 • Lack of consultation and local approval of LDP and STP as gap on Controls and

Assurance on Risk B1 • Development of formal governance and structures to support Integrated

Commissioning identified as gap on Controls and Assurance on Risks D6 and F2 • New Chief Officer in post as gap on Controls and Assurance on Risks D6 and F2

until role beds in • Approval of Improvement Plan by NHS England as gap on Controls and Assurance

on Risks F3 • Risk score increased on Risk D5 as a results of 360 results • Gap added to Risk D5 related to production of Action Plan in response to 360 • Updates to Responsible Committees

Conclusion

Governing Body members are asked to approve the proposed changes, discuss new risks and assess whether any risk scores need to be modified.

2016-17 Assurance Framework (May 2017) Wirral Clinical Commissioning Group Page 1

A

B

C

D

E

F

To adopt a health and well being approach in the way services are both commissioned and provided

To commission and contract for services that: Demonstrate improved person centred outcomes ; Are high quality and seamless for the patient; Are safe and sustainable; Are evidenced based and Demonstrate value for moneyTo be known as one of the leading Clinical Commissioning Groups in the country


WIRRAL CLINICAL COMMISSIONING GROUPASSURANCE FRAMEWORK FOR 2017-18

FOR CONSIDERATION AT THE GOVERNING BODY MEETING - MAY 2017Workstream / Task Descriptions and Strategically Significant risks are detailed against the Strategic Aims:

To empower the people of Wirral to improve their physical, mental health and general well being

To reduce health inequalities across the Wirral


Paul EdwardsDirector of Corporate AffairsOld Market HouseHamilton StreetBirkenheadMerseysideCH41 5AL.

Document produced by Wirral Clinical Commissioning Group Governing Body by:


1

2

3

Identifying and Scoring Risks5

a)

Identifying Corporate Aims / ObjectivesEach year the Clinical Commissioning Group's Governing body agrees a set of corporate objectives which define whathas to delivered in the coming year (in this case from ). The corporate aims for 2013/14 can be seen on the front coverof this Assurance Framework. These are underpoinned by a number of objectives and work streams

The Clinical Commisioning Group next considers those factors which may stop it from delivering each of theseworkstreams - these are the risks to delivery (Column 4), each of which is numbered (Column 1). Risks areconsidered in two stages, each of which is given a score in line with the Clinical Commissioning Group's RiskManagement Strategy.

The Clinical Commissioning Group considers what would be the effect upon the organisation should the risk, asdescribed, actually occur. An impact rating score is then assigned based upon the impact on the ClinicalCommissioning Group should the described risk occur - with a score of 5 meaning the risk occurring would be'catastrophic' to the organisation and 1 having an 'insignificant' impact on delivering. The impact rating is shown inColumn 5.

A BRIEF GUIDE TO THE ASSURANCE FRAMEWORKIntroduction

All NHS organisations are required to develop and maintain an Assurance Framework in accordance with thegovernance regulations applied to the NHS. The Assurance Framework allows the Governing Body to consider therisks that may hamper the Clinical Commisisoning Group from delivering its statutory duties and functions – these arethe strategically significant risks facing the Clinical Commisisoning Group. The Framework also outlines how theGoverning Body is provided with assurance that these risks are being effectively managedIdentification of a risk does not mean that it will occur. The Assurance Framework is a self-assessment process whichallows the Governing Body to identify where it may need to prioritise the use of resources to improve services andinternal processes.


b)

6

7 When considering the most appropriate impact and likelihood rating scores for a risk the GP Consortium will considerthe following definitions

Impact Measures

once a risk has been identified, the Clinical Commisisoning Group has to consider what controls are in place staff,training, financial resources, systems, controls and processes to mitigate the possibility of the risk from occurring.By having these key controls the Clinical Commisioning Group attempts to reduce the likelihood of a risk actuallyoccurring . A likelihood rating score is used to show how effective the Clinical Commissioning Group rates thesekey controls in mitigating the possibility of the risk occurring - with a score of 5 meaning a risk is 'certain' to occurand 1 meaning the chances are 'remote'. The likelihood rating is shown in Column 8.

A risk score is then calculated by multiplying the impact rating by the likelihood rating (Column 9). Using the matrixbelow, each risk is then assigned a risk rating (Column 10). Both the risk score and the risk rating are used by theClinical Commissioning Group to help it prioritise the use of resources and development of action plans.

Level Descriptor Examples Frequency/ Occurrence

Consequence

1 2 3 4 5 Likelihood

1 Rare Difficult to believe that this will ever happen/ happen again

Annually 1 1 2 3 4 5

2 Unlikely Do not expect it to happen/happen again, but it may

Bi-annually 2 2 4 6 8 10

3 Possible It is possible that it may occur/recur

Monthly 3 3 6 9 12 15

4 Likely Is likely to occur/recur but is not a persistent issue

Weekly 4 4 8 12 16 20

5 Almost certain

Will almost certainly occur/recur and could be a persistent issue

Daily 5 5 10 15 20 25


Level

1

2

3

4

5

Level

1

2

3

4

5

8

9

a)

Almost Certain an event is expected to occur (recur) in most circumstances

Risk scores are under constant review by the Clinical Commisisoning Group. Column 11, with the use of arrows, simply showing if their have been any changes to a risk score since the Assurance Framework was discussed at thelast Governing Body Meeting.

Providing Assurance to the Governing Body

One of the roles of the CCG Governing Body is to assure itself that the CCG has robust systems and processes inplace which do what they say they will do. The Assurance Framework therefore maps out to the Governing Bodywhere they can obtain that assurance for those risks that have been identified. This assurance takes 2 main forms:

Assurance (Column 7) - the Governing Body receives assurance from its own Committees, Members andManagers on the effectiveness of internal systems and controls. For example this can take the form of reports,perfromance data and minutes of meetings demonstrating that the key controls (identified in Column 6) are inplace and operating effectively.

unlikely an event that could occur (recur) at some time/ Do not expect it to happen

Posible an event that may well occur (recur) at some time

Highly likely an event will occur (recur) in most circumstances

Catastrophic Severly critical performance rating, adverse national media coverage, loss of publicconfidence, failure to meet statutory duties.

Likelihood Measures

Descriptor Example, something that involves

Rare an event that may only happen in exceptional circumstances/ Difficult to believe this wouldhappen

Minor Minor adverse publicity/ reduced performance/ business interruption <8 hours, small financialloss

Moderate Reduction in public confidence, slippage in business objectives, financial loss < 0.5% budget,Service interruption > 1 day

Major Improvement notices, critical media coverage, major slippage in business objectives delivery,financial loss up to 1% of budget.

Descriptor Example, something that involves

Negligible No or minimal impact/ breach of stat duty/ financial loss/ business interuption


b)

10

The CCG may also receive assurance on the effectiveness of internal systems and controls from otherorganisations. For example this includes assessments / reports from Mersey Internal Audit Agency (our internalauditor), Grant Thornton (our external auditor), NHS England, Care Quality Commission and other regulatory /statutory organisations.

Gaps in Control and AssuranceBy identifying those risks that may stop the CCG from undertaking its duties together with the key controls whichmitigate these risks, the organisation may identify gaps where it either has ineffective controls in place or cannotprovide sufficient assurance to the Governing Body. Column 12 identifies these gaps in control and assurance. Where a gap has been identified, the action necessary to address it is recorde in a detailed Action Plan. This shouldbe monitored by the Director of Corporate Affairs

Wirral CCG

Page 7

Controls Assurances Gaps Responsible CommitteeRisk No Risk Owner/ Lead Risk Description Impact

Rating Key Controls Assurance on Controls Likelihood Rating

Risk Score

Risk Rating

Status Gaps in Control and Assurance Action plan Target Impact Target Likelihood Target Score Target Deadline Narrative

1 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

A1

Dire

ctor

of Q

ualit

y an

d Pa

tient

Sa

fety Failure to engage general public

in change, difficultly in engaging with hard to reach groups.

3

Governing Body Reporting Format incorporating Engagement reports. Expo Event and other

Healthy Wirral events set up to engage with wider public. New Engagement and Experience Strategy

approved. Head of Communications and Engagement Recruited. Implemetation Plan for

Engagement Strategy brought to Governing Body November 2016.

Quality and Performance Committee Minutes and reports, Governing Body minutes and reports, including Engagement Report. Feedback captured from Healthy Wirral events. Several extensive engagement exercises evidence through Governing Body papers

2 6 ↔ Governing Body 3 2 6 Quarter 4

A2

Dire

ctor

of Q

ualit

y an

d Pa

tient

Saf

ety

CCG fails to understand people's health experiences due to lack of engagement.

3

PALS, Complaints management, website feedback mechanisms, Communications support systems provided by CSU, Quality and Performance Committee Committee monitoring. Patient Engagement Reports to CCG Governing Body. CQC relationship, Quality Surveillance Group, Complaints Monitoring. Healthwatch. Quarterly aggregated reported to Quality and Performance Committee. New Governing Body Reporting Format incorporating Engagement reports. New Engagement and Experience Strategy approved. Head of Communications and Engagement Recruited. Implemetation Plan for Engagement Strategy brought to Governing Body

Quality and Performance Committee Minutes and reports, Governing Body minutes and papers including Engagement Report. Quality Surveillance Group minutes. Healthwatch member on Governing Body. Quality & Safety Group. Several extensive engagement exercises evidence through Governing Body papers


B1

Dire

ctor

of C

omm

issi

onin

g

Failure to promote and commission safe services, therefore, outcomes for patients don’t improve or deteriorate.

4

CCG Strategy and Plans, Health & Wellbeing Strategy, Contractual Quality and Performance requirements, patient engagement, public health support and reports, Quality and Performance Committee Committeee monitoring and reporting. Assurance process from NHS England. New Governing Body Reporting Format addresses outcomes/performance on regular basis.. Serious Incident Review process in place. Developemnt of Local Delivery Service Plan, Sustainability and Transformation Plan CCG Operational Plan

JSNA and public health data and reports. Quality and Performance Committee committee minutes. Governing Body minutes. Shared measures via the Better Care Fund External CCG Assurance Framework. Minutes of Serious Incident Review received at Quality and Performance Committe. Plan delivery monitored through Governing Body

3 12 ↔Local Delivery Plan and Sustainability and Transformation plans yet to be consulted on and approved

Engage on and agree Local Delivery Plan and Sustainability and

Transformation planQuarter 1 2017/18Lead: Chief Officer

Quality and Performance Committee 3 2 6 Quarter 2 STP not yet locally

approved

B2

Dire

ctor

of

Com

mis

sion

ing

Fail to deliver agreed health priorities and objectives. 3

CCG Strategic Plan, NHS England performance monitoring, Patient Feedback, Patient Practice Groups, Quality and Performance Contract meetings, Quality and Performance Committee Monitoring. Refreshed Strategic Plan. Financial Recovery Plan. QIPP Reports. Finance Committee now established. Turn around Group now established.

Performance reports to Governing Body, Quality and Performance Committee Committee minutes. External CCG Assurance Framework. External CCG Assurance Framework. Monitoring of Financial Recovery Plan through 'Confirm and Challenge' Group and new Operational Group focus

4 12 ↔ Quality and Performance Committee 3 3 9 Quarter 4

B3

Chi

ef F

inan

cial

Offi

cer

Reducing financial resource available across health and social care and failure to agree financial arrangements.

4

QIPP Strategy and plans, DASS membership on CCG Governing Body, Health & Wellbeing Board, Quality and Performance Committee Committee monitoring. Integrated planning processes. Joint Strategic Commissioning Group established. Healthy Wirral finance workstream. New Governing Body Reporting Format. Development and monitoring of Financial Recovery Plan. QIPP Plan. Finance Committee now established. Turn around Group now established.

Health and Wellbeing Board, Quality and Performance Committee Committee minutes. Healthy Wirral SLG minutes. Joint Strategic Commissioing minutes. Reports to Health and Well Being Board. Pooling arrangements for Better Care Fund. External CCG Assurance Framework. Monitoring of Financial Recovery Plan through 'Confirm and Challenge' Group, Finance Committtee, Turnaround Group and new Operational Group format

5 20 ↔ Finance Committee/Governing Body 4 4 16 Quarter 4

Risk Appetite

To empower the people of Wirral to improve their physical, mental health and general well being

To reduce health inequalities across the Wirral

To adopt a health and well being approach in the way services are both commissioned and provided

Strategic Aim A

What actions are in place to close the gaps in the controls and

assurance

What are the principal risks that could prevent the CCG from achieving this

aim/ objective e.g types of risk - clinical, financial, reputational,

statutory,

Priority

Detail of gaps where the controls / systems / assurances have either not yet been put in place or are yet to be fully

effective. What needs to be done

Evidence that the controls are operating and the CCG is reasonably managing its risks with aims/

objectives being delivered

What controls / systems does the CCG have in place to manage the risk

Strategic Aim B

Strategic Aim C

Wirral CCG

Page 8



Risk Score

Risk Rating


Risk AppetitePriority

Acute care does not have sufficient focus on parity of esteem, therefore leading to failure to deliver high quality services for mental health patients. Contractual values could also impact on the quality of services being provided.

3

Friends and Family test, Quality Impact meetings. Monitoring of CQUINS. Implementation of Datix risk management system. Hospital visits & walk arounds. Quarterly aggregated reports to Quality and Performance Committee. Lay Member for Quality as part of new structure. Head of Contacting and Delivery in post. Director of Commissioning appointed. New Governing Body Reporting Format.


C4

Chi

ef F

inan

cial

Offi

cer

Inabiliy to manage rising demand and reducing capacity in a constrained financial environment.

4

CCG Strategic Plan, QIPP Plan with measurable outcome targets, Quality and Performance Committee Committee monitoring and, Indicators of success/ failure in demand management and action plans as needed. QSG. CQUINS monitoring. Quality and Performance Committee. Clinically led workstreams. 2 year plan in place & refocus of commissioning intentions. New Governing Body Reporting Format. Financial Recovery plan developed. QIPP Reports. Confirm and Challenge Meetings. Primary Care Quality Scheme introduced, PMO established and Finance Committee established. Turnaround Group established

Quality and Performance Committee Committee monitoring of QIPP. Systeme Resilience Group now in place to address economy wide pressures. Governing Body minutes. External CCG Assurance Framework. Monitoring of Financial Recovery Plan through 'Confirm and Challenge', and Finance Committee and new Operational Group focus. Monitoring impact of Primary Care Quality Scheme through Quality and Performance Committee


C5

Dire

ctor

of Q

ualit

y an

d Pa

tient

Sa

fety Organisations fail to put the

patient at the heart of everything they do.

3

Continuing work with community partners in voluntary, community and faith sectors plus representatives of individuals with protected characteristics to ensure their full representation in our commissioning plans . Friends and Family Test. Public Health intelligence. Analysis of provider organisations complaints. New Engagement and Experience Strategy approved. Head of Communications and Engagement Recruited. Implemetation Plan for Engagement Strategy brought to Governing Body November 2016

Quality and Performance Committee Committee reports on shifting local demographies and take up of services by diverse populations. Friends and Family Test results. Quarterly aggregated complaints reports to Quality and Performance Committee. Incidents reported and reviewed. Engagement activities reported through Governing Body


C6

Dire

ctor

of

Com

mis

sion

ing

Failure to adequately benchmark with peers. 3

Involvement in Clinical Senates; use of benchmarking analyses when undertakng needs assessments. Joint work on reshaping the health provider economy with neighbouring CCGs. CLRN meetings. AQUA and other membership/subscription

Quality dashboard, Right Care data, minutes of Cheshire and Merseyside Chairs and Chief Officers.

2 6 ↔ No gaps indentified Quality and Performance Committee 3 2 6 Quarter 4

D1

Dire

ctor

of Q

ualit

y an

d Pa

tient

Saf

ety

Socio demographic changes (e.g. ageing population, migrant population) prevent inclusion.

3

CCG Strategic Plan, use of JSNA in plans, Lay member for Patient Engagement, Public Health inclusion on CCG Governing Body.Engagement events and activities. Patient Engagement Reports to CCG Governing Body. Healthwatch member at Governing Body. Healthy Wirral work re self care & prevention. New Engagement and Experience Strategy approved. Head of Communications and Engagement Recruited. Implemetation Plan for Engagement brought to Governing Body November 2016

Patient Group/Practice feedback, Public Health Reports. Plans based on JSNA presented at Governing Body. Engagement activities reported through Governing Body


D2

Dire

ctor

of Q

ualit

y an

d Pa

tient

Sa

fety Failure to engage widely means

that decisions may be skewed by particular interest groups.

3

Communications Support from CSU, Website development, Use of social media, Engagement events and activities, Public CCG Governing Body meetings. Engagement Reports to CCG Governing Body. Links to Healthwatch via Governing Body attendance and ongoing relationship.. New Engagement and Experience Strategy approved. Head of Communications and Engagement Recruited. Implemetation Plan for Engagement brought to Governing Body November 2016

Patient and public feedback, feedback/ interaction with public at engagement events. Governing Body minutes. Engagement activities reported through Governing Body


D3

Dire

ctor

of Q

ualit

y an

d Pa

tient

Saf

ety

Cultural and attitudinal issues skew expectations against self care.

3

CCG Strategic Plan. Integration team work re patient care. Healthy Wirral workstream re self care and prevention. New Engagement and Experience Strategy approved. Head of Communications and Engagement Recruited. Implemetation Plan for Engagement brought to Governing Body November 2016

Engagement activities reported through Governing Body 2 6 ↔ Governing Body 3 2 6 Quarter 4

To commission and contract for services that: Demonstrate improved person centred outcomes ; Are high quality and seamless for the patient; Are safe and sustainable; Are evidenced based and Demonstrate value for moneyStategic Aim D

Dire

ctor

of Q

ualit

y an

d Pa

tient

Saf

ety

Quality and Performance Committee Committee receives regular reports from providers which include an agreed set of HR metrics indicating adequate levels and competencies of staffing. Friends and Family test result. Monitoring of patient complaints. Safe staffing levels now reported. External CCG Assurance Framework

C1

Wirral CCG

Page 9



Risk Score

Risk Rating



D4

Dire

ctor

of C

orpo

rate

Affa

irs

CCG fails to get information across in a way that engages the public and is understandable to them (allowing for differing levels of understanding).

3

Communications Support from CSU, Website development, Choose Well/ Public Health campaigns, Some use of social media. Patient Engagement Reports to CCG Governing Body. New Engagement and Experience Strategy approved. Head of Communications and Engagement Recruited Implemetation Plan for Engagement brought to Governing Body November 2016. Purchase of 'Browse Aloud' and newlly designed website that enhanced accessibility

Patient and public feedback, feedback/ interaction with public at engagement events, PALS/ Complaints reporting through Quality and Performance Committee. Engagement activities reported through Governing Body

2 6 ↔ Ongoing Governing Body 3 2 6 Quarter 4

D5

Cha

ir Ineffective engagement from clinicians 4

New CCG structures enable clinical involvement through the Clinical Senate, Provider Forum and Membership Council as well as clinical membership of other committees and Governing Body New Governing Body Reporting Format. Consultant Connect established, cycle of Practice Visits established, CCG to introduce locality approach. Review of Clinical Senate, Membership Council and Provider Forum taken place.

Clinical Senate minutes. Key themes from practice visits. Membership Council Minutes. 360 results.

4 12 ↑360 results require action plan

Action plan to be produced to address member engagement

Quarter 1 2017/18Lead: Diurector of Corporate

Affairs

Governing Body 3 3 9 Quarter 4

D6

Acco

unta

ble

Offi

cer /

Cha

ir

Providers/ Health and Social Care fail to work together in partnership 4

JSNA and HWB Strategy and Board, Contract management arrangements, development of service specifications which require collaborative approach, Joint CQUIN development, Social Care represenentation on CCG Governing Body. Integrated planning processes. Joint Strategic Commissioning Board being established. Better Care Fund. Senior Leadership Group established

Contract management meetings and minutes, Quality and Performance Committee Monitoring and reporting, QIPP Team minutes, Social Care updates to CCG Governing Body. Healhty Wirral SLG minutes. Joint Strategic Commissioing minutes. Reports to Health and Well Being Board. Better Care Fund Plan sign off by HWB and pooled budget arrangements

2 8 ↔

Develop governance and structures for Integrated Commissioning

Need to estbalish timellines for parallel development of integrated provider development

Develop and Implement Governance and Structural

arrangementsQuarter 1 2018/19

Lead: Director of Cororate Affairs

Output of AQUA work supporting provider integration


D7

Dire

ctor

or C

omm

issi

onin

g

Adverse public reaction to decommissioning or reduction in access

3

Public consultation, Engagement through Wirral Voice/PPGs, CSU support, Use different comms mechansims e.g local press. Engagement Reports to CCG Governing Body. New Engagement and Experience Strategy approved. Head of Communications and Engagement Recruited. Commissioning Decision Making process agreed. Implemetation Plan for Engagement brought to Governing Body November 2016

Patient group feedback, web site and social media feedback. Engagement activities reported through Governing Body. Several extensive engagement exercises evidence through Governing Body papers


E1

Med

ical

Dire

ctor

/ Dire

ctor

of C

orpo

rate

Af

fairs

CCG fails to be innovative and deliver sufficient appropriate change

4

AQUA and other membership/subscriptions. QIPP/Commissioning Plan/Urgent Care/Strategic Plan and Healthy Wirral programme all require innovation to change to system. Staff trained in Experience Lead Commissioning. Development of Clinical Senate to drive clinical innovation. Examples of innovation include Think Pharmacy, OPAT, Single Front Door, Conultant Connect. Delivery against planning guidance and the Five Year Forward View. Review of Clinical Senate, Membership Council and Provider Forum taken place. New Organisational Development Strategy approved. QIPP Plan and Confirm and Challenge meetings

Governing Body minutes. CCG plans. Clinical Senate minutes. Organisational Development implementation plan. Confirm and Challenge meetings and monitoring of QIPP Plan via Finance Committee


E2

Dire

ctor

of C

orpo

rate

Affa

irs

Failure to be proactive with opinion makers and the population of Wirral.

3

Regular communications with local politicians, open, transparent communication with local media. Staff and community newsletters from CCG , Regular briefings of encouragement to the voluntary, community and faith sectors, Healthwatch and other local community representatives through area fora etc. Patient Engagement Reports to CCG Governing Body. New Engagement and Experience Strategy approved. Head of Communications and Engagement Recruited. Implemetation Plan for Engagement brought to Governing Body November 2016

Engagement activities reported through Governing Body 2 6 ↔ Governing Body 3 2 6 Quarter 4

E3

Dire

ctor

of C

omm

issi

onin

g

Failure to deliver QIPP targets 4

Quality and Performance Committee Committee monitoring. Development and monitoring of Financial Recovery Plan. QIPP Plan, Finance Committee. Finance Committee established and PMO established. Turnaround Group in place

Quality and Performance Committee minutes. Finance Committee minutes External CCG Assurance Framework. Monitoring of Financial Recovery Plan through 'Confirm and Challenge' Group and new Operational Group focus

4 16 ↔ Turnaround Group/Finance Committte 3 3 9 Quarter 4

To be known as one of the leading Clinical Commissioning Groups in the country and locally across Wirral to patients / public

Provide systems leadership in shaping the Wirral health and social care system so as to be fit for purpose both now and in five years timeStrategic Aim F

Strategic Aim E

Wirral CCG

Page 10



Risk Score

Risk Rating



F1

Acco

unta

ble

Offi

cer Failure to secure buy into Healthy

Wirral and the CCG's role as systems leader.

3 Healthy Wirral Memorandum of Understanding in place

Healthy Wirral Memorandum of Understanding in place. SLG minutes. 3 9 ↔ CCG's new Chief Officer to start in post To start in post April 2017 Governing Body 3 3 9 Quarter 4

F2

Acco

unta

ble

Offi

cer/

Dire

ctor

of

Cor

pora

te A

ffairs

Failure to agree and operate appropriate and efficient governance processes and framework.

4

Healthy Wirral Memorandum of Understanding in place

Formation of Ingtegrated Commissionong Board and strengthened partnershp arrnagements between commissioners

Healthy Wirral Memorandum of Understanding in place.

Minutes of Integrated Commissioning Board

3 12 ↔

Develop governance and structures for Integrated Commissioning

Need to estbalish timellines for parallel development of integrated provider development

Develop and Implement Governance and Structural

arrangementsQuarter 1 2018/19

Lead: Director of Cororate Affairs

Output of AQUA work supporting provider integration


F3

Acco

unta

ble

Offi

cer Capability and capacity for CCG

staff to deliver key objectives and duties

3 Independent Assessment of CCG Capability and Capcacity by Price Waterhouse Cooper

Report form Price Waterhouse Cooper and Action Plan in response to recoomendations 3 9 ↔ Improvement Plan submitted to NHS England and

awaiting approvalQuarter 1 2017/18

Lead: Director of Corporate Affairs


F4

Dire

ctor

or

Com

mis

sion

ing/

Chi

ef F

inan

cial

O

ffice

r Failure to achieve 'good' or 'outstanding' in the external CCG Assessment Framework

3Close monitiring of new clinical domains and other indicators that contribute to overall rating. Clinical Senate in place

Quality and Performance Committee minutes. Finance Committee minutes External CCG Assurance Framework meetings. Monitoring of Financial Recovery Plan through 'Confirm and Challenge' Group and new Operational Group focus

3 9 ↔ 2 2 4 Quarter 4


Briefing from the Chair of the Audit Committee 20 April 2017

Purpose

Wirral NHS CCG Audit Committee is a sub-committee of the Governing Body which provides assurance in relation to the operation of key financial, clinical and corporate control systems operated by and on behalf of the organisation. It regularly receives and scrutinises progress and compliance reports from the external and internal auditors, Anti-Fraud Specialist and Information Governance Manager. It also assesses the accuracy and comprehensiveness of the Annual Governance Statement, and oversees the CCG’s approach to the identification, assessment, mitigation and management of those key risks which might prevent the achievement of the organisation’s strategic objectives or the safe custody of its assets.

The Audit Committee agrees an annual workplan, which drives the agenda for its meetings.

The Audit Committee is free to invite any officer of the CCG to attend a meeting, or to commission expert independent advice to assist in the discharge of its responsibilities.

Significant agenda Items/Key topics discussed

• Internal Audit Plan 2017/18 • Director of Internal Audit Opinion 2016/17 • Assurance Framework Opinion 2016/17 • Draft Annual Report and Annual Accounts 2016/17 • Annual Information Governance Report 2016/17 • Service Auditors Reports 2015/16 • Implementation of new arrangements for IR35 • Anti-Fraud Services Annual Report 2016/17 • Anti-Fraud Workplan 2017/18 • External Audit Plan 2017/18 • External Audit Progress Report 2016/17


• Internal Audit Plan 2017/18 – The Committee approved the risk based Internal Audit Plan and noted the potential requirement for a contingency to review progress in implementation of the Improvement Plan.

• Internal Audit Progress Report 2016/17 – The Internal Audit Plan was delivered and recent reports provided significant assurance for reviews of the Primary Care Quality Scheme a positive outcome for the implementation of effective arrangements to manage Conflict of interests.

• Director of Internal Audit Opinion 2016/17 – The Director of Internal Audit Opinion

provided significant assurance that the CCG has a generally sound system of internal control and that controls are being applied consistently. This is a notable achievement for the organisations.

• Assurance Framework Opinion 2016/17 – The CCG’s Assurance Framework is structured to meet the NHS requirements is used by the Governing Body and clearly reflects the risks discussed by the governing body. The Assurance Framework was assessed as ‘Green’ (i.e. compliant) in all categories (structure, engagement, quality and alignment). This is another very positive level of assurance for the CCG.

• Draft Annual Report and Annual Accounts 2016/17 – The committee reviewed the early draft of the Annual Report and Accounts 2016/17 and suggested amendments to strengthen its contents particularly in regard to evidence of improved service delivery. A final draft will be reviewed at the next meeting.

• Annual Information Governance Report 2016/17 – The assessment of compliance with Information Governance toolkit requirements was an overall score of 91% with particular strength in IG mandatory training compliance. An action plan has been prepared in order to achieve a higher score for 2017/18

• Service Auditors Reports 2015/16 – The committee reviewed reports for 2015/16 from Deloitte relating to the key control systems operated by the Clinical Support Unit on behalf of the CCG. Overall these indicated that the controls tested were operating with sufficient effectiveness throughout the period. Progressive improved compliance was evident during the year. The controls operated within the CCG also provide further assurance. This position was achieved in spite of significant organisational change during the period within the CSU.

• Implementation of new arrangements for IR35 – The committee was assured that a detailed assessment of the implications of new arrangements for IR35, which were effective from 6th April 2017, have been introduced.

• Anti-Fraud Services Annual Report 2016/17 – The CCG compliance with NHS Protect Standards for Commissioners was ‘Green’ with 18 areas receiving a green assessment and 6 receiving an amber assessment. Two of the amber assessments where due to the absence of cases of fraud where retribution could be pursued.

• Anti-Fraud Workplan 2017/18 – The committee approved the Anti-Fraud workplan for 2017/18

• External Audit Plan 2017/18 – The committee agreed the External Audit Plan for 2017/18 which provided a detailed overview of the key stages of assessment of the annual accounts including materiality, significant risks and value for money. It is likely that the Annual Accounts 2016/17 will receive a qualified opinion as a consequence of the breach of the statutory resource limit.

• External Audit Progress Report 2016/17 – The progress report indicated

completion of all relevant stages of the plan as at 31st March 2017.


The recommendations to the Governing Body from the meeting are as follows:-

1. Note the Director of Internal Audit opinion of Significant Assurance 2. Note the ‘Green’ assessment of the Assurance Framework 3. Note the Information Governance toolkit compliance assessment was ‘Green’ with a

score of 91% 4. Note the satisfactory conclusion of Service Auditors Reports in relation to key control

systems operated by the CSU 5. Note the Anti –Fraud Services ‘Green’ assessment of compliance with the NHS

Protect Standards for Commissioners 6. Note the likelihood of a qualified opinion for the Annual Accounts 2016/17

Chair Name: Alan Whittle

Chair of Audit Committee

Date: 22 April 2017

GOVERNING BODY BOARD REPORT

1/4

Report Title Medical Director’s Report Lead Officer Dr Paula Cowan Recommendations To note progress of the work of the Medical Director and clinical

team

1. INTRODUCTION This report provides Governing Body with an update on the activities and delegated duties of the Medical Director and CCG clinical leads.

2. KEY ISSUES / MESSAGES

Medical Director: Dr Paula Cowan

Wirral Care Record and Global Digital excellence.

• Ongoing work continues with WUTH (Wirral University Teaching Hospital) colleagues and Cerner

on the development of the Wirral Care Record. Some issues have been identified data from the Primary Care System but these are being addressed. The aim is for pilot practices to begin using the system from mid May 2017.

RightCare: • An update on the RightCare methodology has been circulated to Primary Care. This explains the

data, the comparisons to similar CCG’s and how this may be utilised to improve pathways across the local healthcare system and reduce variation.

Urgent Care Update: Dr Helen Downs Clinical Lead Urgent Care • The urgent care system continues to experience significant pressures. High levels of escalation

continue almost daily • The Urgent Care Recovery Group (UCRG) continues to meet fortnightly. A pilot Streaming project

has been trialed over the weekend 2/3rd April and again over Easter with favourable results. The aim is for a streaming process to be embedded over the coming months.

• The urgent care transformation team now meets fortnightly also aiming to further develop the outputs from the Urgent Care Value Stream Analysis last year.

• The OPAT (Outpatient Parenteral Antibiotic Therapy) service is improving the communication processes in order to streamline referral pathways from primary care.

• The ‘Think Pharmacy’ scheme is to be extended for a further 12 months. There are now approximately 48 pharmacies involved representing about 80 % of all pharmacies on Wirral.

• Promoting the ambulatory clinic within ACU as an option for GPs in order to improve flow through the ACU is being encouraged, aiming to reduce the demand on the ED.


2/4

Long Term Conditions Update: Dr Sian Stokes, Clinical Lead Long Term Conditions

Diabetes

• The CCG is still awaiting the outcome of the bid that was submitted for the Diabetes Transformation Fund. This is a national fund of £40 million pounds. It is unclear exactly how much Wirral may receive if successful with the bid, but may be in the region of £240,000. If successful, it will help support some changes to the way in which diabetic care is delivered to patients, but will need to show sustainability in order for the bid to be successful.

• The National Diabetes Prevention Programme is now underway in Wirral with referrals already being made to the service. The programme will provide 9 months of education and support for patients with Pre-Diabetes, with the aim of reducing the progression to Diabetes.

Respiratory

• Funding for the continuation of the community diabetes service has been broadly agreed across providers.

• Work continues with Wirral Ways to Recovery to develop a pathway to improve uptake of medical care for COPD for their service users as it has been identified that there is a high mortality rate in their service users from COPD.

• Hot slots at the community respiratory clinics are running well.

Elderly Care

• The service specification for the care home scheme has been and sent to practices. The scheme will be rolled out to patients in dual registered homes in year one, and to all care home patients in year two.

• The care home tele-triage pilot specification has been agreed by the local authority and will be delivered by Wirral Community Foundation NHS Trust. The start date for this project has been pushed back to May 2017 due to problems with staff recruitment and installation of WIFI in the care homes.

End Of Life Care

• Work is on-going regarding the implementation of a Wirral Wide End of Life Care Plan in the community. This has already been developed and is in use in secondary care palliative care. It is hoped that this will help to standardise care and drive up standards, but the form will need to be amended for use in the community.

Fire Service Safe and Well Pilot

• Merseyside Fire Service are piloting a scheme called ‘safe and well’ visits. These visits are targeted at patients over the age of 65 years who live alone, as this group has already been identified at increased risk of house fires. As well as delivering advice about fire safety, they will also be undertaking some basic health screening to include: Falls risk assessment, Bowel cancer screening uptake, BP, Smoking and Alcohol screening. Working in conjunction with the Fire


3/4

Service, the CCG is looking at piloting a scheme where GP practices can refer high risk patients for a safe and well visit.

Primary Care Update: Dr Simon Delaney, Primary Care Lead

Phlebotomy • The current service is receiving positive feedback. The procurement process for future service

delivery is being worked up.

7 day working

• A contract has been agreed at PMCCC (Primary medical care Co-Commissioning Committee) so

this process can now start to mobilise. The 2 Wirral Federations are developing systems to deliver this service.

Primary Care Quality Scheme

• The Primary Care Quality Scheme was agreed at the PMCCC and has been issued to practices

ahead of the commencement date of April 1st 2017.

Member engagement

• Unfortunately the GP education event (Protected Learning Time) had to be cancelled in March due to the pressures across the health economy. The next GP members meeting is scheduled for April 20th 2017. An evening event to discuss Primary Care Transformation has been arranged by Wirral LMC for the evening of May 10th. GP involvement and feedback is encouraged in order to shape the plan going forward.

Prescribing • The repeat prescribing pilot scheme continues. The Over the Counter (OTC) and Products of Low

Clinical Value (PLCV) policies also continue to be monitored. The Prescribing incentive scheme was discussed at the Finanical Recovery group. GP members will be updated on April 20th by the Director of Finance.

Primary – Secondary care interface

• Further to feedback from GP’s regarding flow of communication between Primary and Secondary

care, a meeting took place with positive outcomes in terms of clinical handover. This will make the transition smoother for clinicians and aim to improve delivery of care to patients.


4/4

Planned care update: Dr Lax Ariaraj, Clinical Lead Planned Care

RightCare:

• An overview of the Rightcare work was given at the March Clinical Senate with a full meeting scheduled for May with WUTH colleagues to address the implications of the right care data and address variation.

Neurology:

• A pathway for the management of headache has been developed and this is awaiting final endorsement. There are ongoing discussions regarding the prescribing of generic vs trade antiepileptic agents.

Smears follow up post colposcopy and routine:

• Due to the implementation of national guidance regarding follow up post colposcopy, discussions are ongoing with WUTH regarding the smooth transition to primary care and ensuring that follow up is appropriately arranged. Also discussions underway with Public Health (PH) regarding routine smear as the community sexual health clinics are no longer commissioned by PH to deliver this service.

Pre-op Medical Optimisation:

• Ongoing work is taking place on ensuring that patients are medically optimised pre-operatively. EMIS (GP computer system) templates is to assist optimisation are being developed. Discussions are underway with the WUTH Pre op Clinical Lead and also Public Health around delivery of weight management and smoking cessation services.

Upper Gastroenterology 2 week referrals:

• Engagement underway with secondary care on the referral forms and pathways.

Clinical Senate The clinical senate meets on a monthly basis. See attached Senate report.

3. CONCLUSION Governing Body is asked to note the ongoing work of the Medical Director and Clinical Team in progressing the objectives of Wirral CCG.

Dr Paula Cowan Medical Director Wirral CCG.


Briefing from the Chair of the Clinical Senate Committee

Purpose

Wirral NHS CCG Clinical Senate is a subcommittee of Governing Body. The principle aims of the Senate are to provide a multidisciplinary, multi-organisational forum for clinical debate, allowing senior clinicians the opportunity to influence and give leadership in driving forward service transformation.

The Clinical Senate contributes to the delivery of our strategic and operational plans whilst providing clinical ownership of the objectives of the CCG.

The Clinical Senate will ensure that improved health outcomes for the population of Wirral are underpinned by a focus on quality and safety.

The Clinical Senate meets on a monthly basis and below are key topics discussed and debated at the March and April 2017 meetings.


• NHS Rightcare • Update on Healthy Wirral and Wirral Care Record • Update on Pre-Op Medical Optimisation • Health improvements : Women’s and Children and sporting community integration • Medicines management and Local Pharmacy Update

Outcomes & actions:

• A brief summary of the NHS Right care methodology was given to senate, highlighting the comparison to similar CCG’s and how this data may be used in pathway redesign to reduce variation and improve patient outcomes. The Clinical Senate of May 2017 will look more specifically at the key clinical areas.

• Ongoing work with Cerner continues to develop the Wirral Care record. Pilot practices have been identified and data testing is underway.

• Work continues with the lead for Pre Op clinics at Wirral University Teaching Hospital (WUTH), CCG and Public Health into the development of a robust medical optimisation pathway.

• Health Improvements across various aspects of the health economy was discussed. This included the free “Baby Box” scheme, first developed in Finland, it aims to offer new parents practical support and guidance as well as a “baby box”. Also discussed was the concept of working with the sporting community to bring health education and healthy lifestyle advice to local communities. An example from Halton of work with the Vikings rugby team was described.

• Antibiotic prescribing and the use of Broad Spectrum antibiotics were again

highlighted. Specific ways to target this were discussed. • An update on local Pharmacy initiatives and services highlighted schemes such as

Think Pharmacy and Medicines Use Reviews (MUR).


Senate agreed with the benefits of the Health Improvement agenda and supported the Baby Box scheme.

Senate also agreed that work with the local sporting community should be explored and a group have agreed to take this forward with Tranmere Football club.

Chair Name: Dr Paula Cowan

Chair of Clinical Senate Committee

Date11th April 2017

Minutes of the WCCG QPF Meeting – 31.01.2017 Page 1 of 4

WIRRAL CLINICAL COMMISSIONING GROUP Quality Performance and Finance Committee

Minutes

Tuesday 31st January 2017

1pm Room 539, 5th Floor, Old Market House Present: Linda Roberts (LR) Lay member Quality and Outcomes Chair Alan Whittle (AW) Lay Member Audit & Governance Dr P Cowan (PC) Medical Director Nesta Hawker (NH) Director of Commissioning Dr S Wells (SW) CCG Chair Lorna Quigley (LQ) Director of Quality & Patient Safety Sue Smith (SS) Lead Nurse for Quality and Patient Safety Mike Treharne (MT) Chief Financial Officer Laura Wentworth (LW) Corporate Affairs Manager Board Support: Allison Hayes (AJH) Corporate Officer In attendance

Ref No. Minute

Action QPF16-17/0054

1.0 Standing Agenda Items 1.1 Apologies for absence

Apologies were received from: Paul Edwards. There were no chair’s announcements.

1.2 Declarations of Interest There were no declarations of interest.

1.3 Minutes of Previous meeting from 20th December 2016

The minutes from the meeting held on 20th December 2016 were agreed as a true and accurate record of the meeting not withstanding grammatical errors. Matters Arising There were no matters arising

QPF16-17/0055

2.0 Items for Assurance 2.1 Risk Register

On behalf of PE, LW gave an overview of the current risk register. Committee members were asked to note: 14-15P Financial risk MT gave an update and recommended that the risk score remains the same. 14-15T CHC LQ advised that the CHC joint committee risk register has now been received and the risks identified here have been included on the CCGs risk register. This


Ref No. Minute

Action risk remains at 16 and will be reviewed again in February 2017. 14-15V Delicate negotiations continue to take place regarding the sub lease of Old Market House and PE will brief the Chair of this meeting regarding this. Committee agreed this needed to remain on the risk register. 14-15X Number of significant issues raised by MIAA report into Personal Health Budgets which LQ will follow up and feedback the outcome at the February QP meeting. 14-15Y Potential Sustainability of Non-NHS providers – members agreed to leave this as an ongoing risk. It was agreed that MT would produce a list of non-NHS providers for the committee to review. Members agreed that a process is to be developed for identification and adding of new risks to the register. Action agreed for PE to develop such a process. 2.2 Quality and Performance Reports Safeguarding Annual Report LQ presented the annual safeguarding report for period April 2015 to March 2016. LQ advised the committee that the report summarises the work associated with safeguarding activity with particular reference to updates relating to new government publications, serious case reviews, work of the Wirral Safeguarding Boards, safeguarding assurance items and potential risks. Key areas included:

• OFSTED inspection • Notable achievements 2015-2016 • National and legal challenges in particular FGM related cases • Care Homes and Care Home standards • Priorities for 2016-2017 • Safeguarding Children

LQ gave thanks to the Safeguarding team and members acknowledged the work and commitment that the team had shown. AW praised the team for obtaining statutory compliance and highlighted a number of points within the report that could reflect new commentary around co commissioning. It was agreed that LQ would feed this back to the team. Further discussions took place with regards to care home closures and adequate bed capacity and LQ advised that despite the closures there continues to be vacancies in care homes on Wirral. Members of the QP committee noted the Safeguarding Annual Report. Performance Pack NH presented the performance pack for November 2016 and highlighted performance against the following key standards:

• A&E – WUTH performance

LQ MT PE LQ


Ref No. Minute

Action • Ambulance performance • RTT performance • Cancer • IAPT

NH explained that in November the combined A&E and WIC performance fell below the national standard at 87.98% against the Wirral CCG’s threshold of 95%. Members discussed the current constitutional standards that the CCG have commissioned and it was agreed that the Chair of the QP committee would write to WUTH with regards to their current activity and performance and their agreed trajectories with NHS Improvement. In terms of Referral to Treatment (RTT) performance at WUTH, SS shared with members that key lines of enquiries in relation to quality aspects have been raised and that WUTH have advised the CCG that there is a new intensive support team in place. NH advised that the CCG is participating in the NHS Demand Management Assurance Programme which will provide additional support in improving performance against the RTT standard. Members noted that all targets in relation to cancer performance had been achieved in November 2016. Further discussions took place with regards to IAPT and SS explained the areas of concern due to the long waiting times and key lines of enquiries. SS informed members that NHSE are supporting a quality risk profile which will identify the actions required further to the key lines of enquiry and that the CCG are awaiting a date for the meeting between the regulators, CCG and NHSE. Feedback will be reported to the QP committee in February. LQ reported on the quality aspect of the performance report and drew members attention to following areas:

• Healthcare acquired infections relating to community cases • Mixed sex accommodation standards – in November there were 5 breaches of the

same sex accommodation guidance LQ advised that contract performance notices have been issued with regards to HCAI, and that the CCG are awaiting a response from the provider. Members agreed for this issue to also be raised in the letter to be sent to WUTH by the Chair of the QP committee. The Quality and Performance committee noted the performance report.

LR/MT

QPF16-17/0056

3.0 Items for Approval 3.1 MultiSystemic Therapy (MST)

NH presented a draft paper detailing the current commissioning position of MST which highlights the current staffing issues, which pose a risk to the safety and sustainability of service delivery. Members discussed the options presented within the draft report and it was agreed that after consideration of the evidence provided and a balanced view taken, the CCG would withdraw their contribution to this service based on the evidence that the service is unsafe and not sustainable.

QPF16- 4.0 Items for Information


Ref No. Minute

Action 17/0057

4.1 Other Committee Minutes Serious Incidents Review Group of 7th December 2016 – Members noted the Serious Incidents Review Group minutes of the 7th December 2016. Wirral Drug and Therapeutics Panel January 17th 2016 – MT gave feedback on his attendance at the WDTP of 17th January. Members discussed how future agendas could include mental health issues and prescribing across a wider footprint to provide consistency and continuity. It was agreed that MT would provide an update in 6 months’ time.

MT

QPF16-17/0058

5.0 Risk Register 5.1 Risk Register

LW is to feedback the committee’s thoughts in relation to existing risks and the need for a process for adding newly identified risk to PE and update the risk register accordingly.

LW/PE

6.0 Any other items of Business 6.1 AOB

Chair summarised the action points of the meeting. There were no other items of business and the meeting closed at 2.35pm.

Date and Time of next meeting The date and time of the next QPF meeting is scheduled for:

Tuesday 28th February at 2pm in Room 539 OMH Please forward any apologies to [email protected]


Minutes of the WCCG QP Meeting – 28.02.2017 Page 1 of 7

WIRRAL CLINICAL COMMISSIONING GROUP Quality and Performance Committee

Minutes

Tuesday 28th February 2017

2pm Room 539, 5th Floor, Old Market House Present: Linda Roberts (LR) Lay member Quality and Outcomes Chair Alan Whittle (AW) Lay Member Audit & Governance Dr P Cowan (PC) Medical Director Nesta Hawker (NH) Director of Commissioning Dr S Wells (SW) CCG Chair Lorna Quigley (LQ) Director of Quality & Patient Safety Mike Treharne (MT) Chief Financial Officer Paul Edwards (PE) Director of Corporate Affairs Board Support: Allison Hayes (AJH) Corporate Officer In attendance: Dr Helen Downs (HD) GP Lead for Unplanned Care

Gareth James (GJ) HR Business Partner

Ref No. Minute

Action QP16-17/0059

1.0 Standing Agenda Items 1.1 Apologies for absence

Apologies were received from: Jon Develing and Sue Smith.

1.2 Declarations of Interest Chair reminded the QP members of their obligations to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of Wirral Clinical Commissioning Group. Declarations declared by members of the QP committee are listed in the CCGs Register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link: https://www.wirralccg.nhs.uk/Downloads/AboutUs/WhosWho/Register%20of%20Interests%20Version%20Updated%20June%202016.pdf All GP members present at the meeting declared their interest in agenda item 3.2 Procurement of Phlebotomy Service. Chair ruled for GP colleagues to remain in the room in order to contribute to discussions, however they would not be involved in any decision making.

1.3 Chairs Announcements Chair welcomed Dr Helen Downs, GP lead for Unplanned Care to the meeting.

1.4 Minutes of Previous meeting from 31st January 2017




Ref No. Minute

Action The minutes from the meeting held on 31st January 2017 were agreed as a true and accurate record of the meeting not withstanding grammatical errors. Matters Arising LQ reported that a letter has been received from WUTH in response to the CCG seeking assurance around A&E, RTT performance and mixed sex accommodation breaches at the hospital. WUTH have requested to meet with the CCG Governing Body in the near future. Members discussed the appropriate direction of travel and it was agreed that LQ would discuss the next steps with JD, Chief Officer. Action – LQ to discuss next steps with JD with regards to WUTHs performance and capacity issues.

LQ

QP16-17/0060

2.0 Items for Assurance 2.1 Risk Register

PE advised that a process has now been developed for identifying and adding new risks to the risk register. 14-15G - A&E 4 hour target, including quality of care and standards to patients. Members acknowledged that a letter has been received from WUTH and it was agreed to add in any identified next steps. 14-15P - Financial risk to CCG in achieving the planned circa £12 million deficit. Members agreed for the risk to remain the same. 14-15T – Delivery of Continuing Care Healthcare (CHC) risks in relation to: packages of care, complex patients, reputational and financial risk to the organisation with regular reviews not being undertaken by CHC, retrospective complaints, quality and personal health budgets. LQ advised members that an action plan has now been implemented. 14-15U – Improving Access to Psychological Therapy (IAPT) service will not meet the targets related to access and treatment and performance will not improve with additional resource and will deteriorate with any claw back of resource by NHS England. Members agreed for the risk to be reassessed in March. 14-15X – Number of significant issues raised by MIAA report into Personal Health Budgets. Members agreed for the risk to remain the same. 14-15Z Increase in potential patient safety issues leading to moderate or severe harm at acute provider organisations. Members agreed for the risk to be reviewed in March. 2.2 Quality and Performance Reports Continuing Healthcare Report (CHC) Report LQ provided an overview of the Continuing Healthcare (CHC) and Complex Care performance for November 2016 with a snapshot of activity as at 5th January 2017 and advised that the report summarised the performance for each of the Cheshire and Wirral Clinical Commissioning Groups. Highlights included:


Ref No. Minute

Action

• Wirral CCG are now part of the CHC national development programme which will give access to further support for good processes and achievement of standards.

• Decreased number of checklists this is largely due to escalation issues within acute trusts.

• Fast Track cases with packages in place within 48hours increased from 89% to 91% this is supporting end of life care

• Decrease in complex care packages • Packages over £110k have decreased (7 cases in December)

Members noted the CHC reported. Performance Pack NH presented the performance pack for December 2016 and highlighted performance against the following key standards:

• A&E – WUTH performance • Ambulance performance • RTT performance • Cancer • IAPT • Mixed Sex Accommodation • Healthcare Acquired Infections

NH explained the current A&E position and advised that the performance fell below the national standard at 82.08%. The CCG has not agreed to the NHSI trajectory and continues to monitor the provider against CCG plan. NH reported that in December the Wirral performance for ambulance response times CAT A red 1 did not meet the standard at 74.26%. Members discussed the RTT standard for December and NH explained that Wirral CCG failed to achieve the RTT standard performing at 83.93%. NH highlighted a briefing report from NHSI intensive support team who are currently working within the trust, which raised concerns around RTT recovery rates and further discussions took place with regards to the data received in relation to this. This would be discussed at the Contract meeting with WUTH. Due to the concerns raised, members agreed for RTT standards to be included on the CCGs risk register: impact 3 and likelihood 5. Action – PE to update risk register to reflect RTT issues. 2.3 Compliance Report PE updated members of cases received and incidents reported to NHS Wirral CCG within the period of December 2016 and January 2017 in relation to complaints, MP enquiries and patient enquiries. Key trends and themes included:

PE


Ref No. Minute

Action

• Complaints regarding Phlebotomy service changes • Continuing Healthcare processes and challenges around providers/packages of

care and eligibility criteria. Members noted the compliance report update and went on to review and acknowledge the key issues and messages in relation to Freedom of Information requests and serious incidents. 2.4 HR Report Update GJ provided the committee with an overview of a quarterly report relating to key HR indicators. GJ drew members attention to the following areas:

• Ethnic composition of the workforce; this is lower than in other CCG’s • Cumulative turnover rate; this remained high during the period of October 2016 –

December 2016, with it peaking at 25.48% in November 2016. It was acknowledged this could be due to the cessation of the Vanguard programme as people where employed by the CCG.

• Sickness absence rates • Statutory and mandatory training • Personal development reviews

Members acknowledge the overall compliance rate for statutory and mandatory training and PE informed members of two new areas of good practice: moving and handling (office related) and preventing radicalisation. Members agreed that these two new training programmes should be included in the staff statutory and mandatory training requirements. Further discussions took place around Personal Development Reviews and members noted the significant improvement on previous compliance rates. Members of the QP committee noted the HR Report presented today.

QP16-17/0061

3.0 Items for Approval 3.1 Assessment for Autistic Spectrum Disorder in Adults – Commissioning in

2017/18. NH presented a paper regarding the assessment of autistic spectrum disorder in adults and asked the committee to approve a revised tariff and model for adult ASD assessment in 2017/18 and a joint commissioning arrangement with Cheshire CCGs. NH reported that CWP have prepared a proposal for a reduced tariff, matching the original provider’s tariff of £800 per assessment which constituted a reduction of £575 per assessment and confirmed that the contract value for Wirral CCG would remain the same as at 2016/17 of £110,000.00. NH recommended that the CCG continues to commission an ASD assessment service from CWP, against the revised service model at a reduced tariff of £800 per assessment and that the level of investment by Wirral CCG remains the same as in 2016/17 due to the long waiting times, however, the reduced tariff will mean that more patients are able to be seen and waiting times will reduce. NH advised that it is also recommended that in


Ref No. Minute

Action line with the direction of travel of the STP, this service is jointly commissioned across Cheshire and Wirral CCGs, with Wirral as the lead commissioner. Members discussed the proposal for the charging for DNAs and it was agreed that NH would look into this further. Based on the information provided at today’s meeting, the committee approved the proposal and recommendations subject to NH reviewing pathways and DNA rates and charges. Action – NH to review pathways and DNA rates/charges. 3.2 Community Phlebotomy Service Re-procurement NH presented a paper with regards to the community phlebotomy service re-procurement and explained that the contract expires in July 2017. NH provided an overview of the contents of the paper which included:

• An initial update on the recently introduced hub model by the Community Foundation Trust.

• An options appraisal of the procurement models and recommendation of the preferred contracting approach to be adopted and details on the requirement of an extension to existing contract arrangements.

NH asked members to consider each re-procurement option and provide a decision on the preferred approach. Options included: Option 1 – Framework Agreement (Qualified Provider) Option 2 – Single contract via a Prime Provider of Prime Contractor Model Option 3 – Do nothing NH explained that to enable the service to be appropriately re-procured there is a requirement to extend the current service form July 2017 until 31March 2018 approximately. This is to allow adequate time for the revised delivery model to embed and time to undertake full stakeholder engagement as part of the procurement process. Members discussed the options for procurement and whether discussion had taken place with GP practices providing the service and federations. NH explained that this is a commissioning decision and not a provider decision. NH advised that the procurement was to define the contractual framework to be adopted and the specification of the service will be developed with stakeholders and that engagement processes will be developed to support this. LQ requested the model is co-produced with patients in order for the public to express their views. In conjunction with this PC requested that the LMC (Local Medical Committee) and GP leads are involved with the production of the model. Further discussions took place around practices that may wish to opt out of the proposal and the TUPE process that may impact on staff. Chair ruled that non GP members would be required to vote on the options and it was agreed that option 2 would be the preferred choice of the committee, provided that GP colleague’s concerns were noted along with a consultation process which is to include the LMC and patients.

NH


Ref No. Minute

Action Members also agreed that the following caveat is explored: for practices to have sub-contractor arrangement with the prime provider. 3.3 PLCP and Fertility policy NH advised that the Procedures of Lower Clinical Priority (PLCP) policy and Subfertility policy have now been updated to incorporate additional procedures based on best practice, clinical evidence of effectiveness and benchmarking. NH asked the QP committee to ratify the final PLCP policy and subfertility policy ready for implementation on 1st April 2017. Members discussed the clinical input towards the amendments to the policy and NH clarified that a number of clinical leads have contributed towards the final draft of the policy. SW raised that she had identified some minor amendments. Action – SW to work through proposed minor policy amendments with programme managers. 3.4 Integrated MSK Procurement/Next Steps NH introduced a paper with regards to the Integrated MSK procurement and next steps. NH advised that the CCG is bound by the Public Contract Regulations (PCR) 2015, as such the project team are requesting authorisation to publish a Prior Information Notice (PIN) to seek interest from the market to deliver an Integrated MSK service. NH explained that the PIN will include technical and financial exclusion criteria appropriate to the opportunity and that it is envisaged that the financial model and plan will be as follows:

• CCG to provide budget based on activity and HRG4+ to provider • Provider to provide full service operating costs below that of the CCG budget • The variance between CCG cost and operating costs are to be divided, partly into

a guaranteed saving for CCG financial recovery and partly as a contingency budget to address any unforeseen cost creep by both CCG and WUTH

• Any surplus contingency to be divided as a gain share at the end of the financial period

Discussions took place with regards to the CCGs current annual costs for the services and the fact that an additional exclusion criteria used for the project will include financial requirement to have a turnover of at least the total contract value of £125m. AW sought clarity around the total acute contract value and requested that MT/NH seeks further advice in relation to this and it was agreed that NH would investigate this further. Action – NH to investigate the total acute contract value with RB. Members approved the publication of a PIN for the MSK project team.

SW NH

QP16-17/0062

4.0 Items for Information 4.1 Other Committee Minutes

Serious incidents Review Group of 07.12.2016


Ref No. Minute

Action Members noted the minutes of the SI Review Group of the 7th December 2016. 4.2 IFR Report LQ highlighted the above report and members noted the updated contents. AW commented on the improvement plan and how the team measured success as there were a number of red where a number of activities have taken place. SW commented on the number of requests that where rejected and if this could be training issue. LQ agreed to ask the team for clarification on the above. 4.3 OFSTED Improvement Plan Committee where asked to note the OFSTED improvement plan and advised the committee that Ofsted’s overall rating was of the effectiveness of the Council’s arrangements and the effectiveness of the local children’s safeguarding board arrangement are inadequate . LQ reported that the improvement work required may take up to approximately 18 months. The QP committee noted the update.

QP16-17/0063

5.0 Risk Register 5.1 Risk Register

It was agreed that PE would update the risk register with the suggested changes discussed within the meeting. Please refer to agenda item 2.1.

6.0 Any other items of Business 6.1 AOB

There were no other items of business.

Date and Time of next meeting The date and time of the next QPF meeting is scheduled for:

Tuesday 28th March at 2pm in Room 539 OMH Please forward any apologies to [email protected]


P a g e 1 of 7

Clinical Senate Meeting

Tuesday 14thFebruary 3.00pm Room 539, Old Market House

Present: Paula Cowan (PC) Medical Director Wirral CCG Chelsea Worthington (CW) Corporate Support Admin Assistant Wirral CCG Elspeth Anwar (EA) Public Health Melanie Carroll (MC) Community Pharmacy Cheshire and Wirral Sian Stokes (SS) Lead for Long Term Conditions Helen Downs (HD) Urgent Care Clinical Lead WCCG In Attendance: Sue Smith (SuS) Lead Nurse for Quality and Patient Safety Clare Pratt (CP) Deputy Director of Nursing Maria Jones (MJ) End of Life Clinical Lead WCCG Sue Borrington (SB) Commissioning Support Manager WCCG Deb Lowe (DL) CD Medicine WUTH Sara Radcliffe (SR) AQUA Catherine Hayle (CH) Consultant in Palliative Medicine WUTH & WHSJ Rachael Pugh (RP) Medicines Optimisation Pharmacist MLCSU Eddie Roche (ER) GP Apologies: Lesley Doherty (LD) Registered Nurse WCCG Governing Body Lax Ariaraj (LA) Planned Care Clinical Lead Wirral CCG Gaynor Westray (GW) Director of Nursing and Midwifery/Director of Infection Prevention and Control- WUTH Ewen Sim (ES) Medical Director CT Simon Delaney (SD) Primary Care Lead Lorna Quigley (LQ) Director of Quality and Patient Safety Sandra Christie (SC) Director of Nursing and Performance

Item No.

Agenda Items

Action

PRELIMINARY BUSINESS

1.1 Welcome and introductions: PC welcomed members to the group, as there were a lot of new attendees at today’s meeting; each member introduced themselves and their job role.

1.2 Conflicts of Interest

P a g e 2 of 7

Wirral CCG has updated their policy regarding Conflicts of Interest in line with new guidance. This will be addressed at each meeting and a declaration must be made by anyone who has an ‘individual’ conflict of interest with an agenda item in the meeting. The chair will then make a ruling as to the action to take in light of the significance of that conflict. PC reminded committee members of their obligation to declare any interest they may have on any issues arising within the meeting as an individual. There were no conflicts of interest.

1.3 Minutes and Actions from Previous meeting The minutes of the previous meeting held on 17th January 2017 were agreed as a true and accurate record notwithstanding grammatical/typographical errors which will be ratified.

1.4 Matters Arising: There were no matters arising.

ITEMS FOR APPROVAL

2.1

AQUA Update re Healthy Wirral SR, ER & DL are in attendance to present the work to date on developing an Accountable Care Organistaion for Wirral. This programme started in October 2016 and is due to finish at the end of March 2017. The work that has been carried out is divided into 3 sections: Section 1- Leadership and Governance – Creating the Direction

• To put in place the robust system leadership and governance arrangements

• NHS Chief Executives, GP Fed Chairs and LA Directors

Section 2- Senior Change- Creating the Drive • To produce a strategic outline case • Senior Clinicians and Manager from 6 Provider Organisations

Section 3- Older People Care Programme – Creating the Design

• To develop a delivery model of implementation • Providers and Commissioners

Accountable Care is a national priority across the health and social care system. The ambition is to provide better care for local population by:

• Defining a shared population group and care model across the system • Providing co-ordinated care • Creating interdependency which is more likely to enable effective and

efficient care

P a g e 3 of 7

• Sharing care management and predictive modelling • Shared system governance • Shared accountability for quality and cost of care • Shared risk and savings

Discussions have been undertaken with provider organisations to gain an understanding of their views and opinions of Accountable care. Feedback has been represented in a Wordle (a diagrammatic representation of the language and words used). Words such as duplication, too many chiefs and hardworking staff were repeatedly seen. The key messages are:

• Prioritising Function Leads to the Right Form • Older Person Care Programme First • Place as Foundation Stone for the Older People Model • From Silo Management to System leadership for Older People • One Older Person Workforce Across All Providers • Pooled Resources for Older Person Care Programme

Manchester is currently the only area within the region who has undertaken this work, so they have been invited to attend Workshop 4 to share their experiences. AQUA are facilitating the development of a business case for the Accountable Care on Wirral which is due to be presented to the Healthy Wirral Partners Board in March 2017. There are a number of different ways and pathways we can work on to help develop the Elderly Care Business Case such as an integrated falls service, dementia care across the sector and pre frailty risk stratification and identification. Why focus on an Older Person Care Programme First?

• Growing demographic – specific to the communities people live in • Increasing needs and demands • Potential to create a different function across the system • Potential to have an impact on flow across the system • VSA already completed and priorities have been identified • Evidence in other areas of transformation (vanguards) • Key area for Five Year Forward View and GP Forward View • Right people already engaged in the room

SS advised of a further 2 providers whose engagement in the process would be of benefit: Older People’s Parliament and Care Homes. The service re-design will now focus on wellness not illness and health before treatment. The main focus is care which is delivered to our patients; this is why an ICO (integrated care organisation) is crucial in this accountable care work. DL advised that as of yesterday (13/02/2017) there are 100 patients in the hospital medically fit, yet still awaiting discharge.

P a g e 4 of 7

ER presented to the group some questions which have been raised by GPs in Primary Care: is there a skill mix, are there resources to engage in service re-design and what is the attitude to risk and budget holding. SuS asked if the senior group has had good nurse representative as they will be highly involved in the re-design. SR advised that there has been a lot of nurses attend workshop 3 who have been very vocal and helpful in what they said. The cohort of people within the senior change team have been nominated. There has been some patient and public involvement within the workshops, but as yet there is no specific timeline for when patients and families will get fully involved. PC asked DL and ER; as clinicians what have they learnt from the work which has been done so far:

• Real willingness to work together • Willingness to do things differently from all of the providers • Low trust levels in groups • There are talented people involved in elderly care on Wirral • Things don’t technically need to be complicated • There are fundamental differences in providers

CH welcomed the work that has and is continuing to be done as these are the same challenges which she is faced with in End of Life. Action – CW to send out the presentation to member of the group.

2.2 Cancer and Wirral Palliative and End of Life Care Strategy Wirral CCG has been through an internal process to produce its own population wide strategy for 2015-18. The focus of the strategy covered key themes such as health inequalities, urgent care, planned care and long term conditions. The generic nature of the strategy meant that both Cancer and Palliative & End of Life did not feature as specific work streams but were an underlying element of the key themes. In the absence of clear references to Cancer and Palliative & End of Life Care the need for individual strategies has been identified as a gap that needs addressing. Palliative and End of Life Care Strategy 2017-20 The following key events have occurred in recent years that also have reinforced the need of the Wirral health economy to have its own Palliative and End of Life Care Strategy

• The abolition of the Liverpool Care Pathway (LCP) • Neuberger report and 5 priorities of End of Life Care • Wirral Specialist Palliative Care Team Service Review • Plethora of national reports, policies and strategies • Variety in performance of providers through CQC and CODE reports • Wirral Citizens End of Life Charter • Six ambitions for Palliative and End of Life Care

P a g e 5 of 7

All providers have adopted the North West End of Life Care Model as a replacement for the LCP and new NICE guidance which came on stream in December 2015. The Wirral Care Record will help for all providers to allow sharing of patients records. Members discussed the different care and bereavement care which is available for patients and families on the Wirral. When patients have received End of Life care on Wirral, there is a short friends and family survey sent out to families, including families of sudden deaths. Over the past 6 months the percentage of people to recommend the service has been at between 89% and 100%. CH advised of a meeting that she has recently attended at the Hospital which included a number of different departments where it was discussed that patients who are diagnosed with illnesses are not aware of how serious and their needs for when they pass away. Cancer Strategy The national Cancer Strategy – Achieving world class outcomes – A strategy for England 2015-16 identifies that:

• More people are coming forward with suspected Cancer symptoms • More people are living for up to 20 years following a cancer diagnosis • There are concerns about unwarranted variation in the diagnosis and

treatment of cancer across the country Key measures that inform the local position, and fall within the responsibility of the CCGs include:

• The key cancer performance standards – these are considered by patients and the public to be an important of the quality of cancer diagnosis, treatment and care NHS organisations deliver

• The CCG improvement and assessment framework – this identifies cancer as one of six priority areas that will be assessed and CCGs will be given a CQC style rating. The results will be published in June 2016 focusing on early diagnosis, one year survival, 62 day waits after referral and overall patient experience.

• NHS Rightcare commissioning for value pack- this identifies potential

areas of unwarranted variation against comparable areas and the national average.

Regionally, key changes are taking place; Cancer Alliances are being formatted to drive forward change on a regional basis. The Wirral falls within the Wirral and Cheshire local service delivery team, an area of huge variation in terms of health, economic and social needs and with very differing provider pathways. It is therefore important that Wirral has in place a strategy.

P a g e 6 of 7

This follows on from the last cancer strategy that was in place. This will be supported by a 1 year operational plan produced by the CCG and monitored monthly. There have been a number of events in Liverpool aimed at encouraging and highlighting awareness of cancer : Eg Everton FC have been speaking to older men to encourage them to get a bowel cancer screening. Members noted the plan on a page which shoes how we can increase life expectancy of Wirral residents. Early diagnosis and treatment for the patient improves outcomes. Liverpool has a prevention strategy; this is something that Wirral could review and consider adapting. Liverpool’s demographic is similar to Wirral. Both Cancer and PEOLC strategies are very comprehensive and include a lot of useful information which should avoid duplication. Early supported care can help improve outcomes and prognosis for patients. There’s a lot of work being done and a big push for this nationally that Wirral should be considering. SB also advised that she is working to help get patients a direct route into Leisure Centre’s, this should be rolled out later this year.

2.3 Coeliac Pathway The Coeliac paper has been brought to the committee as the review date is for February 2017. This is for members to note as there are no changes made to the paper.

2.4 Feedback regarding Medical optimisation pathway Following the last meeting Heather Harrington discussed the suggestions from the last clinical senate with the operations team at WUTH and how this may be implemented. Janelle Holmes and Susan Gilby from APH welcome the clinical discussion but are keen that engagement is with the appropriate clinicians. Kath Broadbelt has sent through to both PC and LA the top tips in Anaesthesia and Pre-Op management.

ITEMS FOR NOTING 3.1 Clinical Safety Case

This has been brought for the committee for members to note and to have assurance that the data provided is being validated before the live date of March 2017.

3.2 Papers from Clinical Groups Members noted the draft minutes and papers from other clinical groups

P a g e 7 of 7

ANY OTHER BUSINESS

4.1 There was no other business discussed.

DATE AND TIME OF NEXT MEETING

The next meeting will be held on: 14thMarch 2017, 3pm –5pm, Room 539, Old Market House. Please forward apologies / agenda papers to [email protected]

ALL


P a g e 1 of 4

Clinical Senate Meeting

Tuesday 14thMarch 3.00pm Room 539, Old Market House

Present: Paula Cowan (PC) Medical Director Wirral CCG Chelsea Worthington (CW) Corporate Support Admin Assistant Wirral CCG Elspeth Anwar (EA) Public Health Lax Ariaraj (LA) Planned Care Clinical Lead Wirral CCG Sian Stokes (SS) Lead for Long Term Conditions Helen Downs (HD) Urgent Care Clinical Lead WCCG Lorna Quigley (LQ) Director of Quality and Patient Safety In Attendance: Clare Pratt (CP) Deputy Director of Nursing Rachael Pugh (RP) Medicines Optimisation Pharmacist MLCSU Nicola Mendrick (NM) GP Shadowing Apologies: Lesley Doherty (LD) Registered Nurse WCCG Governing Body Gaynor Westray (GW) Director of Nursing and Midwifery/Director of Infection Prevention and Control- WUTH Melanie Carroll (MC) Community Pharmacy Cheshire and Wirral Ewen Sim (ES) Medical Director CT Simon Delaney (SD) Primary Care Lead

Item No.

Agenda Items

Action


1.1 Welcome and introductions: PC welcomed members to the group; each member introduced themselves and their job role. Nicola Menderick is in attendance shadowing PC as a registrar at Upton Group Practice to see how things are done at the CCG.

1.2 Conflicts of Interest Wirral CCG has updated their policy regarding Conflicts of Interest in line with

P a g e 2 of 4

new guidance. This will be addressed at each meeting and a declaration must be made by anyone who has an ‘individual’ conflict of interest with an agenda item in the meeting. The chair will then make a ruling as to the action to take in light of the significance of that conflict. PC reminded committee members of their obligation to declare any interest they may have on any issues arising within the meeting as an individual. LA declared his conflict of interest as doing endoscopy’s at WUTH.

1.3 Minutes and Actions from Previous meeting The minutes of the previous meeting held on 14th February 2017 were agreed as a true and accurate record.

1.4 Matters Arising: There were no matters arising.

ITEMS FOR APPROVAL

2.1

NHS Righcare Professor Sir Bruce Keogh, the national Medical Director for NHS England has said that there is no doubt that transparency of data, transparency of difference and transparency of variation promotes change and improvement. The Rightcare programme places NHS at the forefront of addressing unwarranted variation in care. NHS Rightcare should make the best use of resources, offering better value for patients, the population and the tax payer. We should start to understand how we are doing as a CCG by identifying unwarranted variation between demographically similar populations. We should start focusing on the areas of greatest opportunity by identifying priority programmes which offer the best chances to improve healthcare for populations and to start talking about healthcare rather than organisations. LA presented a number of slides with graphically representation of WCCG against 10 similar CCGs which are based on 12 demographic variables. There is considerable data available but LA highlighted specific areas of concern for Wirral. LA would like Clinical Senate members to discuss and decide how we as a Wirral Health Economy can move forward with this. The group will need to agree on just 3 headings to work on at first as this will generate a lot of work. EA suggested that it would be useful to bring the Rightcare work which has been carried out at recent workshops to a Clinical Senate meeting for members to review. LA suggested to the group that a Rightcare overview committee to be put in place which will include a number of different providers to work together on this. CP advised that she would be able to provide the correct people’s names that would be best to attend this meeting including consultants,

P a g e 3 of 4

medical director and nurses. As not many people are aware of what Rightcare is a number of bullet points will be put together for the Communications team to send out to both Primary and Secondary care to give them a quick overview of the Rightcare work that is being undertaken and the positive outcomes it will bring.

2.2 Healthy Wirral: Brief Update PC provided the group with a brief update regarding the Wirral Care Record. The Wirral Care Record has been a regular item on the Clinical Senate’s Agenda within the last 2 years, and now PC as Medical Director has started to work with Cerner on any IT and IG issues. Sheila Stewart from WUTH has also been doing a lot of work with Cerner and PC. There will be 2 GP practices piloting the Wirral Care Record next month which are; Marine Lake and Eastham Group Practice. There is not yet a confirmed date in place for when the record will be rolled out to everyone. PC highlighted some operational issues at present which are being addressed. There will be a lot of good work to come out the Wirral Care Record but the key at present is ensuring validation of data. Members noted that PC has also briefed the CCG Directors on the issues as this is something that we need to get right first time. WUTH are awaiting the Global Digital Excellence funding which will financially assist forward movement of the project.

2.3 Medical Optimisation Kath Broadbelt has sent to PC top tips for anesthetic that can be sent round to all GPs to refer to when it comes to referring patients for surgery. There is current work taking place on developing a pathway for elective care surgery. Heather Harrington has set up a virtual group and members are very enthusiastic about the work. Clinical Senate will be kept up to date on the work that is being carried out and members noted that the comments regarding Medical Optimisation from the previous Senate meeting have been taken on board to be put into place. Members had a lengthy discussion around the referral for criteria for this pathway and LQ advised it may be useful for the Medical Optimisation paper to come back to Clinical Senate for members to review that they are happy and understand fully before this is rolled out.

2.4 Future Senate Meetings Clinical Senate is a cross clinical meeting, PC explained to members that she is keen for others to submit agenda items and papers in which they see fit for discussion. It was also suggested for a provider agenda and guest chair.

P a g e 4 of 4

ITEMS FOR NOTING 3.1 Papers from Clinical Groups

Members noted the draft minutes and papers from other clinical groups. LQ raised regarding the Opthamology and EOL meetings only taking place every 3 months and actions are not being actioned sooner. There is now an EOL lead in place who also wants to take this forward. PC will raise with Sue Borrington who chairs the Opthamology meeting. There were a number of apologies given for the April meeting, CW to check quaoracy for the next meeting.

ANY OTHER BUSINESS

4.1 There was no other business discussed.

DATE AND TIME OF NEXT MEETING

The next meeting will be held on: 11th April 2017, 3pm –5pm, Room 539, Old Market House. Please forward apologies / agenda papers to [email protected]

ALL


S i g n e d – C h a i r P a g e 1 of 8

Audit Committee Meeting

Thursday 26th January 2017 10.30am – 1.00pm, Duncan Room, Old Market House

Present: Alan Whittle (AW) Lay Member (Audit & Governance) Chair Bernard Halley (BH) Audit Lay Member Sylvia Cheater (SC) Audit Lay Member In Attendance: Anne-Marie Harrop (AMH) Assistant Director, MIAA Chelsea Worthington (CW) Administrative Assistant (minute taker) Laura Wentworth (LW) Corporate Affairs Manager Paul Edwards (PE) Director of Corporate Affairs Chris Whittingham (CWh) Grant Thornton Mike Treharne (MT) Chief Finance Officer WCCG Charles Black (CB) MIAA Mike Cunningham (MC) Deputy Chief Finance Officer Karen McArdle (KMc) Anti-Fraud Specialist

Item No.

Agenda Items

Action

AC16-17/04


1.1

Apologies: Robin Baker, Linda Roberts and Emma Styles AW congratulated Sylvia Cheater for receiving her recent MBE award.

1.2

Declarations of Interest: Wirral CCG has updated its policy relating to the management of Conflicts of Interest in line with new guidance. This will be addressed at each meeting and a declaration must be made by anyone who has an ‘individual’ conflict of interest with an agenda item in the meeting. The chair will then make a ruling as to the action to take in light of the significance of that conflict.


AW reminded committee members of their obligation to declare any interest they may have on any issues arising within the meeting as an individual or on behalf of an organisation. There were no declarations of interest made.

1.3

Minutes of Previous Meeting/Action points of previous meeting held on 17th November 2016 The minutes of the previous meeting held on 17th November 2016 were reviewed and agreed. Action- CW to amend the action points to state open and closed.

1.4 Matters Arising: AW and PE to discuss the possibility of a replacement Lay Member, since Tracey Fisher has left the CCG, outside of this meeting, MT will chase for the Service Auditor Report from Charlotte, which was promised at the last meeting. AMH has a copy of the CSU element which she agreed to send to members. Action – CW to add the Audit workplan as a standing item (needs to be refreshed) Members noted that GB has formally agreed the changes discussed at the last meeting regarding the MIAA workplan. As SC was not at the last audit committee meeting, AW provided further information of the Primary Medical Care Co-Commissioning Committee.

AC16-17/4

ITEMS FOR DISCUSSION

2.1

CCG Agenda Items Note business of other committees and review inter relationships From the last meeting, members will be aware that the CCG has submitted some proposed Constitutional changes to NHS England. There has been some feedback from NHS England to advise that they have agreed the changes with one exception relating to the vice chair arrangements for the Primary Medical Care Co-Commissioning Committee, which the CCG has now amended. It was noted that the CCG is awaiting further feedback but PE is certain that there will be no issues. AW advised that at the effectiveness session held prior to today’s Audit meeting, it was agreed that the chairs’ reports from other committees will also be reviewed at the Audit committee meetings going forward.


2.2 2.3 2.4 2.5 2.6

Annual Report and Annual Governance Statement Template PE presented the template/guidance for the committee to review. It was noted that the guidance is a lot clearer this year, easier to read and understand. PE explained that NHS England has advised the CCG that the Health and Wellbeing Board should be included in the approval of the Annual Report. The CCG will be taking the same approach as last year in which the Annual Report document will be circulated for the comments and thoughts of Health and Wellbeing Board members. CCG Annual Report 2016/17 Month 9 Governance Statement Report PE presented the Month 9 governance statement report which has been sent via email to members who have all approved its contents. NHS England did come back to the CCG and advised to include reference to the failure to deliver NHS Constitution standards for A&E and RTT which has been included in the final version. There is no further action, members noted and agreed. Conflicts of Interest indicator: Part two (Quarterly assessment) LW explained that this has been brought to today’s committee for members to review and advised that the CCG is required to complete this template on a quarterly basis, which is required to be signed off by the Accountable Officer and Audit Chair, Members noted that a GP partners register is currently in the process of being published by February 2017. The Chair is pursuing GPs to declare their interests as to date approximately 80% have responded. The information will also be available on the CCG’s website. Losses and Special Payments register MC presented the losses and special payment paper to the group. The summary presented is for the Audit Committee to note. MC advised that actions are being taken to minimise the risk of recurrence. The financial impact of the write-offs has been accommodated within the year-end forecast position. As well as formally advising the Audit Committee of actual Losses and Special Payments, the committee should receive early warning of any risks that arise. Review risks and controls around financial management Currently the CCG’s Governing Body receives the risks and controls around financial management, MT advised that it would be best for this information to also be included in the MIAA financial system report, this will also allow the Audit Committee to have insight and be kept up to date of the risks.


2.7 2.8

MT’s monthly finance report is presented to both the Finance Committee and Governing Body to ensure there is a consistent understanding of the CCG’s financial performance. CWh advised that he meets regularly with MT and continues to get assurance of the movements within the figures. Review IG progress report MT presented the IG progress report on behalf of the CSU who were unable to attend the meeting. The report provides the committee with an overview of the progress of compliance with the IG toolkit throughout the year. The latest version of the IG toolkit which was released on May 27th 2016 has made no substantial changes from the previous year. A breakdown of the attainment levels for the toolkit submission will be provided to the CCG in the Annual Report to be provided on March 17th 2017. However as the meeting of the Audit Committee will take place on 18th May, it was agreed that the Chair of the Audit Committee receives and approves the report on behalf of the committee. Information Asset Register Currently there are no assets that have been recorded within the UAssure system. The first information risk workshop is due to take place on 27th January 2017 and following this session, IAAs can begin to log the assets on UAssure ready for approval. Incident ID 1012- members noted that steps have been taken to prevent any recurrence of the incident. Members discussed the need for the report to include a context page at the beginning of the report which will draw attention to any risks or key messages that the committee is to be made aware of. Action – MT will speak to Emma outside of the meeting. Committee members noted that Naomi, the IG support officer now works at the CCG office on Thursdays and Fridays each week, which has improved access to support. Members received and noted the report. Audit tracker LW presented the audit tracker to the committee. Each item was discussed and further updates were provided. Two items, as requested, were formally agreed by the committee to be closed. Corporate Governance Compliance review – There are currently 2 low risk level rated recommendations - LW explained that the Constitution has been


2.9 2.10

amended and the CCG is currently awaiting confirmation from NHS England that the proposed amendments have been agreed. Co Commissioning Baseline Review - There is currently 1 medium rated level recommendation. LW updated that progress against each of the priority areas of work for the CCG is identified within the Operational Plan 2016-17. It was noted that overall the current position with completion of actions is on track and assurance was provided at Governing Body in November 2016 that work is progressing as per the plan. It was also noted that the Director of Commissioning had updated the Governing Body at the Annual General Meeting (held in public) in September 2016. Members agreed that the appropriate action had been taken and for this to be closed from the tracker. It was agreed that Directors should produce a quarterly report on implementation of audit recommendations to be reviewed at a Directors’ meeting. Action- MT, PE & LW to pick up outside of the meeting. Review Counter Fraud Progress Report KMc presented the MIAA counter-fraud progress report which sets out the work which has been undertaken during the period of 1st September 2016 to 31st December and highlights the activities and outcomes for consideration by the committee. Members noted that previously the national deadline for submissions had been on or around the 31st May. In order to fulfil internal and external information requirements NHS Protect has now revised the next submission date to 1st April 2017. KMc is meeting with MT next week to discuss working this into the Audit Workplan. Members noted the current pharmacy investigation is still ongoing and KMc is currently collecting the data. AW thanked KMc for the dashboard presented as this is very helpful and easy to follow.

Internal Audit

Review Internal Audit progress reports Since the previous Audit Committee meeting the following reports have been finalised:

• QIPP • Contract Management • Finance Systems

The QIPP review was finalised before the Turnaround director and Finance Committee came into place. The recommendations from MIAA are 2 high, 3 medium and 2 low.


2.11

MT has concerns, although the CCG is starting to identify the gaps in QIPP delivery and actions to close them, the CCG needs to start holding responsible managers to account. There has been significant progress since Wendy Farrington-Chadd has been appointed. There is a role that the Lay Members can provide to support challenge and scrutiny. The CCG is considering the establishment of a Turnaround group which will be chaired by Wendy/Jon until Simon Banks the CCG’s new AO starts. This will also include Lay Members who will bring an independent perspective. Contracts with major providers were signed by the due date (23rd December 2016). This will enable more time and resource to be devoted to early implementation of the 2017/18 QIPP programme. The key areas to be agreed for action to strengthen future contract management arrangements are:

• All unsigned contracts for 2016/17 to be reviewed urgently, and proactively managed through the contract process. Senior review and sign off of control accounts

• All contracts not currently managed monthly will be reviewed and a comprehensive timetable developed to ensure that each contract is managed according to risk matrix

• CCG to review areas of responsibility and communicate clearly what is expected of the team in terms of ownership of tasks and ongoing structure to be developed

• To update all the current information recorded on contract database for all contracts

• Files to be stored consistently (going forward). An agreed folder has been developed and will be utilised for the new contracting round 2017/19.

There are a number of MIAA reviews in progress and at planning stages: • Primary Care Quality Scheme – work in progress • Better Care Fund- work in progress • Follow up- work in progress

MIAA produce an annual risk-based work plan which will be submitted at the April Audit Committee meeting. MIAA requested the involvement of CCG Lay Members and a draft version of the plan will be circulated via email for comments prior to the April meeting, where it will be considered for adoption. Copy of the final report following the recent External Quality Assessment of MIAA against the Public Sector Internal Audit Standards CIPFA has recently completed an assessment of MIAA’s compliance with Internal Audit Standards, which is done every 5 years. The full report was brought to the committee for members to note and gain assurance.


2.12

2.13

2.14

MIAA Insight Update Members noted the upcoming events and conferences provided free of charge for clients as part of MIAA’s services. Assurance Framework Bespoke Benchmarking report The MIAA annual Assurance Framework benchmarking report has been brought to the committee for members to note.

External Audit

Review External Audit report This report provides the Audit Committee with an understanding of the progress in delivering the responsibilities for Wirral CCG as External Auditors. The 2016/17 draft audit plan will be shared with members prior to it being brought to the April meeting, as this has already been shared with MT and JD. As the CCG has declared a forecast deficit for 2016/17, a letter will be sent to Secretary of State. Members noted that the letter for 2016/17 has been drafted and will be sent in the coming days.

AC16-17/4

ITEMS FOR INFORMATION

There were no further items for information.

AC16-17/4 ANY OTHER BUSINESS

3.1

Briefing update from chair AW advised members that the Auditor Panel met last on 28th November 2016 and a Grant Thornton representative was also in attendance. A discussion took place about how the group can work together in the future and it was suggested that there could be an Auditor Panel for the Cheshire and Merseyside area as a whole. It was noted that James Kay, Lay Member – Patient Champion, will be retiring at the end of January. Members noted their appreciation for the work that James Kay contributed whilst at Wirral CCG and especially as former Audit Committee chair. Congratulations were given to the contracts team with regards to the work undertaken to ensure that the contracts were signed by the new deadline


date of 23rd December 2016. Any other business A discussion took place regarding the timescales for papers to be discussed and amended for the Account sign off in May. It was agreed to keep the current dates in the diary as Audit Committee account sign off 18th May and GB account sign off is 23rd May. Members agreed to also keep free the morning of the 23rd May in case it was needed for an extraordinary Audit Committee, prior to the GB meeting being held in the afternoon.

AC16-17/4 DATE AND TIME OF NEXT MEETING

The next meeting will be held on: Thursday 20th April 2017 10am till 1pm room 539 Please forward apologies / agenda papers to [email protected]


GOVERNING BODY MEETING – A meeting in public€¦ · MT reported that the CCGs QIPP challenge...

Documents

Transcript of GOVERNING BODY MEETING – A meeting in public€¦ · MT reported that the CCGs QIPP challenge...