GOVERNING BODY MEETING – A meeting in public...v5.docx WUTH plan on a page SQ SH v5.docx GB...

Agenda – Wirral Governing Body Meeting PUBLIC SESSION – 2nd December 2014 of 3

GOVERNING BODY MEETING – A meeting in public

Tuesday 2nd December 2014 Nightingale Room, OMH

2pm

AGENDA

Ref No. No Time Item Papers GB14-15/0049 1. 2.00pm PRELIMINARY BUSINESS

(Acting Chair – Dr P Naylor)

1.1 Apologies for Absence 1.2 Chair’s Announcements

• Constitution Update

1.3 Declarations of Interest 1.4 Comments/questions from

members of the public

1.5 Minutes and Action Points of Last Meeting – held on 11th November 2014 (All)

• Action Points

DRAFT GB Minutes PUBLIC MEETING 11 11

DRAFT Action Points of WCCG -PUBLIC GB M

1.6 Matters Arising

1.7 Patient Story (Lorna Quigley)

GB 14-15/0050

2. ITEMS FOR APPROVAL 2.1 GB 14-15/0051

3. ITEMS FOR DISCUSSION 3.1 Interim Accountable Officer’s

Update (Jon Develing)

Verbal

3.2 Joint Working Proposal (Jon Develing)

Proposed arragments for Joint Working Cove

Joint position statement of Wirral co

3.3 Co Commissioning (Iain Stewart)

Co_commissioning update Dec14 cover sh

Co_commissioning update December 2014

3.4 Commissioning Intentions (Andrew Cooper)

Cover Sheet - 15-16 Commissioning Intentio

Commissioning Intentions - GB Paper N

CT plan on a page - Intentions and SDIP - 1

CWP plan on a page v5.docx

WUTH plan on a page SQ SH v5.docx

GB 14-15/0052

4. ITEMS FOR INFORMATION


Ref No. No Time Item Papers 4.1

4.2 4.3

Quality Performance and Finance- QPF (Lorna Quigley/Mark Bakewell) CHC Transition Programme (Lorna Quigley/Iain Stewart) Vision 2018 Update (Jon Develing)

Integrated Performance and Finan

Slides for GB 021214(2).pptx

Q1 and Q2 Quarterly template.pdf

CHC_Transition_Cover_Sheet_GBB_021214.

CHC Transition Dec14 GB.docx

Appendix 1 RATIFIED GB Minutes PUBLIC ME

Appendix 1 CHC_Provision_Oct14_

Appendix 2 CHC Dec14 GB.pdf

Appendix 2b CHC Stage 2 3 4 Governan

Board report cover sheet template Vision

Final Draft Vision 2018 Board Update 17

GB 14-15/0053

5. ITEMS FOR NOTING 5.1

Subgroups (Ratified Minutes):

• WACC Executive Board minutes of: 23.09.2014

• WGPCC Executive Board minutes of: 16.09.2014

WACC Executive Board Meeting PUBLIC

WGPCC Executive Board Minutes 16 09 1

GB 14-15/0054

6. RISK REGISTER Current Risk Register

Copy of Risk Register - December GB.xlsx

Risk 13-14E AP Nov 14.pdf

Risk 14-15B AP November 2014.pdf

Risk 14-15E AP Nov 14.pdf

Risk 14-15G AP November 2014.pdf

Risk 14-15I AP NOvember 2014.pdf

Risk 14-15J AP November 14.pdf

7. ANY OTHER BUSINESS


Ref No. No Time Item Papers 7.1 8. End DATE AND TIME OF NEXT MEETING

Tuesday 6th January 215 2pm – 4pm

Nightingale Room OMH Please forward any apologies to [email protected] ****Papers require by Friday 21st December 2014****

Wirral Clinical Commissioning Group – Future Meetings 2014

Day Date Time Venue Tuesday 6th January 2pm – 5pm Nightingale Room Tuesday 3rd February 2pm – 5pm Nightingale Room

mailto:[email protected]

Minutes of the WCCG –Governing Body Meeting – PUBLIC SESSION – 11th November 2014 Page 1 of 6

WIRRAL CLINICAL COMMISSIONING GROUP GOVERNING BODY BOARD MEETING

Minutes of Meeting – Public Session

Tuesday 11th November 2014 2pm

Nightingale Room, Old Market House Present: Jon Develing (JD) Interim Accountable Officer Dr P Naylor (PN) Acting Chair WCCG Mark Bakewell (MB) Chief Finance Officer Lorna Quigley (LQ) Head of Quality and Performance Dr M Green (MG) Consortium Chair

Dr H McKay (HM) GP Executive (WGPCC) Dr J Oates (JO) Consortium Chair Dr D Jones (DJ) GP Executive (WHCC) Andrew Cooper (AC) Consortium Chief Officer (WHCC) Paul Edwards (PE) Head of Corporate Affairs Dr S Wells (Swe) Acting Chair (WHCC) Graham Hodkinson (GH) Director of DASS Dr A Smethurst (AS) Secondary Care Doctor Simon Wagener (SW) Lay member (Patient champion) James Kay (JK) Lay Member (Audit & Governance) Fiona Jonhstone (FJ) Director of Public Health

In Attendance:

Allison Hayes (AJH) Executive Assistant Richard Williams (RW) Wirral LMC

Ref No. Minute GB14-15/0043

Preliminary Business 1.1 Apologies for absence Apologies were received from: Christine Campbell, Akhtar Ali and Iain Stewart.

1.2 Chairs Announcements Chair welcomed all members to the meeting. 5 members of the public attended the meeting. 1.3 Declarations of Interest All members declared an interest in the item regarding the proposed Constitution amendments, as the paper directly refers to the Governing Body and its members. (Item 2.1). 1.4 Comments/questions from members of the public A patient from Claughton Medical Centre raised concerns regarding ‘critical care data’ and the option for patients to opt out of providing information to other health organisations. He requested


Ref No. Minute that people are made aware of the benefits of the facility and asked why people are being asked to opt out. Members agreed that core clinical data is vital and that this should be shared across all health organisations but the Chair clarified that patients have the right to opt out of their information from being shared. SWe explained that the decision to opt out is not a one off decision and can be re-visited. 1.5 Patient Story LQ gave an overview of a patient’s story which highlighted Stroke Prevention. FJ commented about the information provided to patients to help them make informed decisions and the importance of listening to patients and reflecting on their requirements. SWe also highlighted the importance of prevention and the work streams that are dealing with this. JK commented on staff training for those who carry out health checks and the importance of not just carrying out processes but to listen. Members noted the contents of the patient story. 1.6 Minutes from previous meeting held on 7th October 014. The minutes of the previous meeting held on 7th October 2014 were agreed as a true and accurate record notwithstanding grammatical/typographical errors which will be rectified. There were no matters arising. Action Points – please refer to separate Action Sheet. 1.7 Matters Arising Procedures of low clinical priority Members were asked to carefully note the minutes of the last meeting in regard to Procedures of Local Clinical Priority which recorded the amendments to the policies. Members agreed that there were an accurate reflection of the decisions.

GB14-15/0044

2.0 Items for approval 2.1 Proposed amendments to NHS Wirral CCG’s Constitution PE gave a presentation to the Governing Body regarding the proposed amendments to NHS Wirral CCGs constitution. A number of the recommendations of the Capability and Governance Review directly related to the CCG’s constitution and a significant degree of change was required to that document to address the concerns highlighted by the Review. An overview of these proposed changes were presented to the Governing Body in October 2014 and were supported by members. A number of key drivers had shaped these proposed amendments, including:

• Dedicated member engagement events


Ref No. Minute • GP fora • Patient groups • Stakeholder views • Patient and public engagement • LMC survey, were the majority of respondents were supportive of the changes • Legal opinion

It was recognised that there were varied views from practices and that the proposals represent a best fit to accommodate those reviews. A letter had been sent to practices to seek their intentions in regard to supporting the proposed amendments. Results from member practices on amended constitution were:

– Over 70% response rate – Over 75% of respondents in favour – 82% in favour from all practices, where non-response was indicated as a yes vote

in line with the letter sent to practices – 2 practices who have not initially supported proposals have indicated they would

support if that was majority view, which would mean 86% in favour

Some points of clarity had been raised by Governing Body Members regarding:

– Accountability arrangements of Accountable Officer to Chair – Standardisation/clarity on Terms of Reference wording – Election arrangements – Clarity on Scheme of Reservation and Delegation

PE addressed these issues and stated that these minor points of clarity could be addressed in the submission. He stated that the election arrangements would be developed and implemented with the LMC and all processes published in a clear and transparent manner. In addition, issues were noted from practices in the areas of:

• Membership Council • Local arrangements • Concerns raised by WGPCC GP Forum

With regard to the Membership Council, PE pointed out that this is something that would be co-designed with Member Practices in the near future and local engagement arrangements were also something that would be developed with practice and patients. PE also addressed the concerns raised by WPGCC GP Forum, which focussed on the GP membership of the Governing Body and the proposed model. PE explained that the amendments were a result of the specific recommendations of the review and the varied views of practices and should therefore be recognised as a ‘best fit’ that has developed significantly in response to those views. These developments have included increased elected clinical posts, an additional registered nurse role and an additional lay member. PE summarised the next steps in terms of completing the required impact assessment and informed members that the proposed amendments, together with the impact assessment, would now be submitted to NHS England for approval. JD highlighted that he genuinely believes that the proposed structure and amendments provide the best possible opportunity to move forward and focus on the most important things in relation to the Wirral economy.


Ref No. Minute JD thanked the LMC for their support and cooperation with regards to the proposed amendments and went on to thank all members of the Governing Body for their contributions. DJ positively commented on the pre consultation process and the impact it has had in developing the proposed amendments. RW sought clarity around those practices who have not agreed to the proposed amendments and how the CCG are going to approach and support these practices. Chair clarified that there is an on-going offer to visit practices to discuss the constitution. PE stated that the CCG would wish to engage with all practices moving forward. PE informed that the constitution will continue to be refined over time and should not be seen as ‘set in stone’. He stated that, as an example, the CCG would need to amend the constitution again in the New Year should it wish to undertake co-commissioning. JK welcomed the proposed amendments and thanked members for their input and support; however, he highlighted the need to ensure that the election processes were clear and explicit. PE clarified for members that the voting and election process will be jointly agreed with LMC and published ahead of an election being undertaken. SW asked how GP practices will engage with their patients in any voting processes. Governing Body members stated that this would be at the discretion of member practices JO informed members of views from some of the constituent practices of WGPCC. These included: further information on geographical localities, voting rights, election and appointment processes and the clarification as to whether the constitution is a new one or amended one. PE clarified that the changes to the constitution were considered amendments and not a new constitution (the CCG already has a constitution) and that the development of a localised approach is something that the CCG has already stated it would be working with practices to develop. He reiterated that the constitution represented a ‘best fit’ of views and pointed out that there was a mixture of opinions on whether the GP posts should be elected or appointed and hence the resulting balance that has been proposed. JO went on to state that he supports the proposed amendments personally, but did wish to raise those concerns as Chair of WGPCC. FJ commented on how she welcomed the proposed amendments and how transparent and honest the debate had been and how the amendments provide a strong platform to work alongside Local Authority colleagues. MG highlighted that those members of the WACC welcomed the proposed changes and looked forward to working with the new structure. He went on to thank members for their work and the support of his CCG colleagues. The Governing Body then voted for the proposed constitution amendments. There were no votes against or abstentions. All members voted in favour of the proposed amendments. PE will now submit the proposed amendments to NHS England and will communicate the outcome to GP colleagues, staff members and the wider Wirral community. Chair thanked Paul Edwards for his contribution and input to the proposed amendments.

GB14-15/0045

3.0 Items for Discussion There were no items of discussion.

GB14-15/0046

4.0 Items for Information 4.1 Quality Performance and Finance Report


Ref No. Minute Quality Performance LQ gave a presentation on the activity performance for month 5 (August) and highlighted the positive areas and the areas of improvement. Areas included:

• Family and friends tests and response scores in relation to Maternity services and minor casualties and how future response scores can be improved in the future

• NWAS turnaround • Delivering the same sex accommodation • Diagnostic test • MRSA & Cdifficile • Referral to treatment – NHS Constitution 4 hour target • Health Care Associated Infection

JD highlighted the importance on the Urgent Care strategy and whole system involvement and he paid testament to those staff who have engaged in this to improve performance. He went on to formally recognise the work being undertaken to improve performance in relation to the Bewick review. The Governing Body noted the contents of the Quality and Performance Report. Finance Report MB provided information of the Financial performance against budgeted allocation for 2014/15 as at month 6 (September).

• 1% Surplus - £4.68m • 2.5% Headroom (non-recurrent resources) - £11.4m • Minimum 0.5% Contingency

CCG hold £3m vs £2.2m (0.5%)

• Better Payment Practice Code • Cash Management

Year to Date (Month 6) Financial Performance Planned Year to Date Surplus - (£2.34m) Current Year to Date Surplus - (£1.90m Key Issues

• WUTH Contract Position – (£2.4m) under @ M5 vs [(£1.7m) @ M4 (£1.05m) @ M3]

• Other NHS Providers – Notably Royal Liverpool and Broadgreen (£0.36m) over • Commissioned Out of Hospital - £0.664m (CHC / Package costs) • Prescribing £0.1m over performance (in month improvement £0.07m) • QIPP Gap 6/12 - £3.4m (of £6.7m)

Forecast Outturn 2014/15

• Forecast Assumptions • Planned Forecast Surplus - £4.68m (1%) – remains deliverable but with risks as outlined. • YTD position reflect challenges of forecast delivery (but slight favourable movement in


Ref No. Minute month position of £0.3m)

• Risk remain consistent with plan around main expenditure areas • WUTH (variation away from outturn as per QIPP assumptions) • Prescribing • Commissioned Out of Hospital Care • QIPP Gap

Risks

• Mitigation action plan is being developed and reviewed to close the £3m gap, NHSE require regular feedback on implementation of action plans.

• WUTH – Contract issues/ Performance/ QIPP initiatives/ Referrals/ Trends • CHC – Reduce forecast position (CSU Action plan/ package review) • Specialist Care – Review of brain rehabilitation patients packages, pathway rules for out

of areas • Prescribing – work with Medicines Management more pricing/ wastage efficiencies (QIPP

projects/ impact on incentive schemes) • Non- Wirral Acute pressures – elective care review

AS sought clarity regarding the £3m mitigation plan and whether this will be discussed at the next Governing Body and MB clarified this for members. The Governing Body noted the financial report as at month 6 (September).

GB14-15/0047

5.0 Items for Noting 5.1 Subgroups (ratified minutes for noting)

• WHCC of 16.07.2014 - noted • QPF of 30.09.2014 – noted

AS sought a point of clarification regarding the percentage of patients waiting more that 18 weeks for treatment as reported in the QPF minutes of 30th September and LQ and JD clarified this for members. The Governing Body noted the reports of the above subgroups.

GB14-15/0048

6.0 Risk Register PE gave an overview of the current risk register and all items were reviewed and noted today.

7.0 Any other Business There were no other items of business. Chair thanked members for their attendance. The Board meeting ended at 16:00pm.

8.0 Date and Time of Next Meeting The date and time of the next meeting is Tuesday 2nd December 2014 in the Nightingale Room, OMH please contact [email protected] with any apologies or agenda items.

Board meeting ended at: 16:00pm


Draft Action Points – Wirral Clinical Commissioning Group, Governing Body Meeting - PUBLIC SESSION – 02.12.2014 1/1

Wirral Clinical Commissioning Group

Governing Body

Draft Action Points re Meeting of 11th November 2014 (Public Session)

Duncan Room, OMH 2pm

Outstanding Actions from: 7th October 2014

Topics Discussed Minute Action Points Responsibility Action Target date

Continuing Health Care 4.4 • IS to bring back a fuller more detailed report to December Governing Body • IS • 11.11.2014 New Actions from: 11th October 2014

Topics Discussed Minute Action Points Responsibility Action Target date

Minutes and Action Points of the last meeting

• AJH/PE to rectify grammatical errors • AJH • 11.11.2014

• • •

Agenda Items for next meeting / Decisions to note for next meeting / Date & time of next meeting

The date of the next meeting is Tuesday 2nd December 2014 at OMH, Duncan Room. Agenda items and apologies are to be sent to: [email protected]


WCCG Governing Body Meeting 05.11.2013 1/3

Proposal for a Joint Commissioning Approach with Wirral Borough Council

Agenda Item: 3.2 Reference: GB14-15/0051

Report to: Governing Body

Meeting Date:

Lead Officer: Jon Develing, Interim Accountable Officer

Contributors:

Governance: Link to Commissioning Strategy

To be a high performance, high reputation organisation with ambition. To reduce waste and inefficiency and duplication within the patient journey and between partners.

Link to current governing body Objectives

Summary: Over the last few months, colleagues from both Wirral CCG and Wirral Borough Council have been holding informal discussions to explore how they can work more effectively together, specifically in the areas of joint commissioning and commissioning support arrangements.

These discussions have been held in the context of organisational and financial challenges for both organisations, along with responding to the implications of:

• National drivers, namely the Better Care Fund requirements, the Care Act and the Children and Families Act.

• Local drivers, namely the Vision 2018 programme established to provide a health and social care sector response to the significant system wide pressures in Wirral.

The ambition of the two organisations is to collaborate, building on the positive work to date to proactively integrate, share and align resources where is makes sense to do so.

Recommendation: To Approve

To Note X

Comments

Next Steps: Continue working with Wirral Borough Council to develop the colloaborative approach


This section is an assessment of the impact of the proposal/item. As such, it identifies the significant risks, issues and exceptions against the identified areas. Each area must contain sufficient (written in full sentences) but succinct information to allow the Board to make informed decisions. It should also make reference to the impact on the proposal/item if the Board rejects the recommended decision. What are the implications for the following (please state if not applicable): Financial

Integration and closer joint working may lead to reduced duplication in commissioned services. There is also the potential to futher explore pooled budgets

Value For Money Joint apppointments and closer alignment may lead to efficiencies for both organisations

Risk Any joint arrangements will need to be underpinned by robust governance arrangements that may include risk sharing agreements

Legal Joint appointments and the formation of management agreements will require reference in the CCG’s Constiution

Workforce Potenetial joint posts will require clear employment arrangements that are compliant with both organisations’ policies

Equality & Human Rights

Closer working arrangements will require a common approach to equality in specifications and commissioned services

Patient and Public Involvement (PPI)

The need for patient and public engagement has not been assessed at this stage

Partnership Working

This proposal is centred on improving partnership working arrangements

Performance Indicators

N/A

Do you agree that this document can be published on the website? (If not, please note that it may still be subject to disclosure under Freedom of Information - Freedom of Information Exemptions

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 ie. other papers that are directly related to the current paper under discussion.

Report History/Development Path

Report Name Reference Submitted to Date Brief Summary of Outcome

http://www.foi.gov.uk/yourRights/exemptions.htm


Private Business The Board may exclude the public from a meeting whenever publicity (on the item under discussion) would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution. If this applied, items must be submitted to the private business section of the Board (Section 1 (2) Public Bodies (Admission to Meetings) Act 1960). The definition of “prejudicial” is where the information is of a type the publication of which may be inappropriate or damaging to an identifiable person or organisation or otherwise contrary to the public interest or which relates to the provision of legal advice (for example clinical care information or employment details of an identifiable individual or commercially confidential information relating to a private sector organisation). If a report is deemed to be for private business, please note that the tick in the box, indicating whether it can be published on the website, must be changed to a x. If you require any additional information please contact the Lead Director/Officer.

Joint position statement of Wirral council (Families and Wellbeing Directorate) and Wirral CCG clarifying our collective ambition, intended actions and milestones.

Introduction

Over the last few months colleagues from both organisations have been holding informal discussions to explore how the above organisations can work more effectively together, specifically in the areas of joint commissioning and commissioning support arrangements.

These discussions have been held in the context of organisational and financial challenges for both organisations along with responding to the implications of:

• National drivers, namely the Better Care Fund requirements, the Care Act and the Children and Families Act.

• Local drivers, namely the Vision 2018 programme established to provide a health and social care sector response to the significant system wide pressures in Wirral and the £150m reduction in collective resources by 2018.

At the first joint team to team meeting on 26th September 2014 it was agreed that the starting point for the development of a collaborative agenda spanning a range of opportunities was the creation of this paper which could be shared with both organisational Boards (in case of the Council – officer and political).

Ambition

The ambition of the two organisations is to collaborate, building on the positive work to date to proactively integrate, share and align resources where is makes sense to do so. We recognise that a pragmatic approach is necessary and to note that it may not be appropriate to bring together all the elements of activity for a variety of reasons.

In order to develop and take forward out ambition we have set out a number of guiding principles which we all own and will be informed by:

• We will always use the approach set out above to consider opportunities for changing the way we do things e.g. where we have vacancies we will look at the opportunity to develop joint roles, we will develop lead roles to represent both organisations on specific subject matter, we will co locate where it makes sense to do so.

• We will agree a common narrative understood by all – and we will use it. • We will always clarify the risks associated with any integrated, shared and aligned

activity and be open and clear about how that will be managed. • We will ensure that we have transparent and robust governance arrangement with

clear reporting lines into our respective governing bodies.

Actions to deliver this ambition

We have identified that there will be a range of actions we will can engage in and take forward. These will fall into short (as in the next 3 months), medium (as in the next 12 months) and longer term (12 months to 2 years) activity. We need to clarify this plan and

ensure our proposals are agreed by our respective Boards. So far we have identified the following:

Short Term (by the end of December)

• We have identified opportunities where we can co-locate staff within the same building to improve the working arrangements and sharing of information and expertise.

• Explore the opportunity of creating joint senior commissioning posts • We are keen to use the existing opportunity to review current structures particularly in

relation to joint commissioning and commissioning support arrangements. • We want to map our current separate delivery arrangements around key service

areas to understand where those synergies are and develop alternate delivery proposals.

• We will meet regularly as a joint team and have agreed that will be on a fortnightly basis.

• We want to have an agreed view on the current provider landscape • We want to strengthen the workings of the Joint Commissioning Group and ensure it

reflects our joint approach with an agreed Joint Commissioning Strategy

Medium Term Intent (By October 2015) We will put appropriate management arrangements, providing assurances to respective organisations, in place to support:

• an integrated commissioning function with joint roles within the structure. • a joint commissioning support function that maximises the opportunity for health

intelligence and strategic planning. Develop further integrated/joint teams (as appropriate) We will further explore the pooled budget and would anticipate that a greater resource than that presently would be developed in support of our joint commissioning priorities. The actual activity and value has yet to be determined

Long Term Intent (By October 2016)

• We will have met our stated ambition, will have reviewed our progress and set out our ambitions for the next 3 years.

• We will have a pooled budget and will be commissioning a significant amount of health and social care activity through an integrated commissioning unit.

Clare Fish, Strategic Director for Families and Wellbeing

Jon Develing, Interim Accountable Officer Wirral CCG

Wirral CCG Governing Body 02.12.2014 1/4

Primary Care Co-commissioning update


Report to: Governing Body Meeting Date:

Lead Officer: Iain Stewart, Head of Direct Commissioning

Contributors:


Delivering high quality planned care; Adult Mental Health services; Management of long-term conditions and chronic disease management


Enhance the quality of life for people with long-term conditions; Helping people to recover from episodes of ill health or following injury; Ensuring people have a positive experience of care; Prevent people from dying prematurely; Ensuring people are treated and cared for in safe environment and protected from avoidable harm.

Summary: Primary Care co-commissioning is one of a series of changes set out in the NHS Five Year Forward View and is seen as a key enabler in developing seamless, integrated out-of-hospital services based around the diverse needs of local populations. It will drive the development of new models of care such as multi-speciality community providers and primary and acute care systems. There are 3 primary care co-commissioning models that CCGs could take forward:

a) Greater involvement in primary care decision-making

b) Joint commissioning arrangements c) Delegated commissioning arrangements

Governance arrangements for the respective models: Joint commissioning - formation of a joint committee or “committees in common” with their Area team in order to jointly commission primary medical services Delegated commissioning - NHS England have developed a model governance framework for delegated commissioning arrangements.


Support and resources for co-commissioning Primary care commissioning by area teams is currently delivered across a large geography spanning several CCGs and guidance states there is no possibility of additional administrative resources being deployed on these services at this time due to running cost constraints.

CCGs and area teams are encouraged to seek pragmatic and flexible local solutions to support arrangements for 2015/16. Conflicts of interest management A national framework for conflicts of interest management in primary care co-commissioning is being developed in partnership with NHS Clinical Commissioners and with formal engagement of Monitor and HealthWatch England. Approvals and implementation process The approvals process for co-commissioning arrangements will be as straightforward as possible due to the robust authorisation process CCGs previously underwent in their establishment as statutory bodies. Proposals for joint and delegated commissioning arrangements will require an amendment to a CCG’s constitution, which must be submitted by 9th January 2015.

Submission deadlines for co-commissioning applications are as follows;

Joint commissioning – 30th January 2015 Delegated commissioning – 9th January 2015


To Note √

Comments

Next Steps: The CCG to commence a comprehensive engagement process with member practices, in conjunction with Wirral Local Medical Committee, to consider the range of options and implications that co-commissioning will present to primary care on Wirral.



Co-commissioning will give the CCG the option of having more control of the wider NHS budget, enabling a shift in investment from acute to primary and community services. Historic variations in primary care funding across England and localities requires a move towards a fair distribution of resources for primary care based on the needs of diverse populations.

Value For Money Co-commissioning offers the opportunity to develop more affordable services through efficiencies gained.

Risk The following risk areas will require the appropriate mitigation; disinterest of member practices in co-commissioning; inadequate management of conflicts of interest matters; consequences of addressing funding variations; and increased workload on CCG staff.

Legal Technical advice will be provided by NHS England on the legalities of joint and delegated arrangements.

Workforce As there is no additional staff resources available from NHS England to support the extra responsibilities of taking on co-commissioning, the CCG will need to identify a flexible and local solution in conjunction with the local area team.


Any change to commissioned services must be undertaken in consideration of not impairing/worsening patients’ rights. The considerations and recommendations in this document are designed to continue the securing of healthcare services that meet the current health needs of the Wirral population, based upon agreed evidenced CCG objectives and supported by data from the Joint Strategic Needs Assessment (JSNA).


Co-commissioning could lead to benefits for the public and patients including improved access to primary care and wider out-of-hospital services, with more services available closer to home; improved health outcomes, equity of access and reduced inequalities and a better patient experience through more joined up services. Open and transparent engagement with public and patients in the consideration of co-commissioning, will be an important key component of the overall CCG approach with member practices.

Partnership Working

The CCG and its member practices, in conjunction with Wirral Local Medical Committee, will form the pivotal partnership in progressing co-commissioning. Joint commissioning will require the formation of a joint committee or “committees in common” between other CCGs and NHS England. Delegated commissioning will require the formation of a primary care commissioning committee.


Not applicable to this document.


Yes



Prepared by Iain Stewart, Head of Direct Commissioning

NHS Wirral CCG

Co-commissioning update Introduction

1. Primary Care co-commissioning is one of a series of changes set out in the NHS Five Year Forward View and is seen as a key enabler in developing seamless, integrated out-of-hospital services based around the diverse needs of local populations. It will drive the development of new models of care such as multispeciality community providers and primary and acute care systems.

2. There are 3 primary care co-commissioning models that CCGs could take forward:

a) Greater involvement in primary care decision-making

o Invitation to collaborate more closely with the Area team to ensure decisions taken about primary care services are strategically aligned across the local health economy

b) Joint commissioning arrangements o Enables one or more CCGs to assume responsibility for jointly

commissioning primary medical services with their Area team, either through a joint committee or “committees in common”

c) Delegated commissioning arrangements o CCG to assume full responsibility for commissioning general

practice services – legally, NHS England retain the residual liability for the performance of primary medical care commissioning and therefore will require robust assurance that its own statutory functions are being discharged effectively by the CCG.

The scope for primary care co-commissioning in 2015/16 is general practice services only.

3. Governance arrangements for the respective models are as follows;

a. Greater involvement in primary care decision-making – no new governance arrangements would be required and this type of involvement could be agreed between the CCG and its Area team at any time. The effectiveness of this arrangement is reliant upon strong local relationships and approaches to collaborative working. This model is unlikely to encounter an increase in conflicts of interest as the CCG would not have formal accountability for decision-making.

b. Joint commissioning arrangements – formation of a joint committee or “committees in common” with their Area team in order to jointly commission primary medical services. Due to the passing of a Legislative Reform Order by parliament, CCGs can now form a joint committee with one or more CCGs and NHS England. The joint committee structure allows a more efficient and effective way of working together than a committees-in-common approach therefore is


the recommended governance structure for joint commissioning arrangements. Individual CCGs and NHS England always remain accountable for meeting their own statutory duties, i.e. quality, financial resources, equality, health inequalities and public participation, meaning NHS England retains accountability for the discharge of its statutory duties in relation to primary care commissioning.

c. Delegated commissioning arrangements – NHS England have

developed a model governance framework for delegated commissioning arrangements. The recommendation is that CCGs establish a primary care commissioning committee to oversee the exercise of the delegated functions. CCGs will remain

4. Committee membership arrangements;

- Joint commissioning arrangements model – joint

committees should be agreed between the Area team and CCG and in the interests of transparency and mitigation of conflicts of interest, a local Healthwatch representative and Local Authority representative from the Health & Wellbeing Board will have the right to join the joint committee as non-voting attendees. CCG should ensure that membership of the committee enables appropriate contribution from a range of stakeholders and it will be important to retain clinical leadership of commissioning in the joint committee.

- Delegated commissioning arrangements model – CCG to agree the full membership of the primary care commissioning committee – must be chaired by a lay member and have a lay and executive majority plus in the interests of transparency and mitigation of conflicts of interest, a local Healthwatch representative and Local Authority representative from the Health & Wellbeing Board will have the right to join the delegated committee as non-voting attendees. CCG should ensure that membership of the committee enables appropriate contribution from a range of stakeholders and it will be important to retain clinical leadership of commissioning in the delegated committee.

5. Support and resources for co-commissioning

It is recognised that implementing primary care co-commissioning and ensuring CCGs can access the necessary resources, needs to be managed in a way that both supports those CCGs wanting to take on co-commissioning responsibilities and allow area teams to continue to safely and effectively deliver their remaining responsibilities.


Primary care commissioning by area teams is currently delivered across a large geography spanning several CCGs and guidance states there is no possibility of additional administrative resources being deployed on these services at this time due to running cost constraints. CCGs and area teams are encouraged to seek pragmatic and flexible local solutions to support arrangements for 2015/16, ensuring that;

- CCGs taking on delegated commissioning responsibilities have access to a fair share of the area teams’ primary care commissioning staff resources and;

- Area teams retain a fair share of existing resources to deliver all their ongoing primary care responsibilities

6. Conflicts of interest management

Conflicts of interest, perceived or actual, need to be managed carefully within co-commissioning. It is a matter of public interest and in the interest of the primary care profession that this issue is robustly and transparently handled. CCGs already manage conflicts of interest as part of the day-to-day work, however, without a strengthened approach, co-commissioning could significantly increase the frequency and range of potential conflicts of interest, especially for delegated commissioning arrangements. Section 14O of the NHS Act 2006 (as amended by the Health and Social Care Act 2012) sets out minimum requirements for managing conflicts of interest, including;

- NHS England provide guidance to CCGs on the discharge of their duties

- CCGs must; • maintain appropriate registers of interests • publish or make arrangements for the public to access

those registers • make arrangements requiring prompt declaration of

interests by the persons specified and ensure the interests are entered into the relevant register

• make arrangements for managing conflicts of interest and potential conflicts and have regard to guidance published by NHS England in relation to conflicts of interest

A national framework for conflicts of interest management in primary care co-commissioning is being developed in partnership with NHS Clinical Commissioners and with formal engagement of Monitor and HealthWatch England. The guidance will be published in December 2014 as statutory guidance in accordance with section 14Z8 of the NHS Act 2006 (as amended by the Health and Social Care Act 2012). The guidance will be specifically aimed at CCGs


exercising delegated authority but all CCGs will be required to have regard to the principles set out in the guidance. Each CCGs’ Audit Committee Chair and Accountable Officer will be required to provide direct formal attestation that the CCG has complied with conflict of interest guidance.

7. Approvals and implementation process The approvals process for co-commissioning arrangements will be as straightforward as possible due to the robust authorisation process CCGs previously underwent in their establishment as statutory bodies. The process will be governed by the following principles;

- Conducted openly and transparently and contain no surprises

- Minimise the administrative demands placed on CCGs and area teams

- On-going assurance of co-commissioning arrangements will form part of the CCG assurance process

Unless a CCG has serious governance issues or is in a state akin to “special measures”, NHS England will support CCGs to move towards implementing co-commissioning arrangements. CCGs must be able to demonstrate appropriate levels of sound financial control and meet all statutory and business planning requirements to progress delegated arrangements. As membership organisations, CCGs should fully engage with their members when considering co-commissioning options. It would also benefit CCGs and local stakeholders such as patients, local authorities, Health and Wellbeing boards and local HealthWatch, to have an open and inclusive conversation about options and possible arrangements. Proposals for joint and delegated commissioning arrangements will require an amendment to a CCG’s constitution, which must be submitted by 9th January 2015. Submission deadlines for co-commissioning applications are as follows;

- Joint commissioning – 30th January 2015 - Delegated commissioning – 9th January 2015

8. Next steps The CCG to commence a comprehensive engagement process with member practices, in conjunction with Wirral Local Medical Committee, to consider the range of options and implications that co-commissioning will present to primary care on Wirral.


9. Recommendation The Governing Body is asked to note the update on primary care co-commissioning and support the proposed next step as detailed in item 8.

2015/16

Commissioning Intentions


Report to: Governing Body Meeting Date: 2nd December 2014

Lead Officer: Lesley Doherty

Contributors: Andrew Cooper Christine Campbell


The high level commissioning intentions, service developments and improvements outlined in this document for the 3 main CCG contracts detail the contractual amendments required to support the delivery of the CCG commissioning strategy

Link to current strategic objectives

1 Prevent people from dying prematurely 2 Enhance the quality of life for people with long term conditions 3 Helping people to recover from episodes of ill health or following injury 4 Ensuring people have a positive experience of care 5 Ensuring people are treated and cared for in a safe environment and protected from avoidable harm

Summary: The paper provides the high level commissioning intentions, service developments and improvements proposed by Wirral CCG for each of the 3 main CCG contracts, those being the contracts with Wirral University Teaching Hospital, Wirral Community Trust and Cheshire & Wirral Partnership respectively. The detail is presented in a ‘plan-on-a-page’ format which will form the basis of negotiations for the 2015/16 contracting round. Negotiations this year will focus on the delivery of transformational change through lead programme areas of the Wirral Vision 2018 programme, i.e. planned care, urgent care and long term conditions.


To Note X

Comments

Next Steps:

The commencement of contract negotiations based on the principles outlined in the plan on a page documents.

This section is an assessment of the impact of the proposal/item. As such, it identifies the significant risks, issues and exceptions against the identified areas. Each area must contain sufficient (written in full sentences) but succinct information to allow the Board to make informed decisions. It should also make reference to the impact on the proposal/item if the Board rejects the recommended decision. What are the implications for the following (please state if not applicable):

Financial

The signing of the contracts allows for planning for the forthcoming year for both providers and the CCG.

Value For Money

By developing a robust process for the contracting process based on transformation, activity and patient flow will demonstrate value for money

Risk Not agreeing the approach earlier in the contracting process will potentially cause delay in the signing of the contract which will put the CCG at financial risk.

Legal If the contract is not signed through negotiation and mutual agreement then there are legal consequences and a process of arbitration would need to be undertaken

Workforce CCG staff are actively involved in the process of contract negotiation. Agreeing a contract within appropriate timescales also enables providers to plan for their required workforce.


Equality Impact Assessments will be undertaken for all proposed changes to service provision.


Enganment with the patient and public has been undertaken as part of the vision 2018 programme and consortia patient groups. Further engagement will be undertaked as necessary in relation to any individual service changes proposed.

Partnership Working

The approach that is being adopted enhances partnership working across the health economy with care providers


As part of transformation, performance indicators and KPI’s will be developed. There will be no negative impact on the NHS constitutional standards


NO Currently

commercial in

confidence





Private Business The Board may exclude the public from a meeting whenever publicity (on the item under discussion) would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution. If this applied, items must be submitted to the private business section of the Board (Section 1 (2) Public Bodies (Admission to Meetings) Act 1960). The definition of “prejudicial” is where the information is of a type the publication of which may be inappropriate or damaging to an identifiable person or organisation or otherwise contrary to the public interest or which relates to the provision of legal advice (for example clinical care information or employment details of an identifiable individual or commercially confidential information relating to a private sector organisation). If a report is deemed to be for private business, please note that the tick in the box, indicating whether it can be published on the website, must be changed to a x. If you require any additional information please contact the Lead Officer.

Commissioning Intentions, Service Developments and Improvement Plans

2015/16 Contract Round Introduction

1. In order to ensure Wirral CCG commissions services that continually develop to meet the current and future requirements of the population, an annual process of identifying commissioning intentions and areas of service development and improvement is undertaken.

2. This process informs the contract negotiations undertaken with the service

providers during the final quarter of the year to develop the service contract for the following year.

Progress to date

3. The CCG Operational Group commenced the process with a ‘time-out’ session to collate information identified from work currently underway within the CCG that had implications for the 2015/16 contract round.

4. In addition, the outputs from the Vision 2018 programme areas were also reviewed and collated to inform the process.

5. The proposed areas of focus for commissioning intentions and service developments were reviewed against the broader strategic focus of the Vision 2018 programme and the Wirral CCG Strategic Plan to ensure that any proposed intentions and developments supported strategic delivery.

6. It was agreed that contract negotiations for the 2015/16 contract year would focus on the delivery of transformational change through the lead programme areas of the Wirral Vision 2018 programme, namely Planned Care, Unplanned Care and Long-term Conditions / Complex needs.

7. The contract leads for the three largest CCG contracts (namely those contracts with Wirral University Teaching Hospital, Wirral Community Trust and Cheshire and Wirral Partnership Trust) worked with the CCG Contract Group to develop a ‘Plan-on-a-Page’ for each of the three contracts. These documents are included in Appendix 1.

8. The ‘Plan-on-a-Page’ documents were shared with the CCG GP Member practices for information and comment.

9. A letter detailing the proposed high level commissioning intentions, service developments and improvements was developed from the ‘Plan-on-a-Page’ documents and sent to each of the three providers with the intention of

providing an early indication of the CCG’s plans in order to facilitate discussions during the forthcoming contract negotiation meetings.

10. A further letter detailing the contracting principles and transactional contracting issues relating to the 2015/16 contract negotiations has also been sent to the providers.

Recommendations

11. The Wirral CCG Governing Body is asked to note the content of the ‘Plan-on-a-Page’ documents for the three main CCG contracts.

Andrew Cooper Head of Strategic Planning and Outcomes (Designate) NHS Wirral CCG

Unplanned Care

Planned Care

Long-term Conditions and Complex Needs

Review cardiology pathways and consider a cost-per-case tariff for cardiology services provided by Wirral Community Trust Heart Centre

Re-commissioning of the GPOOH service

DEVELOPMENT AND IMPLEMENTATION OF AN UNPLANNED CARE STRATEGY FOR WIRRAL –with the following anticipated commissioning

intentions for Wirral Community Trust:

Full delivery of Integrated Care Coordination Teams

RIGHT CARE, RIGHT PLACE, RIG

HT TIME

Aim Wirral Community Trust – DRAFT 2015/16 Commissioning Intentions Outcomes

Measurable outcomes Primary Vision 2018 Outcome

• Increased ICCT caseload numbers • Reduction in unplanned admissions to

hospital • Increased provision of care in the most

appropriate setting

• Reduction in unnecessary hospital emergency activity

• Provision of an efficient GPOOH service that supports delivery of the unplanned care strategy for Wirral

• Reduction in unnecessary A&E attendances and subsequent admissions

• Increased provision of care in the most appropriate setting

• Increased community provision of appropriate cardiology procedures – funding follows patient

1

4

1

3

1

4

2

4

3

3

Integrated service provision to support initiatives such as Early Supported Discharge, Discharge to Assess, Community IV Therapy etc.

8

1 8

Unplanned Care

Planned Care


Estate

Community provision of percutaneous tibial nerve stimulation (PTNS) for overactive bladder syndrome

Community provision of Botox follow up for overactive bladder syndrome

Transfer of GP Out-of-Hours (GPOOH) call handling function to NHS 111 provider

Single urgent care front door on the Arrowe Park site

Implementation of revised Integrated Care Service Specification for 2015/2016

Implementation of revised service specification for Specialist Palliative Care service

Discontinue transitional arrangements relating to legacy PCT estate

RIGHT CARE, RIGHT PLACE, RIGHT TIME

Aim Wirral Community Trust – 2015 / 16 Service Developments and Improvements Outcomes


• Redirection of resource to provision of patient services

• Increased ICCT caseload numbers • Reduction in unplanned admissions to

hospital • Increased provision of care in the most

appropriate setting

• Improved communication between

• Provision of an efficient GPOOH service that supports delivery of the unplanned care strategy for Wirral

• Reduction in unnecessary A&E attendances and subsequent admissions


• Increased utilisation of NHS 111 service

• Provision of a fully integrated Single Point of Access that is able to redirect individuals to the most appropriate setting

• Provision of high quality DVT services delivered in the most appropriate setting

• Increased community provision of appropriate continence procedures – funding follows patient

• Increased community provision of appropriate continence procedures – funding follows patient

•

1

1

11

1

6

1

3

13

1

4

4

1

14

2

11

3

6

11

10

1

11

Implement findings of Parkinson’s Service review

Provide timely updates relating to status of service provision for all services in order to maintain the NHS 111 Directory of Services

Review and implement revised pathways for Single Point of Access

Implement findings of DVT service review

7 3

Implement the agreed requirements of the Crisis Care Concordat 3 8

Wirral Vision 2018 – Agreed Programme Outcomes

1 We deliver the right care in the right place at the right time. First time & every time.

2 We deliver an improved health & wellbeing experience to all patients, service users and carers, in all health, community and social care settings

3 We reduce the frequency and necessity for emergency admissions and for care in hospital, residential and nursing home settings

4 We enable more people to access appropriate and effective services closer to home

5 We improve health & social care outcomes in early years to improve school readiness

6 We enable more people to live independently at home for longer

7 We improve the health and social care related quality of life for people with more than one long term condition, physiological and/or psychological

8 We increase collaboration and effective joint working between health and social care partners

9 We improve the satisfaction levels for our workforce colleagues across all health, community and social care settings

10 We improve the end of life experience for individuals and their carers.

11 We are better able to prevent ill health and diagnose conditions quickly thereby reducing the burden on treatment facilities

12 We enable people to live longer, healthier lives

13 We reduce the cost of health & social care while maintaining balance of quality and value

14 We ensure equal and fair access to clinically appropriate services for everyone on the Wirral

15 We will reduce health inequalities so that all Wirral’s residents can expect and receive the same health & wellbeing opportunities

Continue review of learning disabilities services, seeking to move towards a joint commissioning arrangement with the Local Authority, to ensure quality of service

provision and value for money

Review of CAMHS services in collaboration with the Local Authority with a view to commissioning a more integrated and comprehensive service offer

Prime provider model for primary care mental health

Programme CWP DRAFT 2015/16 Commissioning Intentions Outcomes

Right care, right place, right time

Long term conditions and complex needs

Unplanned care

Parity of esteem

Outcom

es-based payments

Recovery-focussed Transition-planning

3

1

5 8

7 1

Primary Vision 2018 Outcome

Reduced inpatient bed days for people with a learning disability

Increased prevalence of all ages entering IAPT programme, and waiting times:

>75% treated in 6 weeks; >95% in 18

Reduced CCG spend on care packages (CHC, LD, Children’s, Mental Health), and people in care packages reviewed within contractual timeframes

Full delivery of Integrated Care Coordination Teams 3 8 4

Working in partnership with the police to commission Street Triage as a pilot, to reduce Section 136 numbers

Review of Psychiatric Liaison service and Mental Health Assessment Unit, in line with national best practice and RAID models, which is likely to lead to a change in the

commissioning of the service

Working closely with the Local Authority, the CCG will review current commissioning of packages of care, with a view to establishing greater value for money and more appropriate care packages 8 13

3

1

Reduced length of stay in acute care for those with a mental illness

Reduced number of suicides and incidence of self-harm

Reduction in hospital activity for those with medically unexplained symptoms

Fewer s136 assessments 3 11


intentions for CWP:

Unplanned care

Long term conditions and complex needs

ADHD and PD to merge into a single complex needs service, offering a case management approach, along with homelessness outreach, with firm links into

drug and alcohol, and young people’s, services

Shared care for those with complex needs, where elements of management can be delivered in primary care

Parity of esteem

Outcom

es-based payments

Recovery-focussed Transition-planning

Programme CWP DRAFT 2015/16 SDIP Outcomes


Increased number of physical healthchecks for people with a mental illness

Reduced DNA rate within ADHD service

Greater number of ‘green’ LDSAF categories

Fewer hospital admissions for those that are homeless, have a personality disorder, and or have ADHD

Greater number of people with a mental illness in settled accommodation

Greater number of people with a mental illness in employment

3

4

1

3

2

8

13

7

Right care, right place, right time

CWP to implement the agreed requirements of the Crisis Care Concordat

CWP to deliver agreed requirements of the Perinatal Mental Health Pathway from 01.04.15

CWP to comply with the requirements of the LD SAF data collection exercise, and of the subsequently produced action plan

15

8

Reduced number of emergency admissions for those with a mental illness / dementia

Reduced number of people admitted under the mental health act

Increase in proportion of perinatal women accessing IAPT services

Reduced number of significant events concerning perinatal women

Reduced number of suicides and incidence of self-harm

Increased dementia diagnosis rate

Dementia Nurses to target care and residential homes to support those with challenging behaviour and increase diagnosis rate 3 11

Unplanned Care

Planned Care


Estate

Integrated triage and management of MSK / orthopaedic referrals initially for hip and knee

One stop models for surgical pathways focusing on cholecystectomy

Development of ICCTs

Single urgent care front door on the Arrowe Park site

Implementation of revised Integrated Care Service Specification for 2015/2016

Development and implementation of integrated respiratory, diabetes and cardiology pathways



Aim Service Developments and Improvements Outcomes



• Increased ICCT Health and social coordinated care management plans

• Reduction in unplanned admissions to hospital


• Improved communication – Directory of services

• 5% reduction in non-elective admissions

• 95% 4 hour target and meeting national ambulance turnaround times

• Zero tolerance minors breaches and GP redirects

• Reduction in unnecessary A&E

attendances and subsequent admissions

• Reduction in occupied bed days against peers for targeted areas

• Reduction in secondary care outpatient attendance

• Increased community provision and appropriate follow-up

• Increase in direct to test or to surgical procedures

• Increase in virtual, appropriate non face to face attendances as per innovation

1

1

1

13

2

4

4

2

6 1

11

Community interventions for overactive bladder syndrome and ear care

Community IV Therapy, developments

Discharge redesign including development of Integrated Discharge Team, Early Supported Discharge, Discharge to Assess

Development of a rapid response service (affecting the Pull Team)

Development of the substance misuse service

Redesign of medical assessment, ED processes and inpatient processes

Community outpatient management for anticoagulation and ENT initially and provision of virtual clinics, initially fracture clinic

1 4

1 4

1

3 1

1 11

1 11

1 11

3 14

8

9 3

14

Unplanned Care

Planned Care


Estate

To deliver an out-patient and drop in clinics review with a plan to re-design the out-patient solution and focus on community care

Review and deliver a re-design of pathways for top 3 planned care Vision priorities, T&O, Ophthalmology and gastroenterology

Develop and implement innovative pathways as per exemplar – one stop hernia and innovative virtual clinics e.g. fracture clinic

Active development of integrated care delivery across the hospital and the community in partnership with key providers


intentions for Wirral University Teaching Hospital NHS FT:

New model for medical assessment including AAU tariff / Non elective marginal rate

Achieve full delivery of Integrated Care Coordination Teams including implementation of revised Integrated Care Service Specification

Deliver and achieve community re-design of pathways for top 3 LTC Vision priorities, diabetes, COPD, CVD

Implementation and Delivery of Older People’s Community Service



Aim Intentions Outcomes



• Increased ICCT Health and social coordinated care management plans

• Reduction in unplanned admissions to hospital


• Improved communication – Directory of services

• 5% reduction in non-elective admissions

• 95% 4 hour target and meeting national ambulance turnaround times

• Zero tolerance minors breaches and GP redirects

• Reduction in unnecessary A&E

attendances and subsequent admissions and readmissions

• Reduction in occupied bed days against peers for targeted areas

• Reduction in secondary care outpatient attendance

• Increased community provision and appropriate follow-up

• Increase in direct to test or to surgical procedures

• Increase in virtual, appropriate non face to face attendances as per innovation

• Activity/financial targets modelling in progress

1

1

1

11

3

9

1

15

1

3

13

1

4

4

4

2

4

1

14

2

3

10

3

14

Ensure all actions in the urgent care recovery plan are implemented and maintained

1 8

8

6

Integrated Performance and Finance Report Agenda Item: 4.1 Reference: GB14/15/0052


2nd December 2014

Lead Officer: Mark Bakewell, Lorna Quigley

Contributors: CCG Finance and Business Intelligence teams


Sound financial control is essential to the Clinical Commissioning Group (CCG) strategy and is directly linked to the delivery of the CCG Commissioning and Operational Plan for the financial year. Ensuring that services that the CCG commission for the population comply with patient’s rights under the NHS constitution.


To achieve financial control total with sound financial management. To ensure that providers achieve strong performance against national targets.

Summary: This report updates the Governing Body on; • Activity & Performance for 6 (September) in addition to

performance for Quarter 2 (July/August and September) • Financial performance against budgeted allocation for

2014/15 as at Month 7 (October)


To Note

Comments

Next Steps: Continuation of performance monitoring through the remainder of the financial year


The report sets out the financial performance within the CCG for 2014/15 financial year

Value For Money

All expenditure plans are subject to an ongoing value for money review.

Risk The report details the key risks and how these will be monitored in

year as part of the reporting process Legal Legal advice is sought on issues as and when required.

Workforce The financial plan includes budgeted “running costs” expenditure and is reflective of the respective workforce implications in these areas


Plans will consider as appropriate the equality impact assessment for proposals within the budgeted expenditure


Budgets include funding to ensure continued involvement of patients and public in CCG decisions. Patient choice is a right under the constitution in relation to referral for treatment.

Partnership Working

The CCG works with a number of NHS Trusts and the Local Authority on a number of its commissioning budgets.


The plan reflects the planned achievement of statutory financial duties and patient’s rights under the NHS constitution




Report Name

Reference Submitted to Date Brief Summary of Outcome

QPF Updates Quality, Performance and

Finance Committee

30th September

Private Business The Board may exclude the public from a meeting whenever publicity (on the item under discussion) would be prejudicial to the public interest by reason of the confidential nature of


the business to be transacted or for other special reasons stated in the resolution. If this applied, items must be submitted to the private business section of the Board (Section 1 (2) Public Bodies (Admission to Meetings) Act 1960). The definition of “prejudicial” is where the information is of a type the publication of which may be inappropriate or damaging to an identifiable person or organisation or otherwise contrary to the public interest or which relates to the provision of legal advice (for example clinical care information or employment details of an identifiable individual or commercially confidential information relating to a private sector organisation). If a report is deemed to be for private business, please note that the tick in the box, indicating whether it can be published on the website, must be changed to a x. If you require any additional information please contact the Lead Director/Officer.

“Your partner in a healthier future for all”

Finance & Performance Update to Governing Body Meeting

2nd December 2014


NHS Wirral CCG 14-15 Q1 14-15 Q2 14-15 Q3 14-15 Q4CCG Dashboard 2014/15

Target / Threshold Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

MRSA - Incidence of HCAI YTD 0 0 0 0 0 0 0 ####### ####### ####### ####### ####### #######C. difficile - Incidence of HCAI YTD 8 13 16 23 31 42C. difficile - YTD Ceiling 4 11 15 19 23 27


RTT admitted 90% 93.2% 93.6% 93.8% 91.8% 85.7% 92.0%RTT non-admitted 95% 97.4% 97.5% 97.1% 95.5% 94.1% 94.2%RTT incompletes 92% 94.9% 95.1% 94.5% 93.4% 93.8% 94.2%RTT 52+ week waiters 0 1 1 3 1 0 1

Diagnostics Diagnostics - 6 weeks+ <1% 3.7% 3.0% 0.9% 1.1% 0.5% 1.1% - 2 week wait 93% 97.4% 97.2% 95.6% 96.1% 95.9% 96.9% - Breast symptom 2 week wait 93% 96.0% 90.4% 95.9% 96.9% 96.0% 95.1% - 31 day first definitive treatment 96% 97.5% 98.1% 98.8% 97.3% 99.3% 97.7% - 31 day subsequent treatment - surgery 94% 100.0% 95.7% 92.6% 97.6% 100.0% 93.5% - 31 day subsequent treatment - drug 98% 100.0% 98.1% 100.0% 100.0% 100.0% 100.0% - 31 day subsequent treatment - radiotherapy 94% 100.0% 100.0% 96.8% 100.0% 98.0% 96.7% - 62 day standard 85% 80.9% 85.1% 91.9% 81.7% 88.6% 88.4% - 62 day screening 90% 100.0% 91.3% 86.7% 94.1% 93.3% 94.7% - 62 day upgrade n/a 88.0% 73.9% 78.6% 83.7% 87.8% 82.4%

Mixed Sex Mixed-sex accommodation breaches 0 1 1 1Mental Health CPA follow up within 7 days 95%


- Total elective (YTD) 4,080 8,152 12,438 16,870 20,786 25,113 - Total elective plan (YTD) 4,217 8,454 12,481 16,900 20,940 25,158 25,158 25,158 25,158 25,158 25,158 25,158 - Non-elective (YTD) 3,977 8,097 12,001 16,247 20,245 24,338 - Non-elective plan (YTD) 3,653 7,433 11,085 14,863 18,638 22,290 22,290 22,290 22,290 22,290 22,290 22,290 - Outpatients (YTD) 7,467 14,828 22,755 30,955 37,985 46,646 - Outpatients plan (YTD) 7,866 15,738 23,248 31,471 38,984 46,849 46,849 46,849 46,849 46,849 46,849 46,849 - GP referrals (YTD) 5,035 10,325 15,515 21,087 26,207 31,702 - GP referrals plan (YTD) 5,091 10,195 15,058 20,387 25,255 30,349 30,349 30,349 30,349 30,349 30,349 30,349

Other - Activity & Efficiency

Cancer - 62 day

97.5% 97.6%

Cancer - 31 day

Health Outcomes Framework/Every one Counts

Safe environment and protecting from avoidable harm

NHS Constitution

RTT

Cancer - 2 week

Q1 Q2 Q3 Q4


Friends and Family Test (inpatients)

Acute Trust Jun-14 Jul-14 Aug-14 Sep-14 Jun-14 Jul-14 Aug-14 Sep-14 Jun-14 Jul-14 Aug-14 Sep-14Wirral University Teaching Hospital NHS FT 91.3% 89.3% 89.8% 84.5% 3.4% 3.9% 5.0% 6.4% 44.6% 33.5% 25.7% 31.5%Mid Cheshire Hospitals NHS FT 96.6% 97.1% 97.0% 97.4% 1.4% 1.0% 1.6% 0.5% 49.8% 44.5% 36.2% 33.8%The Clatterbridge Cancer Centre NHS FT 100.0% 100.0% 100.0% 100.0% 0.0% 0.0% 0.0% 0.0% 60.8% 32.8% 28.7% 43.9%East Cheshire NHS Trust 89.8% 91.2% 92.6% 88.7% 1.5% 0.4% 0.4% 0.7% 21.0% 24.2% 28.6% 15.7%Countess of Chester Hospital NHS FT 93.9% 94.1% 93.1% 94.8% 0.4% 1.0% 0.2% 1.1% 45.9% 25.6% 34.1% 48.5%Warrington & Halton Hospitals NHS FT 94.8% 93.7% 95.0% 94.0% 0.7% 1.1% 1.8% 1.9% 34.6% 32.2% 30.0% 26.4%#N/A#N/A#N/A#N/A

Inpatients Friends and Family test% who recommend % who don't recommend Response rate


Friends and Family (Accident and Emergency)

Acute Trust Jun-14 Jul-14 Aug-14 Sep-14 Jun-14 Jul-14 Aug-14 Sep-14 Jun-14 Jul-14 Aug-14 Sep-14Wirral University Teaching Hospital NHS FT 97.9% 98.7% 99.3% 99.0% 0.6% 0.4% 0.1% 0.0% 19.9% 26.3% 30.4% 28.1%Mid Cheshire Hospitals NHS FT 92.6% 88.1% 89.8% 85.0% 4.5% 5.9% 5.6% 7.7% 21.0% 20.4% 16.7% 22.5%East Cheshire NHS Trust 84.7% 84.0% 85.9% 83.6% 11.3% 9.6% 7.1% 11.2% 18.7% 20.4% 23.3% 20.3%Countess of Chester Hospital NHS FT 85.3% 82.1% 82.4% 84.3% 8.6% 10.8% 9.6% 9.6% 21.2% 21.1% 12.3% 13.0%Warrington & Halton Hospitals NHS FT 73.8% 79.8% 79.7% 82.3% 5.2% 5.2% 3.1% 3.2% 20.8% 19.5% 17.6% 14.5%#N/A#N/A#N/A

Accident and Emergency: Friends and Family test% who recommend % who don't recommend Response rate


Friends and Family (Maternity)

Acute Trust Jun-14 Jul-14 Aug-14 Sep-14 Jun-14 Jul-14 Aug-14 Sep-14 Jun-14 Jul-14 Aug-14 Sep-14Wirral University Teaching Hospital NHS FT 100.0% 100.0% 100.0% 97.4% 0.0% 0.0% 0.0% 0.0% 33.7% 12.7% 16.0% 19.7%Mid Cheshire Hospitals NHS FT 87.8% 91.5% 90.1% 93.2% 9.5% 2.4% 4.9% 1.4% 16.6% 16.3% 17.9% 16.7%East Cheshire NHS Trust 92.9% 100.0% 91.5% 95.8% 0.0% 0.0% 0.0% 0.0% 30.9% 31.8% 26.3% 47.7%Countess of Chester Hospital NHS FT 100.0% 100.0% 100.0% 0.0% 0.0% 0.0% 1.1% 4.0% 0.6% 0.0%Warrington & Halton Hospitals NHS FT 89.4% 90.0% 92.9% 90.6% 0.0% 10.0% 0.0% 1.7% 35.7% 3.6% 5.3% 45.9%#N/A#N/A#N/A




Maternity Friends and Family Test Question 1: Antenatal care (touch point 1)% who recommend % who don't recommend Response rate

Maternity Friends and Family test Question 4: Postnatal community provision (touch point 3)% who recommend % who don't recommend Response rate

Maternity Friends and Family Test Question 2: Birth (touch point 2)% who recommend % who don't recommend Response rate

Maternity Friends and Family Test Question 3: Care on postnatal ward (touch point 2)% who recommend % who don't recommend Response rate


2014/15 Key Planning Requirements

• 1% Surplus - £4.68m • 2.5% Headroom (non-recurrent resources) - £11.4m • Minimum 0.5% Contingency

– CCG hold £3m vs £2.2m (0.5%)

• Better Payment Practice Code • Cash Management


Year to Date (Month 7) – Financial Performance Planned Year to Date Surplus - (£2.73m) Current Year to Date Surplus - (£2.07m) * Activity based contracts for month 6 (contracts) / month 5 (prescribing)

Key Issues • WUTH Contract Position – (£2.8m) under @ M6 vs [(£2.4m) @ M5 (£1.7m) @

M4] • Other NHS Providers – Notably Royal Liverpool and Broadgreen (£0.49m) over • Commissioned Out of Hospital - £0.88m (CHC / Package costs) • Prescribing £0.02m over performance (in month improvement £0.07m) • QIPP Gap 7/12 - £3.4m


Month 7 Forecast movement Operational position has further deterioration between M6 and M7 Unadjusted FOT - WUTH reduced (cut 2 of month 6) £0.2m - Non-NHS Contracts (quarter 2 activity update) £0.4m - Other NHS (Wirral CT, NCA’s, Mersey) had worsened £0.7m Notified of Prescribing pricing

impact (further 50% impact of £400k included) £0.2m - Restitution Admin Costs £0.5m (previously assumed covered within PCT Provision (legacy

issue) - Running Cost £0.2m (compromise agreements, transitional arrangements extended)

Overall movement in Outturn £2.2m Existing mitigation plans have been reviewed and not considered likely to further reduce expenditure - hence decision to amend forecast expenditure position.


Month 7 - October Year to Date (M7) Forecast Outturn Position Planned ytd Surplus - (£2.73m) (£4.68m) - Planned Current ytd Surplus - (£2.07m) (£2.5m) – Reported Operational Position - £0.66m (£2.18m) Movement

YTD Forecast Risks to Outurn Plan Assumptions

WUTH (£2.80m) (£3.4m)

Other NHS £1.06m £1.53m

Non NHS £0.08m £0.29m

Prescribing £0.3m

CHC £0.88m £1.2m

Other £0.5m

Identified Slippage (£0.54m) (£1.64m)

QIPP £3.73m £6.4m

Contingency (£1.75m) (£3.0m)

£0.66m £2.18m (£0m)


Self Assessment at Month 7 (October) 2014/15


Other Performance Indicators Cash Management

– Balance as at the end of the October £98k

Better Payment Practice Code

WCCG – Governing Body Meeting 02.12.2014 1/3

Continuing Healthcare service transition



Lead Officer: Iain Stewart, Head of Direct Commissioning

Contributors:


Enhance the quality of life for people with long-term conditions Helping people to recover from episodes of ill health or following injury Ensuring people have a positive experience of care Ensuring people are treated and cared for in a safe environment and protected from avoidable harm


Summary: This paper provides Governing Body with the summary details of the transition project that is underway. Wirral CCG in conjunction with the 4 Cheshire CCGs (NHS South Cheshire CCG, NHS Vale Royal CCG, NHS Eastern Cheshire CCG, NHS Western Cheshire CCG) is developing a new service delivery model for the management of Continuing Healthcare, Complex Care, Funded Nursing Care and associated Quality & Safeguarding. There are two phases to the work; stabilise the current service and manage the transfer of the existing service (including workforce) from North West Commissioning Support Unit (NWCSU) to a host CCG by end January 2015; and redesign and oversee the delivery of the service transformation. The 5 CCGs have commissioned the services of Integral Health Solutions to project manage the successful service transition. The project design and governance framework for the Stage 2 of the transition project is shown at Appendix 2. The Governing Body is asked to approve the approach to the transition of the CHC service.

Recommendation: To Approve √

To Note

Comments

Next Steps:



Expenditure on Continuing Healthcare (CHC) packages continues to rise year on year due to an increase in the shift of care into the community for patients with complex care needs. The current year forecast for 2014/15 is a c£2m overspend against the CHC budget. A key element of the CHC Framework is the review of care packages to ensure the current care needs are being met and where appropriate, packages of care be reasonably adjusted. In the absence of regular reviews the CCG is unable to achieve best value for money against the use of its financial allocations. A service transition to the CCG will provide greater assurance and control on the mechanisms for reviews.

Value For Money The CCG is not as informed as it needs to be via performance reporting and assurance on procurement processes, and as such cannot determine best value for money against the use of its financial allocations. A service transition to the CCG will provide greater opportunity to develop a meaningful performance framework that informs the CCG.

Risk Along with the financial risks (see above), the current CHC service delivery is creating the potential for clinical and safeguarding risks, due to the backlog of annual reviews of patients’ care packages. A service transition to the CCG will provide greater assurance and control on the mechanisms for reviews.

Legal The CCG has a legal duty to achieve financial balance. The failure to commission high quality, best value services that will likely lead to budgetary overspends, will impact on this statutory requirement.

Workforce Under TUPE regulations a number of NWCSU staff have been identified as eligible to transfer with the service back to the CCGs. Several current roles have been deemed not eligible for transfer and therefore the CCGs will need to work collaboratively through its service redesign phase, to identify solutions.


The CCG must be mindful of its priority to ensure people are treated and cared for in a safe environment and protected from avoidable harm. Whilst the current performance issues exist within the CHC service commissioned from the CSU, the CCG must take action to assure itself that patients in receipt of CHC packages continue to be supported appropriately with their current care needs.


Stakeholder consultation is underway through a series of joint staff consultation meetings between affected staff groups and the CCGs and NWCSU. As the service component for the “lift & shift” phase of the service transition remains unchanged, PPI engagement is not currently active. Following the successful transfer of the service back to CCGs, the service redesign phase will require the engagement and involvement of patient and public to inform any service delivery changes.

Partnership Working

The CCG is part of a pan-Cheshire/Wirral transition project to successfully transfer the CHC service from NWCSU back to the CCGs, with agreement that NHS South Cheshire CCG will host the service for the purposes of employment of the staff.


The agreed milestones within the service transition project are applicable to all 5 CCGs and Integral Health Solutions in order to achieve the transition of the service by 31st January 2015.



Yes



Report Name Reference Submitted to Date Brief Summary of Outcome Verbal update Minutes Quality

Performance & Finance Committee

26th August 2014

Risk identified on financial spend and service performance matters

Paper Minutes Governing Body 7th October 2014

Update on current service issues; due diligence review and service transition proposal




NHS Wirral CCG

Continuing Healthcare transition Introduction

1. Further to the papers considered by the Governing Body at its meeting on 7th October 2014 (copies attached at Appendix 1) in which details of current service issues and outcomes from a due diligence review was shared, the next phase is service transition.

2. This paper provides Governing Body with the summary details of the

transition project that is underway. Wirral CCG in conjunction with the 4 Cheshire CCGs (NHS South Cheshire CCG, NHS Vale Royal CCG, NHS Eastern Cheshire CCG, NHS Western Cheshire CCG) is developing a new service delivery model for the management of Continuing Healthcare, Complex Care, Funded Nursing Care and associated Quality & Safeguarding. There are two phases to the work; stabilise the current service and manage the transfer of the existing service (including workforce) from North West Commissioning Support Unit (NWCSU) to a host CCG by end January 2015; and redesign and oversee the delivery of the service transformation.

3. The 5 CCGs have commissioned the services of Integral Health Solutions to

project manage the successful service transition. The project design and governance framework for the Stage 2 of the transition project is shown at Appendix 2.

4. As part of the transition, there is an extensive Human Resources component

involving staff consultation and ensuring the correct process is followed for TUPE purposes. The CCGs alongside NWCSU, are engaged in a series of joint consultation meetings with affected staff within NWCSU.

5. NHS South Cheshire CCG has offered to act as “employer” in the new service

delivery model with TUPE transfer of appropriate individuals able to occur as early as 31st January 2015, subject to Governing Body endorsement of the approach to the service transition.

6. Affected staff would be integrated into the CCGs either as a dedicated locality staff or as specialist staff covering the wider geographical area of Cheshire and Wirral. A governance structure is being developed to ensure full leadership and ownership by the respective CCGs.

Recommendation 7. The Governing Body is asked to approve the approach to the transition of the

CHC service.

Minutes of the WCCG –Governing Body Meeting – PUBLIC SESSION – 7th October 2014 Page 1 of 8

WIRRAL CLINICAL COMMISSIONING GROUP GOVERNING BODY BOARD MEETING

Minutes of Meeting – Public Session

Tuesday 7th October 2014 2pm

Nightingale Room, Old Market House Present: Jon Develing (JD) Interim Accountable Officer Dr P Naylor (PN) Acting Chair WCCG Mark Bakewell (MB) Chief Finance Officer Lorna Quigley (LQ) Head of Quality and Performance Dr M Green (MG) Consortium Chair

Dr H McKay (HM) GP Executive (WGPCC) Dr A Ali (AA) GP Executive (WGPCC) Iain Stewart (IS) Consortium Chief Officer (WACC) Christine Campbell (CC) Consortium Chief Officer (WGPCC) Dr J Oates (JO) Consortium Chair Dr D Jones (DJ) GP Executive (WHCC) Andrew Cooper (AC) Consortium Chief Officer (WHCC) Paul Edwards (PE) Head of Corporate Affairs Dr S Wells (Swe) Acting Chair (WHCC) Graham Hodkinson (GH) Director of DASS Dr A Smethurst (AS) Secondary Care Doctor Simon Wagener (SW) Lay member patient champion

In Attendance: Allison Hayes (AJH) Executive Assistant

Richard Williams (RW) LMC Representative Sarah Quinn (SQ) Commissioning Manager

Ref No. Minute GB14-15/0037

Preliminary Business 1.1 Apologies for absence Apologies were received from: James Kay, Fiona Johnstone and Karen Prior.

1.2 Chairs Announcements Chair welcomed all members to the meeting. 2 members of the public attended the meeting. 1.3 Declarations of Interest PN stated that he was involved with work with NICE in an area not related to the item on Procedures of Low Clinical Priority. This was therefore a declaration, and not a conflict of interest. All members declared an interest in the item on the Constitution, as the paper directly refers to the Governing Body and its members.


Ref No. Minute 1.4 Comments/questions from members of the public There were no comments or questions from members of the public. 1.5 Patient Story LQ gave an overview of a patient’s story which highlighted the importance of how the NHS works as a system within various departments. It highlighted the importance of respecting a patient’s wishes with regards to their treatment. SWe commented on how important integration and communication with the wider public is, and all members agreed. Members noted the contents of the patient story. 1.6 Minutes from previous meeting held on 2nd September 2014. The minutes of the previous meeting held on 2nd September 2014 were agreed as a true and accurate record notwithstanding grammatical/typographical errors which will be rectified. There were no matters arising. Action Points – please refer to separate Action Sheet.

GB14-15/0038

2.0 Items for approval 2.1 Procedure of Low Clinical Priority SWe gave an overview of the Procedure of Low Clinical Priority report. The purpose of this report is to:

• Provide an overview of the process undertaken to update the Commissioning Policies which included: a review of clinical evidence, public consultation and equality impact assessment. It was highlighted that for exceptional cases independent funding requests are available.

• Present the final policy to the Governing Body for approval Particular areas of discussion included: subfertility, Varicose Veins, Penile Implants and Diabetes/Continuous Glucose monitoring, complementary therapies and circumcision. Some of these areas may be subject to further review in due course.

The Governing Body were asked to consider whether the CCG should adopt and put into practice the updated policy but with the recommended exceptions and amendments. Chair gave thanks to Dr Wells and the Clinical Strategy Group for their work GB agreed to adopt NICE guidelines regarding subfertility which includes offering 3 cycles of IVF up to age 4, 1 cycle age 40-42 and some provision for same sex couples. MG queried the possible position where other CCGs may not adopt the same stance as Wirral CCG. PE assured members that Wirral CCG has followed NICE guidelines and those CCGs who had not done so, would need to explain their rationale as part of their Governing Body deliberations. DJ sought clarity regarding the policy for Childlessness. SWe clarified that there is no current guidance in relation to the definition of childlessness available. JD suggested that the CCG


Ref No. Minute continue with the current definition of childlessness. SWe highlighted the need to consider a timescale and mechanism to review all policies and PE clarified that there would need to be a regular global review process, but individual areas would be reviewed on a case by case basis when there was a significant change in NICE guidance or other significant change in local factors. PE also explained that, if adopted, the CCG would develop an implementation process for making sure these procedures were built into contracts of current providers. The Governing Body noted the report presented today and agreed the proposed direction of travel to implement NICE Guidelines as outlined in the report. Members also agreed to adopt the current definition of Childlessness. 2.2 Emergency Preparedness, Response and Resilience PE gave an overview of the Emergency Preparedness Response and Resilience plans and processes of the CCG and the requirement to self-assess compliance with core standards. PE talked members through the standards, the evidence of compliance and the action plan. Members agreed to self-assess as ‘green which is fully compliant. SW suggested that public engagement should be considered and that the public are assured that the CCG have robust plans in place. The Governing Body noted and agreed the EPRR self assessment rating and PE will submit to the NHS England Area Team.

GB14-15/0039

3.0 Items for Discussion 3.1 NHS Wirral CCG Response to the Capability and Governance Review & Constitutional Implications JD provided members with an update regarding the NHS England Capability and Governance Review. NHS England’s ‘Capability and Governance Review’ in relation to NHS Wirral CCG has made a number of key recommendations and these have been fully accepted by the CCG. As a result, a high level action plan has been developed in response and this is included here together with the Review summary issued by NHS England. A number of the recommendations directly relate to the CCG’s constitution and a significant degree of change is required to that document to address the concerns highlighted by the Review. In line with the guidance from NHS England entitled ‘Procedures for Clinical Commissioning Group Constitution Change, Merger or Dissolution’ (May 2013), the CCG has an opportunity to update its constitution at two yearly submission dates and is currently aiming to submit a revised constitution at the next submission date in November 2014. The report presents an overview of proposed key changes to the constitution in response to the Review and it is envisaged that the full revised constitution will be presented to November 2014 Governing Body. Recommendations aimed at strengthening the CCG and addressing the issues raised include:

• To improve its leadership and development of the whole system strategy • To improve its delivery of A&E and urgent care • To improve relationships with stakeholders


Ref No. Minute • To improve its Governing Body capability • To improve governance • To improve its senior leadership capability

The CCG has developed a high level action plan that addresses each of these recommendations and also acknowledges that the CCG has already made significant progress in these areas. Next steps A more detailed action plan, with timescales, will be developed and the process for amending the CCG constitution will continue in line with NHS England guidance. The Governing Body were asked to note the action plan in response to the recommendation of the ‘Capability and Governance Review’. Constitutional Implications JD gave an overview of the proposed amendments to the CCGs constitution. The purpose of the report is to outline the constitutional implications arising from the Capability and Governance Review. In addressing the fundamental problems resulting from the consortia and governance arrangements highlighted by the review, there are number of areas that require immediate change:

• Methods for determining clinical leaders • Governing Body Composition • Membership and clinical engagement methods • Governance arrangements

In addition to the evidence provided from the CCG 360 degree survey, LMC survey of members and the review itself, the CCG has utilised a number of sources to inform the amendments

• Other ‘best practice’ constitutions • NHS England advice • Member practice engagement events • GP Consortia forums • Patient Forums • Local Medical Committee • CCG staff briefings and feedback

The constitutional amendments are a result of careful and considerate engagement and reflective of the urgent need for change. It is now recommended that these are incorporated into a revised constitution for consideration by the CCG Governing Body and submission to NHS England. JD gave thanks to Governing Body members and the LMC for their work in supporting the direction of travel of the CCG. GH commented positively on the features of the proposed constitution and highlighted the importance of engaging in new ways of working. AA commented on how comprehensive the proposed amendments are and that there had been compromise to incorporate differing member practice views. He sought clarity as how the CCG could ensure member practices are assured that all appointment and election processes that are carried out are open, fair and transparent. JD assured AA that the CCG would be open and collaborative in these processes. AA concluded that the prime objective is to be successful and that the CCG would receive his full support. JO also stated that the proposals represented a


Ref No. Minute good compromise of member views. SWe agreed with AA and stated that there is evidence that concerns that have been raised have been listened to; however the CCG will support those seeking for further support and consultation. RW thanked the CCG for their recent level of engagement with LMC and how the amendments to the constitution are being received by its members. HM commented on the robust processes of appointments and the transparent nature required to fulfil these. SW informed members of comments made by James Kay and sought clarity as to how GP practices vote for Governing Body members. He went on to suggest how the CCG need to communicate to its patients on a wider perspective in relation to any amendments made to the constitution. PN clarified the voting process for members. DJ commented on how practices need to be considered in the involvement of developing the future of the CCG on an on-going basis. JD reiterated the need for strong governance mechanisms and how the CCG can help members understand the election, voting and appointment processes. JD reminded members that NHS England will be required to ‘assure’ the process. PN thanked the management team and the LMC for their work and gave thanks to JD for his work and support. The Governing Body supported the proposed direction of travel of the CCG.

GB14-15/0040

4.0 Items for Information 4.1 Quality Performance and Finance Report Quality Performance LQ gave a presentation on the activity performance for month 4 (July) and highlighted the positive areas and the improvements in the challenges that were originally presented. Areas included: • Family and friends • NWAS turnaround • Delivering the same sex accommodation • Diagnostic test • MRSA • Referral to treatment – NHS Constitution 4 hour target • Health Care Associated Infection LQ also highlighted the CCG achievements as detailed in the Health Outcomes Framework. The Governing Body noted the contents of the Quality and Performance Report. Finance Report MB provided information of the Financial performance against budgeted allocation for 2014/15 as at month 5 (August).


Ref No. Minute 2014/15 Key Planning Requirements

1% Surplus - £4.68m • 2.5% Headroom (non-recurrent resources) - £11.4m • Minimum 0.5% Contingency • – CCG hold £3m vs £2.2m (0.5%) • Better Payment Practice Code • Cash Management

Year to Date (Month 5) Financial Performance Planned Year to Date surplus – (£1.95m) Current Year to Date surplus – (£1.24m) Key Issues

• WUTH Contract position - (£1.7m) under @ M4 vs (£1.05m) @ M3 (£1.7m) @ M2 • Other NHS Providers – notably Royal Liverpool and Broadgreen (£0.42m) over • Commissioned Out of Hospital - £0.678m (in month increase in CHC/package costs) • Prescribing £0.16m over performance (in moth improvement £0.1m) • QIPP Gap 5/12 - £2.6m (of £6.3m)

Forecast Outturn 2014/15 Forecast Assumptions

• Planned Forecast Surplus - £ 4.68m (1%) – remains deliverable but not without risk an • Risks remain consistent with plan around main expenditure areas • WUTH (variation away from outturn as per QIPP assumptions) • Prescribing, • Commissioned Out of Hospital Care, • QIPP Gap • YTD position reflect challenges of forecast delivery

Other Issues

• Hosting Arrangements • Discussions held with Cheshire & Merseyside Commissioning Support Unit with regards

to ceasing of arrangements relating to Isle of Man commissioner and use of CCG Ledger • Continuing Healthcare Restitution • New Guidance suggests future financial year top-slice to support national shortfall on risk

share basis The Governing Body noted the financial report as at month 5 (August). AS sought clarity regarding any shortfalls that the CCG may meet and the need to focus on how the CCG deals with these. 4.2 Progress Report re: System Resilience Plan AC provided an overview of the System Resilience Plan and introduced Sarah Quinn, Commissioning Manager who went on to explain the details of the paper. Work undertaken to date has secured £2.4 million system resilience funding from NHS England and the paper provided a summary of progress to date with the development of the Wirral System Resilience Group and Operational Resilience and Capacity Plan. The next steps include:


Ref No. Minute

• Continue to develop the system resilience group and implement the work plan • Continue to develop the operational resilience and capacity plan as this work plan is

progressed • Work with providers to implement and monitor system resilience schemes

The CCG Governing Body was asked to note the progress to date with the development of the system resilience group and operational resilience and capacity plan. HM thanked SQ, AC and LQ for their work in relation to the plan. 4.3 Progress Report re: BCF (Better Care Fund) SQ informed members of the current progress of the Better Care Fund. The paper summarised the current progress with the development of the Better Care Fund, and provides all the latest papers submitted to NHS England for the September submission giving a summary of initial feedback from the national BCF assurance team. Formal feedback on the Wirral BCF submission is expected from NHS England by the end of October 2014. The CCG and Council commissioning teams are working on an implementation plan and with Vision 2018 Programme leads to ensure that the programmes and projects are set up and monitored via the new Programme Management Office. MB highlighted to the group the importance of the risk of non-delivery of performance targets. GH commented on the achievement of integrated working relationships and the high level of ambition to achieve the targets set out. The full document is to be circulated to members at a later date. The CCG Governing Body noted the current progress regarding the Wirral Better Care Fund Proposals. 4.4 Progress Report re: Continuing Health Care (CHC) IS provided members with a current progress report in relation to Continuing Health Care. The paper presented updated the Governing Body on recent key operational decisions taken by the management team to attempt to address current service matters and follows on from the issue identified in the Quality, Performance & Finance Committee on 26th August 2014 and subsequently included in the CSU Service Level Agreement update provided to Governing Body meeting on 2nd September 2014. Key concerns include:

• Backlog of annual reviews (which increases the risk of safeguarding matters arising due to lack of updated clinical assessment and financial implications of care package costs)

• Performance reporting not adequate to inform the commissioner of key aspects of the service

• Speed of response in relation to patient queries about CHC eligibility decision-making and subsequent quality of complaint response letter content.

CC sought clarity around how the CCG are currently monitoring the action plan set out by the CSU and IS explained the current process.


Ref No. Minute GH suggested that forward planning is required to meet the demand being presented in related to care packages. SWe highlighted the quality and risk implications to patients care and in summary JD suggested that a weekly report is to be provided to the Ops team and also on a monthly basis to the Quality, Performance and Finance Committee. Members were asked to note the accompanying letter to Leigh Griffin, Managing Director of the CSU, outlining the timescales for transition, including staff transfer to the new arrangements by 31st January 2015. The Governing Body were asked to note the operational decision taken by the management team and the current direction of travel.

GB14-15/0041

5.0 Items for Noting 5.1 Conflicts of Interest Policy PE presented the Conflicts of Interest Policy to the group. The existing policy was approved by the Governing Body in March 2013. While the principles described within the policy have not changed there is a need to update it to reflect the changes in structure and personnel that have been implemented since its approval. The Terms of Reference for the Approvals Committee have also been updated and are amended within this policy. The Governing Body noted the policy presented today. 5.2 Vision 2018 Update Members noted the contents of the bulletin provided at today’s meeting. 5.3 Commissioning Plan/Commissioning Intentions Members noted the commissioning plan presented at today’s meeting. 5.4 Subgroups (ratified minutes for noting)

• WGPCC of 11.06.2014 • Approvals Meeting of 27.08.2014 • Audit Meeting of 28.05.2014

The Governing Body noted the reports of the above subgroups.

GB14-15/0042

6.0 Risk Register PE gave an overview of the current risk register and all items were reviewed and noted today. It was agreed to increase the risk ratings in relation to the financial position.

7.0 Any other Business There were no other items of business. Chair thanked members for their attendance. The Board meeting ended at 16:15pm.

8.0 Date and Time of Next Meeting The date and time of the next meeting is Tuesday 11th November 2014 in the Nightingale Room, OMH please contact [email protected] with any apologies or agenda items.

Board meeting ended at: 16:15pm


Produced by Iain Stewart, Chief Officer, Commissioning Lead for Continuing Healthcare

NHS Wirral CCG

Continuing Healthcare provision Background

1. When the CCG was established in April 2013 it determined that a CHC service would be commissioned from the Commissioning Support Unit (CSU) as part of a wider Service Level Agreement covering a full range of support functions (e.g. Finance, Business Intelligence, Contracting etc). The service specification agreed, encompasses all aspects of a CHC service and is described by the CSU as an “end to end service”, meaning the CCG should only expect to have minimal involvement in operational and managerial aspects of the day to day delivery of the service.

2. It became clear during 2013 that increasing instances of operational and managerial issues were being presented to the CCG to resolve. It was also clear that processes for requesting funding authorisation for high cost packages or increases to existing packages of care, appeared un-co-ordinated, reactive and rushed, resulting in pressure on the CCG to approve high value cost proposals without a reasonable time to seek assurances that the proposals represented value for money and that all procurement options had been considered in determining the care package costs.

3. The CCG established a monthly CHC Forum as a means of enabling the

opportunity for the CSU provider colleagues to meet with the commissioner and discuss operational matters, planning considerations for changes in CHC payment rates; focus on greater explanation on processes used and improving knowledge about joint funded care packages developed in conjunction with Wirral Department of Adult Social Services.

4. As part of the current interim management arrangements within the CCG, the

interim Chief Operating Officer reviewed the current level of complaints received to-date on CHC-related issues. She identified serious failings in both the delay in responses and the overall content quality of responses, when finally provided to complainants. To-date, two complainants have written to the Parliamentary Health Ombudsman as a result of dissatisfaction with their responses.

Introduction

5. This paper updates Governing Body on recent key operational decisions taken by the management team to attempt to address current service matters and follows on from the issue identified in the Quality, Performance & Finance Committee on 26th August 2014 and subsequently included in the CSU Service Level Agreement update provided to Governing Body meeting on 2nd September 2014.

Produced by Iain Stewart, Chief Officer, Commissioning Lead for Continuing Healthcare

Current Issues identified

6. On 21st August 2014, the CCG met with senior managers from the CSU to discuss a range of concerns regarding the current service delivery and requested an action plan from the CSU. Key concerns were;

- Backlog of annual reviews (which increases the risk of safeguarding matters arising due to lack of updated clinical assessment and financial implications of care package costs)

- Performance reporting not adequate to inform the commissioner of key aspects of the service

- Speed of response in relation to patient queries about CHC eligibility decision-making and subsequent quality of complaint response letter content.

In response the CSU has provided an outline action plan to address the areas of concern raised (see Appendix 1).

7. A Due Diligence Review of the existing service has been completed on behalf

of the CCG (as part of a wider commission of work in conjunction with the Cheshire CCGs) and highlights a general failure to deliver the service in line with the service standards expected locally and nationally.

8. The CCG, along with the Cheshire CCGs has taken the decision to withdraw this service from the CSU on the basis of a failure to deliver the service in line with the agreed specification. Further concerns relate to the nature of complaints received from members of the public and timeliness of monitoring of care being received. A notice of service failure letter was sent to the CSU on 16th September 2014 (Appendix 2 refers).

9. The CCG continues to hold the CSU to account for on-going delivery of the

current service.

10. The Governing Body is asked to note the operational decision taken by the management team.

Transition of CHC and Complex Care Services from CSU to CCG

Revised Proposal for Stage 2

Hilary Heywood

8 October 2014

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3.  Phase 1 : Scope of work 4.  Phase 1 : Stages required to ‘liF and shiF’ 5.  Stages 2, 3 and 4 : Scope of work 6.  Stage 2 : Key Workstreams and AcOviOes 7.  High Level Plan : Stages 2, 3 and 4 8.  Stage 2 : Approach 9.  Service StabilisaOon & Service Redesign : Workforce Redesign 10.  Breakdown of Stage 2 : Design 11.  Commercial ProposiOon for Stages 2 & 3 (revised proposal) 14.  Commercial Terms

Contents

2

Note: numbers refer to the slide numbers

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Phase 1 : Scope of work

Five CCGs across Cheshire and Wirral are looking to develop a new service delivery model for the management of ConOnuing Healthcare, Complex Care, Funded Nursing Care and Quality and Safeguarding. These CCGs include South Cheshire CCG, Vale Royal CCG, Eastern Cheshire CCG, Western Cheshire CCG and Wirral CCG. NoOce has been served on the current provider of these services – Cheshire and Merseyside Commissioning Support Unit (CMCSU) – to transfer the following services to the CCGs by the end of January 2015:-‐ •  CHC, FNC and Complex Care clinical and administraOve

service •  Quality and Safeguarding service There are 2 phases to the work: •  Phase 1: to stabilise the service and manage the transfer of

the exisOng CHC, FNC, complex care, Quality and safeguarding service -‐ including workforce -‐ from the CSU to the host CCG by end of January 2015

•  Phase 2: Re-‐design and overseeing delivery of the iniOal CHC service transformaOon

Phase 1 deliverables are: 1.  Leading the safe transfer of the nursing and supporOng

administraOve teams for CHC, FNC, Complex Care and Quality and Safeguarding service to the new host CCG

2.  Leading the strategic and operaOonal transfer of these services with a target date of end of January 2015

3.  Develop and oversee governance arrangements, including a clearly idenOfied project plan, to deliver the transfer which includes some, but not all, of the required support services to the team

3

The Phase 1 objecOve is to ensure the effecOve transiOon of the CHC, FNC and Complex Care service from the CSU to CCGs by 31 January 2015 This proposal sets out the following:-‐ v  Scope of work to

be provided v  High level plan v  Resources and

budget v  Commercial

details The scope of this proposal is the transfer of clinical locality based staff. Central CSU teams, contracOng, finance and procurement will be addressed during 2015/16 (Phase 2)

4.  Leading the idenOfied Programme team and nominated resources from CCG’s and CSU available to help with this transfer.

From the findings of the Due Diligence Report and Workforce Reports as part of Stage 1: Diagnosis; we have developed this proposal with the acOviOes, Omescales, costs and resource support required to ensure the safe transiOon of the service by the date specified. Given the imminent Omescales and scale of the transiOon and risk miOgaOon required, a swiF decision on moving forward by the CCG’s is strongly recommended.

Diagnose Understand what we

have now

Design Developing the CCG

service model, iden=fying the gaps & designing the plan to deliver the transi=on

Deliver

Delivering the transi=on

Demonstrate Ensuring pa=ent services are

maintained, adhere to quality standards and

are responsive

4

Phase 1: Stages required to ‘liF and shiF’ and ensure an effecOve transiOon We have significant experience in managing service transiOons across organisaOons. The model we adopt concentrates on four stages in order to manage successful transiOons. Stage 1 is criOcal and provides the baseline from which the transiOon to the proposed operaOng model for the CCG’s can be delivered – this is now complete. This proposal concentrates on detailing the acOviOes to be undertaken within Stages 2, 3 and 4 whilst providing an indicaOon of how this will link to the subsequent phase 2 for implementaOon during 15/16. These were the key acOviOes within each of the 4 stages in Phase 1 from our original proposal. Based on the Stage 1 : Diagnosis findings, the acOviOes required to ensure a smooth transiOon have been detailed further and a high level plan produced in the slides overleaf.

Stage 1 – Diagnose Understand what we have now

(due diligence review)

• Review current scope of the CHC and Complex Care service and idenOfy acOviOes to transfer and those excluded • Undertake an assessment of current ‘actual’ performance – assessed against service KPI’s • Undertake workforce review and producOvity assessment • IdenOfy key risks and issues • Work with the CCGs and CSU to idenOfy all direct and in direct staff affected by the transiOon to inform the TUPE/consultaOon process • Provide a high level current state finance posiOon • Assess current levels of demand across all CCGs within scope • Assess current rate of referrals across all CCGs within scope • Review current contracts and highlight any issues or risks in relaOon to the ‘liF and shiF’ transiOon phase

Stage 2 – TransiOon Developing the CCG transiOon

model & designing the transiOon plan

• Work with the CCGs to define the CCG operaOng model • Build upon the current state diagnosOcs to idenOfy gaps between the current and transiOonal model • Work with the CCGs and CSU to design the end to end transiOon process • Provide detailed plans to ensure a smooth transfer of service

Stage 3 – Deliver Delivering the transi=on

• Work with the CCGs and CSU to implement the transiOon plans • Undertaken transiOonal service re-‐design to miOgate risks idenOfied from the Due Diligence Review and Workforce Review.

Stage 4 – Demonstrate Ensuring pa=ent services are maintained, adhere to quality standards and are responsive

• Develop performance dashboard to measure quanOtaOve and qualitaOve outputs • Establish mechanisms for measuring paOent outcomes and provider levels of care

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Stages 2, 3 & 4 : Scope of work To manage the transfer of the exisOng CHC, FNC and complex care service -‐ including workforce -‐ from the CSU to the host CCG by end of January 2015

Phase 1 Stage 1 : Diagnosis – Complete Stage 2 : Design Based on the outcomes of the diagnosis stage, we recommend the following workstreams are implemented within the scope of Stage 2: 1.   Advisory support to the HR / TUPE process and exit

management plan to ensure the transfer of staff into the host CCG by 31st January 2015

2.  CCG-‐led CHC OperaMng Model, Commercial Arrangements

& Financial PosiMon

3.   Service StabilisaMon and Service Re-‐design : a)  Service stabilisaOon, establishing a stable state and miOgaOng

immediate areas of risk (Due Diligence Report) b)  Workforce Redesign (Workforce Report) c)  Service Re-‐design: Immediate opportuniOes for improvement,

streamlining and efficiency for delivery from Day 1 of the transfer

All the workstreams will have strong interdependencies and criOcal path acOviOes which require robust project managing and control. The exisOng CCG governance arrangements will require acOve parOcipaOon from all CCG’s, effecOve decision making and leadership support to enable a smooth transfer.

5

The Phase 1 objecOve is to ensure the effecOve transiOon of the CHC, FNC and Complex Care service from the CSU to CCGs by 31 January 2015 Stage 2 will focus on designing the service upon transfer into the CCG’s, service stabilisaOon and miOgaOng the risks idenOfied, undertaking service redesign, producing a business case, managing the TUPE process and providing clarity to staff There are 4 proposed workstreams, all of which require a robust plan which is acOvely managed and progress tracked against

Stage 3: Deliver Timescales dictate that the TUPE process needs to commence and unlike the other workstreams in Stage 2, this process will need to run in parallel as other Stage 2 acOviOes are undertaken. Engagement, consultaOon will be key elements of Stages 2 and 3; requiring leadership sponsorship and direcOon from the CCG’s

Diagnose Understand what we

have now

Design Developing the CCG

service model, iden=fying the gaps & designing the plan to deliver the transi=on

Deliver

Delivering the transi=on

Demonstrate Ensuring pa=ent services are

maintained, adhere to quality standards and

are responsive

6

Stage 2: Key Workstreams and AcOviOes Design and transiOon of CHC service to CCG’s Stage 2 will focus on designing the service upon transfer into the CCG’s, service stabilisaOon and miOgaOng the risks idenOfied, undertaking iniOal service redesign, supporOng the CSU HR TUPE process and exit management plan. It will comprise of 4 work-‐streams with the following acOviOes:-‐

1. SupporOng the HR TUPE process and Exit Management Plan

• General consultaOon support for CSU (including briefing staff consultaOon groups)

• Individual consultaOon support for CSU

• ResoluOon of queries & formal response to requests

2. CCG OperaOng Model, Commercial

Framework & Financial Arrangements

• Clarity in CCG-‐led OperaOng Model, role of the ‘host’ CCG & interfaces with other CCG’s & CSU • Agreed organisaOon structure and delivery approach across the CCG footprint • Detailed commercial framework underpinning CCG’s & host CHC service agreed across CCG’s • Financial arrangements across all CCG’s confirmed. Current year financial posiOon clarified, forecasted spend, budgets defined, mechanism for reporOng & process for undertaking acOvity agreed across CCG’s. Handover between CHC and Finance teams clarified

3. Workforce Redesign

• AcOvity survey will deliver a detailed and reliable set of acOvity data upon which to base the workforce requirements plan. • Process map from iniOal referral through to package insOgaOon and reviews. • Structured pathway which will review current process and idenOfy effecOveness improvements • AcOvity map detailing acOviOes of each grade of staff, aligned to the agreed pathway • A root and branch review and recommendaOons in the shiF of acOviOes to reflect a more modern workforce design and address current imbalances in acOvity • Staffing role redesigns mapped to grade and staff group to derive an opOmal grade structure

4. Service StabilisaOon & IniOal Service Re-‐

design

• Service stabilisaOon, establishing a stable state and miOgaOng immediate areas of risk (Due Diligence Report)

• Immediate opportuniOes for improvement, streamlining and efficiency for delivery from Day 1 of the transfer

Purpose : To manage the transfer of the exisOng CHC, FNC and complex care service -‐ including workforce -‐ from the CSU to the host CCG by end of January 2015

Scope September October November December January February March

Stage 1 : Diagnosis

Diagnosis complete

Stag

e 2 : D

esign

Service StabilisaMon & Service Re-‐design : a) Service stabilisaOon, establishing a stable state and miOgaOng immediate areas of risk (Due Diligence Report) b) Workforce Redesign (Workforce Report) c ) I mme d i a t e o p p o r t u n i O e s f o r improvement, streamlining and efficiency for delivery from Day 1 of the transfer

CHC OperaMng Model: CCG-‐led CHC OperaOng Model, Commercial Arrangements & Financial PosiOon

HR ConsultaMon / TUPE Process ad Exit Management: Advisory supporOng the HR TUPE process and transfer of staff into CCG’s

Stage 3 : Deliver Delivery of transiOon of CHC service to CCG’s – formal implementaOon

Stage 4 : Demonstrate

Ensuring paOent services are maintained, adhere to quality standards and are responsive

Engagement & ConsultaHon

Robust and formal engagement & consultaOon with staff, stakeholders, CCG’s, CSU’s & providers

Governance Governance framework, project plan, steering group, working group

Stage 1: Diagnosis

Robust CCG governance, project plan, steering group established to underpin the transfer of CHC services to CCG’s

Service Stabilisation Design

Workforce Redesign

Day 1 Transfer Service Efficiency Opportunities

Selection to roles

TUPE Policy , Process & Plan

Define assessment process

TUPE Process – general & individual consultation and formal transfer to CCG’s

Collation of transformation plan & service change for 15/16

CCG Operating Model

Collation of risks, issues, workforce – long term service

efficiencies, aspirations & plans – feed into 15/16 planning & preparation for service

change

Resolution of individual grievances

Ongoing consultation, engagement & involvement of CSU, CHC staff & key stakeholders as fundamental to transitioning & improving the service

Phase 1 : Stages 2, 3 & 4

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Stage 2: Approach

8

The approach adopted within the 4 workstreams in Stage 2 will be fundamental to delivering a smooth transiOon. Engagement, consultaOon, communicaOon with key stakeholders, needs to be underpinned by robust governance and decision making by the CCG’s Working in partnership with the CSU and staff consultaOon groups will be key determinants of success and need to epitomise the way the CCG’s wish to effect service transfers in future

Purpose : To manage the transfer of the exisOng CHC, FNC and complex care service -‐ including workforce -‐ from the CSU to the host CCG by end of January 2015

Scope Approach Stag

e 2 : D

esign

Service StabilisaMon & IniMal Service Re-‐design : a) Service stabilisaOon, establishing a s t a b l e s t a t e a nd m iO gaOng immediate areas of risk (Due Diligence Report) b)Workforce Redesign (Workforce Report) c)Immediate opportuniOes for improvement, streamlining and efficiency for delivery from Day 1 of the transfer

Preference would be to engage with key CHC staff in CHC service redesign at an operaOonal and tacOcal level through a series of focused workshops (dependent on approval by the CSU)

Workforce Redesign will be carried out through a series of individual discussions, workshops and focus groups. Specific emphasis will be given to Specialist Staff who currently provide a service across a wider footprint where a firm knowledge of the volumes of acOvity, complexity of the workload, locality specific pressures and challenges will be drawn out.

Structured discussions and facilitated workshop with CCG’s

All proposals to be captured in a project plan which will be acOvely managed and progress tracked both up to the transfer of CHC on 31 Jan 2015.

CHC OperaMng Model: CCG-‐led CHC OperaOng Model, Commercial Arrangements & Financial PosiOon

Series of structured workshops across the Cheshire & Wirral CCG’s to agree the operaOng model, commercial arrangements and organisaOon design. Individual CCG discussions to ensure all concerns and issues are known and miOgated

TUPE Process: Managing the TUPE process and transfer of staff into CCG’s

Needs to be iniOated and led by the CSU and CCGs. However, we will provide some limited advisory support ensuring agreement to policy, process and plan.

Engagement & ConsultaHon

Robust and formal engagement & consultaOon with staff, stakeholders, CCG’s, CSU’s & providers

AcOve engagement with all stakeholders whilst adherence to the TUPE requirements for approaching staff due to transfer. To be led by an agreed engagement and communicaOon plan.

Governance Governance framework, project plan, steering group, working group

ExisOng CCG Steering Group and individual CCG governing bodies providing the leadership sponsorship, direcOon seong and decision making

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Service StabilisaOon & Service Redesign Workforce Redesign

Based on the findings from the Workforce Report, it is proposed to focus on 3 main aspects:

1. Detailed survey of current acMvity •  This will deliver a more detailed and reliable acOvity set upon

which to base the workforce requirements plan. It is a 2 week survey which will be designed with the staff to ensure ownership. The quesOonnaire will include specific apenOon provided to Specialist Staff, volumes of work, footprint areas, specific locality challenges

•  Pilot and amend •  Launch and support •  Analysis and write up

2. QualitaMve redesign •  AcOvity and process analysis from iniOal referral through to

package insOgaOon and reviews •  Current staff acOvity mapping of each staff grade, including

administraOve staff. All acOviOes are then listed and mapped against three categories:-‐

•  (i) professional – only a registered nurse can undertake these acOviOes

•  (ii) support – those which are both convenOonally, and by redesign, administraOve funcOons

•  (iii) discreOonary – acOviOes which have tradiOonally or by default or lack of support have been performed by registered nurses, but given increased competence via specific training a non-‐registered person could and indeed should undertake these tasks

•  A root and branch review and recommendaOons in the shiF of acOviOes to reflect a more modern workforce design and address current imbalances in acOvity

•  Staffing role redesigns mapped to grade and staff group to derive an opOmal grade structure

9

A fundamental area of the DiagnosOc stage was the Workforce Report. Given the limited data available on staff roles, performance, producOvity; assessment of overall capacity of the service requires further informaOon before extra CHC resources are deployed. This will be the iniOal priority, which will then feed into a Workforce Redesign and the Plan to deliver the agreed changes.

3. Workforce plan For each of the 5 CCGs we will produce a bespoke workforce plan that sets out workload to staffing parameters. This will include requirements of staffing establishments against each of the grades, providing the populaOon and appropriate acOvity levels. This will cover both permanent workforce and fixed-‐term / temporary workforce (for example addressing backlog reviews etc). Other deliverables include:-‐ •  Agree producOvity, throughput performance levels •  Model staffing requirements using re-‐designed roles •  RecommendaOons on staff role development/training •  ImplementaOon plan

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Breakdown of Stage 2: Design Key acOviOes and deliverables

Key AcMviMes

Stage 2 will focus on suppor=ng the delivery of the HR Consulta=on plan and the role of the incoming organisa=on, mi=ga=ng the risks iden=fied, and undertaking ini=al service redesign. Based on the outcomes of the diagnosis stage, we recommend the following workstreams are implemented within the scope of Stage 2:

1.  Advisory support to the HR TUPE ConsultaOon process and exit management plan regarding the transfer of staff into CCG’s

2.  CCG-‐led CHC OperaOng Model, Commercial Arrangements & Financial PosiOon

(stranded costs). In-‐house CCG financial model to be developed by CCGs.

3.  Service StabilisaOon & Service Re-‐design : a)  Service stabilisaOon, establishing a stable state and miOgaOng immediate areas

of risk (Due Diligence Report) b)  Workforce Redesign (Workforce Report) c)  Immediate opportuniOes for improvement, streamlining and efficiency for

delivery from Day 1 of the transfer

All the workstreams will have strong interdependencies and criOcal path acOviOes which require robust project managing and control. The exisOng CCG governance arrangements will require acOve parOcipaOon from all CCG’s, effecOve decision making and leadership support to enable a smooth transfer.

10

Stage 2 -‐ Deliverables §  TUPE transiOon plan and process with

the CSU – including the process for idenOfying and selecOng staff

§  Defined CHC operaOng model,

commercial arrangements and clarity in the stranded costs

§  Service StabilisaOon plan detailing

miOgaOng soluOons for immediate areas of risk, efficiency and service improvements from day 1 of the transfer

§  Workforce Redesign proposals covering

workforce capacity, capability, roles, accountabiliOes, organisaOon structure, performance measures

§  Wider stakeholder engagement plan

covering third parOes, idenOfied CCG’s, providers

Phase 1: To ensure the effec=ve transi=on of the CHC, FNC and Complex Care service from the CSU to the host CCG by 31 January 2015 Stage 2: Design Developing the CCG service model, iden=fying the gaps & designing the plan to deliver the transi=on Here we outline the key acOviOes which underpin Stage 2 – the design; together with the deliverables you will receive

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CHC Governance Framework

0

This slide describes the proposed programme governance hierarchy for CHC Stage 3:

PMO

CHC Steering Group – Monthly Meeting CSU/CCGs – Part 1

CCGs – Part 2

CHC Operational Group - Cheshire and Wirral CCGs and NWCSU

Target Operating

Model Lead: Mick

Dolan

CFOs/AO’s

Workforce Redesign

Lead: Hilary Heywood

Clinical and Quality Group Lead: Sally Rogers

Esca

latio

n/Ap

prov

al/D

ecis

ion

Mak

ing

CHC Operation

BAU Groups/

Turnaround Teams

CHC Core Focus Group

(CSU)

Operating Model

Commercial/Legal/

Procurement

Model Costing

Service Transformation

Specialist Focus Group

(CSU)

Work streams – Task and Finish Groups:

Exit Mgt. -Engagement

& Consultation

Lead : Lisa Kelly

Entry Mgt. – Supply & Demand,

Recruitment Lead: Lisa

Kelly

HR / TUPE Work-streams:

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Governance

1

Programme Governance • Approves plan/recommendations • Proactively drives the programme through effective leadership • Controls programme scope • Ensure alignment and consistency across the Programme • Understand programme status, progress & significant variances • Manages risk and resolves escalated issues • Removes barriers to programme success • Adherence to authorisation and governance framework within each individual CCG – escalate/seek approval as

appropriate

Project Governance • Manages the scope and delivery of the work stream project plans • Manages issues and risks • Reports progress to Account Director and Project Manager • Captures dependencies and critical path activities • Production of Weekly Highlight Report, circulated to CHC Working Group members

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CHC Summary of Groups and their Members •Part 1: P Meakin, L Kelly, Y Lochhead, others from CSU as required plus CCG (see part 2 below). •Part 2: H McCairn (Chair), F Field, G James, A Whittingham/J Burchell, I Stewart, J Thorley, N Evans, S Rogers, S Clein, S Dilks, H Heywood (IHS), D Edwards (IHS), extend as required at future points in time

CHC Steering Group

•H McCairn, F Field, G James, A Whittingham/J Burchell, I Stewart, J Thorley, N Evans, S Rogers, S Clein, S Dilks, H Heywood (IHS), D Edwards (IHS), P Meakin, Y Lochhead (NWCSU)

CHC Operational Group

•Sally Rogers (Lead), Judith Thorley, Sarah Clein, Sheila Dilks, Lesely Doherty, H Heywood Clinical Quality Group

•Lisa Kelly, Jenny Williams, Fiona Field, Sarah Clein, Phil Meakin, Hilary Heywood / Denise Edwards, Julie Weeks HR / TUPE / Workforce Group

•M Dolan (IHS), D Edwards (IHS), others to be confirmed Target Operating Model

•H Heywood (IHS), S Rogers, S Clein, Y Lochhead, D Edwards (IHS) others to be confirmed Workforce Re-design

2

This slide summarises the various groups set up and their members to support and direct the Transition and interim Re-design of CHC, in order to stabilise the service. Note, they do not necessarily include all the resources identified to undertake all the tasks to deliver The work stream/project plans. Terms of Reference for the CHC Steering Group is currently being Updated In order to strengthen and illustrate Closer links to DOFs and AOs during these phases (Fiona Field)


Vision 2018: an update for partner Governing Bodies/Organisational Boards


Report to: Governing Body Meeting Date: 2nd December 2014

Lead Officer: Jon Develing, Interim Accountable Officer

Contributors: Anna Rigby, Vision 2018 Programme Manager Terry Whalley, Project Director, North West Leadership Academy Lesley Doherty, Interim Assistant Accountable Officer


The Vision 2018 programme is based on the CCG Operational and Strategic Plans.

Link to current strategic objectives

1 Prevent people from dying prematurely 2 Enhance the quality of life for people with long term conditions 3 Helping people to recover from episodes of ill health or following injury 4 Ensuring people have a positive experience of care 5 Ensuring people are treated and cared for in a safe environment and protected from avoidable harm

Summary: The paper describes the progress to date in regards to; • the review of Vision 2018 governance arrangements and programme

structure and priorities; • the case for change describing the size of the financial challenge and

population need; • and the development of the next steps for implementing change.

Recommendation:

To Approve

To Note X

Comments

The members of the Governing Body are asked to: • to note the progress of the development of Vision 2018 • to provide feedback to the Strategic Leadership Group

regarding progress to date and next steps

Next Steps:

The next steps of Vision 2018 are highlighted in the paper and summarised below

• Continuing to ensure that there are clear links Vision 2018 projects and the commissioning process

• Establishing frameworks to enable the Fast 5 projects to be implemented quickly and efficiently so that the benefits can be maximised

• Developing plans for the Big 5 projects detailing how they will be designed and how changes can be made over the coming years (eg using a value stream analysis approach to identify options to redesign the current system for unplanned care establishing the short term and long term benefits and the timescales for proposed changes)

• Continuing to review capacity in the Programme Management Office to ensure that there is sufficient resource to deliver Vision 2018 effectively in the timescales necessary.



The financial challenge for the health and social care system is outlined in this paper. Without the partnership approach and reaching an agreed solution to the financial challenge via Vision 2018, there is a risk of cumulative financial pressures to the health and social care economy and consequently poorer health and social care outcomes to Wirral residents.

Value For Money Each of the projects within Vision 2018 is required to complete cost benefit analysis as part of the Project Outline Document and then depending on the type of project will require further financial assessment and tracking.

Risk The update paper does not detail the current risks of the programme, a risk register is held by the Programme Management Office and escalated to the Implementation Group and Strategic Leadership group as appropriate.

Legal There are processes in place to ensure that both Local Authority and NHS statutory duties e.g. the Public Sector Equality Duty are met in the implementation and delivery of Vision 2018.

Workforce The update paper does not detail the workforce implications of the Vision 2018 Programme, however this is being addressed by the Communications and Workforce Workstream.


Each individual project within Vision 2018 will assess equality implications as necessary. In the Vision 2018 Project Documentation the stakeholder analysis prompts the project managers to plan the necessary engagement activity and if significant change to a protected group a project manager must complete a Equality Impact Assessment to ensure Public Sector Equality Duty is met.


In the development of the Vision 2018 Programme we are undertaking a number of methods of engagement in order to encourage participation of local residents. A key principle of the engagement process is to ensure that it is undertaken in a co-design approach where models of care are designed with staff, service users and carers to ensure they meet the needs of the population, achieving the strategic outcomes. The requirement for any formal consultations will be considered and agreed for each individual project. Following the initial launch event the ‘Engagement with People Group’ has been established to ensure that we are involving all Wirral communities with Vision 2018. The group includes traditionally under-represented groups of all ages (including those identified in the 2010 Equalities Act as being most risk of discrimination). It is utilised to develop the engagement strategy for Vision 2018 as well as being a ‘sounding board’ to focus test publicity and the programmes/project outcomes and a cascade mechanism to engage with the wider stakeholders that the group represents.

Partnership Working

The Vision 2018 Strategic Leadership Group consists of Executive Leaders including the key partners across the Wirral Health and Social Care economy, with additional key stakeholders represented in the workstreams.



The Strategic Outcomes for Vision 2018 are detailed in the attached paper, key performance indicators are currently being developed along with a finance and outcomes dashboard to monitor the benefits of the projects.




Report Name Reference Submitted to Date Brief Summary of Outcome Vision 2018: an update for partner Governing Bodies/ Organisational Boards

Vision 2018 Strategic

Leadership Group

22nd October 2014

Approved

Vision 2018: an update for partner Governing Bodies/ Organisational Boards

Joint Strategic Commissioning

Group

23rd October 2014

Noted


Vision 2018 Programme

Managers Group

5th November 2014

Noted


Vision 2018 Implementation

Group

18th November 2014

Noted

Private Business The Board may exclude the public from a meeting whenever publicity (on the item under discussion) would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution. If this applied, items must be submitted to the private business section of the Board (Section 1 (2) Public Bodies (Admission to Meetings) Act 1960).



The definition of “prejudicial” is where the information is of a type the publication of which may be inappropriate or damaging to an identifiable person or organisation or otherwise contrary to the public interest or which relates to the provision of legal advice (for example clinical care information or employment details of an identifiable individual or commercially confidential information relating to a private sector organisation). If a report is deemed to be for private business, please note that the tick in the box, indicating whether it can be published on the website, must be changed to a x. If you require any additional information please contact the Lead Officer.

1

Vision 2018: an update for partner organisations’ Boards

Document History

Authors: Terry Whalley, Project Director - Vision 2018, North West Leadership Academy Anna Rigby, Vision 2018 Programme Manager, Wirral Clinical Commissioning Group Approved: Vision 2018 Strategic Leadership Group (SLG): 22.10.14 Version: Final Draft (including amendments noted at SLG): 17.11.14

2

The purpose of this paper is to provide an update to Board members of partner organisations in respect of the Vision 2018 programme.

Contents 1. Vision 2018 Context .................................................................................................................................................. 3

2. Governance ............................................................................................................................................................... 3

3. Strategic Leadership Group Terms of Reference ...................................................................................................... 5

4. Implementation Group Terms of Reference ............................................................................................................. 8

5. The Case for Change ............................................................................................................................................... 11

6. Strategic Outcomes ................................................................................................................................................. 13

7. Programme Scopes ................................................................................................................................................. 15

8. Current Position and Next Steps ............................................................................................................................. 17

9. APPENDIX ................................................................................................................................................................ 19

A. Programme Structure ......................................................................................................................................... 19

B. Lead Programmes ............................................................................................................................................... 19

C. Programme Directors and Managers .................................................................................................................. 20

D. Scenarios ............................................................................................................................................................. 21

E. Checklist – Big 5, Fast 5 ....................................................................................................................................... 25

F. Long Term Conditions and Complex Needs Big/ Fast Projects ........................................................................... 26

.................................................................................................................................................................................... 27

G. Timeline October – December 2014 ................................................................................................................... 27

H. Glossary of Acronyms.......................................................................................................................................... 28

3

1. Vision 2018 Context Vision 2018 is the plan to re-shape health services and social care in Wirral, whilst supporting people to take more responsibility for looking after their own health. Over the next 20 years, the number of people who are aged 85 or over will more than double, meaning many more people with multiple, long term health conditions and increased financial pressures. However the challenges also present opportunities. Vision 2018 will transform GP, primary care, community health, hospital and social care services in Wirral. It will mean:

• Community based health services (e.g. access to GPs, community nurses and social workers) seven days a week • More hospital services in the community, with consultant led teams • Health and social care professionals working together for people with on-going needs: one assessment, one

care plan, one key coordinator • Specialist in-patient hospital care for those that need it • Support for people to look after themselves and stay healthy

We are developing a Vision 2018 Strategy to outline the case for change, to describe the vision for Wirral health and social care economy and how this will be achieved. We have established a new shape to Vision 2018 which allows us to focus our efforts on 3 key programmes of work; Planned Care, Unplanned Care and Long Term Conditions and Complex needs (Appendix B). We also have a number of enabling programmes, for example Integration Adults, which focuses on the development of integrated teams, services and systems to provide coordinated care for people aged over 18. For the full programme structure see Appendix A. We have done more work to ensure we have really clear strategic outcomes defined for Vision 2018; these have been informed by local evidence base and national drivers including the Better Care Fund aims and objectives (Section 6 – Strategic Outcomes). Each of the programmes are developing a detailed definition of scope to ensure its aims and objectives are linked back to these strategic outcomes. This will enable a clear description of how those programmes will enable benefits that will ultimately improve health outcomes for the people of Wirral together with their experience of health care. At the same time, balancing quality and value to improve the efficiency of services delivered will be the third major consideration for each programme. As part of a series of 30 day challenges each of the programmes are identifying the projects that can be done quickly to start to make a real difference in 2015 i.e. ‘the Fast 5 projects’ along with those bigger, transformational projects that will need further planning ‘the Big 5 projects’. It is important that we balance the need to re-imagine health and wellbeing in 2018 and consider how best we achieve this future state vision with the need to make real and practical improvements to the services we have today. It is this balance that the Vision 2018 team is now focused on achieving. 2. Governance The Vision 2018 Strategic Leadership Group (SLG) is made up of the Chief Executives from NHS Providers and Commissioners along with equivalent Stakeholders from Local Authority. The SLG recognises that there exists already a Health Economy governance framework; the Health and Wellbeing Board and the Joint Strategic Commissioning Group, there are also respective Provider and Commissioner Boards or similar Governance Arrangements. In no way shape or form is any proposed governance arrangement for Vision 2018 intended to replace or interfere with any of these established governance models.

4

Rather, the Vision 2018 SLG is seeking to establish the best way to integrate decision making within the context of Vision 2018 into this broader established framework, the desired outcome being an appropriate balance of pace and rigour to enable safe but rapid progress to be made meeting the challenges this health economy faces. It is proposed therefore that respective organisations’ Boards delegate through their Chief Executive some level of decision making authority to enable the SLG to take certain decisions in a more timely fashion, but at the same time provide clarity on the expectations each Board has for when their CEOs will refer back to their Boards. It is also proposed that the Implementation Group, on behalf of the SLG, provides recommendations to the Commissioners on matters which affect Commissioning, contracts and use of Better Care Fund (Figure 1). If this is done, and done effectively, there is increased probability that the organisations can become better performing collaborators in defining solution options for Wirral’s Health and Social Care Economy, and that an effective delivery and tracking mechanism can be wrapped around the whole transformation agenda to ensure a joined up approach, informed decision making, robust benefits and costs management plus effective dependency and risk management. There will need to be different ‘checkpoints’ during the development and implementation of the projects within Vision 2018 and to ensure that the governance model enables faster projects to be implemented quickly whilst ensuring that that they align to the longer term vision and principles of the individual organisations. There are four scenarios that have been developed to described how the governance model will be applied to 1) Faster projects 2) Bigger Projects 3) Commissioner Led Projects and 4) ‘Other’ non contractual projects (Appendix D). Figure 1: Proposed Governance Structure

5

3. Strategic Leadership Group Terms of Reference Role/Purpose

• To be accountable for delivering a sustainable Wirral Health and Social Care Economy

Tasks • To agree the strategy and implications of this • To agree the processes and resources for delivery • To steer the implementation group • To enable delivery/resolution of issues • To resolve conflict/issues

Interfaces

• Health and Wellbeing Board (the Strategic Leadership Group will report to the Health and Wellbeing Board) • Wirral Joint Strategic Commissioning Group (this group also reports directly to the Health and Wellbeing

Board) • Strategic planning for each organisation needs to link in with the development of the Vision 2018 strategy • Organisational Boards to be informed and updated by members of the Strategic Leadership Group • Implementation Group (this group will report to the Strategic Leadership Group), the Implementation Group

Chair will be a member of the SLG to provide a link. Governance and Accountability The Strategic Leadership Group (SLG) will be accountable for delivering a sustainable Wirral Health and Social Care Economy. It will hold the Implementation Group to account to lead and manage the successful delivery of the strategy. The Implementation Group (IG) will hold the programmes identified below to account to organise and manage the delivery of the goals and objectives assigned to the programme of work/enabling groups. The Strategic Leadership Group will report its progress to Health and Wellbeing Board. The Programme Management Office (PMO), hosted by the CCG, will support the Implementation Group in organising and managing programme development and delivery, providing a central function for the programme in collating and reporting overall status. The programmes will report progress to the Implementation Group on a monthly basis and exceptions and risks to the Strategic Leadership Group. The members of the group, through the Memorandum of Understanding, will also hold each other to account for delivery of agreed objectives and ensuring each partner contributes appropriately to overall vision and aims. The SLG, while appropriately empowered by respective organisations to take decisions with delegated limits, will nonetheless ensure that assurance is provided back to respective Boards and to the Health and Wellbeing Board and Joint Strategic Commissioning Group as to those decisions, and will refer recommendations to those Boards when limits of decision making are reached. This mechanism will maximise the opportunity for effective collaboration while eliminating the risk of collusion.

6

Programmes of Work A number of programmes of work have been established to deliver specific elements of the overall aims and objectives of Vision 2018, these programmes of work will report into the Implementation Group. The lead programmes are;

• Planned Care • Unplanned Care • Long Term Conditions and Complex Needs

The programmes that deliver care or system enablers are:

• Communications and Workforce o Engagement (sub group)

• Integration - Adults • Integration - Children • Prevention, Self-Care and Community Development • Information Technology and Information Governance • Primary Care Strategy Group • Finance and Contracting • Estates

There is also the Outcomes and Quality Assurance group (OQuA), which is charged with providing scrutiny to proposals and providing oversight and responsibility for ensuring that outcomes and modelling support is made available to programmes.

Role of Members The members of the Strategic Leadership Group will be of senior level within their respective organisations and have the ability to make decisions and escalate issues as appropriate. They will also ensure compliance with governance arrangements. Members will be responsible for disseminating information to and from their organisations, departments or professional groups. Membership

Name Title Organisation Role Jon Develing Interim Accountable Officer CCG Commissioner

Clare Fish Strategic Director of Families and Wellbeing

WMBC Commissioner

Fiona Johnstone Director of Public Health WMBC Commissioner Graham Hodkinson Director of Adult Social

Services WMBC Commissioner

David Allison Chief Executive WUTH Provider Simon Gilby Chief Executive CT Provider Sheena Cumiskey Chief Executive CWP Provider Dr Peter Naylor Acting Chair CCG CCG Provider

7

In cases where members cannot attend for a single meeting, apologies should be sent. A deputy would not be permissible for the core members section, but is encouraged for the Business Items for Decision. Also in attendance at the Business Items for Decision segment of SLG are:

Name Title Organisation Anna Rigby Vision 2018 Programme Manager CCG Terry Whalley Project Director - Vision 2018 NWLA Clare Grainger Vision 2018 Project Manager CCG Andrew Crawshaw Director of Operations and Delivery NHS England

Additional members will be invited as and when required. Frequency of Meetings Monthly (to be reviewed after 6 months) Communication and Accountability Arrangements Members will retain accountability to their respective organisational governance arrangements, but with agreed levels of delegated authority from their respective organisations Resources In terms of publicity, engagement and other activities related to Vision 2018, member organisations should be prepared to contribute resources on an equitable on-going basis as details arise. In addition, partner organisations will be expected to provide resource to enable members to attend and will not be reimbursed additionally. Administrative Arrangements Decisions and Actions will be recorded, but there will be no need for full meeting minutes. Chair/Vice Chair Chair: Jon Develing Vice Chair: Pete Naylor Quorum 2 Commissioners and 2 Providers Date of Ratification/Date of Review First draft: 30.05.14 Second Draft: 10.06.14 Third Draft 10.10.14 Date of approval: 22.10.14 Date for review: 01.03.15

8

4. Implementation Group Terms of Reference Role/Purpose

• To lead and manage the successful delivery of the strategy through the core components of Delivery, Grip and Coherence.

Function

• To identify gaps in programme resource and areas of risk to be reported to the SLG • Utilise the Programme Management Office to:

• Define the goals and objectives of the workstreams • Manage the performance of the workstreams • Drive the implementation of the strategy activity • Identify if the programme is delivering benefits to the system • Link cross cutting themes across programmes • To identify gaps in programme resource and areas of risk to be reported to the SLG

Interfaces • Programmes (chairs to sit on this) • Strategic Leadership Group

Governance and Accountability (See Governance Structure Figure 1) The Programme Management Office, hosted by the CCG, will support the Vision Programme in organising and managing programme development and delivery, providing a central function for the programme in collating and reporting overall status. The programmes will be accountable to the Implementation Group and report progress to the group on a monthly basis. A meeting of the programme managers will assist with alignment, cross-cutting themes, delivery and reporting. The Programme Directors will be held accountable by the Implementation Group for delivery of agreed objectives and for ensuring each member and partner contributes appropriately. Members will retain accountability to their respective organisational governance arrangements, but with maximum levels of delegated authority from their respective organisations. If there are any issues with contribution from work-stream members or sub-groups that tasks are delegated to, the Programme Director will be expected to escalate these to the Implementation group to resolve. Role of Members Implementation Group members have the ability to make decisions and escalate issues as appropriate within their organisation. They will also ensure compliance with governance arrangements. Members will be responsible for disseminating information to and from their organisations, departments or professional groups. Membership In cases where members cannot attend for a single meeting, apologies and a deputy should be sent. Additional members will be invited as and when required.

9

Name Title Organisation Representing which Programmes/Functions

Fiona Johnstone Director of Public Health WMBC Outcomes and Quality Assurance David Allison Chief Executive WUTH Planned Care

Jon Develing

Interim Accountable Officer CCG Unplanned Care

Sheena Cumiskey Val McGee

Chief Executive Service Director for Wirral

CWP CWP

Long Term Conditions / Complex Needs

Graham Hodkinson

Director of Adult Social Services WMBC Integration – Adults

Clare Fish

Strategic Director of Families and Wellbeing

WMBC Chair – Implementation Group

Julie Webster Head of Public Health WMBC Prevention, Self-Care and Community Development

Simon Gilby

Chief Executive CT Communications and Workforce

Julia Hassall Director of Children's Services WMBC Integration – Children Mark Blakeman Director of Informatics WUTH IT and Information Governance Pete Naylor Acting Chair CCG Primary Care Strategy Group Mark Bakewell Chief Financial Officer CCG Finance and Contracting Simon Gilby Chief Executive CT Estates Richard Freeman Interim Head of QIPP Delivery,

Specialised Commissioning NHS England N/A provides link to NHS England

Terry Whalley Project Director - Vision 2018 NWLA N/A Anna Rigby Vision 2018 Programme

Manager CCG N/A

Clare Grainger Vision 2018 Project Manager CCG N/A Resources / Capacity and Capability It is the responsibility of the Implementation group to consider any additional capacity and capability resources identified by workstreams as necessary to deliver the work stream programme. Frequency of Meetings Monthly Leadership Programme Director /Chair: Clare Fish Programme Manager / Vice Chair: CCG Accountable Officer Quorum Representation from each lead programme of work. Administrative Arrangements Decisions and Actions will be recorded, but there will be no need for full meeting minutes.

10

Reporting The Implementation Group will review monthly workstream update reports PMO Each work stream will need to adhere to PMO principles and methods. Date of Ratification/Date of Review First draft: 10.07.14 Final Draft: 16.10.14 Date of approval: 22.10.14 Date for review: 01.03.15

11

5. The Case for Change We know from our planning that the demand for health and social care will be increasing against a background of reducing resources across all organisations. In this context, we need to transform the way we provide health and social care, to ensure we are working as efficiently as possible, and we will need services that empower patients to manage their health and wellbeing. People will need to share in the decision-making process about themselves and their care and support. The interactions between community, residential and hospital services will be improved, with care delivered through integrated services 7 days a week that are joined up around the needs of patients. This integrated care will be provided across the community, bringing specialised care and treatment (when appropriate) into community settings near patients’ homes, to enable the right care to be provided at the right time and the right place, with patients supported to self-care as appropriate. These changes will implemented between now and 2018, and the model of care will be co-developed with the public and staff to ensure it meets the needs of the Wirral population, with the right capacity and balance across the community, residential and hospital services. A piece of work has been undertaken which models the scale of the challenge faced by Wirral Health Economy, the ‘Shape Change Analysis’. This piece of work requires further validation in the coming months however shows a potential gap of around £150m given forecast of cost pressures and assumptions around funding growth (Figure 2). This is an unprecedented position, and we need to reimagine how health and wellbeing is delivered and consider making assumptions about the scale of change required. Figure 2: The challenge facing the system

Alongside the financial pressures, the demand for local services is increasing. Wirral’s overall population is projected to increase by 1.4% from 319,863 in 2011 to 324,226 in 2021. The older population (aged 65 years and above) are

400,000,000

500,000,000

600,000,000

2013/14 2014/15 2015/16 2016/17 2017/18 2018/19

Funding Forecast costs

c£150m

£

12

expected to increase at the fastest rate, with an 18% increase projected by 2021. They are also more likely to have a long term condition; the 2011 Census reported about 36,000 (57%) people living in Wirral aged 65 years and over have a long term condition or disability that limits their daily activities. The health outcomes of Wirral residents vary depending on the area of Wirral in which they live, which has an impact on the health inequalities across the population. Due to the size of the gap and the needs of the population changing there is a need to reimagine health and social care and make transformational changes that will create a new health and social care system to improve health outcomes, patient and service user experience and value for money (Figure 3). Figure 3: A significant change in approach

In addition to continuing with traditional incremental change (Cost Improvement Programmes (CIP) based on current operating models), the transformational change that we will need to make begins with managing the demand on services e.g. via prevention, referral management, integrated care. Then, making sure that of those people who do require services that they are provided with the right care in the right setting and finally a focus on the efficiency is needed to ensure the pathways are delivered in the most efficient way (Figure 4). As much of the evidence base is focused on efficiency rather than managing demand and right care right setting it is necessary for us to create some high level assumptions of how we can change the health and social care system in a different way. Figure 4: Logic Model for transformational change

Managing Demand

Prevention Integrated

Care

Referral Manageme

nt

Right care – right setting

Right setting LoS

Efficiency

Improved pathway

Workforce flexibility

avoid c 10% episodic demand 15% of episodic

demand differently improve pathway

efficiency by 15-20%

prevent x% LTC demand via self

care transfer 20-40% of planned care to community

Examples of What other systems are basing their

strategies upon

13

6. Strategic Outcomes To provide some further guidance to colleagues working on Vision 2018, and to ensure we have the right focus on patient safety and quality in addition to the financials, we have identified three guiding principles that underpin the scope of work within Vision 2018;

1. We will improve Health and Wellbeing outcomes 2. We will improve patients’ and service users’ experience 3. We will reduce the cost of health and social care

Figure 5: Outcomes Pyramid These guiding principles, the ‘triple aim’ have then been further defined in a set of Strategic Outcomes that we are striving to achieve through Vision 2018. Some of these are highly aspirational and ambitious, but they serve as a goal that all programme objectives and benefits should directly link back to. Taking this approach will ensure that the deliverables at project level will be demonstrably and directly linked back to one or more of the triple aims. The Strategic Outcomes defined are listed below.

Defined at Project Level by any programme these are the things that enable benefits to be realised or objectives to be met, which in turn contribute to the Vision 2018 Strategic Outcomes

Guiding

Principles

Vision 2018 Strategic Outcomes

Programme Objectives and Benefits

Deliverables and Enabling Impacts

Set and governed by Strategic Leadership Group, with potential delegation to Implementation Group

Defined by three Lead Programmes of Work, with input and intelligence from Care Enabling Programmes, with a clear line of sight back to Vision 2018 Strategic Outcomes. Governed by Implementation Group

14

Table 1: Vision 2018 Strategic Outcomes

Vision 2018 Strategic Outcomes 1 We deliver the right care in the right place at the right time. First time and every time. 2 We deliver an improved health and wellbeing experience to all patients, service users and carers, in all health, community

and social care settings 3 We reduce the frequency and necessity for emergency admissions and for care in hospital, residential and nursing home

settings 4 We enable more people to access appropriate and effective services closer to home 5 We improve health and social care outcomes in early years to improve school readiness 6 We enable more people to live independently at home for longer 7 We improve the health and social care related quality of life for people with more than one long term condition,

physiological and/or psychological 8 We increase collaboration and effective joint working between health and social care partners 9 We improve the satisfaction levels for our workforce colleagues across all health, community and social care settings 10 We improve the end of life experience for individuals and their carers. 11 We are better able to prevent ill health and diagnose conditions quickly thereby reducing the burden on treatment

facilities 12 We enable people to live longer, healthier lives 13 We reduce the cost of health and social care while maintaining balance of quality and value 14 We ensure equal and fair access to clinically appropriate services for everyone on the Wirral 15 We will reduce health inequalities so that all Wirral’s residents can expect and receive the same health and wellbeing

opportunities

15

7. Programme Scopes Each of the programmes are developing a detailed definition of scope to ensure its aims and objectives are linked back to these strategic outcomes. This will enable a clear description of how those programmes will enable benefits that will ultimately improve health outcomes for the people of Wirral together with their experience of health care. At the same time, balancing quality and value to improve the efficiency of services delivered will be the third major consideration for each programme. The programmes are identifying the projects that can be done quickly to start to make a real difference in 2015 i.e. ‘the Fast 5 projects’ along with those bigger, transformational projects that will need further planning ‘the Big 5 projects’. The Programme Managers are using a checklist to identify if their project is faster or bigger (Appendix E). The existing projects and evidence base including Better Care Fund schemes and Quality, Innovation, Productivity and Prevention (QIPP) initiatives are being incorporated into this work to enable a coherent view and governance over all change projects across the system.

Figure 6: Hexagon ‘Deep Dive’ model

For the Big 5 projects a Hexagon ‘Deep Dive’ model for data collection is being used to develop a more detailed view of the current model/pathway and opportunities for improvement prior to developing a future state service model with staff, patients and carers (Figure 6). Some initial examples of the Big 5 and Fast 5 projects for the Lead Programmes are in Figure 7. The next step is to implement the Faster projects identified below and for the Bigger projects to initially focus on a couple that will have the biggest impact such as ‘Unplanned care system redesign’ and ‘Respiratory’. For these Bigger projects a focused approach would be undertaken to identify opportunities to transform models of care in these areas of work and establish the short term and longer term benefits.

Priority Area (E.g.

Ophthalmology)

Population Need (now /

5 years)

Present Care Pathway

Financial Expenditure

Performance / Activity

Quality / Outcomes Measures

Provision /Provider

Marketplace

N.B. Including benchmarking data

16

Figure 7: DRAFT BIG and FAST Projects for Lead Programmes

Planned Care

1. Orthopaedics 2. Gastroenterology 3. Ophthalmology 4. Urology 5. Gynaecology

1. Orthopaedic pre-secondary care referral work-up

2. One stop hernia service 3. Ear care clinic (drop-in) 4. PTNS/Botox (drop-in) 5. Trial without catheter 6. Anticoagulation services 7. Cancer strategy

Unplanned Care

1. Unplanned care system

redesign 2. Development of Community

Care of Older People’s services 3. Develop an integrated single

front door on the Arrowe Park site

4. Review of tariffs relating to unplanned care

5. Community rapid response team

1. IV antibiotics and blood transfusion

2. Early Supported Discharge 3. Pharmacy First 4. Collation and publication of

available services to all providers

5. Development of a communication strategy for Winter

Long Term Conditions and Complex Needs

1. Respiratory 2. Cardiology 3. Stroke 4. Dementia, 5. Alcohol 6. Anxiety and Depression 7. Diabetes 8. Back Pain 9. Long term, out of area,

expensive placements

1. Implementation of 15 Better Care Fund schemes e.g. Wirral Independence Service, ICCT’s/ Neighbourhood 7 Day working (for details see Appendix F)

2. Single Care Plan

BIG Projects

FAST Projects

17

8. Current Position and Next Steps

As part of the review of Vision 2018 a programme methodology has been developed (Figure 8) that is based upon Public Sector Programme Management Approach. There are five distinct phases each broken into key steps and can be used across all Vision 2018 programmes or individual projects. The current position of the Vision 2018 programme in is at the initiation phase and depending on the pace and complexity of individual programmes and projects within Vision 2018 the speed at which they progress will differ. Figure 8: Programme Methodology Progress to date: Review and Initiate Phase The paper has indicated the progress to date in regards to the review of Vision 2018 governance arrangements and Programme structure and priorities. This has enabled the baseline quantum of change required (£) to enable sustainable health and social care economy between now and 18/19 and a consensus on the Strategic Outcomes. An alignment exercise of all Better Care Fund and QIPP initiatives and along with this strategic direction has informed the development of initial programme plans for each area, identifying co-dependencies and benefits that link back to the endorsed strategic outcomes. It has also led to initial ideas of the ‘Faster’ and ‘Bigger’ Projects that aim to deliver the benefits. Next steps: Define, Design and Implement Phase The next steps are as follows (see timeline in Appendix G for more information):

• Continue the mapping to commissioning intentions and 15/16 contracting round to ensure that the Vision 2018 planning is linked into the Commissioning Cycle.

• Establish rapid cycle testing frameworks for quick wins to enable benefits to be realised at pace (see Appendix D, Scenario 1).

• Establish plans for delivering bigger initiatives for delivery during 2015/16 to follow a methodology to enable transformational change and clarity on the outputs that will be realised.

• Undertake a focused approach for Respiratory to identify opportunities to transform models of care in these areas of work and establish the short term and longer term benefits.

• Undertake a focused approach for Unplanned Care System Redesign to identify opportunities to transform models of care in these areas of work and establish the short term and longer term benefits.

INITIATE DEFINE IMPLEMENT CLOSE

1. Mandate/ case for change

2. Programme brief/ vision

3. Organise programme

4. Define governance

5. Investigate/ scope benefits

6. Programme blueprint

11. Plan project

12. Change management

13. Programme monitoring

14. Benefits realisation

15. Formal close down

16. Learning capture

DESIGN

7. Engage stakeholders

8. Develop future state

9. Define metrics

10. Consult

18

• Implement tools and templates to enable the Implementation Group to have a ‘Grip’ on the project planning, so that we can effectively manage delivery, interdependencies, cost and benefit tracking for example see Figure 9.

• Embed the Governance Framework to ensure Programme Directors and Programme Managers have clear checkpoints to report to the Implementation Group and the Strategic Leadership Group so that decision making can be made in a fully informed way by the right people.

• Determine opportunity and right size/capability for a pooled Vision 2018 Change Management Office, and how to align enabling functions ‘supply’ (e.g. workforce management, communications, engagement, finance, business intelligence) with the ‘demand’ from primary and system enabling programmes. This will ensure that there is sufficient resource to form the Vision 2018 strategy and deliver it effectively in the timescales necessary.

Figure 9: Example of Project Dashboard

Impact Low Med High

**IG = Implementation Group

BCF Projects Scale of Opportunity

Risk Start Date Development of

scheme*

Scheme aligned –

Vision 2018

Scheme approved by

**IG Delivery

date

Flexible social care support at night (6)

Low Med In place 1 UPC 2014-15Care arranging team(7)

Low Med In place

Admissionprevention (14)

High High In progress

IV antibiotics / blood transfusion (15)

Med In progress

Early supported discharge (16)

High In progress

Project DevelopmentYear 1 BCF (2014/15): in year

NWAS demand reduction (17)

High

NWAS street triage (18)

Med Med In progress

Step up step down (12)

High In progress

1

In progress

Integrated discharge team (13)

High In progress

Joint MH posts(24) High In progress

Dementia nurses(25) High In place

*Development level of scheme:1 – Full impact on non elective modelled, wil l be implemented prior to April 20152 – Non elective impact projected, will be implemented in April 20153 – Full impact on non elective not yet known as further work required, will be implemented after April 2015

1

1/2

1/2

1

1

1

2

3

1

1

UPC

UPC

UPC

UPC

UPC

UPC

UPC

UPC

LTC/CN

LTC/CN

To be approved-14.10.14











Vision 2018 Programme

Planned

Unplanned

Long Term Conditions /Complex Needs

Project REF

BCF6 UPC

BCF 7 UPC

BCF12 UPC

BCF 13 UPC

BCF14 UPC

BCF15 UPC

BCF16 UPC

BCF17 UPC

BCF18 UPC

BCF24 LTC

BCF25 LTC

2015/16£ benefit

Impact StatusProject Ref

Key Status Complete In

Progress Not Started

Medium

High

High

High

High

Med

Med

2014-15

2014-16

2014-16

2014-16

2015-16

2014-15

2014-15

2014-15

2014-15

2014-15

Low £0-50KMedium £50-100KHigh £100K +

19

9. APPENDIX A. Programme Structure

B. Lead Programmes

Planned care

Unplanned care

LTC / complex

needs

Finance & contracting

Comms & workforce

(Engagement - sub-group)

IT & info governance Estates

Prevention & self care

Outcomes and Quality

Assurance

Strategic Leadership

Group

Decision making

Primary Care Strategy

Lead Programmes

Planning and Delivery

Integration - Adults

Integration - Children

Vision Programme

Management Office *

Implement-ation

Group

Health & Wellbeing Board

*Programme Management Meeting

supports

High Level

Programmes (sub

groups also sit beneath

these)

Care enabling programmes

System enabling programmes

Self-care, early intervention prevention, building resilience and maintaining wellbeing

Integrated health and social care system principles: Right care, right time, right place, rapid response, change in culture and expectations, prioritising elderly care, 7 day integrated care, early

intervention and prevention, building on community based assets

begins with a diagnosis in the community, leading to treatment in the community or specialist input for further opinion, diagnosis, treatment or procedure. There is a planned pathway and patient is able to make decisions about their own treatment.

represents the largest proportion of people who access planned and unplanned services and require ongoing support. Eg people with diabetes, suffering from drug abuse, alcohol abuse, mental health condition or homelessness

not planned or pre-booked with a GP or hospital. It includes urgent / emergency: •GP appointments •social care •mental health crisis •pharmacists, opticians, dentists •walk-in centres •minor injuries units •North West Ambulance Service •accident and emergency (A&E) • emergency admission to hospital • GP out of hours

Short term care

Unplanned Care Long term conditions and complex needs

Ongoing Care

Planned Care

20

C. Programme Directors and Managers

Group Chair Programme Manager

Boards Strategic Leadership Group Jon Develing (CCG)

Terry Whalley (NWLA)Project Director - Vision 2018

Implementation Group Clare Fish (LA)

Anna Rigby (CCG) PMO Programme Manager

Programme Programme Directors Programme Manager

Lead Programmes

Planned Care Anthony Hassall (WUTH) Jo Goodfellow (WUTH) Unplanned Care Jon Develing (CCG) Andrew Cooper (CCG) Long Term Conditions/ Complex Needs Sheena Cumiskey (CWP) Val McGee (CWP)

Care Enabling Programmes

Integration -Adults Graham Hodkinson (LA) Peter Tomlin (CCG/LA) Prevention, Self-Care and Community Development Clare Fish (LA) Julie Webster (LA)

Primary Care Strategy Group Dr Peter Naylor (CCG)

Christine Campbell (CCG) Barbara Dunton (CCG)

Integration -Children Julia Hassall (LA) Janice Montey(LA)

System Enabling Programmes

Informatics / IT and Information Governance Mark Blakeman (WUTH)

Communications and Workforce Simon Gilby (CT)

Jane Loughran -Communications (CT), Roger Nielson- Workforce (CWP)

Engagement (sub group – C and W)

Chairs - Sandra Wall (Older peoples parliament)

Peter Tomlin (CCG) Jane Loughran (CT)

Finance and Contracting Mark Bakewell (CCG)

Estates Simon Gilby (CT) TBC Key (CCG) – Clinical Commissioning Group (LA) – Local Authority (CWP) – Cheshire and Wirral Partnership NHS Foundation Trust (CT) – Community Trust (WUTH) – Wirral University Teaching Hospital NHS Foundation Trust

21

D. Scenarios

25

E. Checklist – Big 5, Fast 5

26

F. Long Term Conditions and Complex Needs Big/ Fast Projects Bigger Projects Disease group (care pathway) Pieces of work linked to each disease profile

1. Respiratory

Review of current care pathway Respiratory specialist admission avoidance scheme Psychological input to respiratory patients around prognosis and managing anxiety

2. Cardiology

Review of current care pathway Review opportunities around creating a Community LTC rehabilitation unit – including Cardiac/Pulmonary and Cancer and aligning Live Well programme

3. Stroke Review of current care pathway 4. Dementia

Review of current care pathway

5. Alcohol

Review of current care pathway ARBD development including ABI

6. Anxiety and Depression

Review of current care pathway Link with the tendering of the PCMH service

7. Diabetes

Review of current care pathway Care planning Community Diabetes Unit

8. Back Pain Review of current care pathway 9. Long term, out of area, expensive

placements

Integrated provider hub – as per West’s model

Faster Projects Topic Details BCF – all need to be in place by 31st March 2015 • Wirral Independence – Community Equipment,

Telehealth/Telecare and Falls service • Community care of the Elderly services Unplanned

care and LTC • CCG/DASS third sector spend LTC – linked to self-care

self-management and community assets • ICCT’s Investment • Care Home schemes • Flexible social care support at night • Care arranging team Care and support bill

implementation • Investment in social services in the community • Dementia • Specialist Alcohol unit • Complex needs service • Direct joint MH posts

Single Care plan Development of a single care plan (relevant for all

programmes)

27

G. Timeline October – December 2014

28

H. Glossary of Acronyms

BCF Better Care Fund

CCG Clinical Commissioning Group

CEO Chief Executive Officer

CIP Cost improvement Programme

Comms Communications

CT Community Trust

CWP Cheshire and Wirral Partnership NHS Foundation Trust

HWBB Health and Wellbeing Board

ICCT Integrated Care Coordination Teams

IG Implementation Group

IT Information Technology

IV Intravenous

LA Local Authority

LTC Long Term Conditions

NWLA North West Leadership Academy

OQuA Outcomes and Quality Assurance group

PMO Programme Management Office

PTNS Percutaneous tibial nerve stimulation

QIPP Quality Innovation, Productivity and Prevention

SLG Strategic Leadership Group

WJSCG Wirral Joint Strategic Commissioning Group

WMBC Wirral Metropolitan Borough Council

WUTH Wirral University Teaching Hospital NHS Foundation Trust

Minutes of the WACC Executive Board meeting - Public session – 23rd September 2014 Page 1 of 5

WIRRAL ALLIANCE COMMISSIONING CONSORTIUM EXECUTIVE BOARD MEETING – PUBLIC SESSION

Minutes of Meeting

Tuesday 23rd September 2014 Nightingale Room, Old Market House

Present:

Dr M Green (MG) St Hilary Brow (Chair) Dr H Downs (HD) Civic Medical Centre Iain Stewart (IS) Chief Officer Debbie Marsden (DM) Nurse Member Allan Stewart (AS) Practice Manager Member

In Attendance:

Karen Duckworth (KD) Project Support Officer (WACC) Louise Morris (LM) Senior Accountant

Ref No. Minute WACC/EB/ 13-14/0007

1.0 Preliminary Business 1.1 Apologies for absence Apologies were received from: Dr G Francis, Dr B Conlan, Dr M Salahuddin, Dr R Williams, Dr I Camphor and Wendy Sheen

1.2 Declarations of interest There were no declarations of interest received. 1.3 Public comments/Questions There were no members of the public present at the meeting. Ellen Ascroft expected but did not arrive. 1.4 Minutes and Action Points of Previous Meeting/Matters Arising The previous minutes of the meeting held on 17th June 2014 were agreed as a true record of the meeting. But as the meeting was not quorate was unable to be signed off. Action Points – Please refer to the attached sheet. Matters Arising 1.5 Chair Report Chair gave an update around the following areas: The Chair updated that the Capability Review was now completed. Recommendations from the review have been circulated to all GP’s and asked all to refer to the Alison Tonge, NHS Engalnd letter. A press release regarding the review has also gone out to the media.


Ref No. Minute An action plan is now in place and is currently being worked through. The Chair advised that there have now been 2 GP’s events held in regards to CCG constitutional changes. At the event held on 9th September at Thornton Hall the main focus was around trust and transparency. Also tabled was the proposed new structure of the CCG, which will reflect the constitutional changes. Some debate also took place around the appointment or election of members. The Chair advised that there will be another GP event being held at Thornton Hall on 1st October to give a further presentation in order to gain views from member practices regarding the constitutional changes. Also planned throughout October are Stakeholder Engagement events including patients and providers. The Chair thanked all the members for their hard work over the last 3 years, with making budget efficiencies in years 1 and 2 and in the last year also being the lowest underspent of the consortia’s, thus proving that being a small consortium has been successful. As well as being influential regarding the capability review and constitutional change. The Chair asked that with today’s meeting not being quorate whether the next schedule meeting on 18th November should be an Informal Board. Also with regards to CWG, the last couple of meetings have had poor attendance and a decision is required as to whether to cancel the next meeting scheduled for 6th November. ACTION: Chief Officer to email Board members with regards to future meetings

WACC/EB/ 13-14/0008

2.0 ITEMS FOR INFORMATION 2.1 Quality, Performance and Finance Quality Apologies from the Strategic Analysts had been received. Finance Senior Accountant provided an update to the group with reports detailing the financial position for Wirral Alliance Commissioning Consortium as at the end of July (Month 4) within the 2014/15 financial year. The total budget available to the Alliance consortium for the current year is £48m (compared to £45m last year) showing an increase in budget provision, which is based on a ”fair share” approach (WACC fair share equates to 12.52%) of the overall amount allocated to the consortiums (£385m). The total amount allocated to the CCG is £468m. The Executive Board were asked to note:

• The financial position as at the end of July 2014 • The favourable movement in the month of £547k due to the underperformance at WUTH. • The year to date position from budget variance showing a budget underspends in Acute

contracts £475k, Non acute contracts £193k and Prescribing £39k.


Ref No. Minute Members of WACC Executive Board noted the finance report. The Chief Officer asked how accurate is the underspend reported? Louise Morris, Senior Accountant advised that the overspend does have an element of growth built into the figures, thus if this element was removed there would be a more accurate figure available. Louise Morris, Senior Accountant also advised that they are about to start a piece of work in relation to budget profiling which looks at each practice and comparing each practice’s budget figures against the previous years The Chair thanked Louise Morris, Senior Accountant for all the hard work and support that has been given to the Alliance. 2.2 CCG Commissioning Plan The Chief Officer updated the group that the final draft plan is going into the October Governing Body Meeting. 2.3 New Primary Care Schemes The Chief Officer advised that the specifications included in the Board pack were for noting by the group. Members noted the specifications.

WACC/EB/ 13-14/0009

3.0 ITEMS FOR DISCUSSION 3.1 WCT 5 Year Business Plan This agenda item was discharged as the meeting was not Quorate. ACTION: The presentation to be circulated with the minutes of the meeting. 3.2 Service Development The Chief Officer updated the group with regards to the Service Development Monies which are available. Following on from the discussions which took place at the Informal board on 7th May, the Chief Officer confirmed that the money which is now available is £120k. There has been a slight reduction in the amount due to a service provision having to be made for 3 practices which had opted out of the Phlebotomy Service provided by the Community Trust. Regarding the remaining amount of £120k, there has to be a robust, evidenced proposal for CCG Approvals Committee on how this money will be used. The Chief Officer put forward a suggestion which is based on a scheme which Warrington CCG is currently piloting, called Guided Care Pilot. The Warrington scheme is piloting guided care plans for those with Long Term Conditions. This allows the practice to put aside one hour for each identified patient who has 3 or more Long Term Conditions in order to review and make sure that their care is co-ordinated, in order to improve the quality of their care. The Chief Officer asked for the thoughts of the group for the service development monies to be put into the practices based on this scheme and therefore run a pilot in conjunction with Warrington CCG. ACTION: The Chief Officer to make further investigations with Warrington CCG to obtain more information about the components of the scheme.


Ref No. Minute 3.3 Prescribing Incentive Scheme This agenda item was discharged as the meeting was not Quorate and Steve Riley had also presented the scheme to the Patient Engagement Group on 16th September 2014. 3.4 Patient Engagement Group (PEG) Update There was no representation from the Alliance PEG to provide an update.

WACC/EB/ 13-14/0010

4.0 ITEMS FOR APPROVAL There were no items for approval.

WACC/EB/ 13-14/0011 5.0 MINUTES FOR NOTING

5.1 The minutes from the following subgroup committee meetings were noted:

• WCCG Governing Body from 05.08.2014 5.2 Patient Engagement Group (PEG) Minutes from the following meetings were noted:

• PEG Minutes from 16.07.2014.

WACC/EB/ 13-14/00012

6.0 RISK REGISTER No new risks noted.

7.0 Any other Business HD asked a question with regards to the contract for Trent Wirral PTS. The Chief Officer confirmed that the current Mental Health contract runs out in March 2015 and the CCG is looking at commissioning a new prime provider model, in order for whoever takes on the contract for the whole of Wirral to be able to subcontract other specialist services to provide an integrated service. 2 engagement events have been held in order to bring together all the providers. Through the procurement process this will look at all the data, success rates etc. An invitation to tender was due to go out on 1st October but Kerry Hogan has just returned from maternity leave who will be managing this process, thus this will look to be pushed back a couple of months. HD advised that there is a gateway which is used when dealing with children and social services and you can log into that and this will tell you the pathway for which service you need, could something like this be included in the specification as this is a very good tool. ACTION: The Chief Officer to highlight the details regarding the gateway to Kerry Hogan for inclusion in the specification. Chair thanked members for their attendance and the meeting was closed at 14.15pm


Ref No. Minute Private Business

Private business minutes are recorded separately.

8.0 Date and Time of Next Meeting The next WACC Board Meeting will take place on Tuesday 18th November 2014 at 1pm -3pm Nightingale Room, OMH Please send any apologies to Karen Duckworth – [email protected]

Board meeting ended at: 14:15pm. Signed: Chair


Minutes of the WGPCC Executive Board meeting – 16th September 2014 Page 1 of 6

WIRRAL GP COMMISSIONING CONSORTIUM

EXECUTIVE BOARD MEETING Minutes of Meeting

Tuesday 16th September 2014, 6.30pm Nightingale Room, Old Market House

Present: Dr Akhtar Ali (NA) GP Lead Penny Angill (PA) Practice Manager Member Christine Campbell (CC) Chief Officer Dr Simon Delaney (SD) GP Lead Dr Maria Earl (ME) GP Lead Dr Andrew Lee (AL) GP Lead Dr Hannah McKay (HM) GP Lead Louise Morris (LM) Consortia Finance Lead Dr John Oates (JO) Chair Sam Saminaden (SS) Lay Representative In attendance: Anita Fletcher (AF) WGPCC Administrator

Ref No. Minute WGPCC/EB/ 14-15/013

1.1 Apologies for absence There were no apologies received.

1.2 Declarations of interest There were no declarations of interest made.

1.3 Public Comments/Questions There were no members of the public present.

1.4 Minutes and Action Points of the last meeting The minutes were agreed to be a true record of the meeting. Matters Arising There were no matters arising discussed. Action Points WGPCC Medicines Management Approach – Action complete – No comments were received from members for a reporting pack to be put together. Medicines Management data was tabled at the meeting and members were advised that this is the standard report that practices receive. Members present were happy with the format that is issued to practices. Tier 1 Gynaecology Evaluation Report – Action complete – CD collated and shared details of practices that use the Tier 1 service. Tier 1 Gynaecology Evaluation Report – Action complete – Members agreed at the last


Ref No. Minute

meeting that the service should be continued and additional funding for a consultation appointment would be introduced. Members were advised that a single Wirral tier 1 gynaecology service is to be worked on and will be effective from April 2015 for all practices. Financial Budget 2013/14 – Action complete – A breakdown of which practices send patients to Peninsula Health service together with tariff charges was shared with members. Patient Council and Engagement Update – Action complete – A letter was sent to Simon Wagener on behalf of the patient group regarding concerns raised at the Patient Council meeting on how views are represented at Governing Body meetings on the patients’ behalf. Any Other Business – Action complete – A letter was sent to Dr Pleasance thanking him for his services as GP Forum Chair. Any Other Business – Action complete – The risk stratification email was resent to WGPCC Practice Managers. Members were advised that the risk stratification tool will be completed in October and will then be shared. New Actions Financial Budget 2014/15 – New Action: LM to provide a side by side comparison of tariff charges to include WUTH to be brought to the next meeting. Financial Budget 2014/15 – New Action: A comparison per service has been circulated previously but it was agreed that LM would resend this information to Board members.

1.5 Complaints, Compliments and Patient Feedback Executive Board members were advised that there is nothing specific to report on relating to services commissioned by WGPCC this month. CC agreed to bring meeting a copy of the Healthwatch report that is presented to the Quality & Safety Committee meetings to the next Executive Board.

WGPCC/EB/ 14-15/014

2.1 Wirral CCG Update Capability and Governance Review Executive Board members were advised that the report following the capability and governance review by NHS England has reported. The report outlines six key findings and six key recommendations together with 24 sub-recommendations. The report was welcomed by the CCG and its recommendations were accepted. The review makes a number of recommendations which focus on the development of a new constitution. The CCG has already made progress on many of the areas highlighted in the report and a more detailed action plan is in development. The support of NHS England to the CCG will continue with Jon Develing, Regional Director of Operations and Delivery (NHS England North) remaining as Interim Accountable Officer so as to oversee the action plan. There have been a number of meetings concerning changes to the constitution at practice level, at divisional level and Wirral-wide. As a division, Wirral GPCC started a discussion with Member Practices at a Members’ meeting in June 2014, after the joint LMC/CCG meeting in May. Paul Edwards, Head of Corporate Affairs, Wirral CCG is attending the next Patient Council meeting on Tuesday 23rd September 2014 to update patient members concerning the review/constitutional change and engagement. Similar meetings will take place in October with the patient groups of the other divisions. The outcome of the constitutional change will have implications for current Board structures and engagement arrangements with practices and patients. The Interim Accountable Officer has offered to visit individual practices and this offer has


Ref No. Minute

already been taken up by at least one of the Wirral GPCC practices. A further offer from the CCG will come for the Interim Chair, accompanied by one of the CCG current GP Board members, to go out to visit Wirral practices. Urgent Care One of the other key recommendations of the review was to improve the delivery of accident and emergency services, and urgent care. The development of an Urgent Care Strategy has been the subject of much effort for some time. The next step towards a joined-up Wirral strategy is a Wirral Urgent Care Conference being held on Thursday 18th September at the Leverhulme Hotel, Port Sunlight. Two representatives per Wirral practice have been invited to attend together with various external stakeholders. The development of a strategy will encompass not only services based at the Arrowe Park Hospital site but also services such as Walk in centres and Minor Illness and Injury units based in the Community. It was confirmed that commissioning of the Minor Injury and Illness services is no longer done at Consortium level, and that budgetary and commissioning responsibility for these has passed to the CCG. At the last Executive Board meeting, members agreed to fund these services from recurrent resources and review this at the end of September 2014. It was confirmed that future commissioning of the Minor Injuries Service at Miriam Medical Centre, Parkfield Medical Centre (Hawthornthwaite) and Moreton Health Clinic will be considered as part of the development of a Wirral strategy. Practice Engagement

In previous years, individual Wirral GPCC practice visits have been undertaken by Dr Oates as Chair and by either the Chief Officer or the Commissioning and Engagement Support Manager. There have also been separate QP Cluster meetings undertaken as part of QOF. For this year, QP meetings are no longer a part of QOF. Wirral GPCC had asked Member Practices at a Members’ meeting if these cluster meetings were helpful and if they should continue; the view at the meeting was that they should. Following this, Cluster meetings are being arranged to replace the individual practice visits. This year, four Cluster meetings between 25th September and 23rd October will be taking place. An invitation had gone out to GP Board members to attend these meetings, but it had now been agreed that the Chair would attend to represent the Board. Practice Schemes Members were advised that the Prescribing Incentive Scheme and the Over 75s and Transforming Primary Care Schemes had been issued to all practices. Joint working to look at urgent demand for home visits is currently being looked at, with the possibility of patients being assessed over the telephone within 15 minutes of a request being received. Part of the transformation scheme is for all practices to develop a plan relating to the above. The practice visits will be a good to start a dialogue in relation to joint working.

WGPCC/EB/ 14-15/015

3.0 Items for Approval There were no items for approval on the agenda.

WGPCC/EB/ 14-15/016

4.1 Financial Budget 2014/15


Ref No. Minute

LM presented the financial position for WGPCC as the end of July (Month 4) within the 2014/15 financial year and advised that the total budget available to the Consortium for the year is £148m. As at the end of July, the year to date position for the Consortium is an overspend of £340k with over performance against commissioning expenditure of £337k and overspend on running costs of £3k. Further detail is included in the three appendices provided within the paper. The performance position in relation to NHS contracts at month 4 shows an overspend of £203k. Contract performance on the WUTH contract shows an overspend of £494k as at July. The Consortia wide position is £669k underspent at month 4). WUTH's current year to date over performance is mainly due to non-elective procedures with a comparison against total consortia variance. Members were advised that the year to date position is based on actual activity as at Month 3. A query was highlighted regarding CWP showing an over performance of £139k. Concern was raised to the overspend as this is a block contract and therefore should not be overspent. CC advised that only ADHD and Asperger’s are cost per case. Action: LM to look into the CWP overspend and report back at the next meeting. At month 4, Non-NHS Contracts are overspent by £64k. Early overperformance shows against Peninsula £151k across all services except audiology and physio, and Midwifery £35k. Budgets are based on actuals from last year for non-NHS contracts. Members were advised that there will be a better understanding next month when further data is available. Consortium budget books for 2014/15 have been issued to practices. Members were advised that the Consortium Budget is £4 million less than last year as a result of application of the new Fair Shares calculation. Wirral GPCC has been the most affected by fair shares due to the shift of weighting away from deprivation and towards the elderly; however, overall there has not been a significant shift for the CCG. The Executive Board noted the financial position for WGPCC as at the end of July 2014.

4.2 Patient Council and Engagement Update Members were informed of the decision by Eddy Shallcross to step down as Chair of the Patient Council. It had been agreed at the last Patient Council meeting that a member of Healthwatch can attend meetings, but would be asked to leave the room when any private business was discussed. Simon Wagener, the Patient Representative from the Wirral CCG Governing Body, advised that he would be happy to attend future Patient Council meetings. Members were advised that Simon Wagener had been very complimentary regarding the WGPCC Patient Council. He feels that it is well run and patients are always given the opportunity to speak. Thanks went to Jordan Lane, Jenny Shaw and Dr John Oates. Members were informed of the death of Harry Parsonage who has been a key member of the Patient Council and Patient Council Executive Board. The first Annual Report of the Patient Council had been included in this meeting pack following


Ref No. Minute

its submission to the last Patient Council meeting. A Wirral-wide patient group meeting is scheduled to take place on Thursday 23rd October 2014. Patients’ views have been sought and these will form part of the agenda.

4.3 Practice Managers’ Update Practice Managers’ Meetings – Executive Board members were advised that a meeting had taken place between the three Consortia Practice Manager leads to look at the Practice Manager Forum going forward. Assumptions have been made by the Practice Managers that there will be four groups continuing with monthly Forum meetings, with the possibility of bi-annual meetings for all Wirral Practice Managers. A draft plan of this has been set up. Members were advised that this grouping has been based on Parliamentary groups which are in line with the ICCT proposal. Practice Schemes – The question was asked if any feedback had been received from practices following the new practice schemes that had been issued to practices. Nothing had been received to date. Members were advised that the new schemes would be discussed at the Practice Manager Forum on 8th October 2014 within the PLT Event. PA voiced concern that schemes have been introduced so late in the year. Clinical Supplies – Executive Board members raised concern over clinical supplies and members were advised that a meeting between the CCG, Community Trust and the LMC would be taking place and following this meeting, further information would be issued to practices. One member felt it is important to note that a number of practices are subsidising the Phlebotomy service with their own nurses and Health Care Assistants. Members were advised that the changes were as much news to the CCG as they were to practices but steps are being taken to try and resolve the issues.

4.4 Items for Risk Register It was agreed that, should the issue relating to clinical supplies not be resolved in a satisfactory way, this issue would be added to the risk register.

WGPCC/EB/ 14-15/017 5. Any Other Business

Domiciliary Phlebotomy – Members were asked for instances to be shared/collated in order to put a case forward to the Community Trust. External PLT Event – Members were advised that the next PLT event would be taking place on Wednesday 8th October 2014 with just Internal events taking place after that date. The CCG is looking at Wirral-wide training events going forward and is currently working with consultants at the hospital to produce a Wirral-wide training plan. The CCG is looking at running training events in a different way, for example evening sessions will be looked at. Wirral-wide training for all members would only take place where necessary, due to the expense and effect on access of booking Out of Hours cover for the afternoon. Concerns were raised regarding the location of large venues in relation to where some Wirral practices are. Members were advised that there must be a compromise in this; practice views will be sought in the future. It was asked to be noted that all Executive Board GPs are opposed to evening education


Ref No. Minute

sessions, preferring short lunch-time sessions to be arranged. Primary Care Mental Health Service – Executive Board Members were advised that will be a Wirral-wide service in 2015/16, and this is due to go out to tender shortly.

WGPCC/EB/ 14-15/018 6. Private Business

There was no private business discussed.

7. Date and Time of Next Meeting The date and time of the next meeting is Tuesday 18th November 2014, 6.30pm in the Nightingale Room, Old Market House, Birkenhead. Please send any apologies to Anita Fletcher on [email protected]

The meeting finished at 7.35pm


of 4

Consequence1 2 3 4 5

1 1 2 3 4 52 2 4 6 8 103 3 6 9 12 154 4 8 12 16 205 5 10 15 20 25

NHS WIRRAL CCG

CORPORATE RISK REGISTER

To be reviewed at Governing Body 2nd December 2014

Likelihood

Master 14-15

Page 2 of 4

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

Consequence

Likelihood Previous Matrix Score

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

Assurance on Controls (reference to evidence)

Gaps in Assurance (reference to evidence)

Action / Link to AP Consequence

Likelihood

Previous Risk Rating

Owner Date of next review

Date of last review

Last review

12-13 A 12-13 Financial Year

Go Live Issues

Gov Body Impact of 111 Implementation and Various Activity Impacts across primary / community and A&E Attendances. Increased demand for clinical input and lack of influence of national specfiication

Quality / Patient Access 3 3 9.00 Current provision of primary care / urgent care services - ability to absorb additional activity

Unknown impact of 111 Service Provision. Increased costs for clinical input

Monitoring of Primary Care/ urgent care activity and performace of NHS111 through information flows

Timely impact on monitoring of primary care activity

AP updated September 14

3 3 9.00 Governing Body - 111 Implementation Team

December QPF

September QPF To be reviewed at September QPF.Updated AP reviewed at September QPF, next due for review at December QPF upon completion.

12-13 E 12-13 Financial Year

QPF Lack of demand data/activity plans to forward plan future needs due to unavailbility of business intellegence

Quality / Financial Management on Cost Per Case / Impact on Future Commissioning Intentions

4 2 8.00 SLA meeting with CSU/ business Intelligence team

Ability to lead contract negotiations. Ability to provide accurate national returns

Regular monitroing through CSU/SLA meetings. Escalation to CSU MD. Monitoring through QPF committee

Abilty to influence behaviour. Ability to plan


4 3 12.00 LQ/MB December QPF

November GB Action plan reviewed. Updates accepted. No change . Reviewed at July QPF, reviewed at September GB. Next due for review at November GB.

AP reviewed at November GB and it was agreed to reduce the likelihood to a score of 2 rather than 3.

13-14 B Jul-13 QPF Impact of Section 251 on Data Flows impacting on ability to perform commissioning function and respective data analysis

Commissioning processes

4 2 8.00 CCG / CSU data flow arrangements have been reviewed and amended in line with requirements. CSU staff have been seconded into DMIC for appropriate data processing roles

100% of all dataflows in line with required guidance, staff awareness within both CCG / CSU regarding personal confidential data issues

Data Flow Mapping exercise as part of Information Governance Toolkit Submission

100% mapping to be completed and in conjunction with CSU Data flow Mapping Exercise


4 3 12.00 MB / LQ December QPF

November GB Action plan reviewed. Updates accepted. ASH status application awaiting decision. No change to risk score at present although improvements have been made to IG systems and processes. Reviewed at July QPF & September GB. Next due for review at November GB upon completion.

AP reviewed at November GB and it was agreed to reduce the likelihood to a score of 2 rather than 3.

13-14 E Dec-13 CCG Gov Body CSU Performance:Business IntelligenceSerious InicdentsComplaints ManagamentFreedom of Information Timings

Quality / Financial / Contracting

4 3 12.00 Contract Monitoring. CSU performance. Monitoring of CSU performance.

Quality ImpactReputation


4 3 12.00 PE/LQ December GB

October QPF Transition work from Customer Solutions Centre started on 1st October 14 - Action plan for further review at December GB, following review at October QPF.

14-15 B Apr-14 CCG Gov Body Safeguarding and the completion of the GP assurance toolkit.

Quality / Patient Safety 4 4 16.00 Process in place for completion of toolkit

Number of doctors trained to complete toolkit from a safeguarding perspective.Non-compliance.


4 4 16.00 LQ December GB

September GB New risk discussed. To be monitored at Governing Body. Action plan to be agreed with lead. Oct 14 - Work still being undertaken to ensure the completion of the plan, therefore for further review at December 14 GB.

14-15 C Apr-14 CCG Gov Body Finance and Availability of Resources - Transitional and Contingency. Risk of using reserves to honour contract negotiations may result in the inability to react in unforeseen events and the reduction in capacity.


4 4 16.00 Contract agreement. No capacity for transitional change requirements.


4 4 16.00 MB January GB September GB New risk discussed. To be monitored at Governing Body. Action plan to be agreed with lead. To be brought back to January GB upon completion.

14-15 D Apr-14 CCG Gov Body Finance and Availability of Resources - Demand Management.


4 4 16.00 Contract agreement. No capacity for reacting to demand.



14-15E Jun-14 CCG Gov Body Capacity and Capability Review being undertaken by NHS England into CCG leadership

Organisational 4 3 12.00 Proactive communications strategy for internal and external stakeholders

Press releases Staff BriefingsMP BriefingsGoverning Body Papers

AP for further update for September.

4 3 12.00 PE December GB

October QPF New risk discussed. To be monitored at Governing Body. Action plan to be agreed with lead. Reviewed further at October QPF, action plan still being completed. Therefore due for furter review at the December GB.

14-15F Jun-14 CCG Gov Body Financial Plan Financial 4 4 16.00 AP updated September 14


14-15G Jun-14 CCG Gov Body A&E 4 hour Target Quality / Financial 4 4 16.00 AP updated September 14

4 4 16.00 LQ December GB

September QPF New risk discussed at June GB. To be monitored at Governing Body. Action plan to be agreed with lead. Next due for review at December GB.

14-15H Jul-14 CCG Gov Body Cdifficile Targets Quality / Patient Safety 4 4 16.00 4 4 16.00 LQ December QPF

August QPF New risk discussed at July QPF/ Action plan to be agreed with lead. To be brought back to August QPF. AP reviewed at August QPF and due back for further review upon completion at the December 14 meeting.

14-15I Jul-14 CCG Gov Body Supreme Court Judegement Deprivation of Liberty Safeguards (DoLS)

Quality / Patient Safety 4 3 12.00 4 3 12.00 LQ December GB

August QPF New risk discussed at July QPF/ Action plan to be agreed with lead. To be brought back to August QPF. AP reviewed at August QPF and due back for further review upon completion at December GB meeting.

14-15J Jul-14 CCG Gov Body Wirral CCG Care Home Provider

Quality / Patient Safety 4 4 16.00 4 4 16.00 LQ December GB

November GB New risk discussed at July QPF/ Action plan to be agreed with lead. To be brought back to November GB. AP reviewed at Nov GB, to be next reviewed at December GB.

Update from LQ at Nov QPF to advise that Four Seasons are closing one of their homes, and the CCG are working closely with LA & CQC with regards to a home closure plan.

14-15K August QPF CCG Gov Body Continuing Healthcare issues re the service provided, the CHC process followed, general performance & quality & inconsistency of complaint response letters

Quality / Patient Safety 5 3 15.00 5 3 15.00 IS December GB

September GB New risk discussed at August QPF. AP to be completed by IS. For noting at September GB & AP to be reviewed at December GB - awaiting AP from lead.

14-15M September QPF

CCG Gov Body Community Trust Contracts Quality / Financial 3 3 9.00 Identified as a risk to the CCG and to be monitored via CT contract meetings

going forward

Action plan to be agreed

4 3 12.00 MG / AC December QPF

November GB New risk discussed at September QPF. AP to be agreed & completed by MG / AC, new risk for review at November GB.

Risk reviewed at the November GB and it was agreed to reduce the consequence score from 4 to 3.

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

Process

Page 3 of 4

Risk Register Process Before QPF Meeting E-mail to be sent to QPF members to request any new risks. Risk added to Register by Laura Wentworth. At QPF Meeting: New Risks and corresponding action plan to be considered for inclusion - either keep or decision escalated to risk owner. Current risks to be reviewed in line with action plan progression. After QPF Meeting Laura Wentworth to update Monitoring column with decisions made at group. Laura Wentworth to amend residual risk rating in line with actions. At Governing Body Review new and escalated risks Agree to include or de-escalate risks After Governing Body Laura Wentworth to update Monitoring column with decisions made at group. Laura Wentworth to amend residual risk rating in line with actions. Add removed risks to the Removed risks Tab. Save and copy for next reveiw.

Gov Body Governing BodyQPF Quality, Performance and Finance CommitteeWGPCC Wirral GP Commissioning ConsortiumPCMH Primary Care Mental HealthDNA Did not AttendKPI Key Performance IndicatorSLA Service Level AgreementCSU Commissioning Support UnitMD Managing DirectorDMIC Data Managerment Information CentreOOH Out of HoursLCAG Local Clinical Advisory GroupNHSD NHS DirectDOS Directory of ServicesQDOS Quality Directory of ServicesPLT Protected Learning TimeAT Area Team

Updated: November 2014 To be sent to GB: 2nd December 2014

ACTION PLAN TEMPLATE FOR RISK No: 13/14E Title of Risk: CSU Performance: Business Intelligence Serious Incidents Complaints Management Freedom of Information

Impact Likelihood Previous Matrix Score

Key Control Established

Key Gaps in Control (reference to evidence)



Impact Likelihood Residual Risk

Rating

4 3 12.00 Contract Monitoring.

CSU performance. Monitoring of CSU performance.

Quality Impact Reputation

4 3 12.00

Monitoring of Action Plan: Quality, Performance and Finance Committee

Areas for Review Recommendation/Action Lead

Person

Target Date

for completion

Progress of Actions Date for

next Review

Date of

Completion

CSU performance - Business Intelligence

On-going review & monitoring of the situation of the team.

Head of Quality & Performance

On-going Weekly reviews undertaken.

Update 19/02/14 - The CCG

formally wrote to CSU in

January 2014 outlining its

intentions in regard to this

service line indicating a

potential move to in-

sourcing and a request for

the CSU to provide more

Not applicable.

September

2014



Person

Target Date

for completion


next Review

Date of

Completion

information to inform the

final decision. Two meetings

have been arranged in

February between CSU and

the CCG to discuss the

practical issues related to

these intentions, with a

focus on agreeing

timelines/potential

transition periods.

Update 22/04/14 Meeting

was held on 04/04/14 and

on-going meetings have

been arranged to discuss

transition of work.

Update 09/06/14: Ongoing

meetings taking place with a

proposed implementation of

September 14.

22/09/14: BI function & staff

have now transferred into

the CCG. Recommend



Person

Target Date

for completion


next Review

Date of

Completion

closure.

Management and quality of Serious Incidents, Complaints, MP letters and Freedom of Information requests by the Customer Solutions Centre, Cheshire & Merseyside CSU

Urgent meeting to be arranged with Customer Solutions centre to raise issues and discuss actions to prevent incidents occurring in future

Head of Corporate Affairs / Corporate Support Officer

16th December 2013

Meeting held on 16/12/13

between CCG and CSU (Head

of Customer Solutions, Head

of Client Operations) to raise

issues and action plan

agreed including –

breakdown of costs provided

by the centre by service, CHC

cases and RCAs to be

undertaken by CSU, list of all

open & on-going complaints

& present) – However above

information has not yet been

received from CSU and

deadlines have been queried

and escalated via Chief

Clinical Officer – Follow up

review meeting arranged for

January 14.






January 2015



Person

Target Date

for completion


next Review

Date of

Completion











focus on agreeing

timelines/potential

transition periods.


has been arranged for 4th

April 14.





transition of work.

Update 09/06/14 Details of

impact of CCG decision to in-

source elements of customer



Person

Target Date

for completion


next Review

Date of

Completion

soultions centre still not

available from CSU.

CCG has issued contract

query to CSU regarding

ongoing performance issues.

Action plan subsequently

received

22/09/14 – A work plan is

now in place for the

transition of these functions

back into the CCG. The first

process to transfer is FOIs on

1st October 2014.

14/10/14 – FOI requests are

now being managed

internally by the Corporate

Team within the CCG and a

transition for other

processes has been agreed

with the CCG / CSU.

24/11/14 – Complaints & MP

letters are scheduled to

transfer back to the CCG



Person

Target Date

for completion


next Review

Date of

Completion

from the end of December

14.

Timelines and quality of responses provided on behalf of the CCG to Complaints, MP letters and Freedom of Information requests by the Customer Solutions Centre, Cheshire & Merseyside CSU

CCG to gain access to the online Datix system which is used by the CSU to record complaint’s, incidents, MP letters and FOIs.

Corporate Support Officer

23rd December 2013


now has ‘read only’ access to

the Datix system, to review

progress on complaints, MP

letters and incidents.

However FOI requests are

not yet available for access

due to web system

N/A 23rd December 2013 - closed

Timelines and quality of responses provided on behalf of the CCG to Complaints, MP letters and Freedom of Information requests by the Customer Solutions Centre, Cheshire & Merseyside CSU

Weekly update reports to continue to be provided for the above also, to provide further assurance

Customer Solutions Locality Lead / Corporate Support Officer

On-going / Weekly

Weekly update report on

FOIs, Complaints, MP letters

and serious incidents is

provided to CCG to provide

further update and

assurance.

On-going / Weekly

Quality, content and formatting of letters provided on behalf of the CCG to Complaints, MP letters and Freedom of

Corporate Support Officer to review (&amend if necessary) all response letters before they are sent to Chief Clinical Officer.


On-going Corporate Support Officer

dedicating time to review

complaints, MP and FOI

responses and make

amendments as necessary

January 2015



Person

Target Date

for completion


next Review

Date of

Completion

Information requests by the Customer Solutions Centre, Cheshire & Merseyside CSU

before they are sent for

review with the Chief Clinical

Officer.
















focus on agreeing

timelines/potential

transition periods.


has been arranged for 4th

April 14.



Person

Target Date

for completion


next Review

Date of

Completion





transition of work.

Update 09/06/14 Details of

impact of CCG decision to in-

source elements of customer

soultions centre still not

available from CSU.

CCG has issued contract

query to CSU regarding

ongoing performance issues.

Action plan subsequently

received.

22/09/14 – A work plan is

now in place for the

transition of these functions

back into the CCG. The first

process to transfer is FOIs on

1st October 2014.

14/10/14 – FOI requests are

now being managed



Person

Target Date

for completion


next Review

Date of

Completion

internally by the Corporate

Team within the CCG and a

transition for other

processes has been agreed

with the CCG / CSU.

24/11/14 – Complaints & MP

letters are scheduled to

transfer back to the CCG

from the end of December

14.

Name of Lead for Action Plan: Lorna Quigley / Paul Edwards / Laura Wentworth Date: 9th June 2014 22nd September 2014 14th October 2014 24th November 2014


ACTION PLAN TEMPLATE FOR RISK No: 14/15B, 14-15 Title of Risk: Safeguarding and the completion of the GP assurance toolkit. Impact Likelihood Previous

Matrix Score






Rating

4 4 16.00 Process in place for completion of toolkit

Number of doctors trained to complete toolkit from a safeguarding perspective. Non-compliance.

N/A N/A N/A



Person

Target Date

for completion


next Review

Date of

Completion

Completion of the GP

Safeguarding Children

Toolkit

Further training to be conducted for

remaining GP Safeguarding Leads

so as to ensure all are competent in

completing the toolkit.

DH June 14 May 14: Briefing meetings

have been held with the GP

Safeguarding Leads to

ensure competence. DH

N/A May 14

Reiteration of Safeguarding Children

Toolkit process to Practice

Managers.

DH June 14 May 14: DH has met with the Practice Managers to reiterate this process. DH

N/A May 14

Consortia leads to ensure the

importance of completing

Safeguarding children Toolkit is

disseminated throughout their

AC/CC/IS July 14 JULY 14: DH has emailed

AC/CC/IS details of practices

who have completed the

audit tool, to enable those

November

2014



Person

Target Date

for completion


next Review

Date of

Completion

consortium. who haven’t to be identified.

CC – This has been raised at

recent consortia meeting.

AC – A number of WHCC

practices have already

returned their completed

audit tools, however an email

has also been sent to WHCC

Practice Managers to request

return of outstanding audit

tools asap.

Awaiting update from IS -

WACC

Reminder letter to be sent to all non

compliant practices, by Named GP,

Clinical Lead GP and Designated

Nurse

DH July 14 July 14 : Letter sent to all

non-compliant practices.

N/A July 14

Monitoring of

Safeguarding Children

Toolkit returns

Continuous monitoring of the toolkit

returns until all GP practices have

been received.

DH August 14 June 14: 50% improvement

in returns since April 14.

Continual monitoring

required until all returns

received. DH

November

2014

Name of Lead for Action Plan: Lorna Quigley / Debbie Hammersley Date: 16th May 2014

Updated: 6th June 2014 , 21st July 2014, September 2014, November 2014


ACTION PLAN TEMPLATE FOR RISK No: 14-15E Title of Risk: Capacity and Capability Review being undertaken by NHS England into CCG leadership







Rating

4 3 12.00 Proactive communications strategy for internal and external stakeholders

Press releases Staff Briefings MP Briefings Governing Body Papers

N/A



Person

Target Date

for completion


next Review

Date of

Completion

Capability and Capacity Review may negativelty impact on reputation and stability of the CCG

Keep staff informed of developments

Paul Edwards Ongoing

18.08.14 – Weekly briefings

are held for staff to advise of

developments and updates.

Ongoing at present.

March 2015

Report progress to Governing Body on work in key areas to give public assurance

Paul Edwards July 2014

18.08.14 – JD has presented

workstream updates at GB.

Sept 14 – Further update has

been provided to GB.

September

2014



Person

Target Date

for completion


next Review

Date of

Completion

Issue external briefings to local stakeholders

Paul Edwards July/August 2014

18.08.14 – NHS England has briefed stakeholders and plans to communicate once the review is concluded. Sept 14 – The summary of the findings of the review has been shared with local stakeholders. Nov 14 – Additional communications provided regarding constitution & interim accountable officer arrangements/

November 2014

Develop action plan in response to the review.

Paul Edwards October 2014 Action plan has been developed and presented to October Governing Body

October 14

Amend Constitution in response to the review

Paul Edwards December 2014 Engagement with member practices, patient event arranged for 23rd October and legal opinion sought. Nov 14 – NHS England approved amendments to the Constitution.

November 2014

Name of Lead for Action Plan: Paul Edwards Date: 9th June 2014 18th August 2014, 25th November 2014


15th September 2014 14th October 2014 24th November 2014


ACTION PLAN TEMPLATE FOR RISK No: 14-15G Title of Risk: A&E 4 hour Target







Rating

4 4 16.00 A&E 4 hour Target - national attention received regarding Emergency Care issues (Monitor & NHS E)

N/A

Monitoring of Action Plan: Quality, Performance and Finance Committee / Governing Body


Person

Target Date

for completion


next Review

Date of

Completion

Target not being met by Wirral economy & rated high risk by NHS England and Monitor

Utilisation Management Review to be undertaken. Additional Project Management support. Recovery Plan to be in place with trajectories. Weekly monitoring against

Lorna Quigley Lorna Quigley Lorna Quigley Lorna Quigley

July 2014 August 2014 July 2014 Ongoing

Presentation of review has

been completed. Action plan

developed.

Additional Project Manager

commenced in role.

Inplementation of project

plan to be completed.

Ongoing at present.

N/A August 2014 December 2014 March 2015

July 2014

August 2014



Person

Target Date

for completion


next Review

Date of

Completion

performance to be undertaken.

Name of Lead for Action Plan: Lorna Quigley Date: July 2014 September 2014, November 2014


ACTION PLAN TEMPLATE FOR RISK No: 14-15I Title of Risk: Supreme Court Judgement Deprivation of Liberty safeguards (DoLS)







Rating

4 3 12.0 Supreme Court Judgement Deprivation of Liberty safeguards (DoLS)

N/A



Person

Target Date

for completion


next Review

Date of

Completion

Understanding the local impact to Wirral based on the Supreme Court Judgement Deprivation of Liberty safeguards (DoLS)

Awaiting national guidance. To work with Provider Organisations. To work with Local Authority to assess the impact fully. Provider Organisations to ensure that this is on their Risk register also.

Lorna Quigley Lorna Quigley Lorna Quigley Lorna Quigley

Ongoing Ongoing Ongoing July 2014

Currently awaiting national

guidance.

Ongoing at present.

Ongoing at present.

This has been added to the

December 2014 December 2014 December 2014 N/A

July 2014



Person

Target Date

for completion


next Review

Date of

Completion

To ensure that there is training in relation to DoLS.

Lorna Quigley

Ongoing

risk register of Providers

organisations – Completed.

Ongoing at present.

December 2014

Name of Lead for Action Plan: Lorna Quigley Date: July 2014 October 2014, November 2014


ACTION PLAN TEMPLATE FOR RISK No: 14-15J Title of Risk: Wirral CCG Care Home Provider







Rating

4 4 16.00 Wirral CCG Care Home Provider

N/A



Person

Target Date

for completion


next Review

Date of

Completion

Concerns raised regarding quality of care provided by some care home providers in Wirral.

To work closely with local organisations (Local Authority, Care Quality Commission, Healthwatch) CCG Safeguarding Team to monitor care home performance

Lorna Quigley Lorna Quigley

Ongoing Ongoing

Partnership working is

ongoing.

Quarterly report provided to

QPF committee by the

Safeguarding team.

25/11/14 – Update provided

at Nov QPF to advise that

Four Seasons are closing one

of their care homes & the

CCG are working closely with

the LA & CQC regarding their

December 2014 December 2014 December 2014

Updated: April 2014 To be sent to QPF: 29th April 2014


Person

Target Date

for completion


next Review

Date of

Completion

Escalation of issues required via the Cheshire Warrington & Wirral Quality Surveillence Group.

Lorna Quigley

Ongoing

closure plan. All patients will

be reviewed as part of this

process and will be tracked

to their new home.

Ongoing at present.

Name of Lead for Action Plan: Lorna Quigley Date: July 2014 August 2014 September 2014, November 2014

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