Meeting of the West Suffolk CCG Governing Body...Nov 30, 2016 · 4. Matters Arising and Action Log...

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Meeting of the West Suffolk CCG Governing Body to be held from 0915–1200 hrs on Wednesday 30 November 2016 at

The Lecture Room, St Edmundsbury Cathedral, Bury St Edmunds, Suffolk

AGENDA

The Governing Body will be available to meet with members of the public from 0900 – 0915

GENERAL BUSINESS 1. Apologies for Absence Dr Christopher Browning 2. Declarations of Interest

To declare any interests specific to agenda items Declarations made by members of the Governing Body are listed in the CCG’s Register of Interests. The Register is available via contact with the CCG’s Corporate Governance officer or at the CCG website via the following link: http://www.westsuffolkccg.nhs.uk/wp-content/uploads/2013/01/16-08-31-WSCCG-Declarations-of-Interest.pdf

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3. Minutes of the previous West Suffolk CCG Governing Body

meeting. To approve as a correct record Minutes of the West Suffolk CCG Governing Body meeting held on 28 September 2016

Dr Christopher Browning

4. Matters Arising and Action Log Dr Christopher Browning 5. General Update

To receive a verbal report from the Chief Officer Ed Garratt

6. Chair/Chief Officer Action No. 02/2016 – Business Case for

Integrated Community Health and Care Services including Integrated Urgent Care Service To receive and endorse a recent Chair/Chief Officer action

Richard Watson Report No:

WSCCG16-56

FINANCE, PERFORMANCE AND SCRUTINY 7. Appointment of External Auditors

To approve External Auditors for 2017/18 as recommended by the CCG’s Auditor Panel

Bill Banks Report No:

WSCCG 16-57 8. Integrated Performance Report - Are the CCGs finances,

performance and quality on track? To receive and note a report from the Chief Finance Officer, the Chief Nursing Officer, the Chief Redesign Officer and Chief Contracts Officer.

Barbara McLean/ Lesley MacLeod/ Richard Watson/

Jan Thomas Report No:

WSCCG 16-58

http://www.westsuffolkccg.nhs.uk/wp-content/uploads/2013/01/16-08-31-WSCCG-Declarations-of-Interest.pdf

http://www.westsuffolkccg.nhs.uk/wp-content/uploads/2013/01/16-08-31-WSCCG-Declarations-of-Interest.pdf

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PATIENT AND PUBLIC ENGAGEMENT 9. Patient Story Barbara McLean

Report No: WSCCG16-59

10. Community Engagement Group Minutes

To receive and endorse minutes of the Community Engagement Group meeting held on 27 October 2017

Jo Finn Report No:

WSCCG16-60 11. Operational Planning 2017/2019

To receive, and note a report from the Chief Operating Officer Kate Vaughton


12. Sustainability and Transformation Plan

To receive and note a report from the Chief Redesign Officer Richard Watson


13. Winter Plan

To receive and consider the Winter Plan for 2016/17 for West Suffolk Richard Watson


14. Procurement Update: Summary of Activity 2016/17

To receive and note a report from the Chief Contracts Officer Jan Thomas

WSCCG 16-64 15. Commissioning of Primary Care (Model 3 - Full Delegation)

To receive and approve the recommended next steps to; apply for fully delegated commissioning – Model 3 or remain at Model 2 following the outcome of a member vote.

Kate Vaughton Report No:

WSCCG 16-65

GOVERNANCE AND CORPORATE BUSINESS 16. Declarations of Interest

To receive and note a report from the Chief Corporate Services Officer Amanda Lyes

Report No: WSCCG 16-66

17. Health and Safety

To receive and note a report from the Chief Corporate Services Officer

Amanda Lyes Report No:

WSCCG 16-67 18. Governing Body Assurance Framework

To receive and endorse a report from the Chief Corporate Services Officer

Amanda Lyes Report No:

WSCCG 16-68 19. Minutes of Meetings:

To receive a report from the Lay Member for Governance seeking the endorsement of minutes of West Suffolk CCG Sub Committees, those being;

a) Audit Committee

The unconfirmed minutes of a meeting held on 4 October 2016.

b) Finance and Performance Committee The confirmed minutes of meetings held on 21 September 2016 and 19 October 2016.

c) Remuneration and HR Committee

The unconfirmed minutes of a meeting held on 18 October 2016

Bill Banks Report No:

WSCCG16-69

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d) Clinical Scrutiny Committee

The unconfirmed minutes of a meeting held on 19 October 2016 e) CCG Collaborative Group


f) Commissioning Governance Committee Decision from a meeting held on 19 October 2016 and 16 November 2016

20. Any Other Business 21. Date and Time of future Governing Body meetings

0915 - 1200 Wednesday 25 January 2017, The Edmund Room, St Edmundsbury Cathedral, Angel Hill, Bury St Edmunds, IP33 1LS

Questions from the public – Maximum 15 minutes

Please note questions should relate to the items under discussion and must be a question rather than statement. Where individuals deviate from this requirement they will be asked to stop and will not be invited to take any further part in the meeting.

Exclusion of the Press and Public

The Governing Body is recommended to exclude representatives of the press, and other members of the public, from the meeting having regard to the confidential nature of the business to be transacted, publicity on

which would be prejudicial to the public interest; Section 1(2), Public Bodies (Admission to Meetings) Act 1960.

Governing Body GP Member Simon Arthur Partner in Medical Practice and Executive Member of Suffolk GP Federation

Medical partnership has contract with Suffolk Community Healthcare to provide GP services to Gastonbury Court

Lay Member for Governance and Vice Chair CCG Bill Banks Nil

Governing Body Practice Manager Member Kevin Bernard Practice Manager Botesdale Health Centre. Health Centre is member of the Suffolk GP Federation

Company Secretary and shareholder in Botesdale Rural Services Ltd trading as Botesdale Pharmacy

CCG Chair Christopher Browning PMS Provider, Practice Partner Long Melford

Chair, Hartest Parish Council

Wife is consultant geriatrician at West Suffolk Hospital

Lay Member for Patient and Public Involvement Jo Finn Previous Chief Executive of West Suffolk Hospital NHS Trust

Ex-husband was Consultant Obstetrician and Gynaecologist

Patient under care of neurologists and rheumatalogists at West Suffolk Hospital

Chief Officer Ed Garratt Chief Officer for Ipswich and East Suffolk CCG

Governing Body GP Member Andrew Hassan Nil

Secondary Care Doctor Crawford Jamieson Consultant in Gastroenterology at Ipswich Hospital

CBG lead for Gastroenterology, general and vascular surgery

Wife is consultant in Medicine for the Elderly at Ipswich Hospital

Governing Body Practice Manager Member Peter Knights Partner Mount Farm Surgery

Mount Farm Surgery is a member of Suffolk GP Federation

Chief Corporate Services Officer Amanda Lyes Chief Corporate Services Officer for Ipswich and East Suffolk CCG

Interim Chief Finance Officer Lesley MacLeod Interim Chief Finance Officer for Ipswich and East Suffolk CCG

Direct of Public Solutions Ltd

Chief Nursing Officer Barbara McLean No response

Governing Body GP Member Bahram Talebpour Nil

Chair of Community Engagement Partnership David Taylor Trustee of Charity Avenues East

Chief Contracts Officer Jan Thomas Chief Contracts Officer for Ipswich and East Suffolk CCG

Chief Operating Officer Kate Vaughton Nil

Governing Body GP Member Firas Watfeh No response

Chief Redesign Officer Richard Watson Chief Redesign Officer for Ipswich and East Suffolk CCG

West Suffolk CCG Governing Body and Sub Committee Members

Declared InterestTitle First Name Last Name

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Minutes of meeting of the West Suffolk CCG Governing Body held in public on

Wednesday 28 September 2016 in the Lecture Room, St Edmundsbury Cathedral, Bury St. Edmunds, Suffolk

PRESENT: Dr Christopher Browning CCG Chair Bill Banks Lay Member for Governance Jo Finn Lay Member for Patient and Public Engagement Ed Garratt Chief Officer Dr Andrew Hassan GP Member Dr Crawford Jamieson Secondary Care Doctor Peter Knights Member Amanda Lyes Chief Corporate Services Officer Lesley MacLeod Interim Chief Finance Officer Barbara McLean Chief Nursing Officer Dr Bahram Talebpour GP Member Kate Vaughton Chief Operating Officer Dr Firas Watfeh GP Member Richard Watson Chief Redesign Officer Jane Webster Deputy Chief Contracts Officer Dr Andrew Yager GP Member IN ATTENDANCE: David Kanka Assistant Director of Public Health Jo Mael Corporate and Governance Officer David Taylor Chair: Clinical Engagement Group

16/084 WELCOME AND APOLOGIES FOR ABSENCE

The CCG Chair welcomed everyone to the meeting and apologies for absence were noted from: Dr Simon Arthur GP Member Kevin Bernard Member Dr Abdul Razaq Director of Public Health Jan Thomas Chief Contracts Officer The Chair advised that this would be Dr Yager’s last Governing Body meeting as he had decided to step down from the end of October 2016. Dr Yager was thanked for his considerable contribution and inspiration to the CCG during his time as a Governing Body member.

16/085 DECLARATIONS OF INTEREST

No declarations of interest, other than those already published, were received.

16/086 MINUTES OF PREVIOUS MEETING

The minutes of the meeting held on 27 July 2016 were approved as a correct record.

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16/087 MATTERS ARISING AND ACTION LOG

There were no matters arising and the action log was reviewed and updated with comment as follows; 16/78 – Managing conflicts of Interest – the Chief Corporate Services Officer reported that actions were being progressed and the CCG was currently out to advert for a third lay member.

16/088 GENERAL UPDATE

The Chief Officer reported that;

West Suffolk Hospital had been recognised as a global centre for digital excellence which should enable them to seek additional funding resources.

Whilst the CCG continued to be under scrutiny by NHS England in relation to its financial position and there would be significant challenges going forward, NHS England had stepped down the level of scrutiny in light of the CCG’s recent progress and robust plans to address the situation.

The planned junior doctors’ strike had been cancelled.

National planning guidance had been published last week and would be considered by the CCG’s Executive. The guidance required delivery of financial control.

The Governing Body noted the Chief Officer’s verbal update.

16/088 CHAIR/CHIEF OFFICER ACTION – 01-2016 (EMERGENCY PREPAREDNESS

RESILIENCE AND RESPONSE (EPRR))

The Governing Body was in receipt of a Chair/Chief Officer Action taken in August 2016 in respect of the Emergency Preparedness Resilience and Response (EPRR) assurance process. On 10 June 2016, NHS England had written to Accountable Emergency Officers outlining the expectations for the 2016/17 EPRR process which had included a requirement for organisations to carry out a self-assessment against updated core standards for submission to the Local Health Resilience Partnership for review. As a result of the above, the CCG had subsequently assessed itself as fully compliant in all the core standard areas and business continuity. In order to facilitate timely submission to the LHRP, Chair and Chief Officer action was sought to agree full compliance as per the presented document. In line with the CCG’s constitution all Chair and Chief Officer actions are required for presentation to the next available public meeting of the Governing Body for endorsement. The Governing Body subsequently endorsed the reported Chair and Chief Officer Action – 01/2016.

16/089 COMMUNITY ENGAGEMENT GROUP (CEG) MINUTES

The Chair of the Community Engagement Group (CEG) presented the minutes of

the Group’s last meeting, which had been held on 25 August 2016 in Haverhill.

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Key points highlighted included;

There had been in excess of 10 members of the public present which had been pleasing. Main concerns raised were in relation to the growing population of Haverhill and the provision of health services to meet that increased demand, together with travelling and access issues.

The CEG was able to comment on the recent consultation in respect of IVG and MVA services.

Visits to practice Patient Participation Groups continued with recent visits to Haverhill and Morton Hall practice groups having taken place.

The CEG had been invited to contribute to the planning of engagement events. Having recognised that a member of the public had highlighted difficulty in navigation of the CCG’s website, it was explained that the issue had been specific to the individual concerned and the matter addressed and changes made outside of the meeting. The Governing Body noted the key items of discussion.

16/090 FUTURE OF INVITRO-FERTILISATION (IVF) AND MARGINALISED

VULNERABLE ADULT SERVICES

The Chair advised that, as a result of review of the consultation feedback by the CCG’s Executive the previous week, it was felt that the information presented was not in such a form to assist the CCG in making a decision on behalf of its community and therefore it was proposed the decision be deferred until a later date. The Governing Body agreed that a decision on the future of IVF and MVA services be deferred.

16/091 COMMISSIONING INTENTIONS 2017/2019

The Governing Body was in receipt of, for approval, the CCG’s 2017/19

Commissioning Intentions which set out how the CCG intended to commission and manage care delivery from April 2017 to March 2019.

The document, as attached to the report at Appendix A, had been discussed in draft at the Integrated Care Organisation (ICO) Board, with the leaders of the CCG’s main providers and also at CCG clinical executive meetings. Whilst traditionally the document had been sent as a letter from the Accountable Officer directly to a small list of providers and published on the CCG web-site, it was now intended that a letter would be sent to all providers alongside the attached document. The communications team would publish the document to the CCG web-site to ensure full distribution and transparency. Key points set out within the commissioning intentions document were the raising in priority of mental health services, increased emphasis on primary care, the re-commissioning of community services, and various programmes of work associated with the digital roadmap. It was recognised that partnership working would be key to the sustainability of services going forward. The document was required to be published by Friday 30 September 2016. Comments included;

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Having recognised that the commissioning intentions now applied to a two year period and the system was evolving at a rapid pace, the Assistant Director of Public Health questioned whether the development of system intentions rather than CCG intentions was more appropriate. It was explained that a system direction of travel would evolve and the commissioning intentions document was the CCG’s local interpretation.

Having questioned funding over the two years, it was explained that funding would be via the clinical innovation hub with anticipation that all providers participating in the Sustainability and Transformation Programme taking a view on the best use of resources.

Suggested revisions to the document were a softening of emphasis on the Suffolk GP Federation being the principle provider, together with identifying that, as well as cancer services the CCG strived to provide high standards in all services.

Subject to minor revision as identified in bullet point three above, the Governing Body approved the CCG’s Commissioning Intentions for 2017/19.

16/092 TRANSFORMING CARE

The Governing Body was in receipt of a report from the Chief Nursing Officer which

provided an update on Transforming Care (TC). The update was planned to accompany the patient story. Key points included;

The Transforming Care Board continued to meet on a monthly basis. The CCG’s Chief Nursing Officer was the Senior Responsible Officer (SRO) with the Deputy SRO being the Assistant Director- Personalisation, Quality and Safeguarding Adult and Community services at Suffolk County Council.

The Board reviewed all guidance and recommendations from the Department of Health and NHS England, and work programme progress was monitored via milestone reports submitted to NHS England on a monthly basis. Detail of key aspects of the milestone reports was set out within section 3 of the report.

Fortnightly teleconferences were held with the regional transforming care team, together with fortnightly updated narrative descriptions on the monitored progress of each patient within the cohort to enable on-going scrutiny of care and effectiveness of the care and treatment review process.

In line with NHS England Guidance, Care and Treatment Reviews (CTRs) continued to be carried out for all current inpatients. In addition, a CTR ‘Overview Panel’ had been formed.

During September 2016, the CCG had commenced a proactive engagement exercise with the local authority to develop a workforce development and training plan.

The Lay Member for Patient and Public Engagement highlighted the opportunity for partnership working. The Governing Body noted the content of the report. and recognised that the

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CCG’s Commissioning Intentions for the next 12 months had included:

The ongoing improvement of services for people with a learning disability and autism with challenging behaviour and / or mental health needs

Increasing and improving Health Checks, including reviewing the primary care LD liaison nurse role and future proposals

A review of how community health care meets the needs of people with learning disabilities.

The Chair deferred item 11 (Sustainability And Transformation Plan (STP) Update).

16/093 LOCAL DIGITAL ROADMAP

The Governing Body received a report from the Chief Corporate Services Officer which provided an update on progress with the Local Digital Roadmap. Following publication of the National Information Boards ‘Personalised Health & Care 2020’ CCGs were accountable for the development and implementation of the ‘Local Digital Roadmap’ (LDR), with assurance provided by NHS England. The LDR, at a minimum, must provide detailed plans to deliver ‘Paper Free at Point of Care’, including 10 ‘Universal Capabilities’ by March 2018.

The themes in Suffolk’s Digital Road Map had been meticulously developed systemwide over two years, and were part of the CCG’s response to challenges of the Forward View, and linked with its planning for a sustainable future. Suffolk’s Digital Road Map included:

1. A detailed plan so that the CCG had mechanisms in place to share high-risk

and critical information for people when they need it most, and with their consent

2. A strategic plan to shift the way the NHS and social care operate in Suffolk. 3. Ways to connect health and social care workers with the wider public sector,

eg police, housing and beyond. The Suffolk LDR (led by NHS WSCCG, encompassing NHS IESCCG, and all key providers and partners) had been submitted on 30 June 2016 following approval by the Health & Wellbeing Board and evaluation of the LDR had concluded it was a ‘national exemplar’. All LDRs were required to be re-submitted by 30 October 2016 and Suffolk’s was currently being expanded to include NHS North East Essex CCG (NEECCG) and ensure it fully aligned with the Sustainability and Transformation Plan (STP) footprint. Recent progress against LDR ambitions was detailed within paragraph 3.4 of the report. Pace of the implementation of the LDR was subject to appropriate investment. Nationally £1.4billion had been identified to implement Local Digital Roadmaps and the CCG awaited publication of the mechanism to secure the Suffolk & North East Essex allocation.

Key expected outcomes of the LDR included;

Online access for patients and their carers to their Health & Care record (subject to consent)

Creation and use of the ‘Shared Care’ record (rather than ‘organisation’ specific records), as well as seamless transmission of critical information across the

https://www.gov.uk/government/organisations/national-information-board

https://www.gov.uk/government/publications/implementing-personalised-health-and-care-2020

https://www.gov.uk/government/publications/implementing-personalised-health-and-care-2020

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system so that in an emergency, the information was available at the point of care. That included information that protected our most vulnerable (specifically Child Protection, and End of Life patients), and would be systemically in place by March 2018.

A digitally aware and supported workforce

Ability for patients and citizens to choose digital interaction with the Health & Care services (such as being able to have a ‘virtual’ consultation with a professional, or being able to share health related information from an app, wearable or other form of telecare direct to the services treating or monitoring them)

The need for increased engagement in light of some patients concern with regard to confidentiality of data was emphasized. It was explained that local induction/procedures had been strengthened to incorporate digital awareness and engagement was taking place with local universities and education providers to maximise any benefit. The Sustainability and Transformation Plan workforce meetings had discussed workforce issues which incorporated the primary care workforce. In response to a question as to whether work was underway to attempt to align secondary care systems, it was explained that the System Informatics Partnership was pursuing discussions in that respect. The Governing Body noted the content of the report

16/094 INTEGRATED PERFORMANCE REPORT

The Chief Nursing Officer, Interim Chief Finance Officer, Chief Redesign Officer

and Deputy Chief Contracts Officer presented the Integrated Performance Report, which provided members with a summary of performance against national targets, contractual targets, clinical quality and patient safety issues, financial performance and acute activity, together with detailing work being carried out by the CCG’s redesign team. Clinical Quality and Patient Safety Key points highlighted included;

There had been 17 cases of C.difficile year to date against a trajectory of 15.

Suffolk Community Healthcare had not reported any grade 3 or 4 pressure ulcers for their inpatient units during the contractual year.

Community services had reported high levels of falls recently and detailed analysis work was underway.

There had been an increase of safeguarding contacts via the hub and analysis of referrals was taking place.

Concerns relating to care homes continued to be monitored closely with information contained within the report having been revised to provide an overall position.

The Governing Body was informed that a C.difficile reduction plan was in place which incorporated a number of initiatives that were ongoing. Work continued with Suffolk County Council to support care homes and work with providers to improve from ‘inadequate’ and ‘requires improvement’ Care Quality Commission ratings. Work included the development of action plans, and policy and care plan development.

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Financial and Performance Delivery The Interim Chief Finance Officer reported that at month five NHS England had de-escalated the CCG from monthly ‘deep dive’ scrutiny back to regular monthly reporting. Whilst the financial challenge remained there was now increased confidence due to the CCG’s formulation and delivery of a robust recovery plan. At month five the CCG was £1.3m off plan with key variances being QIPP delivery and continuing healthcare costs. Prescribing expenditure was improving month on month. The CCG was forecasting an in-year breakeven position and there was an underlying financial deficit of £3.3m which had improved by £600k from previous months. QIPP delivery was currently 62%. The new guaranteed income contract with West Suffolk Hospital was indicating significant outpatient and elective under-performance, which, had there still been a payment by results contract in place would have resulted in accrual of underspend. There was continual discussion with the hospital in respect of the quality of data following its implementation of e-care, and pursuance of claw back of under-performance as permitted by the new contract was being pursued. The need to be mindful, going forward, of the underlying deficit was emphasized together with acquiring more detailed information in respect of QIPP delivery and the guaranteed income contract with West Suffolk Hospital. The Governing Body was reassured that readmission information continued to be monitored closely, along with delayed transfer of care rates. The need for increased work with practices in an attempt to achieve the quality premium aligned to increased use of e-referrals was highlighted and it was noted that discussions had taken place with West Suffolk Hospital in respect of the premium associated with the emergency admission rate of children with asthma. Redesign

Page 5 of the report detailed work associated with the three Sustainability and Transformation Plan (STP) workstreams.

The ‘red’ RAG rating associated to the learning disability community model was a result of the CCG not being successful in acquiring capital funding, although Norfolk and Suffolk NHS Foundation Trust had now put forward an alternative proposal.

The one plus one outline business case had been drafted and the governance approval route was currently being determined.

There was a new requirement to develop and A&E Performance Plan and Board. A Board had subsequently been established and held its first meeting on 7 September 2016, key issues had included a review of 111 calls and how discharge rates and delayed transfers of care might be improved.

West Suffolk Hospital’s Portfolio Board was up and running and had overseen the commissioning intentions plans.

The new IAPT wellbeing service was at mobilization stage.

‘Connect’ work previously halted in light of the financial pressures had now been reinvigorated.

Clinical workstreams were expected to commence in October 2016. In response to questioning it was explained that a ‘red’ rating in respect of finances meant that the scheme had not delivered its intended saving at that current point in

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the year. The importance of building any doubt about full year assumptions into the planning process was emphasized. Contractual Performance Key points highlighted included;

West Suffolk NHS Foundation Trust – continuing to address issues associated with implementation of the Trust’s new e-care system. Other concerns were the Trust’s drop in A&E performance and inability to meet the delayed transfer of care trajectory.

Addenbrookes – referral to treatment performance was of concern, together with cardiology capacity. Invoice validation was taking place.

Norfolk and Suffolk NHS Foundation Trust (NSFT) – the Trust remained subject to special measures and the outcome of a further Care Quality Commission inspection was awaited. Performance concerns had been escalated contractually.

Suffolk Community Healthcare (SCH) – concerns included looked after children targets for which an action plan was in place, high vacancies within the care coordination centre although since the report some recruitment had taken place. Delayed transfers of care within community hospitals had improved. Whilst during the bid stage SCH had indicated there would be one governance structure that did not currently seem to be the case. The CCG had been assured that matter was being addressed and the situation was being reviewed at service level agreement meetings.

111 Service – the service was struggling to meet the 60 second response target and the situation was being monitored closely.

East of England Ambulance Trust (EEAST) – the Trust’s overall performance continued to be a cause for major concern and was being monitored closely by the 19 collaborating CCGs

The Governing Body noted the content of the report.

16/095 SUSTAINABILITY AND TRANSFORMATION PLAN (STP) UPDATE

Jenny Briggs, STP Programme Director was welcomed to the meeting and gave an

update on the STP. In December 2015, the NHS shared planning guidance had outlined a new approach to help ensure that health and care services were built around the needs of local populations. Every health and care system in England had been tasked with producing a multi-year Sustainability and Transformation Plan (STP), showing how local services would evolve and become sustainable over the next five years – ultimately delivering the Five Year Forward View vision of better health, better patient care and improved NHS efficiency. The submission timescales had been set by NHS England and NHS Improvement, who were responsible for overseeing delivery of the plans. All health and care systems had come together into geographic footprints that would help to drive sustainable transformation in patient experience and health outcomes for the long term. Three workstreams had been set up to drive the STP forward, those being;

Safer Stronger Resilient Communities

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Acute Reconfiguration and Transformation

Collaborative working across the system The Sustainability and Transformation Plan (STP) was required for submission to NHS England by 21 October 2016. Formal communication and engagement would commence during October – December 2016, with the expectation that contracting and commissioning agreements to enable implementation of the plan could commence in November 2016. The Governing Body was being asked to delegate authority to the Joint Steering Group for submission of the STP. There was opportunity for the CCG to request review of the STP by its Clinical Executive prior to submission. The need for increased engagement of primary care was emphasized, together with due consideration as to how the STP would address finance and workforce issues. The Governing Body noted that a workforce group had been set up which was currently mapping requirements. Concern was raised that the lack of patient and public engagement. It was explained that whilst there was currently a national embargo on engagement, many of the plans had already been subject to engagement at organisational level, with communication leads having been involved in discussions as to how to facilitate engagement. Having questioned how community hubs were to be determined, it was explained that ‘connect’ areas would be linked into other systems. It was reiterated that, although governance going forward had been highlighted as a key issue, the STP was a plan and not a new body. There was a meeting of participating organisation Chairs scheduled to take place on 29 September 2016 to discuss governance. The Governing Body noted the update and agreed the STP be reviewed by the CCG’s Executive prior to submission.

16/096 GOVERNING BODY ASSURANCE FRAMEWORK

The Chief Corporate Services Officer presented the Governing Body Assurance Framework (GBAF) for September 2016. The GBAF continued to be reviewed by the Chief Officers Team every month and by the Governing Body and Audit Committee at each of their meetings. Revisions to the GBAF were detailed within Section 3 of the report. It was questioned whether clinical risk associated to difficulties experienced by primary care following the transition of IT services to NEL should be included on the GBAF. The Chief Corporate Services Officer advised that NEL had been informed that performance levels were unacceptable, daily meetings were being held, and an action plan had been developed. It was envisaged that practice managers would be provided with an update on 20 October 2016. At present the risk was recorded on the corporate services directorate risk register and in the event that no progress was made following the measures put in place a view as to whether it should be escalated to the GBAF would be taken. Having queried whether other actions might be identified in respect of Risk 27a in relation to Norfolk and Suffolk NHS Foundation Trust, it was explained that actions

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_____________________________ _______________________ Chair (Dr Christopher Browning) Date

were ongoing and, at present, the outcome of the CQC inspection was awaited with current issues being performance rather than quality related. The Governing Body noted and approved the GBAF as presented.

16/097 MINUTES OF MEETINGS

Presented by the Lay Member for Governance, consideration was given to the

minutes of the following meetings:

1) Audit Committee The unconfirmed minutes of a meeting held on 6 September 2016.

2) Finance and Performance Committee

The confirmed minutes of a meeting held on 20 July 2016 and unconfirmed minutes of a meeting held on 17 August 2016. It was suggested that thought be given to the appropriateness of rescheduling these Committees to ensure more timely minutes might be reported to the Governing Body.

3) Clinical Scrutiny Committee

The unconfirmed minutes of a meeting held on 24 August 2016 4) CCG Collaborative Group

The unconfirmed minutes of a meeting held on 23 August 2016 5) NHS England/West Suffolk CCG Joint Commissioning Committee

The unconfirmed minutes of a meeting held on 27 July 2016 The Governing Body received and endorsed the presented minutes and decisions.

16/098 ANY OTHER BUSINESS

No items of other business were received.

16/099 DATE OF NEXT MEETING

The next meeting of the West Suffolk CCG in public was scheduled to take place on Wednesday 30 November 2016 at 0900 hrs at The Lecture Room, St Edmundsbury Cathedral, Bury St Edmunds, Suffolk

16/100 QUESTIONS FROM THE PUBLIC

No questions were received from members of the public.

WEST SUFFOLK CCG Governing Body

ACTION LOG: 28 September 2016 (updated) MINUTE DETAILS ACTION BY WHOM TIMESCALE/UPDATE

Meeting of 27 July 2016

16/078 Managing Conflicts

of Interest – Revised

Statutory Guidance

for CCGs

To action the following as approved by the Governing

Body:

Appointment of a third Lay Member

Introduction of a Conflicts of Interest Guardian

Ensuring a robust process for managing any

breaches

Strengthened provision around decision-making

when a member of the Governing Body, or

committee or sub-committee was conflicted

Strengthened provisions for the management of

gifts and hospitality

An annual audit of conflicts of interest

management

End-of-year governance statement

Mandatory online conflicts of interest training

Identification of a team or individual within the

organisation to support the Conflicts of Interest

Guardian and lead on day to day management

Requirement for all staff to make a declaration of

interest every six months

Revised documentation templates

Timetable: much of the foregoing to be

completed immediately and all by October 2016

in time for the next quarterly declaration of interest

round.

Amanda

Lyes/Colin

Boakes

Update: All of the required actions arising

from the revised NHS England Statutory

Guidance on Managing Conflicts of interest

as listed are being progressed with

anticipated full compliance by the end of

October 2016.

Meeting of 28 September 2016

16/095 Sustainability and

Transformation Plan

(STP)

The Governing Body noted the update and agreed

the STP be reviewed by the CCG’s Executive prior to

submission.

Kate Vaughton Complete

MINUTE DETAILS ACTION BY WHOM TIMESCALE/UPDATE

16/097 Minutes of Meetings Finance and Performance Committee - It was

suggested that thought be given to the

appropriateness of rescheduling these Committees to

ensure more timely minutes might be reported to the

Governing Body.

Kate Vaughton

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GOVERNING BODY

Agenda Item No. 06

Reference No. WSCCG 16-56

Date. 30 November 2016

Title

Chair and Chief Officer Action – 02/2016

Lead Chief Officer

Richard Watson, Chief Redesign Officer

Author(s)


Purpose

To advise and seek endorsement from the Governing Body of a Chair and Chief Officer Action taken in respect of the business case for integrated community health and care services including integrated urgent care services

Applicable CCG Priorities

1. Develop clinical leadership

2. Demonstrate excellence in patient experience & patient engagement

3. Improve the health & care of older people

4. Improve access to mental health services

5. Improve health & wellbeing through partnership working

6. Deliver financial sustainability through quality improvement

Action required by Governing Body: The Governing Body is asked to note and endorse action taken by the Chair and Chief Officer in respect of the business case for integrated community health and care services including integrated urgent care services.

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GOVERNING BODY

Agenda Item No. 07



Title

Appointment of External Auditors

Lead Chief Officer

Lesley MacLeod, Interim Chief Finance Officer

Author(s)

Mark Game – Head of Accounting & Control

Purpose

To receive a recommendation from the auditor panel to approve the appointment the CCGs external auditors from 2017/2018 onwards.








Action required by Governing Body: To decide whether to accept the auditor panel recommendation and approve the appointment of the CCGs external auditors.

1. Background 1.1 The Local Audit and Accountability Act 2014 brings in significant changes to the local public

audit regime in England by replacing centralised arrangements for appointing external auditors to health service bodies (clinical commissioning groups and NHS trusts) with a system that allows each body to make its own appointment and directly manage the resulting contract and relationship.

1.2 The CCG established an auditor panel, a ‘sub-set’ of the audit committee, in early 2016. The

role of the auditor panel is to advise on the selection, appointment and removal of external auditors and on maintaining an independent relationship with them. The auditor panel is an advisory body. Responsibility for the actual procurement and appointment of the auditors remains with the CCGs Governing Body.

1.3 The appointment of external auditors must be made by 31/12/16 for the 2017/18 financial

year. The appointment can be for longer than a year but there must be a new appointment process at least once every 5 years. An auditor can be reappointed for further terms. An external auditor must be eligible for appointment in line with Financial Reporting Council (FRC) requirements.

1.4 The CCG must publish a notice within 28 days of appointing the external auditor stating that

the appointment has been made; who the auditor is; how long the appointment is for. The notice must also summarise the advice given by the auditor panel and reasons for not following it if that is the case. The notice must be published on the CCG’s website.

2. Key Issues 2.1 The auditor panel considered the procurement options available to the CCG, including the

various framework agreements and associated procurement costs. The auditor panel expressed a desire to ensure that the CCG’s existing external auditors were included in the procurement process because of the high quality service that they have been providing. This requirement however restricted procurement options because the CCG’s existing auditors were not on the only framework agreement that was truly free to access.

2.2 At the auditor panel meeting on 4 October 2016 a proposal was discussed for reappointing

the CCG’s existing auditors, Ernst & Young, through the use of a single tender action/tender waiver. At the request of the auditor panel further analysis of the proposal was conducted outside of the meeting with information shared with panel members accordingly.

2.3 The following points were noted:

The CCG’s audit fee had reduced by 9.72% between 2013/14 and 2014/15, and a further 25% between 2014/15 and 2015/16. These reductions were subsidised from reserves held by the Audit Commission;

After considering the element of the West Suffolk CCG audit fee that would be recharged to Ipswich and East Suffolk CCG, for the CCGs share of the costs associated with the Management Delivery Team hosted by West Suffolk CCG, the proposal from Ernst & Young offered a reduction in fee compared to 2015/16 and 2016/17 of 2.77%;

The average existing fee for both Suffolk CCGs was compared to the average fee across all CCG’s and appeared reasonable. Therefore the net reduction of 2.77% was also considered reasonable;

This proposed fee is fixed for the three year duration of the contract and is inclusive of any incidental costs, such as travel, which would normally equate to circa £2,000 per annum;

The total fee for the contract period is below the OJEU limit;

Assessment criteria was established which considered the three key elements of the contract as follows:

o Methodology and Approach - 35% o Resources, Organisation Capability and Experience - 40% o Costs - 25%

When assessed against the above criteria Ernst & Young scored highly at 91%;

The auditor panel agreed that because the contract value was relatively low (below the EU threshold) and Ernst & Young were offering a reasonable deal that demonstrated good VFM, it was not necessary to go ahead with a tendering process. The auditor panel agreed that they had every confidence that Ernst & Young were very competent, understood the business and were able to deliver the audit in a timely and professional manner, whilst also providing continuity and stability.

2.4 After consideration of all the additional information provided, the auditor panel agreed to

recommend that the Governing Body approve the appointment of the CCG’s existing external auditors, Ernst & Young, through the use of a single tender action/tender waiver. This agreement was reached, in line with the auditor panel terms of reference, via a ‘virtual’ meeting using e-mail communication.

3. Recommendation 3.1 The auditor panel recommend that the Governing Body agree to appoint Ernst & Young as

the CCG’s auditors, for the three year period commencing with the 2017/18 accounts audit, at the proposed fixed price which is an overall net reduction on the price previously paid by the CCG.

1

GOVERNING BODY

Agenda Item No. 08



Title

Integrated Performance Report

Lead Chief Officer

Barbara McLean, Chief Nursing Officer Lesley MacLeod, Chief Finance Officer Richard Watson, Chief Redesign Officer Jan Thomas, Chief Contracts Officer

Author(s)

Alex Briggs, Head of Corporate Intelligence

Purpose

To provide members with a summary of performance against national targets, contractual targets, clinical quality and patient safety issues, financial position and workstream activity.








Action required by Governing Body: To note the position regarding financial and service performance; review actions being taken with regard to patient safety and clinical quality issues; and any actions to mitigate risks or poor performance.

Integrated Performance Report

November 2016

1

Contents Part 1 – Clinical Quality & Patient Safety…………………………………………........................... Part 2 - Finance and Information……………………………………………………………………… Part 3 - Redesign………………………………………………………………………………………. Part 4 - Contractual Performance by Provider…........................................................................ Part 5 – PMO ……………………………………………………………………………………………..

3-5

6-8

9-14

15-16

17-21

2

Clinical Quality & Patient Safety

November 2016

3

Clinical Quality & Patient Safety – Executive Summary

4

Slight deteriorations on performance – some concerns/risks noted

Considerable deteriorations on performance – major concerns/risks noted

Improvements and/or continued good performance – no major concerns/risks noted

Area App Ref

Provider Sept Rating

Previous Rating

Headlines

Infection Prevention & Control (1)

3 - 6 West Suffolk Hospital NHS Foundation Trust

WSFT had 1 case of CDI against a trajectory of 1,. WSFT YTD is 13 against a trajectory of 8. WSFT have reported 0 cases of MRSA YTD.

Suffolk Community Healthcare

SCH had 1 case of CDI in September. YTD total is 2 (one case from May has now been assigned to SCH) against a YTD trajectory of 2. No cases of MRSA BSI have been reported YTD.

West Suffolk CCG WSCCG reported 6 cases of CDI for the month of September against a monthly trajectory of 3.This breaks down into 1 acute and 5 non acute (community) of which 0 were diagnosed out of area. YTD cases are 33 against trajectory of 22 and an end of year trajectory of 45.

Harm Free Care Falls (2) *Different RAG rating used

7 & 9 West Suffolk Hospital NHS Foundation Trust

WSFT reported 61 falls for Sept showing a continued static position across the year. The CCG continue to work with the Trust to improve reporting of falls per 1000 bed days


Rate of falls 13.3 per 1,000 bed days. Highest numbers of falls are at Blue Bird Lodge, where the layout presents challenges to the management of falls. SCH are due to report on the falls prevention work at Blue Bird Lodge and Felixstowe Community Hospital ,which has seen a recent increase in falls, at the next quality meeting.

Harm Free Care Pressure Ulcers (3)

8 & 10 West Suffolk Hospital NHS Foundation Trust

15 16 WSFT reported 10 Grade 2 and 5 Grade 3 pressure ulcers – the CCG continue to work with the Trust to obtain a breakdown of avoidable and unavoidable status.


12 6 SCH reported 8 avoidable Grade 2 pressure ulcers for the month (7 community & 1 inpatient). There were also 4 avoidable Grade 3 pressure ulcers reported in month (all community). No avoidable grade 4 pressure ulcers reported.

(1) Infection Prevention & Control – The RAG rating is subjective based on an expert review of the individual organisations overall infection prevention and control performance with particular consideration being given to performance in relation to MRSA BSI and C.Diff infection rates. (2) Falls per 1,000 bed days *Green ≤6.63 (national average RCP 2-15): Amber 6.64 – 7.00: Red ≥7.01 (3) Total number of avoidable pressure ulcers reported

5

Area App Ref

Provider Sept Rating

Previous Rating

Headlines

Serious Incidents and Never Events (4)


6 4 Unexpected/potentially avoidable deaths = 4 (3x Sub-optimal care of deteriorating patient, 1x Maternity). Unexpected/potentially avoidable injury = 2 (2x slips/trips/falls)


0 0 No comment

Norfolk & Suffolk Foundation Trust

1 4 Unexpected/potentially avoidable deaths = 1 (1x Apparent/actual/suspected self-inflicted harm)

East of England Ambulance Service

1 3 Unexpected/potentially avoidable deaths = 1 (1x Apparent/actual/suspected self-inflicted harm)

Patient Experience (5)


No report for complaints and PALS submitted. A&E FF&T 83%, deterioration from last month. Other FF&T scores are positive towards the hospital, however no figures for Post Natal Acute were submitted.


1 complaint received in month. Positive FF&T scores across all areas.

Norfolk & Suffolk Foundation Trust

11 complaints received in month.

EEAST Not reported

6 complaints received in month.

Care UK Not reported

2 complaints received in month for OOH. 0 complaints received for 111.

Transforming Care (6)

15 West Suffolk CCG

WSCCG remains ahead of trajectory

Care Homes (7)

38 - 40 West Suffolk CCG

Outstanding: 5 (+2) Good: 111 (no change) Requires Improvement: 40 (no change) Inadequate: 7 (no change) Total homes captured (CQC database): 163

(4) Serious Incidents – The number of actual serious incidents raised by the individual organisations (5) Patient Experience - The RAG rating is subjective based on an expert review of the individual organisations overall patient experience performance with particular consideration being given to performance in relation to the Friends and Family Test and time frames to respond to complaints (6) Transforming Care - The RAG rating is subjective based on an expert review of the organisations overall performance (7) Care Homes - The RAG rating is subjective based on an expert review of performance within the care home sector

Finance & Information

November 2016

6

7

Rating Key Movement Key

On or better than target Improvement

Below target No Change

Deterioration

Finance – Headlines Month Ending 31st October 2016

Variance from Plan (£1.6m)

At month 7 financial performance is ahead of the Financial Recovery Plan trajectory by £0.7m. However at this point the Recovery Plan forecast an improving position but there is sti l l an in month deficit. Key adverse variances from plan are QIPP schemes in development (£2.5m), Continuing Healthcare (£0.1m) and Prescribing (£0.3m) . These are mitigated by the use of Contingency (£0.9m) and underspends in Mental Health & LD Services (£0.2m) Other Programme (£0.3m), Corporate Costs (£0.1m) and Community (£0.1m) .

Forecast Risks and Mitigations £0.0m

Based on the Financial Recovery Plan the CCG currently has a balanced forecast position. Key risks are QIPP Under delivery (£3.5m), Funded Nursing Care national price increase (£0.7m), additional ambulance costs (£0.2m), Property Services Market Rents (£0.8m). These are mitigated by Contingency (£1.5m), Central Property Services Funding (£0.8m), 15/16 Quality Premium (£0.2m), further prior year benefits (£0.2m) and Other Mitigations which the CCG is currently in the process of pursuing (£2.4m).

Underlying Surplus / (Deficit) (£3.8m)

Key drivers are potential under-delivery of QIPP shown as a risk in the current year and therefore at risk recurrently (£4.5m), risks to the current year position that are deemed to be recurrent in nature such as Funded Nursing Care price increase (£0.8m), plus any mitigations in the current year deemed to be non recurrent such as prior year benefits (£0.8m), Quality Premium (£0.2m).

QIPP Delivery 60% At month 7 the CCG has delivered £4.8m of QIPP against a target £8.1m (post NHSE reporting this position has improved to £5.6m whch is 69% delivery). The forecast delivery is £10.5m against a target of £14.0m. Key forecast variances from plan are Budgetary Control (£1.4m), Prescribing (£0.6m), Over the Counter Meds (£0.8m) and Market Management (£0.5m).

Key Metric Value Last 3 Months Movement

Rating Headlines

8

Finance – Key Variances Month Ending 31st October 2016

QIPP Schemes Under Development

(£2.5m) 100.0% This is the balance of budget virements awaiting approval by budget holders accountable for the delivery of the QIPP schemes within the Financial Recovery Plan. There has been a transfer of £0.7m YTD ,which has had a negative impact on the Acute Services variance.

Acute Services (£0.5m) (0.5%)

Mainly due to QIPP budgets moving to budget holders responsible for their delivery as per the Financial Recovery plan (£672k).Other key over performing contracts are IHT £162k, BMI £17k, EEAST £131k, PTS Contract £139k, Papworth £114k. These are being offset by under performance at Addenbrookes £308k, ECRs £213k and Commissioning Reserve £333k. Enhanced support to validation will be provided by NEL CSU from month 6 to further reduce expenditure.

Prescribing (£0.3m) (1.1%)

A deterioration of £147k in month. GP prescribing overspent by £538k post QIPP based on the month 5 data, QIPP delivery has increased and national price reductions have contributed to an overall improving position. Central Drugs continues to over spend with a £194k variance year to date. Oxygen is overspent by £75k year to date, this should reduce as the new contract starts from October.

Continuing Healthcare Services

(£0.1m) (1.2%) An improvement of £194k in the month. Funded Nursing Care is £834k over spent, of which £456k is due to the nationally agreed 40% price uplift and £378k is due to a higher than budgeted volume of packages. This is being partially offset by an under spend in Continuing Healthcare packages of £715k.

Other Primary care £0.1m 4.4% The level of claims from all LES contracts is currently under budget contributing to an under spend of £77k at month 7.

Category Variance £m

Rating Last 3 Months Movement

Commentary%

Redesign

November 2016

9

Redesign Overarching Headlines • Sustainability and Transformation Plan (STP) submitted on 21 October. STP consists of three priority areas and nine

programmes of work as below diagram. We wait feedback and in the meantime a public facing shorter version is in development.

• Following public consultation, CCG(s) have commenced a dialogue process with partners including Suffolk County Council and Borough Councils concerning the Marginal and Vulnerable Adults (MVA) service re-procurement.

• Connect now has restarted and will be integral to the Alliance work post December constructive dialogue decision. Three new short term system support posts have now been recruited to support implementation

• Discharge to Assess (D2A) – Glastonbury Court now fully operational bringing an additional 20 community beds to support D2A from WSFT.

• Suffolk wide End of Life Guidelines aim to be approved and implemented in December • Early Intervention Team – agreement in principle by WSFT to review the coding of admission prevention activity which is currently

coded as an admission. • MSK Single Point of Referral approved for launch, planned mid November (Phase 1). All orthopaedic referrals for WSFT for

WSCCG patients will be triaged through a community physiotherapy service. Other provider referrals will look to be included and Phase 2 will include Rheumatology Referrals. This will support the demand management in reducing outpatient activity.

• Local Teledermatology solution tested between WSFT and practices, full operational by end of November

Information correct as of 3rd November 2016

Delivery RAG Status

Number of Schemes

Scheme Names

2 MVA Service and LD Community Model

7 Proactive Care, EIT, Pain, Telederm, Generics, Inhaler Devices and Scriptswitch

11 Single Point of Access, Children's Services, IAPT and Wellbeing, LPP, Ophthalmology, Prevention/Self Care, Gluten Free, Self Care, Prescribing Recommendations, Rebate Schemes, Polypharmacy

Integrated Care Headlines

Project Finance RAG

Delivery RAG

£ Full Year Planned

£ Full Year Projection

£ YTD Planned

£ YTD Actual

Headlines

P18a - Redesign of Proactive pathways

£602,574 £40,150 £283,078 £0

Connect (& Frailty) This project holds a Delivery RAG of amber because the project was paused whilst resource was recruited. The restart of the project in October commenced with a review and a new approach is in development with the providers . The frailty and care home workstreams are now embedded into the Connect Plan - over 100 My Care Wishes folders are now in place across West Suffolk following recognition following an emergency admission. Clinical Pathway review The falls and COPD pathways have now been updated and awaiting formal sign off by all system clinical leads before operationalising in December. Both pathways will then be BAU for the system and projects closed down by the CCG. Discharge to Assess Glastonbury Court opened in October and 20 beds are now fully occupied. The beds will support patients on D2A Pathway 2 and 3. This project will produce a progress report to the December A&E delivery Board. New carer Support to Get Home service to support D2A Pathway 1 for patients who can receive their reablement at home in development for potential launch in January 2017 – commercial model between WSFT, ACS and CCG however yet needs to be agreed. End of Life Work on development of Suffolk guidelines for EOL has commenced and will be shared at the December A&E Delivery Board. Final agreement for the Just In Case Medications is also on track for December.

P18c - Redesign of Proactive pathways - EIT

£395,209 £182,500 £195,848 £0

Progress continues across the work strands albeit with some delay due to the need for consultation periods for the changes required. This is reflected in the Amber delivery rating. Financial reporting shows a £0 against YTD mainly due to the coding of admission prevention as an admission on WSFT ecare. – agreement by WSFT to review this has now been agreed and work has commenced with finance and contracting leads to agree a solution. Much analysis has been undertaken and this now needs to be articulated into the project plan and any change control to the plan enacted.

MH & CYP Headlines Project Financ

e RAG PMO RAG



£ YTD Planned

£ YTD Actual

Headlines

3.1 IAPT and Wellbeing Service Procurement and Mobilisation

N/A £0 £0 £0 £0

• On track. Work taking place to ensure GP’s, Schools and Colleges have their lead Primary Mental Health Worker Contact details clearly identified and circulated. Offer to engage with Department for Work and Pensions ‘Employment Advisers’ initiative also being considered by NSFT.

3.2 MVA N/A £0 £0 £0 £0

• Negotiations taking place with the current provide r (NEPT) to extend their contract to the end of September 2017. However, there are current capacity concerns regarding the demand on the service. Information has been requested from the Provider to support this debate. Following the public consultation process, dialogue is taking place with Suffolk County Council , Suffolk Borough Councils etc. to better align the MVA service with other commissioned services for this client group.

3.3 & 3.4 LD Community Model of Care Children and Adults

N/A £0 £0 £0 £0

• Red status due to capital funding turned down by NHS England and alternative plans being developed by NSFT to enable refurbished accommodation for a lower number of beds. Mobilisation plan implementation continues with adverts out for recruitment to the community teams. (no change from Sep 16 update)

P3 - Children’s Community Service

N/A £0 £0 £0 £0

• On track. Structured dialogue process underway. Children’s workshop held on 01.11.16 with the Alliance partners and a session on operational delivery of the new service specification is taking place on 03.11.16 with the CCG.

Planned Care

Project Finance RAG

Delivery RAG



£ YTD Planned

£ YTD Actual

Headlines

P1 – Pain £362,518

£125,323

£181,752

£35,708

• The PID and plan were on hold pending an executives meeting in early November 2016. This meeting agreed an integrated solution to be actioned by April 17

• A recovery plan is in development and expected to bring the project back on track by December 2016.

P2 – Telederm £74,376 £0 £39,090 £0

• All milestones have been met and those expected in Nov 16 are still on track to be delivered to implement the local solution

• The YTD actuals show as £0 as there was an overspend in months May, Jun and August which negates the benefits savings realised in April, July and September. Once the savings have recouped earlier overspends, it is projected that this project will show a £36k saving.

P5 – LPP £850,000 £850,000 £425,225 £322,459

• This project is meeting its milestones and financial targets (projection) to date and shows Green. An increase in the amount of savings is being seen month on month. The Clinical Threshold Service (CTS) will cease as a prior approval service and become a referral review process with WSFT.

P15 – Ophthalmology

£80,841 £40,000 £32,475 £15,034

• This project is now in BAU but will continue to have the benefits monitored. From a delivery perspective, it has achieved its planned milestones. However, the expected savings each month have been around 50% of plan and this is reflected in the full year projection.

P16 - Prevention, Self Care & Shared Decision Making

£18,378 £18,378 £9,300 £63,063

• Diabetes prevention and management, Insulin Pumps and Atrial fibrillation work strands are currently on hold due to focus on financial recovery. The scheme continues to significantly over deliver against plan and shows Finance Green. As the scheme is currently delivering and no significant milestones are due, the plan is able to absorb being on hold for now.

• Respiratory - To be taken forward with the mobilisation of Suffolk Wellbeing.

Prescribing

Project Finance RAG

Delivery RAG



£ YTD Planned

£ YTD Actual

Headlines

P6.1 – Gluten Free £50,000 £87,154 £20,398 £38,866

Project on track and over delivering on savings against plan.

P6.2 - Self Care £30,000 £30,000 £12,239 £16,416 Project on track and over delivering on savings against plan.

P6.3 - Generics £70,000 £70,000 £28,558 £25,855 This project is upgraded to a delivery RAG of Green because progress made with the remaining practice still prescribing branded drugs. Now back on track and over delivering on savings against plan.

P6.4 - Inhaler Devices £150,000 £75,000 £61,195 £0

This scheme is not working and any savings are being negated by previous overspend against plan. Work is progressing as renewed effort to promote more cost-effective prescribing and so this is rated as a delivery Amber, as a scheme in recovery.

P6.5 Prescribing recommendations

£550,000 £550,000 £224,381 £187,831

Savings are slightly less than YTD plan but considered as easily recoverable. Otherwise considered on track with no issues.

P6.6 ScriptSwitch £150,000 £75,000 £61,195 £17,190

Notwithstanding the continuing promotion and training given to take up the Scriptswitch messages, this scheme has consistently under delivered on savings. A n appraisal of how much further resource should be given to this initiative will be discussed with PMO next month.

P6.7 Rebate Schemes £50,000 £50,000 £20,398 £41,656

On track, no issues.

P6.8 Polypharmacy £200,000 £100,000 £81,593 £31,748

The LES is no longer in effect which funded the Polypharmacy reviews. However, the accumulating effect from those reviews already undertaken will continue month on month.

Contractual Performance by Provider

November 2016

15

Contract Headlines

Contract Current Month

Previous 6 months (most recent on left)

Headlines

West Suffolk Hospital NHS Foundation Trust August

A&E performance remains below the 95% requirement at 88.59% , recovery plans are in place for this along with diagnostics . Cancer performance regarding the 2WW for symptomatic breast is decreasing and a deep dive service review will be undertaken to support the recovery plan.

Cambridge University Hospital NHS Foundation Trust August

Overall, A&E performance remains challenged and below the 95% requirement at 87.5%. There has been an improvement in performance on cancer and diagnostics. RTT performance remains of concern, particularly in regards to a number of patients who have waited longer than 52 weeks.

Norfolk and Suffolk NHS Foundation Trust August

CQC upgraded NSFT to requires improvement rating. Significant work ongoing specifically in relation to safety. Performance improving in many areas.

Suffolk Community Healthcare August

Performance in most areas is at the required standard except for the 18 wk RTT for consultant led paediatric services which was 88% in August. There has been a significant improvement noted for the care coordination centre performance towards the end of August.

Care UK: GP Out Of Hours August

The GP out of hours contract continues to perform well with the exception of the KPI regarding `speaking to a GP within 60 minutes`, this will be monitored in order to ensure return to compliance.

Care UK: 111 August

The 111 service met the 60 second response standard 95% requirement at 95.9%. The service continues to fail to meet the warm transfer standard of 95% requirement but has improved by 10% on last month.

East of England Ambulance Service NHS Trust August

The service has increasing activity particularly on red ambulance demand which is affecting performance. A remedial action plan has now been agreed between EEAST and CCG consortium.

Key

Improvements and/or continued good performance – no major concerns/risks noted

Slight deteriorations on performance – some concerns/risks noted

Considerable deteriorations on performance – major concerns/risks noted

16

PMO

November 2016

17

18

• The refresh of the PMO processes commenced in October 2016 • The PMO staff are systematically reviewing and carrying out a

‘Health Check’ of all current schemes and those in the planning stages – work continues

• Draft versions of a more user-friendly PMO report will be socialised in November 2016

• A new content and quality document is being created which allows Chief Officers an overview on the progress of projects within their areas of responsibility.

• Training sessions to communicate the PMO approach and processes are planned for November 2016

• A review of approval Gateways is underway

PMO Summary Sheet – November 2016

19

Month 7

No. Domain Revised QIPP YTD delivery

Full Year Projection (including

block)

Exec LeadProgramme

LeadComments

Project Delivery

RAG

Finance RAG

1 Contract Management £4,816k £1,934k £4,280k

1a •Invoice va l idation £767k £1,278k £2,292k JT CA

Month 6 data i s currently in the process of being reconci led with Providers . Signi ficant progress made with Addenbrookes who have accepted the majori ty of cha l lenges . NEL CSU Cla ims Management has now started and should increase the level of return. The QIPP target for Addenbrookes i s spl i t between 1a and 1c, a l l achievement to date i s included in 1a and therefore 1c i s currently understated.

Addenbrookes Savings v Budget £630k £1,278k £1,665k Awaiting month 4 va l idation

Other Acutes Savings v Budget £137k - £627k Awaiting month 4 va l idation

1b •Penalties £341k £356k JTWork on assess ing penal ties for Q2 i s ongoing. No change from last month’s update

1c•Price re-negotiation/service changes

£3,709k £656k £1,633k JT CA

MDTs have been restarted with a focus on the Top 8 contract va lues ; • Suffolk Community Heal th – WSFT• Transforming Pathology Partnership• In Heal th was Prime Diagnostics• Care UK Ltd (Harmoni HS LTD) – OOH• St El i zabeth Hospice• Al l ied Heal th Profess ionals Suffolk (WEST)• Norfolk Community Heal thcare – Community Contract• East of England Ambulance Service PTS

2 Prescribing Management £1,574k £508k £1,287k

2a •Medicines management £1,500k £508k £1,287k KV LL

Month 5 data shows del ivery of these schemes: Gluten Free, Sel f Care, Generics and Rebate Schemes, with Prescribing Recommendations only s l ightly off track. Speci fic actions are underway regarding the schemes that have not del ivered and to further enhance del ivery of the 17 individual Prescribing Recommendations . Targeted practice vis i ts have taken place with further ones planned, to practices that remain s igni ficantly overspent.

WSFT High Cost Drugs £250k £146k £250k

Prescribing Origina l Schemes £750k £363k £1,037k

Prescribing s tretch target £500k -

2b •Suppl ies management £74k KV LL

Work has begun to implement cost effective prescribing of s toma products .Spl ints have been grouped with medicines management which may need to be reassessed as the most sui table grouping.

20

Month 7

No. Domain Revised QIPP YTD delivery

Full Year Projection (including

block)

Exec LeadProgramme

LeadComments

Project Delivery

RAG

Finance RAG

3 CHC Management £2,329k £861k £1,196k

3a Fast track reviews £445,147 £44,951 £179,804 JT SL

Since 01 Apri l 2016 a l imited number of CHC and fast track reviews have been completed within exis ting cl inica l resource (1.8 WTE B6 cl incians). In January 2017 the EY backlog wi l l be closed and cl inica l resource (an additional 3 WTE B6 cl inicians) wi l l be diverted across to reviewing CHC and fast track patients ; this wi l l augment QIPP savings . Alongs ide the CHC Discharge to Assess '5Q care test' model wi l l be developed in col laboration with SCC socia l care, supported by West Norfolk CCG, which wi l l reduce the overra l l number of CHC and fast track el igible patients and consequently the number of patients requiring fol low-up/ongoing reviews.

3b Nurs ing homes £356,043 -£35,008 £0 JT SL

Fol lowing comms from CCG contracting to a l l care home providers in July, the CHC team is actively promoting the 's tandard' rate of £750 for a l l Nurs ing home placements and £700 for a l l res identia l care home placements ; the 'commiss ioning' s taff are being encouraged to negotiate with providers .

3c STLH £67,500 £37,423 £149,692 JT SL

Targeted negotiations continue around 'batching' high cost patients with dom care packages and individuals in specia l i s t care home placements . An al ternative CHC fast track pi lot i s being scoped with St El i zabeth hospice (IESCCG only) to enable timely discharge from hospice into a patients preferred place of EoL care. A domici l iary care porta l/framework i s being developed to enable providers to bid for care packages , this wi l l increase capaci ty of placement officers and s treaml ine the commiss ioning process .

3d Non fast track reviews £325,613 £144,742 £578,968 JT SL

Since 01 Apri l 2016 a l imited number of CHC and fast track reviews have been completed within exis ting cl inica l resource (1.8 WTE B6 cl incians). In January 2017 the EY backlog wi l l be closed and cl inica l resource (an additional 3 WTE B6 cl inicians) wi l l be diverted across to reviewing CHC and fast track patients ; this wi l l augment QIPP savings . Alongs ide the CHC Discharge to Assess '5Q care test' model wi l l be developed in col laboration with SCC socia l care, supported by West Norfolk CCG, which wi l l reduce the overra l l number of CHC and fast track el igible patients and consequently the number of patients requiring fol low up/ongoing reviews

3e Cost control £1,135,005 £668,670 £287,041 JT SL

An Operational plan/workbook defines key actions and priori ties for the CHC service, which includes s treaml ining of processes , financia l rigour of commiss ioning, clearance of EY backlog (94 as at 17/10/16), subsequent closure of new waiting l i s t (69 as at 17/10/16) and development of wider service transformation to include development of discharge to assess model taking 90% of a l l CHC assessments out of an acute setting, development of new fast track commiss ioning pathway with St El i zabeth hospice and movement towards joint working with NEE CCG through STP.

Financia l cha l lenges to overa l l CHC budget a l igned to increase in FNC upl i ft in costs and NEL adminis trative costs for PUPOC.

21

4 Demand Management £2,519k £1,469k £2,519k

4a •Referra l management £1,669k £974k £1,669k JT NE

The Demand Management Plan i s in draft and due for submiss ion to NHSE on 11/11. The MSK SPOA has been agreed and wi l l go l ive on the 14/11 between CCG, WSFT and AHPS. A joint cl inica l workshop i s being arranged for WSFT and CCG cl inicians date TBA. A proposal for a prior approval process at WSFT i s being submitted to Portfol io Board on 14/11 based on adminis trative triage for hot spot specia l ties (to push back on referra ls that require more deta i l ), supported by the CCG prior approval team to commence the process

4b •Low Priori ty Procedures £850k £496k £850k JT NE

Prior approval i s currently in place for 2 specia l i ties . Ther redes ign team have proposed an a l ternative processes which wi l l be a cl inica l note note review approach to for LPPs/Cl inica l Thresholds which i s a retrospective assessment of surgica l procedures to check compl iance, extract the lessons learnt for consul tants and feedback to primary care – revised approach to a lso be submitted through contract discuss ions .

5 BAU – Budget Management £2,922k £786k £1,200k

5a •Corporate cost management £332k £323k £332k AL

Due to be reviewed w/c 15/08. Phase one projects are on track to del iver with the recrui tment process being s trengthened, a l l vacancy's including bank and agency and requests for increased hours are assessed prior to agreement or otherwise. Maximis ing current resource across teams i .e. Matrix working, sharing and shi fting ski l l set in accordance to bus iness needs .

5b •Budgetary control £2,470k £185k £748k LMc Opportunities have been identi fied but not yet achieved

5c •IFR Management £120k £278k £120k BMc

Private patients pol icy in place. Practice variation investigation i s now complete with no evidence of s igni ficant variance found – action now closed. IFR Triage processes have been establ i shed and are address ing previous high numbers of cases cons idered by Panel – This has reduced to 4 cases at the October Panel . Highs of 50+ were seen in early 2016.

6 Schemes Requring Consultation £750k -

6b •Prescribing over the counter meds £750k - - LL Month 5 data shows that savings of £16,416 have now been achieved to date.

Total Identified £14,911k £5,558k £10,482k

Provision for M7 £87k

TOTAL QIPP £13,982k £5,645k

Part 3 Clinical Quality & Patient Safety

Report

1

Index

2

Infection Control pages 3 – 6 Complaints pages 19 – 37

Falls pages 7 – 11 Patient Experience pages 19 – 37

Pressure Ulcers pages 7 – 11 Care Homes page 38-40

Serious Incidents pages 12 – 13 Out of County page 41-42

Never Events pages 12 – 13

SHMI pages 14

Safeguarding page 15-18

PALS pages 19– 37

INFECTION PREVENTION AND CONTROL

Clostridium Difficile and MRSA

West Suffolk CCG – C-Diff WSCCG reported 6 cases of CDI for the month of

September against a monthly trajectory of 3. This breaks down into 1 acute and 5 non acute

(community) of which 0 were diagnosed out of area. • Total CCG YTD cases are 33 against YTD trajectory of

22 and an end of year trajectory of 45. • Non-acute YTD cases are 22 against a YTD trajectory of

14. Those C.diff cases occurring in the Community

Hospitals are included within the CCG figures and not WSH figures.

5 8

14 17

27

33

2 3

6 9

12 13

3 5

8 10

17

22

0

5

10

15

20

25

30

35

40

45

50

Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

WSCCG cumulative C.diff reporting for year to September 2016

WSCCG YTD WSCCG Traj WSH YTD WSH Traj Non Acute YTD Non Acute Traj

0

10

20

30

40

50

60

70

April May June July Aug Sep Oct Nov Dec Jan Feb Mar

West Suffolk CCG C.diff figures 2013/14 to 2016/17

2013/14

2014/15

2015/16

2016/17



West Suffolk CCG – MRSA WSCCG reported 1 case of MRSA for the month of

September 2016. This a recurrence of a previous bacteremia that took place in July and has been assigned to third party.

Total MRSA YTD cases are 0 against end of year

trajectory of 0.

0

1

2

3

4

5

Ap

ril

May Jun

Jul

Au

g

Sep

t

Oct

No

v

De

c

Jan

Feb

Mar

Number of MRSA cases reported 2016/17

WSCCG

WSH

ASSIGNED TO THIRDPARTY

ASSIGNED TOANOTHER CCG



West Suffolk Foundation Trust – MRSA

West Suffolk Hospital Trust have reported 0 cases of MRSA for the month of September 2016.

Total MRSA YTD case are 0 against end of year

trajectory of 0.

West Suffolk Foundation Trust – C-Diff • WSFT had 1 case against a trajectory of 1, relating to a WSCCG

patient.

• WSFT YTD is 13 against a YTD trajectory of 8.

• Currently WSFT is above trajectory, however, there was only 1 case reported for October at the time of writing. This would bring WSHFT closer to their end of year trajectory. They are currently exploring the possibility of a connection with antibiotics being given due to sepsis and patients being identified as end-of-life within hours of CDI diagnosis.



Suffolk Community Healthcare – MRSA Total MRSA YTD cases are 0 against end of year

trajectory of 0.

Suffolk Community Healthcare– C-Diff • YTD is 2 (Felixstowe Hospital in May, Bluebird

lodge in Sept) against a YTD trajectory of 2.

7

PATIENT SAFETY – HARM FREE CARE

Falls and Pressure Ulcers

West Suffolk Foundation Trust – Falls

The Trust reported 61 falls for the month of September which reflects the continued static position from the Trust in

relation to falls in general with August being the only period to show a slight decrease.

The Trust continue to experience issues with the new reporting system e-Care and figures for falls per 1000 bed days and

multifactorial falls assessments being completed on admission are still unreported on for this contractual year.

The CCG continue to work with the Trust to obtain missing reporting information that has been requested via the contract.

West Suffolk Foundation Trust – Pressure Ulcers

The Trust reported 10 Grade 2 pressure ulcers for the month of September. All cases are currently under review to determine avoidable or

unavoidable status.

The Trust reported 5 Grade 3 pressure ulcers for the month of September. All 5 cases are currently under review to determine avoidable or

unavoidable status.

The CCG continue to work with the Trust to improve pressure ulcer reporting and clarify avoidable and unavoidable status of previously

reported pressure ulcers. Until clarification is provided the CCG will continue to report pressure ulcer figures as avoidable for previous months.

8



9



Suffolk Community Healthcare – Falls SCH reported 47 inpatient falls for the month of September which shows a marked increase from previous months and is the highest level of falls reported for the contract year which commenced in October 2015. SCH recorded a figure of 13.30 for falls per 1000 bed days which reflects the rise in falls for September. The CCG will be raising falls for discussion at the next quality meeting scheduled in November where further information will be requested and assurances around actions and plans to improve performance will be sort.

10



Suffolk Community Healthcare – Pressure Ulcers – Community SCH reported 13 Grade 2 pressure ulcers for the month of September (6 unavoidable / 7 avoidable). This shows an increase against Augusts combined figure of 6 and will be raised for discussion at the next Quality meeting. There were 5 Grade 3 pressure ulcers reported in September (1 unavoidable / 4 avoidable). The 4 cases that were deemed as avoidable will be investigated and further information will be requested ahead of the next Quality meeting with the provider. There were no Grade 4 pressure ulcers reported for the month of September.

11



Suffolk Community Healthcare – Pressure Ulcers – Inpatient There were 2 Grade 2 pressure ulcers reported for the month of September (1 unavoidable / 1 avoidable). There were no Grade 3 pressure ulcers reported for the month of September. There were no Grade 4 pressure ulcers reported for the month of September reflecting a year to date position of zero.

12


Serious Incidents and Never Events

West Suffolk Foundation Trust Serious Incidents – there were 6 incidents

reported for the month of September 2016.

Unexpected/potentially avoidable deaths – 4 (x3 Sub-optimal care of deteriorating patient, x1 Maternity).

Unexpected/potentially avoidable injury – 2 (x2 slips/trips/falls)


Serious Incidents – there were 0

incidents reported for the month of

September.

13


Serious Incidents and Never Events

Norfolk and Suffolk Foundation Trust Serious Incidents – There was 1 incident reported

this month. Unexpected/potentially avoidable deaths – 1 (x1

Apparent/actual/suspected self-inflicted harm)


• Serious Incidents – there was 1 incident reported

this month. • Unexpected/potentially avoidable death – 1 (Sub

Optimal Care of Deteriorating Patient)

14


Summary Hospital-level Mortality Indicator

CLINICAL EFFECTIVENESS

Transforming Care

Transforming Care Cohort

There were 4 patients in cohort in September for WSCCG.

2016 figures are calculated to the end of October 2016.

16

PATEINT SAFETY

Safeguarding

The number of contacts received in August have reduced against contacts received in July but are still significantly above previous

months reporting figures.

450 462

492 494 494 493

439 501

444 483

514 572

555

0 50 100 150 200 250 300 350 400 450 500 550 600 650

Aug-15Sep-15Oct-15Nov-15Dec-15Jan-16Feb-16Mar-16Apr-16

May-16Jun-16Jul-16

Aug-16

Contacts

17

PATEINT SAFETY

Safeguarding

The below table indicates the outcomes for adult safeguarding.

Level 1-3 outcomes indicate the investigation stages.

Levels 1 -3 adult safeguarding investigation depending on severity and/or significance.

50 49 72 52 56 55 40 61 52 87 103 103 110

97 87 96

82 90 92 94

124 109

99 88 94 92 82 81

86 87 57 50

41

74

42 59 69 71 61 8 20

13 17

20 8 7

9

14

12 13 16 10

23 43 42

18 29 22

32

71

74

86 80 92

81

1 1 4

1

2

3

5 5 4

7

0

100

200

300

400

Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16

Outcomes for MASH records

Information Only Level 1 Level 2 Level 3 Request for Social Care Input Request for Social Care Input (Carer)

18

PATEINT SAFETY

Safeguarding

The vast majority of contacts originate from provider services. Such contacts account for around the same volume as the next six

referral sources combined

19

PATEINT SAFETY

Safeguarding

The highest Risk Locations identified are Own Home & Residential Care Home.

0

20

40

60

80

100

120

140

160

180

200

220

240

Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16

Location of Abuse

Own Home (186) No Abuse Identified/BLUE (177) Residential Care Home (86) Hospital (32)

Any Other Setting (27) Nursing Care (24) Service within the Community (12) Public Space (9)

Other Person Home (2) No location recorded (0)

PATIENT EXPERIENCE

Total PALS activity across both CCG’s for September 2016 was 252 calls showed compared with 842 for September 2015.

For locality breakdown, the overall figure for September for West Suffolk CCG was 93 and for queries out of the CCG area was 6.

The reduction in contacts to PALS

reflects the transfer of the

Emergency Dental Line and dental

enquiries to the 111 service and

Primary Care PALS issues to NHS

England from 1st September.

0

200

400

600

800

1000

1200

Num

ber

of calls

Oct-1

5

Nov-15

Dec-15

Jan-1

6

Feb-1

6

Mar-1

6

Apr-16

May-

16

Jun-1

6

Jul-1

6

Aug-16

Sep-1

6

2015/16

Total number of calls received by PALS

Patient Advice and Liaison Service

PATIENT EXPERIENCE

Service type Numbe

r of

calls

Query type

Dental services 11 Redirected to 111

Optical services 11 Jolly Giraffe campaign (via Public Health). Redirected

parents to local opticians

Anglia Community Eye Service (ACES) 10 Patients declined treatment at ACES as service not

commissioned by CCG (See narrative on next slide).

ECR transport 41 Journeys agreed for patient transport outside of

contract.

Medication 3 Changed to generic medication or items that can be

purchased over the counter.

Main topics raised by patients to the Patient Advice and Liaison Service during September 2016


PALS continues to work closely with the Medicines Management team following changes to the prescribing of generic medication or

removal of items from prescriptions which are available to purchase over the counter. Patients have contacted PALS with concerns

with the cost implications or intolerance to generic medication. PALS and Medicines Management have liaised with GPs to ensure

patients are prescribed appropriately.

PALS received several contacts regarding ACES (Anglia Community Eye Service). Patients have been contacted to advise them they

can no longer attend this clinic as the CCG does not commission it. PALS has worked closely with the Contracts and Communication

teams to offer patients guidance and support in the continuity of their treatment.

There were 41 requests for the transport of patient outside the contracted service provided by EEAST. These included discharges from

around the country and where patients required high levels of care on the journeys. There were also patients who contacted PALS as

they were unable to contact PTCAAS to book their transport and where crews failed to arrive for arranged bookings. This was

escalated to the Contract Lead for EEAST and patients were advised how to complain.

Example of good outcome from PALS intervention:

A patient contacted PALS who had received the letter from ACES advising her that her impending surgery could no longer be

performed by them. PALS worked closely with the Redesign team, Contract Lead and Evolutio. Negotiations were successful in

expediting the patient’s appointment and surgery with ACES. Patient was informed and a referral made for her to continue her course

of treatment.

PATIENT EXPERIENCE


PATIENT EXPERIENCE

Complaints

5 complaints were received during September 2016 for the West Suffolk CCG. A breakdown of these complaints is shown below;

West Complaint category Outcome and actions identified

Care UK

(111)

Waiting times – other. Patient unhappy with the delay in

OOD doctor visiting

Complaint Closed due to non-receipt of consent.

CCG Access to treatment or drugs - Access To Services. Patient

unhappy as unable to continue treatment with Anglia

Community Eye Service.

Complaint not upheld

Care UK

(OOH)

Patient care - Failure to provide adequate care. Patient

raising issues with the level of care received from OOH

doctor

Passed to provider - copy of response requested

NSFT Values - Attitude of Other Staff.

Prescribing - Adverse drug reactions. Patient unhappy with

the attitude experienced from a staff member and also

raises issues regarding side effects of medication.

Investigation complete

Complaints not managed by CCG

PATIENT EXPERIENCE

Complaints

Continued…

Providers not commissioned by the CCG

NHS Continuing Healthcare Appeals.

During September there were two CHC appeals received for WSCCG.

There are 18 appeals outstanding for WSCCG.

NHS England Access to treatment or drugs - Access To Services. Incorrect

information available regarding the emergency dental

service.

Passed to provider – copy of response requested

PATIENT EXPERIENCE

Complaints

Complaints data

Total number of complaints received across both CCG's

0

5

10

15

20

25

2013/14 13 9 1 10 12 13 2 8 8 17 14 14

2014/15 16 19 17 10 8 12 14 9 8 18 11 23

2015/16 9 14 1 13 12 18 14 13 4 11 14 15

2016/17 19 13 10 10 17 16

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

In order to provide a consistent comparison from previous years the above chart shows combined East and West figures.

PATIENT EXPERIENCE

West Suffolk Foundation Trust

Patient Experience Report

PALS Queries

The data for April and September 2016 was not available and therefore omitted from the table.

Sep

16

Aug

16

Jul

16

Jun

16

May

16

Apr

16

Mar

16

Feb

16

Jan

16

Dec

15

Nov

15

Oct

15

Admissions, discharge and transfer

arrangements

7

Appointments – including delays and

cancellations

25 32 33 21 23 20 27 20 18 16

Communication 13 9 7 14 19 14 11 7

Compliments 9 8

Facilities services

Patient care including nutrition and

hydration

16

Other 75 48 59 39 32 30

Queries, advice and request for

information

21 24 40 56 33 70 85 48 62 66

TOTAL 68 65 80 91 150 154 185 107 123 136

PATIENT EXPERIENCE

West Suffolk Foundation Trust


Complaints

The data for September 2016 is not available and therefore omitted from the table below.

Sep-16 Aug-16 Jul-16 Jun-16 May-16 Apr-16 Mar-16 Feb-16 Jan-16 Dec-15 Nov-15 Oct-15

Admissions, discharge and transfer arrangements

6 1 1 2

All aspects of clinical treatment

Appointments – including delays and cancellations

7 8 4 5 2 1 2 8

Attitude of staff

Clinical treatment – general medicine group 4

12

4 1 1 4

Clinical treatment – anaesthetics 2

Clinical treatment – surgical group 4 4 1 5 5

Clinical treatment – Accident and Emergency 6 1 2

Clinical treatment – obstetrics and gynaecology

5 1 1

Communication 6 6 7 4 5 6 7 6 10 13

Other 4 1

Patient care – including nutrition/hydration 4 6 7 1 2 5 7

Privacy, dignity and wellbeing 2 1

Values and behaviour (staff) 6 5 3 1 5 8

Trust administration 2 1

Access to treatment or drugs 1

Restraint 1

Total 25 32 21 16 38 20 21 17 16 22 25

PATIENT EXPERIENCE

West Suffolk Foundation Trust Patient Experience Report

Friends and Family Test

WSFT - % of respondents who would recommend the service

80

81

82

83

84

85

86

87

88

89

90

91

92

93

94

95

96

97

98

99

100

Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16

A&E 93 93 91 92 92 90 92 89 94 97 94 83

Inpatients 98 98 98 99 97 99 99 100 98 98 99 99

Outpatients 97 99 96 97 97 96 96 97 96 94 97 96

PATIENT EXPERIENCE

West Suffolk Foundation Trust Patient Experience Report

Friends & Family Test

WSFT Maternity Services - % of respondents who would recommend the service

There is a requirement to ask the Friends and Family question four times across Maternity Services; at the 36 week

antenatal appointment, following birth in the delivery suite or birthing unit, post-natally on discharge from the post-natal

ward and lastly at the time of discharge in the community. The graph above shows the percentage of respondents who

would recommend the service. No results were submitted for in-patient post natal care for September 2016.

84858687888990919293949596979899

100101

Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16

Antenatal care 100 100 100 96 97 97 96 98 98 93 98 97

Birth 100 100 100 100 100 100 100 100 100 100 100 100

Post Natal 98 97 97 96 100 100 86 100 90 100 100 0

Post Natal Community 100 100 100 96 100 100 100 97 95 90 100 100

PATIENT EXPERIENCE



Complaints

1 formal complaint was received during September 2016 for Suffolk Community Healthcare. The breakdown for this complaint

by subject type is as follows;

Sep

16

Aug

16

Jul

16

Jun

16

May

16

Apr

16

Mar

16

Feb

16

Jan

16

Dec

15

Nov

15

Oct

15

Sep

15

CCC/APS 1 1

Children’s Services

(SALT)

1 1 1

Community Health

Team

1 2 3 1 2 1 2 3 1 1

Community Hospital 2 1 1 1 1 2

COPD 1 1

Podiatry 1

Tissue Viability

Nurse

1

MIU

Community

Paediatric Service

1 1 3

Wheelchair Service 1 1 1 1 1 2 2

Continence Service 1

TOTAL 1 5 7 6 2 4 3 4 5 2 3 2 5

Details of the complaint can be seen below

PATIENT EXPERIENCE


SCH - % of respondents who would recommend the service

The combined score for Suffolk Community Healthcare for September 2016 is 98%

PATIENT EXPERIENCE

Norfolk and Suffolk Foundation Trust


PALS

NSFT recorded a total of 27 PALS contacts across West Suffolk during September 2016. 15 contacts were out of area or did

not have their location recorded. A breakdown of the West and OOA/unknown location contacts are as follows;

Sep 16 Aug 16 Jul 16 Jun 16 May 16 Apr 16 Mar 16 Feb 16 Jan 16 Dec 15 Nov 15

West NK West N

K

Wes

t

N

K

West N

K

Wes

t

NK West NK West N

K

Wes

t

N

K

West N

K

Wes

t

N

K

West NK

Access 1 1 1 2 2 1 1 1 2 2 2 2 1 Building

relationships 1 1 2 1 2

Communication 15 6 9 2 8 2 26 1 6 2 5 1 24 1 1 1 8 1 14 2

Environment 1 1 Information 7 7 1 3 1 6 4 4 7 4 3 11 4 7 2 4 1 8 5 3 6 Other Quality of care 2 1 2 3 2 2 1 1 2 2 2 1 3

Waiting 2 2 2 1 2 1 1

TOTAL 27 15 16 5 10 11 35 9 12 10 11 6 39 5 12 5 15 4 24 6 12 7

PATIENT EXPERIENCE

Norfolk and Suffolk Foundation Trust

Subject of complaint Sep

16

Aug

16

July

16

June

16

May

16

Apr

16

Mar

16

Feb

16

Jan

16

Dec

15 Nov

15

Oct

15

Sep

15

Admission/discharge

and transfer

arrangements 1 1 1 1 1

2 1 2 1 1

All aspects of clinical

treatment 8 6 3 3 5 4

6 5 2 2 2 4 1

Attitude of staff 2 1 1 1 3 1 3 2 2 1

Appointments/delay 1 1 1 1 1 1

Communication 1 3 1 2 1 1 2 3 2

Failure to follow agreed

procedures

Other 1 4 2

Patients privacy and

dignity 1 1

1 1

Patients property and

expenses 1

TOTAL 13 9 9 7 14 7 7 9 6 7 12 12 2

13 complaints were received during September 2016 for Norfolk and Suffolk Foundation Trust in the West Suffolk area (5 of

these were county wide). The breakdown for these complaints by subject type is as follows;


Complaints

PATIENT EXPERIENCE


5 complaints and 0 PALS queries were received during August 2016 for the Ambulance Service (West Suffolk). The breakdown for

complaints by service type is as follows;


Primary Subject of

complaint

Sep

16

Aug

16

Jul

16

Jun

16

May

16

Apr

16

Mar

16

Feb

16

Jan

16

Dec

15

Nov

15

Oct

15

Sep

15

Attitude 1 1 1 2 2 1

Clinical treatment and

assessment 1 2 1 1 1 1 1 1

Communication and

call handling 2 1 1 1

Delay 3 1 3 1 5 2 4 4 1 1

Transport and driving 1 2 1 1 1 1

Patient Property 1

Equipment / vehicle 1

Total 5 3 7 4 9 5 7 0 3 0 5 5 3

PATIENT EXPERIENCE


Cont…….

PALS queries

PATIENT EXPERIENCE

NHS Out of Hours and 111

*Information extracted from 111 and OOH report September 2016

Sep

16

Aug

16

Jul

16

Jun

16

May

16

Apr

16

Mar

16

Feb

16

Jan

16

Dec

15

Nov

15

Oct

15

Sep

15

OOH 2 3 4 1 2 1 1 1 2

111 1 1 2 3 2 1 1

TOTAL 2 4 4 2 2 3 2 2 2 1 1 1 2

Subject (primary) Description

Clinical Treatment (OOH)

Patient accessed OOH’s on 3 occasions due to pain in the stomach and was prescribed antibiotics and

advised to continue with antibiotics. When the patient was asked to attend for a review and had arrived,

there was no appointment made. The doctor advised that the patient has been referred to the

paediatrician, however when they arrived at the hospital they were not aware. The patient was

diagnosed with a burst gangrenous appendix.

Clinical Treatment (OOH) Multi agency complaint. Dr who called was rude and abrupt. Visiting nurse practitioner said patient

needed an x-ray but to wait for own GP surgery to open rather than wait in A&E.


PATIENT EXPERIENCE

Jan

2016

Feb

2016

Mar

2016

April

2016

May

2016

June

2016

July

2016

Aug

2016

Sept

2016

Number of queries per month 32 29 24 25 45 49 33 36 30

Number closed per month 7 10 5 13 18 23 13 14 4

Overall number outstanding on system

46 48 56 36 46 42 46 52 62

Queries by Provider

Care UK 0 1 2 1 1 1 1 0 2

IHT 8 3 5 7 18 7 10 10 4

N&N 0 1 0 0 0 2 0 0 0

CUFT 2 1 2 0 2 1 1 1 1

Papworth 0 0 0 0 0 0 0 1 0

WSFT 8 4 4 1 3 14 12 9 12

NSFT 9 5 2 2 6 11 2 4 6

SCH 1 4 4 3 4 4 2 1 3

Private 0 1 0 0 0 0 0 0 0

Other 4 9 5 11 11 9 5 10 2

GP Contract Issues log

PATIENT EXPERIENCE

Please see table below for breakdown of queries in September 2016.

Concerns have been highlighted with the Head of Patient Experience and Clinical Quality and will be

taken forward at the Quality Review meeting and with the Contract Lead for the relevant Trust.

Provider Query trends

WSFT 12 issues raised – 4 regarding discharge summaries, 3 referrals, 2 communication, 2 medications, 1

access to services.

SCH 3 issues raised – 2 regarding access to services, 1 communication.

NSFT 6 issues raised – 3 regarding access to services, 1 communication, 1 referral and 1 general issue.

Care UK 2 issues raised – 1 regarding communication, 1 communication/data breach

CUFT 1 issue regarding communication

CCG 2 issues raised – 1 regarding Prior Approval, 1 regarding referral changes for MSK from IHT to AHP

GP Contract Issues Log

PATIENT EXPERIENCE

Provider Query trends Date Status

WSFT General x 1

General x1

Referral x 1

Follow up Appt x 1

Blood Tests x1

Communication x 1

Communication x 1

Test results x 1

Communication x 1

Referral x 1

Discharge summary x 1

Referral x 1

Referral x 1

Communication x 1

Access to services x 1

Referral x 1

Referral x 1

Meds on discharge x 1

Prescribing x 1

Meds on discharge x 1

Communication x 1

Referral x 1

Referral x 1

Referral x 1

Referral x 1

Referral x 1

03.09.15

22.09.15

13.11.15

13.01.16

04.02.16

02.03.16

03.03.16

13.05.16

06.06.16

15.06.16

17.06.16

21.06.16

27.06.16

01.07.16

05.07.16

06.07.16

08.07.16

14.07.16

19.07.16

19.07.16

15.08.16

23.08.16

24.08.16

24.08.16

26.08.16

26.08.16

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Re-opened

Outstanding

Outstanding

Outstanding

Outstanding

CGH Referral x 1 04.07.16 Outstanding

TPP Access to services x 1

Blood tests x 1

Blood tests x 1

09.12.15

02.08.16

17.08.16

Outstanding

Outstanding

Re-opened

NHSE General x 1 01.08.16 Outstanding

Papworth Follow up x 1 11.08.16 Outstanding

NSFT Prescribing x 1 09.08.16 Outstanding

CUFT Equipment x 1 25.08.16 Outstanding (with Contract Lead)

The table shows the outstanding

queries prior to September 2016.

Re-opened indicates dissatisfied

with response. All providers are

chased for responses to

outstanding issues every month.

There continues to be a backlog

of issues (currently 26, which is

an increase on the August figure)

with WSH which remain open on

the system.


PATIENT EXPERIENCE


Please see table below for breakdown of queries in July 2016.

Concerns have been highlighted

with the Head of Patient Experience

and Clinical Quality and will be

taken forward at the Quality Review

meeting and with the Contract Lead

for the relevant Trust.

There was an increase of issues

raised regarding 2 week wait

appointments at West Suffolk

Hospital following referral by GP.

Provider Query trends

WSFT 12 issues raised – 4 regarding referrals, 2 communication, 2

test results, 2 medication on discharge, 1 prescribing and 1

access to services.

IHT 10 issues raised – 4 regarding referrals, 2 prescribing, 2

discharge summaries, 1 blood test and 1 medication on

discharge.

SCH 2 issues raised – 1 regarding access to services and 1onward

referral.

Care UK 1 issue regarding communication.

NSFT 2 issues raised – 1 regarding prescribing and 1access to

services.

TPP 3 issues raised – 1 regarding blood tests and 2 regarding test

results.

CUFT 1 issue raised regarding pre-op assessment.

In-health 1 issue regarding communication.

Colchester

General

1 issue regarding referral

41

Care Homes

Information from Regulator (CQC)

Ratings: Outstanding: 5 (+2) Good: 111 (no change)

Requires Improvement: 40 (no change) Inadequate: 7 (no change) Total homes captured (CQC database): 163 Updated: 2 November 2016

Joint Performance and Risk Analysis (CCG and SCC):

Provider Performance Panel (South) 22nd September 2016 Risk ratings of 3 (highest): • Anglesea Heights (Bupa) - CQC concerns around medicines management (CQC notice of decision letter not sent, mistake by CQC). Conditions

imposed on provider: every month home must audit every patient’s meds and report back to CQC. Suffolk County Council Adult Protection Team to do Level 2 investigation into home manager, supported by CCG. CQC have issued inspection report – requires improvement now, out of special measures. CQC still concerned re nurse competencies. CCG working with nurse practitioner to monitor progress.

Risk ratings of 2 (medium): • Monmouth Court (Bupa) - Telecon update: Suffolk County Council contracts manager setting up meeting with new home manager. CCG to

monitor progress with nurse practitioner visiting under the Care Homes Locally Enhanced Service. • Prince George House (Care UK) - 1-1 care being reassessed for several individuals. New manager in place. Clinical issues re safeguarding – poor

recording in daily care records, fall with head injury, nutritional concerns, choking concerns, weighing measures out of kilter, residents refusing meals no alternatives, no evidence of risk assessments. Not referring to GP appropriately. CCG working with Ipswich Hospital and Care UK on ‘optimisation project’ to address these concerns.

• Asterbury Place (Care UK) – Suffolk County Council Adult Protection Team visiting – CCG and Provider Support Team to follow up. • The Lodge Copdock – Provider Support Team update re CQC meeting with provider to discuss staffing – meeting didn’t happen, CQC Inspector

serving warning notice on staffing this week. Adult Protection Team to liaise with CCG and Provider Support Team re follow up.


42

Care Homes

• Friars Hall - CQC issued notice of proposal of positive conditions being served on nurse staff training, no window restrictors, clinical oversight, medication for end of life care. 3 types of medical protocols in place for same patient. Adult Protection Team to follow up an investigation, contract suspension to be reviewed following contract compliance visit. CQC report due, likely to be inadequate. New safeguarding regarding diabetes management (respite care).Contracts visits 4/5 October. Healthwatch visit in June – Ops Manager to re-review report and feed back to CCG and Suffolk County Council. Update: incident of patient death following fall from chair with delay in medical advice being sought – police and safeguarding investigation commenced, CHC team aware (although patient not CHC). CCG presence at strategy meeting 2 November.

Provider Performance Board 7 October 2016 Risk ratings of 3 (highest): • BUPA – overall – CQC acknowledge 5 failing services, CQC recently undertook a managers’ workshop – positive overall. Area managers present,

recognised staff hadn’t been working together… internal processes in place but not yet looking externally re CQC info, person centred care, etc. Mock CQC visits. CCG trialling quality and safeguarding dashboard with SCC contracts support.

• Chilton Meadows – root cause analysis report to be released to Suffolk County Council and CCG. Changes to management team. • Melford Court – Suffolk County Council contracts reviewing service re suspension. Continuing Healthcare visit: positive review. New manager in situ. • St Mary’s Nursing Home (Felixstowe) - Some improvement now Req Imp, need to see sustainability, some issues with moving and handling and

bedrails, Provider Support Team supporting. • Highcliffe Nursing Home (Felixstowe) – CQC breaches around safety. Provider Support Team and CCG supporting home. Contracts suspended • Norwood House (Leiston) – new leadership team, and new manager – CQC to comply with warning notice around duty of candour. Open safeguarding

enquiry. Recent case – fall. • Kingfisher House (4 Seasons) – poor quality – SCC contracts involved.

Note: Risk ratings are only attributed to

providers/homes that have been escalated

to Panel and/or Board meetings for discussion

and is not indicative of whole market


43

Care Homes

Overall comment:

New CCG care home strategy being developed following changes in team which will tie in all strands of care home work within both East and West CCGs. Discussions commencing with West team w/c 7 November.

Update: East Suffolk Care Homes Forum – next forum 8 November.

Second meeting 1 September 2016 – shared approach CCG and SCC Chair – IESCCG Care Homes Clinical Support Manager Deputy Chair – SCC Provider Support Team Lead


44

CLINICAL QUALITY

Out of County Providers

Colchester Hospital

Cdiff- the Trust reported 1 incident of Cdiff for the month of September bringing the year to date total to 22 against a trajectory of 18. Cancer – the Trust failed to meet 5 of the 8 targets for cancer in September, 2 week wait targets were achieved but figures show non-

compliance against all of the 31 day targets. Complaints – there has been a rise in complaints for the month of September which the Trust advise is due to a number of PALS contacts not

being responded to in a timely manner which subsequently led to complaints being registered, Sepsis – the Trust saw a positive increase in the correct use of the Sepsis tool with peformance increasing from 42% in August to 100% in

September. Serious Incidents – the Trust reported 8 serious incidents for the month of September which is a decrease against the 13 reported in August. Maternity – supervisor to midwife ratios continued to be below target with September reporting 1:18. The Trust are not continuing with the

supervision arrangements that are currently in place and will replace this with a new model from April 2017.

45

CLINICAL QUALITY

Out of County Providers

Addenbrookes Hospital

MRSA – the Trust reported an outbreak of MRSA within the Neonatal Unit where a number of babies were found to be carrying

methicillinresistant staphyococcus aureus. The Trust are treating the MRSA carriers and screening other patients frequently. Overall compliance with MRSA Decolonisation is 93.8%.

Serious Incidents – The Trust are still reporting a high number of information governance breaches with 8 further cases being reported for September. A meeting to discuss and agree a process of improvement is scheduled for November where consideration will be given to options such as quarterly deep dives, trend and theme analysis.

CQC – The Trust were put into special measures following the CQC visit in April/May 2015. The final report was published in May 2016 and the Trust were rated as Requires Improvement against the areas inspected. The CQC have since re-inspected both through a planned visit in September and unannounced visit on 29th September where a number of positive observations were noted. The report against the latest visit will be available in January 2017.

Pressure Ulcers - Pressure ulcers were low for the month with 2 Grade 1 and 7 Grade 2 pressure ulcers reported. Paediatrics - The Trust continue to raise concerns around paediatric referrals following concerns being raised that there has been an increase in

referrals to the Trust which would long term be unsustainable for Addenbrookes to continue without the need for further bed capacity and funding.

Mixed Sex Accommodation – there were three breaches reported for September which all relate to critical care. As a result of the breaches the Trust have revised their policy and are continuing to review the process around moving patients from ICU as this is where the breaches are occurring.

TPP – discussions are still on-going around how the Trust will manage pathology services going forward. An options analysis is being worked up but the Trust have provided assurance that there should not be any impact on services locally but that other areas may be impacted by the changes.

1

Finance & Information Pack October 2016

2

(Month 7 Ending 31st October 2016)

Contents

Financial Statement…………………………………………….………………………………………………………..………….…. 3

West Suffolk Hospital (WSFT) Activity….………………………………………………………………………………………. 4

Risks & Opportunities ……………………..….………………………………………………………………………………………. 5

Underlying Financial Position………………………………………………………………………………………………………. 6

Statement of Cashflow……………………………………………………………………………………………….……….….…… 7

Quality Premium ……………………………………………………………………………………………….…….……..………..... 8

System Wide View……………………………………………………………………………………………………….…….……… 9

3


• At month 7 the CCG is £1.6m behind

plan but financial performance is ahead of the Financial Recovery Plan trajectory by £0.7m.

• Key adverse variances are QIPP schemes in development (£2.5m), Continuing Healthcare (£0.1m) and Prescribing (£0.3m) .

• These are mitigated by the use of Contingency (£0.9m) and underspends in Mental Health & LD Services (£0.2m) Other Programme (£0.3m), Corporate Costs (£0.1m) and Community (£0.1m) .

Financial Statement

Source & Apps Budget Actual Variance Variance16-17

Budget

£m £m £m % £m

Total Income 172.2 172.2 0.0 0.0 298.6

Acute Services 99.9 100.4 (0.5) (0.5%) 172.1

Mental Health & Learning Disability Services 15.4 15.3 0.2 1.2% 26.4

Community Health services 16.3 16.2 0.1 0.6% 28.0

Continuing Healthcare Services 9.9 10.0 (0.1) (1.2%) 16.6

Prescribing 23.6 23.9 (0.3) (1.1%) 40.4

Other Primary care 1.9 1.8 0.1 4.4% 3.2

Other Programme Services 0.8 0.5 0.3 40.1% 1.6

Better Care Fund 3.0 3.0 0.0 0.0% 5.2

Property recharges 0.0 0.0 0.0 0.0

Non Recurrent Investment 0.0 0.0 0.0 2.9

Contingency 0.9 0.0 0.9 100.0% 1.5

Corporate Running Costs 2.9 2.8 0.1 4.7% 5.0

Total Expenditure 174.7 173.8 0.9 0.5% 302.9

QIPP Schemes Under Development (2.5) 0.0 (2.5) 100.0% (4.3)

'In Year' Surplus/ (Deficit) 0.0 (1.6) (1.6) 0.0

Surplus brought forward from previous year 1.7 1.7 0.0 0.0 2.9

'Reported' Surplus/ (Deficit) for 16/17 1.7 0.1 (1.6) (96.6%) 2.9

YTD Full Year

4


• 16/17 Expenditure on activity at WSFT is on plan due to the block contract agreed.

• The table to the left shows the WSFT view of M01 to M05. Although challenges have been raised, the data validated by the CCG has not been used due to missing datasets.

• E-Care issues within the trust still remain a concern. The expectation is that this will be retrospectively corrected next few months.

West Suffolk Hospital (WSFT) Activity (Month 7 Ending 31st October 2016)

SLA Plan

(Post QIPP) Act Var Var % Act YOY Var Var %

Plan (post

QIPP) Act

Var to

Plan Var % Aug 2015 YOY Var Var %

Outpatients first 2,722 2,734 (12) -0% 2,617 (117) -4% 16,378 16,713 (335) -2% 16,052 (661) -4%

Outpatients follow-up 3,188 3,000 188 6% 3,100 100 3% 34,288 32,882 1,406 4% 33,819 937 3%

Outpatients procedures 3,242 2,829 412 13% 3,097 268 9% 20,267 19,169 1,098 5% 19,813 644 3%

Outpatients telephone 362 358 5 1% 370 13 3% 10,572 9,873 699 7% 10,407 534 5%

Outpatients 9,515 8,921 594 6% 9,184 264 3% 81,504 78,637 2,867 4% 80,091 1,454 2%

Outpatients Maternity 1,671 1,601 70 4% 1,644 43 3% 1,933 1,863 70 4% 3,804 1,941 51%

Outpatients - other care package 157 205 (48) -31% 183 (22) -12% 698 126 572 82% 69 (57) -83%

Outpatient unbundled imaging 924 920 4 0% 880 (40) -5% 9,410 9,845 (435) -5% 9,173 (672) -7%

A&E 2,078 2,086 (8) -0% 1,988 (97) -5% 17,868 18,564 (696) -4% 17,523 (1,041) -6%

Daycase 5,699 5,186 513 9% 5,534 348 6% 7,220 6,960 260 4% 7,114 154 2%

Elective 3,897 3,794 103 3% 3,905 111 3% 1,300 1,199 101 8% 1,312 113 9%

Elective 9,596 8,980 616 6% 9,439 459 5% 8,520 8,159 361 4% 8,426 267 3%

Emergency non-elective 14,977 15,457 (480) -3% 14,431 (1,026) -7% 7,583 7,948 (365) -5% 7,331 (617) -8%

Other non-elective 2,170 2,110 60 3% 1,991 (119) -6% 831 872 (41) -5% 862 (10) -1%

Non Elective 17,147 17,567 (421) -2% 16,422 (1,145) -7% 8,413 8,820 (407) -5% 8,193 (627) -8%

Emergency threshold adjustment (672) (933) 260 -39% (616) 316 -51%

Readmissions (402) (413) 10 -3% (390) 23 -6%

Contract Adjustments (490) (375) (116) 24% (581) (206) 35%

SUS (National Data) 39,523 38,561 962 38,154 (407) -1% 128,346 126,014 2,332 127,279 1,265 1%

Cost and Volume excl drugs 1,691 1,656 35 2% 1,605 (51) -3%

Pathology 107 110 (3) -3% 106 (4) -4%

Drugs & Devices 1,821 2,049 (228) -13% 1,660 (389) -23%

Block 800 800 0 0% 1,313 513 39%

Winter - EEIT 322 322 0 0% 0 (322)

Financial consequences (see table) 0 0 0 (372) (372)

44,264 43,497 767 (0) 42,465 (1,032) -2% 128,346 126,014 2,332 127,279 1,265 1%

CQUIN 1,061 1,036 25 1,022 (14) -1% 0

Block Contract Adjustment 0 793 (793) 0 (793) 0

Contract Consequences annual (see table) 0

Total excluding contract SVs 45,325 45,325 0 43,487 (1,838) -4% 128,346 126,014 2,332 127,279 1,265 1%

M01 Provider View

Contract Adjustments CCG Adj

SLA Plan Act Var Act Total

Colposcopy (73) (12) (61) 0 (12)

First Attendance Adj (89) (55) (34) 0 (55)

JC15Z (117) (67) (51) 0 (67)

Patella Button (133) (114) (19) 0 (114)

Rheumatology Infusion (79) (74) (6) 0 (74)

Ambulatory Care 34 (8) 42 0 (8)

Physiotherapy 0 (30) 30 0 (30)

Podiatry 0 0 0 0 0

Community Glaucoma (32) (15) (17) 0 (15)

LPP 0 0 0 0 0

(490) (375) (116) 0 (375)

M5 YTD 2016 M5 YTD 2015

Finance £'000 Finance £'000 Activity Activity

M5 YTD 2016 M5 YTD 2015

(see below)

5


Risks/Opportunities

• The table to the left provides the CCG’s anticipated view of risks and opportunities .

• The latest forecast anticipates a full year balanced position.

• The main risk continues to be QIPP under delivery of £3.5m, CHC overspend mainly due to increased FNC rates and additional costs relating to Property costs.

• In order to achieve a balanced position the CCG will need to realise additional mitigations of £2.4m which is currently included in other mitigations.

Risks

Full Risk

Value

£m

Probability

of risk

being

realised

%

Potential

Risk Value

£m

Proportion

of Total

%

CCGs

Acute SLAs 0.24 100.00% 0.24 4.47%

Continuing Care SLAs 1.00 78.01% 0.78 14.72%

QIPP Under-Delivery 13.98 25.03% 3.50 66.04%

Other Risks 0.78 100.00% 0.78 14.76%

TOTAL RISKS 16.00 5.30 100.00%Please enter the probability of success of mitigating action

Mitigations

Full

Mitigation

Value

£m

Probability

of success

of

mitigating

action

%

Expected

Mitigation

Value

£m

Proportion

of Total

%

Uncommitted Funds (Excl 1% Headroom)

Contingency Held 1.51 100.00% 1.51 28.42%

Uncommitted Funds Sub-Total 1.51 1.51 28.42%

Actions to Implement

Other Mitigations 2.77 100.00% 2.77 52.28%

Mitigations relying on potential funding 1.02 1.02 19.30%

Actions to Implement Sub-Total 3.79 3.79 71.58%

TOTAL MITIGATION 5.30 5.30 100.00%

NET RISK / HEADROOM (10.70) 0.00

6


Underlying Financial Position

• The underlying position shows the recurrent financial position of an organisation. It excludes all non-recurrent funding and expenditure. This then leaves the true on going spending position of the organisation against its recurrent allocation.

• The CCG has reported an underlying full year position of £3.8m deficit

• This is mainly due to the anticipated under delivery of the QIPP target.

• The YTD financial position also includes prior year benefit of £0.8m

16-17

Budget

Other Non-

Recurrent

Adjustments

Prior Year

Impacts

Other FY

effects

Underlying

Position

£m £m £m £m £m

Total Income 298.6 (0.2) 298.4

Acute Services 172.1 0.0 0.4 172.5

Mental Health & Learning Disability Services 26.4 (0.2) 0.2 26.5

Community Health services 28.0 0.0 0.1 28.1

Continuing Healthcare Services 16.6 0.0 (0.0) 0.8 17.3

Prescribing 40.4 0.0 (0.0) 40.4

Other Primary care 3.2 0.0 0.0 3.2

Other Programme Services 1.6 0.0 0.0 1.6

Better Care Fund 5.2 0.0 0.0 5.2

Property recharges 0.0 0.0 0.0 0.0

Non Recurrent Investment 2.9 (2.9) 0.0 (0.0)

Contingency 1.5 0.0 0.0 1.5

Corporate Running Costs 5.0 (0.0) 0.1 0.2 5.3

Total Expenditure 302.9 (3.1) 0.8 1.0 301.6

QIPP Schemes Under Development (4.3) 4.8 0.0 0.5

'In Year' Surplus/ (Deficit) 0.0 (1.9) (0.8) (1.0) (3.8)

Surplus brought forward from previous year 2.9 (2.9) 0.0

'Reported' Surplus/ (Deficit) for 16/17 2.9 (4.8) (0.8) (1.0) (3.8)

Full Year Underlying Position

7


Statement of Cash Flow

At 31st October 2016 Total Assets employed were (£9.9m). At 31st March 2016 Total Assets employed were (£11.0m). • At 31st October 2016 significant liabilities were as follows:- Prescribing Creditor - £6.3m Payables and Accrued Expenditure with NHS Bodies - £4.9m Payables and Accrued Expenditure with Non NHS Bodies - £6.3m Continuing Healthcare Provision - £0.4m • At 31st October 2016 significant assets were:- Cash - £1.7m - as per Cash Flow Forecast Receivables with NHS and Non NHS Bodies: £1.2m Prepaid Expenditure - £5.7m Accrued Income - £0.8m

• West Suffolk CCG closed the month with a balance of £2.1m in the bank account at 31st October 2016. This has been adjusted to £1.7m on the Statement of Financial Position after accounting for unpresented cheques and BACS payments clearing in the following month.

• The CCG missed its cash target efficiency by £1.8m. NHS

England requires CCGs to limit the cash held in their bank accounts at the month-end to 1.25% of the main cash drawdown for the month. The CCG requisitioned £24,350k cash for the month. Under the KPI the target closing bank account balance was £304k. The CCG missed the target balance by £1,763k (£2,067k minus £304k) this month.

• CCG's Maximum Cash Drawdown (MCD) control total has been

set at £297.8m for 2016/17 (September 16 - £297.8m), this total is based on the control total for the Revenue Resource Limit but adjusted for non-cash transactions such as depreciation and reduced by the value of the CCGs planned surplus for the year.

Percentage of MCD utilised - 59.3% Percentage of months completed in year - 58.3%

Ipswich and East Suffolk CCG 16/17 16/17

Statement of Cash Flows YTD Actual Forecast

Oct-16 Mar-17Period 07 Period 12

£m £mCASH FLOWS FROM OPERATING ACTIVITIES

Net Operating Cost Before Interest (173.8) (298.6)

Depreciation and Amortisation 0.1 0.1

(Increase)/Decrease in Current Assets (3.9) 0.3

Increase / (Decrease) in Current Liabilities 3.1 1.3

Increase/(Decrease) in movement in non cash Provisions (0.5) (0.9)

CASH FLOWS FROM INVESTING ACTIVITIES 0.0 (0.1)

NET CASH INFLOW/(OUTFLOW) BEFORE FINANCING (175.1) (297.8)

CASH FLOWS FROM FINANCING ACTIVITIES

Net Funding 176.7 297.9

Net Cash Inflow/(Outflow) from Financing Activities 1.6 0.1

NET INCREASE/(DECREASE) IN CASH AND CASH EQUIVALENTS

Cash and Cash Equivalents (and Bank Overdraft) at Beginning of the Period 0.1 0.1

Cash and Cash Equivalents (and Bank Overdraft) at YTD 1.7 0.2

8


Quality Premium

Note – the data used for tracking is a combination of monthly, quarterly and annual performance and crosses various periods so should be used as an indication at this stage.

Maximum Quality Premium earnable is £1.2m. Final funds are provided in 2017/18 and cannot be used to support the 2016/17 position.

Currently the CCG is forecasting £108k on Quality Premium from 2016/17.

The cancer diagnosis at stages 1 and 2 are only updated to Q1 14/15. Alternative data sources are being researched. The e-Referral metric has now been agreed with NHS Digital and shows the CCG position with the confirmed target for March 2017.

Maximum QP

Value

Probability of

Success

QP

Projection

Latest

Data

YTD

Target

YTD

ActualComments

Improving Antibiotic Prescribing

a) Reduction in the number of antibiotics prescribed in primary

care by 4% or equal to 1.161 items/STAR-PU61,800£ On track £ 61,800

Q1

16/171.183 1.16 Quarterly data

b) Number of co-amoxiclav, cephalosporins and quinolones as a

% of the total number of selected antibiotics prescribed in

primary care to be reduced by 20% or lower than 10%

61,800£ Challenging - Q1

16/1710.6% 12.6% Quarterly data

Cancer

Cancers diagnosed at stages 1 and 2 to be greater than 60% or 4%

improvement20% 247,200£ On track 247,200£

Q1

14/1560% 61.5% Old data only available

GP Practice

Increase the proportion of GP referrals made by NHS e-Referrals to

80% or improve by 20% compared to March 1620% 247,200£ Possible - Aug-16 64% 27.4% CCG reporting now agreed with NHS Digital

GP patient survey on overall experience for making a GP

appointment (Question 18) to achieve 85% or improve by 3% from

July 16

20% 247,200£ Possible - Jul-16 81% 78.0%July 2016 result is 78%. Next survey result published in

July 2017.

Local Measures

1. Mental Health - percentage of people 'moving to recovery' of

those who have completed IAPT treatment10% 123,600£ On track £ 123,600 Sep-16 50% 56.4%

Target is 50% by Q4 16/17. Currently monitoring YTD

performance.

2. Respiratory - Emergency Admission rate for children with

asthma per 100,000 population to reduce by 5% compared to 15/1610% 123,600£ Possible - Sep-16 51 81 Shows number of admissions

3. Trauma and Injury - injuries due to falls per 100,000 population

ages 65+, to reduce by 5% compared to 15/1610% 123,600£ Possible - Sep-16 508 564 Shows number of admissions

100% 1,236,000 432,600

Potential ReductionsThe % of Referral to Treatment (RTT) pathways within 18 weeks for

incomplete pathways-25% (309,000) On track - Sep-16 92% 93.6%

A&E Waiting Time - total time in the A&E department -25% (309,000) Challenging (108,150) Sep-16 95% 87.2% WSFT position

62 day wait from urgent GP referral to first definitive treatment for

cancer-25% (309,000) Possible (108,150) Sep-16 85% 83.5%

Ambulance clinical quality - Category A (Red1) 8 minute response

times (CCG Performance)-25% (309,000) Challenging (108,150) Sep-16 75% 57.3%

CCG level in 16/17.Actual result will be mapped to

LSOA, so CCG performance is an indication

108,150Expected Quality Premium based on current known performance

10%

9


System Wide View

West Suffolk Hospital

• The Income and Expenditure position for September 2016 is a surplus of £0.06m, against a planned surplus of £0.3m, resulting in an adverse variance of £0.3m in September (£1.0m YTD). Broadly the YTD overspend relates to Escalation Beds £0.5m and Other Pay A&E £0.3m Midwifery £0.1m.

• The September position includes a YTD CIP target of £3.8m of which £3.8m has been achieved. The CIP target is £12.5m for the full year. • The Trust is planning to make an annual deficit of £5.0m. • The Financial Sustainability Risk Rating is 2 YTD. (Source: M6 Board Report - Finance September 2016)

Addenbrookes (CUHFT)

• At the end of September (month 6) the Trust had a deficit of £37.7m, which is £0.4m worse than budget. • Clinical Income was £1.8m greater than budget, Total Expenditure was overspent by £4.5m and eHospital costs were £0.5m less than budget. • The Trust's cash position stands at £12.0m, £1.0m less than budget. • The Trust's Financial Sustainability Risk Rating is 2. • The year to date Cost Improvement Programme (CIP) performance is £0.6m greater than plan. (Source: CUH Integrated report to September 2016)

Ipswich Hospital

• Financial plan 2016/17 deficit of £20.1m, plan assumes receipt of £7.0m Sustainability & Transformation funding in year. YTD at M3 trust is on plan, agreement with lead commissioner re 16/17 contract position – reduced financial risk and improved cash flow in year.

• Focus on workforce initiatives to reduce Agency spend and delivery of CIP are the focus areas for 2016/17, discussion on-going with NHS improvement in respect of cash support, details of STF funding process released.

• The cash position is adverse to plan for June by £0.9m, mainly due to the following receipt of settlement of overdue invoices of £1.0m from West Suffolk FT relating to SCH, increased VAT reclaim due to review by VAT advisor of £0.2m, increase in Non Pay due to delayed payments due in prior months of £1.7m and settlement of TPP invoices netted against income of £1.6m.

(Source: Ipswich Hospital Trust Board Meeting 28th July 2016)

Norfolk & Suffolk

Foundation Trust (NSFT)

• The retained deficit for the month was £0.4m which is in line with the annual plan, the year to date favourable variance remains at £0.2m. • The forecast for the year is a deficit of £4.8m, in line with the control total. This includes national Sustainability and Transformation Plan funding of

£1.3m. • Cash held by the trust at 30 September was £6.7m, compared to the planned level of £6.4m. (Source: NSFT Board Minutes 22nd September 2016)

East of England

Ambulance Service Trust

(EEAST)

• The Financial Deficit for the month was £1.8m against the planned surplus of £0.3m. There is now a YTD deficit for the 5 month period of £5.2m against the planned surplus of £0.7m.

• Cash Balances stand at £7.5m which is below plan. In light of the fact that the Commissioners have not agreed to fund our RAP costs, a thorough review of the Trusts cash flow has been undertaken. It is anticipated that if spending isn't reduced or funding received, the Trust will need to approach the DoH for an interim revolving working capital facility in November as the trust will go overdrawn in December. The following steps are being taken to maximise our cash balance, reduce pay runs to two weekly (to be timed so after receiving SLA income from CCG), stop non urgent capital work & increase our current efforts in credit control.

• The NHSIs Financial Sustainability Risk Rating ratio score is 2 YTD. (Source: EEAST Financial Position report for Meeting 28th September 2016)

10


National Reporting Measures

Indicator

Ref Description Framework

Reporting

Frequency

Current

Period

Current

Period

Target

Current

Period

Actual

Rolling 6

Months

Latest

Applicable

Target

YTD Actual Comments

NHS 2.3.i Unplanned hospitalisation for chronic ambulatory care sensitive conditions (WC1.1.1) NHS Outcomes Monthly Sep-16 149 118 846 118WSFT (indication of performance on

Annual measure E.A.4)

NHS 2.3.ii Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s (WC1.1.2) NHS Outcomes Monthly Sep-16 30 22 111 22WSFT (indication of performance on


E.A.S.1 Estimated diagnosis rate for people with dementiaNHS EC Annex A

Support MeasureMonthly Sep-16 67% 63.0% 67% 63.0% WSCCG

NHS 3a Emergency admissions for acute conditions that should not usually require hospital admission (WC1.1.3) NHS Outcomes Monthly Sep-16 216 239 1479 1,520WSFT (indication of performance on


NHS 3.2 Emergency admissions for children with Lower Respiratory Tract Infections (WC1.1.4) NHS Outcomes Monthly Sep-16 3 3 31 46WSFT (indication of performance on


E.A.S.4 Healthcare acquired infection (HCAI) measure (MRSA)NHS EC Annex A

Support MeasureMonthly Sep-16 0 0 0 0 WSCCG

E.A.S.5 Healthcare acquired infection (HCAI) measure (clostridium difficile infections)NHS EC Annex A


E.B.1The percentage of Referral to Treatment (RTT) pathways within 18 weeks for completed admitted

pathways

NHS EC Annex B

MeasureMonthly Sep-16 90% 71.9% 90% 79.5% WSCCG

E.B.2The percentage of Referral to Treatment (RTT) pathways within 18 weeks for completed non-admitted

pathways

NHS EC Annex B


E.B.3 The percentage of Referral to Treatment (RTT) pathways within 18 weeks for incomplete pathwaysNHS EC Annex B


E.B.S.4 Number of 52 week Referral to Treatment PathwaysNHS EC Annex B


E.B.4 Diagnostic test waiting timesNHS EC Annex B


E.B.5 A&E waiting time - total time in the A&E departmentNHS EC Annex B

MeasureMonthly Sep-16 95% 88.2% 95% 87.2% WSFT

E.B.S.5 Trolley waits in A&ENHS EC Annex B

Support MeasureMonthly Sep-16 0 0 0 0 WSFT

Diagnostic test waiting times

A&E waits

NATIONAL PERFORMANCE MEASURES - 2016/17 - WEST SUFFOLK CCG (1/2)

Enhancing quality of life for people with long term conditions

Helping people to recover from episodes of ill health or following injury

Treating and caring for people in a safe environment and protecting them from avoidable harm

Referral To Treatment Pathways

11


National Reporting Measures

Indicator

Ref Description Framework

Reporting

Frequency

Current

Period

Current

Period

Target

Current

Period

Actual

Rolling 6

Months

Latest

Applicable

Target

YTD Actual Comments

E.B.6 All Cancer 2 week waitsNHS EC Annex B


E.B.7 Two week wait for breast symptoms (where cancer was not initially suspected)NHS EC Annex B


E.B.8Cancer day 31 waits: Percentage of patients receiving first definitive treatment within one month of a

cancer diagnosis

NHS EC Annex B


E.B.9 Cancer day 31 waits: 31-day standard for subsequent cancer treatments-surgeryNHS EC Annex B


E.B.10 Cancer day 31 waits: 31-day standard for subsequent cancer treatments-anti cancer drug regimensNHS EC Annex B


E.B.11 Cancer day 31 waits: 31-day standard for subsequent cancer treatments-radiotherapyNHS EC Annex B


E.B.12Cancer 62 day waits: Percentage of patients receiving first definitive treatment for cancer within two

months (62 days) of an urgent GP referral for suspected cancer

NHS EC Annex B


E.B.13Cancer 62 day waits: Percentage of patients receiving first definitive treatment for cancer within 62-days of

referral from an NHS Cancer Screening Service

NHS EC Annex B


E.B.14Cancer 62 day waits: Percentage of patients receiving first definitive treatment for cancer within 62-days of

a consultant decision to upgrade their priority status

NHS EC Annex B

MeasureMonthly Sep-16 88% 100.0% 89% 80.0%

WSCCG - Target is Monthly National

Average

E.B.15.i Ambulance clinical quality – Category A (Red 1) 8 minute response timeNHS EC Annex B


E.B.15.ii Ambulance clinical quality – Category A (Red 2) 8 minute response timeNHS EC Annex B


E.B.16 Ambulance clinical quality - Category A 19 minute transportation timeNHS EC Annex B


EBS7a Ambulance handover time - 1) Handover delays over 30 minutesNHS EC Annex B


EBS7b Ambulance handover time - 2) Handover delays over 1 hourNHS EC Annex B


E.B.S.1 Mixed Sex Accommodation (MSA) BreachesNHS EC Annex B

Support MeasureMonthly Aug-16 0 1 0 5 WSCCG

E.B.S.2 Cancelled OperationsNHS EC Annex B


E.B.S.6 Urgent Operations cancelled for a second timeNHS EC Annex B


E.A.3 IAPT Roll OutNHS EC Annex A

MeasureMonthly Sep-16 1.25% 1.2% 7.50% 7.7% WSCCG

E.A.S.2 IAPT Recovery RateNHS EC Annex A


E.B.S.3 Mental Health Measure – Care Programme Approach (CPA)NHS EC Annex B


Cancer waits - 62 days

Ambulance Measures

Mixed Sex Accomodation

Cancelled Operations

Mental Health

Cancer waits - 2 week wait

Cancer waits - 31 days

NATIONAL PERFORMANCE MEASURES - 2016/17 - WEST SUFFOLK CCG (2/2)

Redesign IPR Appendix

November 2016

1

Integrated Care Headlines

Project Finance

RAG

Delivery

RAG

£ Full

Year

Planned

£ Full Year

Projection

£ YTD

Planned

£ YTD

Actual

Headlines

P18a -

Redesign

of

Proactive

pathways

£602,574 £40,150 £283,078 £0

Connect (& Frailty)

This project holds a Delivery RAG of amber because the project was paused whilst resource was recruited. The restart of the project in October commenced with a review and a new approach is in development with the providers . The frailty and care home workstreams are now embedded into the Connect Plan - over 100 My Care Wishes folders are now in place across West Suffolk following recognition following an emergency admission.

Clinical Pathway review

The falls and COPD pathways have now been updated and awaiting formal sign off by all system clinical leads before operationalising in December. Both pathways will then be BAU for the system and projects closed down by the CCG.

Discharge to Assess

Glastonbury Court opened in October and 20 beds are now fully occupied. The beds will support patients on D2A Pathway 2 and 3. This project will produce a progress report to the December A&E delivery Board. New carer Support to Get Home service to support D2A Pathway 1 for patients who can receive their reablement at home in development for potential launch in January 2017 – commercial model between WSFT, ACS and CCG however yet needs to be agreed.

End of Life

Work on development of Suffolk guidelines for EOL has commenced and will be shared at the December A&E Delivery Board. Final agreement for the Just In Case Medications is also on track for December.

P18c -

Redesign

of

Proactive

pathways

- EIT

£395,209 £182,500 £195,848 £0

Progress continues across the work strands albeit with some delay due to the need for consultation periods for the changes required. This is reflected in the Amber delivery rating. Financial reporting shows a £0 against YTD mainly due to the coding of admission prevention as an admission on WSFT ecare. – agreement by WSFT to review this has now been agreed and work has commenced with finance and contracting leads to agree a solution. Much analysis has been undertaken and this now needs to be articulated into the project plan and any change control to the plan enacted.

MH & CYP Headlines Project Financ

e RAG

PMO

RAG

£ Full Year

Planned

£ Full Year

Projection

£ YTD

Planned

£ YTD

Actual

Headlines

3.1 IAPT and Wellbeing Service Procurement and Mobilisation

N/A £0 £0 £0 £0

• On track. Work taking place to ensure GP’s, Schools and Colleges have

their lead Primary Mental Health Worker Contact details clearly identified

and circulated. Offer to engage with Department for Work and Pensions

‘Employment Advisers’ initiative also being considered by NSFT.

3.2 MVA N/A £0 £0 £0 £0

• Negotiations taking place with the current provide r (NEPT) to extend

their contract to the end of September 2017. However, there are

current capacity concerns regarding the demand on the service.

Information has been requested from the Provider to support this

debate. Following the public consultation process, dialogue is taking

place with Suffolk County Council , Suffolk Borough Councils etc. to

better align the MVA service with other commissioned services for this

client group.

3.3 & 3.4 LD Community Model of Care Children and Adults

N/A £0 £0 £0 £0

• Red status due to capital funding turned down by NHS England and

alternative plans being developed by NSFT to enable refurbished

accommodation for a lower number of beds. Mobilisation plan

implementation continues with adverts out for recruitment to the

community teams. (no change from Sep 16 update)

P3 - Children’s Community Service

N/A £0 £0 £0 £0

• On track. Structured dialogue process underway. Children’s workshop

held on 01.11.16 with the Alliance partners and a session on

operational delivery of the new service specification is taking place on

03.11.16 with the CCG.

Planned Care

Project Finance

RAG

Delivery

RAG

£ Full

Year

Planned

£ Full Year

Projection

£ YTD

Planned

£ YTD

Actual

Headlines

P1 – Pain £362,518

£125,323

£181,752

£35,708

• The PID and plan were on hold pending an executives meeting in early November 2016. This meeting agreed an integrated solution to be actioned by April 17

• A recovery plan is in development and expected to bring the project back on track by December 2016.

P2 – Telederm £74,376 £0 £39,090 £0

• All milestones have been met and those expected in Nov 16 are still on track to be delivered to implement the local solution

• The YTD actuals show as £0 as there was an overspend in months May, Jun and August which negates the benefits savings realised in April, July and September. Once the savings have recouped earlier overspends, it is projected that this project will show a £36k saving.

P5 – LPP £850,000 £850,000 £425,225 £322,459

• This project is meeting its milestones and financial targets (projection) to date and shows Green. An increase in the amount of savings is being seen month on month. The Clinical Threshold Service (CTS) will cease as a prior approval service and become a referral review process with WSFT.

P15 – Ophthalmology

£80,841 £40,000 £32,475 £15,034

• This project is now in BAU but will continue to have the benefits monitored. From a delivery perspective, it has achieved its planned milestones. However, the expected savings each month have been around 50% of plan and this is reflected in the full year projection.

P16 - Prevention, Self Care & Shared Decision Making

£18,378 £18,378 £9,300 £63,063

• Diabetes prevention and management, Insulin Pumps and Atrial fibrillation work strands are currently on hold due to focus on financial recovery. The scheme continues to significantly over deliver against plan and shows Finance Green. As the scheme is currently delivering and no significant milestones are due, the plan is able to absorb being on hold for now.

• Respiratory - To be taken forward with the mobilisation of Suffolk Wellbeing.

Prescribing

Project Finance

RAG

Delivery

RAG

£ Full

Year

Planned

£ Full Year

Projection

£ YTD

Planned

£ YTD

Actual

Headlines

P6.1 – Gluten Free

£50,000 £87,154 £20,398 £38,866 Project on track and over delivering on savings against plan.

P6.2 - Self Care £30,000 £30,000 £12,239 £16,416 Project on track and over delivering on savings against plan.

P6.3 - Generics £70,000 £70,000 £28,558 £25,855

This project is upgraded to a delivery RAG of Green because progress made with the remaining practice still prescribing branded drugs. Now back on track and over delivering on savings against plan.

P6.4 - Inhaler Devices

£150,000 £75,000 £61,195 £0

This scheme is not working and any savings are being negated by previous overspend against plan. Work is progressing as renewed effort to promote more cost-effective prescribing and so this is rated as a delivery Amber, as a scheme in recovery.

P6.5 Prescribing recommendations

£550,000 £550,000 £224,381 £187,831

Savings are slightly less than YTD plan but considered as easily recoverable. Otherwise considered on track with no issues.

P6.6 ScriptSwitch

£150,000 £75,000 £61,195 £17,190

Notwithstanding the continuing promotion and training given to take up the Scriptswitch messages, this scheme has consistently under delivered on savings. A n appraisal of how much further resource should be given to this initiative will be discussed with PMO next month.

P6.7 Rebate Schemes

£50,000 £50,000 £20,398 £41,656 On track, no issues.

P6.8 Polypharmacy

£200,000 £100,000 £81,593 £31,748

The LES is no longer in effect which funded the Polypharmacy reviews. However, the accumulating effect from those reviews already undertaken will continue month on month.

Contractual Performance

by Provider

Finance

What are the top 3 risks and issues?

Rank Risk Owner Likelihood Impact Mitigation

1 Failure to sustain A&E performance at required level (95%)

Trust High High • RAP in place for compliance in October. Actions on target and trajectory met for July/Aug • DTOC recovery trajectory and actions in place • ED Delivery Board established to oversee systemwide actions and response

2 Unable to accurately report RTT position post e-care implementation

Trust/CCG High High • Agreed priority focus for internal/external validation of waiting list • Trust agreed position with NHSI • Focus on long waiters to minimise likelihood of 52ww breaches

3 Financial position, failure to deliver CIP/QIPP plans CCG/Trust Med Med • Block contract with risk share now agreed

West Suffolk Hospital NHS Foundation Trust

Updates • CQC report published – overall rating ‘good’; care rated ‘outstanding’ • Successfully bid for NHSE funding as a ‘centre of global digital excellence’ • Further perfect week (Think home First) in place until 30/09/16 • Reviewing options in light of CUHFT notice to leave the pathology

partnership in January 2017 • Discussions progressing with other Providers to develop an Accountable

Care Organisation as part of the STP • Ongoing focus on e care implementation

Based on months 1 to 5 the Trust was £793k under plan. However this is still subject to change/validation and the Trust has had to make corrections in previous months due to issues with the use of E Care.

Clinical Quality – August data from Trust October Board report:

RAG National Quality requirement Performance Change

A & E - 4 Hour Target – Aug 88.59% ↑

Cancer 2ww - Aug 93.00% ↑

Cancer 2WW Symptomatic breast - Aug 58.00% ↓

18 Week RTT-Incomplete –July 93.3% (unvalidated)

↓

RTT waits over 52 weeks - July 0 breach ↔

Diagnostics within 6 weeks -Aug 92.16% ↓

RAG Local Quality requirement Performance Change

Stroke – admission to unit within 4 hrs 77.00% ↑

Acute Oncology Service: Door to Needle (Aug)

81.25% ↓

Clinical Quality

Performance Indicator

Threshold

June July Aug Change mth on mth

YTD (2016)

Comments

MRSA - Total number of MRSA: Hospital

0 0

0

0 ↔

2

C.Diff - Maintain Clostridium difficile Incidence below target (total incidence pre review)

16 per year

3 3 3 ↔

11(total incidence –pre review)

Three cases in August of which two deemed non trajectory. 11 cases YTD of which 6 agreed non trajectory

Clinical - Pressure Ulcers - No. of hospital acquired pressure ulcers (Avoidable & Unavoidable)

0

11 23

11

↑

78

YTD: 22 of the 78 cases agreed as avoidable, 29 unavoidable, 27 pending confirmation of grading. Implementing ‘React to red’ campaigning to lead to further improvements

Falls per 1000 bed days

5.6 No data

No data

No data ↔

4.98

No of falls: 62 June, 61 July, 56 August. Data per 1000 bed days not available

Mixed Sex Accommodation breaches

0

0

0

0

↔

5

Performance – Aug 2016 (Note all WSFT performance and quality data based on

Trust October Board Report with Aug performance : CCG data until August only )

RAG Performance Issue Contract Notice Stage

Last 3 months performance

Ch

ange

fro

m

pre

v. m

on

th Current Status

June July Aug

Acute Oncology Service: 1 hour door to needle time ‘DTN’ for all Service Users presenting to A&E or MDU with suspected neutropenic sepsis.

Target: 100% overall 85% for Contract Management

Exception Report (ER201516_01)

82.60% 82.60% 81.25%

↓

Breaches continue to occur in the ED – there were 3 in August. Themes were: missed opportunities to use the antibiotics PGD and medical staff requesting bloods results before initiating antibiotics.

A&E performance 76.47% 73.30% 75.00% ↑

100.00% 100.00% 100.00% ↔ MacMillan Unit

A&E: Percentage of A&E Attendances where the service user was admitted, transferred, or discharged within 4 hours of their arrival at an A&E dept

Remedial Action Plan

83.56% 85.20% 88.59% ↑

Recovery plan and improvement trajectory in place – this is being reviewed by the A&E transformation group and ultimately the A&E Delivery Board: improvement actions include Streaming, triage, frailty, workforce review, patient flow improvements, ED alterations, ecare, implement discharge to assess and Trusted Assessor policy.

Diagnostics: percentage of Service users waiting 6 weeks or more from referral for a diagnostic test (operating standard of no more than 1%)

Remedial Action Plan

5.8% 3.9% 7.9% ↓

Breaches occurring in Endoscopy and non-obstetric ultrasound. Recovery plan and improvement trajectory in place – : Improvement actions on schedule: outsourcing capacity to private provider; identifying further internal rooms and radiologist capacity; and appointed Sonographer -commencing October

Delayed transfers of care of occupied bed capacity (no more than 3.5%

4.5% 5.5% Not available

↓

Recovery plan and improvement trajectory in place – to reach contracted standard in March 2017: Range of actions: in place re improving flow , Doing things differently ( 12-20 September), escalation processes, patient transport and discharge to assess models. Outcome of most recent DtD and Perfect week presented to October ED Delivery Board who are now monitoring the action plan for recovery.

West Suffolk Hospital NHS Foundation Trust – Outstanding Contract Escalations

Finance



1 DTOC – 2,142 bed days lost. 28% increase compared to August 2015 and mainly due to lack of domiciliary and care home capacity.

Trust/CCG High High

• Short and mid term plan developed • Filled vacancies in the discharge planning team • Invested & mobilised additional community capacity; additional capacity being scoped.

2 EPIC: Serious Data Quality issues remain and a PbR tariff is in place for 16/17

Trust/CCG High High

• PbR contract agreed . Full terms and conditions will be implemented if poor data quality continues. • North East London CSU has started validating Suffolk activity

3 ‘Lost’ 60,000 Ophthalmology retinal photographs due to failure in CUHFT’s records system.

Trust/CCG High High

• CUHFT is developing a plan to manage the patients where images have been lost to mitigate any adverse effect as far as possible.

Cambridge University Hospitals NHS Foundation Trust

Updates • A&E performance remains a challenge – a recovery plan has been

developed and is monitored regularly

• Nurse vacancies remain a concern – overseas nurse recruitment visits scheduled

• A full inspection took place 20th-22nd September, the CQC draft report is not due until January 2017

Addenbrookes – 16/17 PBR contract agreed.

Quality

RAG Indicator Comments Change

A & E - 4 Hour Target

Performance improved at 87.5% in August; ytd average 84.7% Paediatric and mental health attendances increased by 11% and 19% respectively compared to last year.

↑

Cancer All cancer standards were achieved in July. ↑

18 Week RTT

August 18 Week RTT performance was 90.4% ; ytd average of 90.6% (target 92%). Recovery plans implemented and work to recover is on-going.

↔

52 and 40 week waiters

4 patients waiting over 52 weeks as at the end of August. 74 patients waited over 40 weeks.

↔

Diagnostics 46% reduction in 6 week diagnostic standard breaches in August, now at 5.8% against standard of <1%.

↑ Clinical Quality

Performance Indicator Threshold June June August YTD Comments

MRSA - Total number of MRSA: Hospital (CQR report) 0 0 0 0 0

The latest comparative data put the trust 2nd out of 10 in the Shelford group of teaching hospitals

Safety thermometer new harms Targer

98% 97.7% 98.8% 97.1% 98.1%

Clinical - Pressure Ulcers - No. of hospital acquired pressure ulcers Grade 1 – 4

0 3 2 2 14

Never Events

0 0 1 0 1 July case was omission of care and the final report due October

Performance

Finance I&ES CCG and WSCCG



1 MH Outcomes measures (PROMS/SWEMWEBS/FFT) are not clearly defined and agreed with the Provider.

CCG/NSFT Med High • NSFT is working on their internal Performance Accountability Review Group which will look

at outcomes measures.

2 A number of vacancies in the Emergency AAT service.

NSFT Med High • NSFT has submitted their recruitment trajectory for review to the Quality Team • Assurance is sought both Clinical Quality Meeting.

3 Implementation of the Mental Health Five year Forward View must do’s.

CCG/NSFT High High

• 17/19 MH Contract to reflect innovative service delivery within existing finite resources. • Updated Service spec for priority areas such as crisis care, AAT, IDT and Out of Area bed.

Norfolk and Suffolk MH NHS Foundation Trust

Update NSFT is no longer under special measures. Work continues with Needs Typing for EIP Service across the IDT’s Review of AAT underway

Performance

Suffolk CCGs Quality

RAG Indicator Comments (n.b. September data is provisional)

Change

Early Intervention in Psychosis (EIP)

5 new cases. Monthly total of 23 against a trajectory of 33. ↓

CPA: 7 day follow up post inpatient care

98.4 % against 95% target. ↑

CPA: completion and quality

Below standard on completion and documentation of core elements. ↔

Improving Access to Psychological

Therapies (IAPT) Prevalence

Dip in IAPT prevalence in September. CCG’s have requested informal improvement plan.

↓

15 weeks referral to treatment: children and young people

95.7 % against standard of 95%. ↑

Psychiatric liaison 4 hours (ED): 93.9% (September) against 95% improved position from last month. 8 hour maximum stay in ED: no breaches in September (await RCA’s for previous months ).

↓

Clinical Quality

Performance Indicator Threshold July Aug Sep Change mth on mth

YTD Comments

Improving Access to Psychological Therapies Recovery rate

50% 47.4

% 52 %

46.1 %

↓

↓

Sep data is unvalidated

MCA Training

95% 94.9

% 97 %

97.1 %

↑

↑ Sep data is unvalidated

DOLS Training

95% 95.2

% 97.5

% 97.2

% ↑

↑

Sep data is unvalidated

Nb Primary care MH contract is covered in a separate contract



Ch

ange

fro

m

pre

v. m

on

th Current Status

July Aug Sept

12 months review: Care Programme Approach (CPA) review

Target: 95% Exception Report 2016-17-02

95.4% 95.8% 95.9%

↑ Performance has consistently improved.

12 months review: nCPA patient review Target: 95%

64 % 65.6 % 81.7 %

↑ NSFT anticipate recovery in November. Improvement noted.

September performance is within agreed trajectory.

Access and Assessment Team Over 18s 4 hrs emergencies

Target: 100% 75 % 95 % 94.1%

↓

September data is unvalidated. RAP has not been agreed.

Over 18s 72 hrs urgent assessment Target: 98% 82.5 % 63.4 % 97%

↑

September data is unvalidated and performance is on trajectory. RAP has been agreed. CCG proposed NSFT to be fully compliant in October.

Over 18s 28 days for routine assessment Target: 95%

57.1 %

77.5 %

81.1 %

↑

Performance remains behind trajectory. RAP has not been agreed. NSFT anticipate recovery in December.

Norfolk and Suffolk MH NHS Foundation Trust – Outstanding Contract Notices

Finance



1 The paediatric Speech and Language Therapy service waiting list hasn’t reduced to expected levels. The new integrated service model will not be implemented in September 16 as planned. The waiting lists could increase in the interim.

Trust High High

• Use unspent monies to purchase additional therapists. Review options from CAMHS transformation funding

• Increase capacity to see more children by securing more clinic space

2 The contract governance arrangements may not meet the needs of all providers involved in providing the community services . The lines of accountability may be unclear.

Trust Medium High

• SCH is leading a review of the governance arrangements • CCGs written to SCH to understand proposed model and consultation

process. CCG quality leads to be involved in the consultation process. • Escalated to CNO

3 The community equipment service has had an increase in demand which is impacting on delivery performance

Trust Medium Low

• Data is being interrogated in order to understand route and cause of increase in activity


Updates 1. A joint cost & service improvement review group has

been set up to support SCH SIP/CIP. 2. There remains a lack of clarity about proposed changes

to the Clinical Governance model. This has been escalated to the CNO.

3. A plan is being developed to keep the paediatric S&LT waiting lists as low as possible until the new model can be implemented in 2017. The CCGs are working with SCC to develop an integrated care model & service.

Performance

Quality


Response Times

The Local Health Care Teams met response times for referrals within 4 hours, 72 hours, and 18 weeks. Achieved 18 week RTT for all adult Consultant and Non Consultant led services. Did not achieve paediatric Consultant 18 wk RTT at 88%. Recruitment challenges – scoping interim options.

↔

Care coordination centre

% of calls answered in 60 seconds has reduced to 75.6% with around a quarter of all CCC posts being vacant. Remedial Action Plan agreed, some vacancies filled and performance improved significantly second half of August.

↓

Delayed Transfers of care

The number of patients identified as DTOC reduced to 29 in August , against 44 in July.

↑

Clinical Quality

Performance Indicator Threshold Aug YTD(from Oct 2015)

Comments

MRSA - Total number of MRSA: Community Hospital

0 0 0

Clostridium difficile – minimise rates of Clostridium difficile 4 per year 0 6

Pressure ulcers – reduce Grade 2 & 3 avoidable pressure ulcers (in-patient units) Grade 2 -13

Grade 3 – 2 0 – G2 1 – G3

24 – G2

2 – G3

Pressure ulcers – zero Grade 4 avoidable pressure ulcers (in-patient units) 0 0 0

Falls – number of inpatient falls resulting in moderate or significant harm

No more than 1.25

per month 1 5

Mixed Sex Accommodation breaches 0 0 0

NHS Friends and Family Test (% of patients who would recommend SCH services)

85% 98%

Number of formal complaints 5

Number of formal compliments 21

£0.00

£1,000,000.00

£2,000,000.00

£3,000,000.00

£4,000,000.00

M7 M8 M9 M10 M11 M12

IESCCG

WSCCG


OOH KPI’s OOH performance KPI’s all met trajectory in September. No current performance concerns. ↑

111 – Calls answered in 60 secs

Performance in September dipped below the 95% target this month at 94.6%. As a result, the performance notice will remain open until October performance is known, and once assurance can be given on Winter Planning.

↓

111 - Warm Transfer

Performance for Warm Transfer dipped to 37% in September and remains non-compliant against national target (95% ). Combined target of calls warm transferred or a call back within 10 minutes from a clinician, Suffolk achieved 68% in September against a National performance of 64%.

↓

999 despatch from 111

% of calls being despatched to 999 from 111 saw a decrease in the number of ambulances dispatched from 1579 in August to 1497 in September , although this was a slight increase in % (11.26% to 11.35%) against calls answered.

↓

Finance/Activity



1 Red ambulance ‘inappropriate’ levels increased. Risks are that this ties up ambulance resource that is needed for higher priority cases.

CCG Medium High

• Draft report received with a number of initiatives to address inappropriate referrals. CCG will monitor the outcomes of this at the monthly SLA meeting.

2 Increase in ED referrals as a side effect of reduction in green ambulances could impact on the 4 hour A&E target and patient outcomes.

CCG Med High

• New KPIs agreed to address reduction • Trajectory agreed with 111 service should deliver reduction of ED referrals of 15%year on year. Financial

penalties for this KPI will come into effect from October 2016.

3 Volume of calls not warm transferred or called back in 10 minutes increases . The risk is that patients opt to use a more expensive resource such as A&E.

CCG High Med

• Care UK performance below target. This predominantly struggles to recruit clinical staff. Breach report reviewed at monthly contract meetings focused on safety and ‘live’ clinical oversight of any queue is monitored for risk and process has been reviewed by CCG.

• Clinical Safety KPI’s are being developed in line with Networks Clinical Bridge.

Care UK Limited – 111 & Out of Hours

Performance

111 contract activity based on 170000 calls a with cap and collar 10% prior to marginal rates being applied. Financial KPI’s now focussed on 999 and ED only.

Clinical Quality

Performance Indicator Threshold May June July Change mth on mth

Average (3 Months)

Comments

Local Health Advisor Audits (111) over 3 months employment 86% 92% 93% 90% -3% 92%

6/72 staff on improvement action plans following August audits

Local Clinical Advisor Audits (111) over 3 months employment 86% 93% 92% 94% 2% 93%

5/47 staff on capability plan

Suffolk Clinicians paper records documentation and assessment audit (OOH)

90% 97% 97% 98% 1% 97%

Improvement in audit noted

Suffolk Clinicians voice recording audits 90% 97% 94% 98% 4% 96%

Clinicians reminded confirm patient details and document allergies

Emergency Scenario (September) n/a n/a n/a n/a 100%

Monthly audits following Care UK audit schedule

Updates • New KPI’s for ED and 999 trajectories agreed, targeting a month on

month improvement/reduction in ED and 999 referrals. • During the month of September 111 re-directed approximately 343

calls that would have led to an ambulance dispatch to a more appropriate service .

• ED referrals from 111 was 8.5% for September against calls answered. This is over the planned trajectory of 6.5%. Sept is a developmental month to embed actions to achieve this KPI.

0

5000

10000

15000

20000

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

Calls Answered

KPI penalties



Ch

ange

fro

m

pre

v. m

on

th Current Status

July August Sept

111 Calls answered in 60 seconds Performance notice against above metric issued in November. Networking of call centres took place in December performance trajectory is not currently being achieved.

Target: >95%

Warning Notice (WN 1516-01)

96% 96% 94.5%

↓

Performance in September dipped slightly below trajectory so performance notice will remain open until October performance is known. Assurance around winter planning will also need to be received in order to close this notice.

111 Warm Transfer and Call Back in 10 mins Performance against these national metrics continues to be non compliant

Target: >95

Warning Notice (WN1314-02)

32% 42% 37%

↓

Nationally 111 services are struggling to achieve this KPI due to the ability to recruit clinical staff. Care UK have confirmed they have reverted to attempting warm transfer for all calls that require a clinician and moving away from the clinical prioritisation model which was being trialled. New Clinical Safety KPI’s are to be developed inline with the Networks Clinical Bridge.

Care UK Limited – 111 & Out of Hours – Outstanding Contract Notices

Finance/Activity Current annual activity 16/17 0.15% (+23 cases) above contract additional cost £3,856



1 Underachieving against red ambulance targets resulting in potential safety and outcomes risks to patients.

EEAST/ CCG

High High

• Weekly performance meeting in place with EEAST and commissioners, RAP focus agreed • EEAST increasing PAS and agency paramedics to support service during recruitment process

for 16/17, this includes increasing volume of hear and treat volumes as part of CQUIN • New EEAST handover procedure and early escalation for ‘live’ delays in place with acutes

2

Increasing call volume and balance of Red to Green calls changing with increasing Red calls impacting on overall service delivery. The risk is the more serious red calls are not seen in a timely manner.

EEAST/ CCG

Med High

• 111 have implemented an audit on solely red ambulance calls approx 500 dispatches reviews • New training program being worked through from lessons learnt from audit planned to be

completed prior to Christmas. • Expanding CSD desk will have target for increasing Hear and Treat volumes and not requiring

a dispatched paramedic 9% by March 17 currently 6%

3 Recruitment/Staffing , EEAST continues to struggle to recruit and retain sufficient levels of qualified staff to meet target requirements.

EEAST High High • On-going recruitment plan • Development of Operational plan to encourage career pathway • Discussions/plans with other Providers to scope potential staff cross working ongoing.

East of England Ambulance Service NHS Trust

• CQUIN –Clinical Support Desk (CSD) expansion from1/10/16

following recruitment and training equivalent of 11% of calls to be achieved by March 16

• Remedial Action Plan focussed on improving Red 1 performance with additional in year funding has been agreed across the consortium. This includes a monthly hourly staffing fill requirement.

• Activity increase above contracted volume is within Red call volume. Commissioners attend weekly EEAST’s Performance Improvement Action Group where activity, performance and are discussed .

Updates

Performance


Red 1,2 75% 8 mins

August Red 1 performance 69.3% (Suffolk), Red 2 performance 56.8% (WSCCG).

↑

Arrival to Handover >15mins

Un-validated EEAST data Handover Delays 170 hours in September decrease of 34 hour from August increase of 37 lost hours from September 15.

↓

Handover to clear

Un-validated September EEAST data 94 hours lost over 15 minutes for handover to clear.

↑

Green 2 75% 30mins

September Green 2 performance 58%. ↓

Clinical Quality

Performance Indicator Threshold June July August Change mth on mth

YTD Comments

ROSC (Return of Spontaneous Circulation) at time at arrival at hospital

27% 0% 30% 0% -30% 19% August number of cases 8

Outcome for Cardiac Arrest – Survival to Discharge overall survival rate 6% 0% 0% 0% 0% 7.4%

August number of cases 8

Outcome for Cardiac Arrest – Survival to Discharge – Utstein comparator group

25% 0% No

cases No

cases 0% 0%

August no cases

Outcome for Cardiac Arrest – Survival to Discharge STEMI appropriate care bundle

81% 100%

100% 100% 0% 96% August number of cases 4

Stroke - FAST positive stroke patients HASU <60mins

56% 48% 46% 57% 11% 51% August number of cases 14



Ch

ange

fro

m

pre

v. m

on

th Current Status

July August Sep

Red 1,2 and 19 (R1 used for last 3 months performance)

RAP trajectory and details agreed

55% 69% 69%

↔

Remedial Action Plan covering Red call improvement over 16/17 between EEAST and CCG consortium has now been finalised . Focus is on Red 1 performance and is being monitored at weekly Performance Improvement Groups with additional detailed reporting. Increased finance is agreed on improving performance. Staffing fill has to be achieved over EEAST footprint and hear and treat performance.

East of England Ambulance Service NHS Trust – Outstanding Contract Notices

of 4

GOVERNING BODY

Agenda Item No. 09



Title

Transforming Care

Lead Chief Officer

Barbara McLean, Chief Nursing Officer

Author(s)

Gabby Irwin, Head of Clinical Quality and Patient Experience

Purpose

To update the Governing Body on the current position on Transforming Care (TC) in relation to the Milestone Reports submitted to NHS England as a requirement of programme monitoring.



2. Demonstrate excellence in patient experience & patient engagement /


4. Improve access to mental health services /

5. Improve health & wellbeing through partnership working /

6. Deliver financial sustainability through quality improvement /

Action required by Governing Body: To note the content of the report.

1. Purpose

1.1 To update the Governing Body on the current position on Transforming Care (TC) in relation

to the Milestone Reports submitted to NHS England as a requirement of programme monitoring.

1.2 At the Governing Body meeting in May, a further update was requested and the opportunity

to meet and hear of the importance of this work to an individual patient was discussed. The timing of the update on progress has been planned to coincide with the availability of a person who has lived experience of the programme, in an agenda item entitled Patient Story.

2. Background

2.1 At the Governing Body in May 2016 the Chief Nursing Officer presented a report on the

current position on Transforming Care. This paper describes the ongoing progress of the programme in the last three months based on the recommendations that have been provided by NHS England which are set out in the Milestone Report.

2.2 The Transforming Care Board continues to run on a monthly basis. The Senior Responsible

Officer (SRO) is Barbara McLean, IECCG and WSCCG Chief Nursing Officer and the Deputy SRO is Julie Bateman, Assistant Director- Personalisation, Quality and Safeguarding

Adult and Community services at Suffolk County Council. The Board continues to review all guidance and recommendations from DoH and NHS England. The work programme progress is monitored via a Milestone report outlined below. The Transforming Care Partnership Board also use the Milestone reporting process to identify risks to the programme. Fortnightly Teleconferences are ongoing with the Regional TC team and there is regular feedback to ad hoc requests with NHSE Specialist Advisors, Steve Thumpston and Francis Ma. Fortnightly updated narrative descriptions on the monitored progress of each patient within the cohort are also provided to the TC Local Area Team to enable ongoing scrutiny of care and effectiveness of the Care and Treatment Review process.

2.3 In line with NHS England Guidance, Care and Treatment Reviews (CTRs) continue to be

carried out for all current inpatients. In addition, a CTR ‘Overview panel’ has been formed with NSFT operational leads, IECCG/WSCCG, Experts by Experience and Expert Clinical Reviewers. This collaborative initiative is overseeing the completion of all CTRs and developing a ‘gold standard framework’. This work has been presented to and discussed with Inclusion East and with NHSE at a regional Expert Reference Group.

2.4 In September 2016, the IECCG and WSCCGs are commencing a proactive engagement

exercise with the LA to develop a Workforce Development and Training Plan. This will seek to scope the needs of the Transforming Care cohort across the Health and Social Care economy both in the Children’s and Adults Health and Social care services and will include all opportunities for implementation of the Positive Behavioural Approach working with all staff and families.

2.5 The number of inpatient beds currently commissioned is within trajectory.

As of 15th November 2016 Figures:

WSCCG = 3 patients in cohort IESCCG = 12 patients in cohort

3 Key Points

Milestone Reports are submitted to NHS England on a monthly basis. These are broken down into 4 key areas which include: Co- production The CCG and the LA are focusing on the following:

People with learning disabilities will be included in all redesign decisions within TC through patient and customer engagement events at ACE.

The Learning Disabilities Partnership Group will have regular updates on progress with the TC plan as part of the LD strategy through being represented at the Learning Disabilities Partnership Group (LDPG) meetings.

All CTRs include an Expert by Experience on every panel. This is achieved through liaising with families and carers who have lived the experience of being involved with services for family members.

Bed Closures

Ipswich and East Suffolk and West Suffolk have decommissioned all but 1 of the inpatient beds at Airey Close. In-patient beds for children were decommissioned at this location during 2015/16.

The out of county beds are due to be decommissioned over the next three years. The process of reviewing each of the patients who are currently in out of county placements is taking place at a dedicated, multi-disciplinary panel meeting which meets on a monthly basis.

In addition, each patient is reviewed at a Clinical Treatment Review meeting every six months in which a member of the CCG reviews the suitability of the placement with a Clinical Reviewer and an Expert by Experience.

New Service Models

The redesign of Walker Close will include the provision of 2 bungalows (each with 3 beds). The focus of this provision will be an ‘Assessment and Treatment’ unit which will be compliant with CQC standards, with a focus on supporting people to return to or remain in the community.

A Home Intensive Support Team is currently being recruited to, which will see the opportunity for teams to work with individuals in the community preventing in-patient admission or supporting early return. The service specification for this service has been completed.

Plans for a ‘Time Away from Home Service’ are being developed so that individuals are able to remain in the community at times when additional family support is needed, without having to be admitted into an acute hospital bed. A bid to access funds from

NHS England is currently being developed. The Time Away from Home Service will be developed alongside the Home Intensive Support Team.

A short term step up/step down supported housing provision is being developed to support those individuals who are not able to return home but may need a period of time outside the usual care setting.

The national Shared Lives initiative is further being explored for application within Suffolk. This provides individuals with the opportunity to live within a family / home environment with support.

The Integrated Delivery Teams and the neurodevelopmental pathways are being reviewed to ensure that they work effectively within the revised care model.

A full review of Health and Social Care provision for adults with autism and Attention Deficit Hyperactive Disorder with challenging behaviour and or mental health issues is to be discussed at the Transforming Care Board in September.

Financial Arrangements The commissioning Intentions going forward are being developed. Joint commissioning of care packages is in place with the Local Authority, which enables more comprehensive consideration of the needs of individuals with Learning Disabilities and/or autism. The health and care needs of individuals identified by the Transforming Care programme remain a priority to the Clinical Commissioning Groups and Adult Social Care, monitored by the Suffolk Transforming Care Board.

4 Public Engagement

Public Engagement continues through the Learning Disabilities Partnership and through the Experts by Experience. A full Communications Strategy is to be developed.

5. Recommendation

The Governing Body is asked to note the content of the report and that the Commissioning Intentions for the next 12 months include:

The ongoing improvement of services for people with a learning disability and autism with challenging behaviour and / or mental health needs

Increasing and improving Health checks, including reviewing the primary care LD liaison nurse role and future proposals

A review of how community health care meets the needs of people with learning disabilities

of 4

GOVERNING BODY

Agenda Item No. 10



Title

Community Engagement Group

Lead Chief Officer

David Taylor, Chair of Community Engagement Group

Author(s)

Jonathan Ford, Communications Manager

Purpose

To present the unconfirmed minutes from the Community Engagement Group meeting held on 27 October 2016.








Action required by Governing Body:

The Governing Body is asked to consider and note the key items of discussion from the Community Engagement Group.

of 4

West Suffolk CCG Community Engagement Group Thursday 27 October 2016

1000-1230 Mildenhall - Jubilee Centre

M I N U T E S

PRESENT: APOLOGIES:

David Taylor (Chair) Jane Ballard Jo Finn, WSCCG Lay Member Warwick Hirst Anne Nicholls Gill Jones Michael Simpkin Peter John Owen Carol Mansell Kate Vaughton John Rapley David Dawson IN ATTENDANCE: Isabel Cockayne; Head of Communications Jonathan Ford, Communications Manager Richard Watson; Chief Re-Design Officer Ruth Manning-Brown; Deputy Chief Finance Officer

Item Action GENERAL BUSINESS

1. WELCOME & APOLOGIES FOR ABSENCE

The Chair welcomed everybody to the meeting and apologies for absence were noted. Members introduced themselves and the Chair gave a historic overview of the town of Mildenhall.

2. MINUTES & ACTIONS ARISING

The minutes of the last meeting (25 August 2016) were approved by the group as an accurate record. Suggestion put that in future CEG meetings don’t clash with Healthwatch meetings. RW gave an update on Connect and explained resources had been allocated back into Connect after suspending work – Sandie Robinson, Dawn Barrick Cooke and two other staff have been reallocated to the project. JFo confirmed that Amanda Stevens from Healthwatch would attend next CEG meeting on Dec 22. Action 1 from August 25 meeting (To obtain an answer to the claim made

JFo

of 4

that there is a high number of applicants for nurse training places and many are being turned away. BMcL to investigate further) to be carried forward as there had been no response yet from the Chief Nursing Office. Action 6 from August 25 meeting (JFo to email ambulance trust with pharmacy fax numbers that have been sent through) will be complete in the next few days.

3. MATTERS ARISING NOT ON THE AGENDA

None.

4. CHAIRMAN’S REPORT DT included an update on the Governing Body meeting held on 28th September 2016 and explained that there are plans for a joint workshop with PPGs in the New Year. DT also told members about the Haverhill Health Open Day due to take place on October 28th.

5. LAY MEMBER’S REPORT J Fi delivered the report. The Chairmen and Lay members of the West Suffolk and Ipswich and East Suffolk CCGs engagement groups met with Healthwatch Suffolk to discuss engagement going forward. Another meeting to discuss co-production is planned.

6. HEALTH AND SOCIAL CARE PLANS (Sustainability and

Transformation Plans)

Richard Watson (Chief Re-Design Officer for West Suffolk and Ipswich & East Suffolk CCGs) gave the members an update on the STP with a presentation and took questions from the group. He asked for the group to consider any particular areas of work that they would like further detail on going forward as the project progresses. IC then provided a summary of the current communications plans in place relating to STPs. DT thought it would be helpful to have input from social care and the consequences of STP on their work at some point at a future CEG.

7.

FINANCIAL UPDATE

Ruth Manning Brown gave the members a verbal update on the financial position of the West Suffolk CCG. As an update to the paper submitted for the meeting, Month Six had seen the deficit increase to £1.4m but she stated the CCG is ahead in terms of the financial recovery plan. Work

of 4

9.

continues with Multi-Disciplinary Teams looking at contracts, examples of the work included a focus on reducing prescribing costs, and internally the CCGs are also looking closely at their own processes. RMB stated there is still a need to manage and mitigate risks with a £3.5m deficit to meet with less than six months to recover. The CCGs are continually looking at how things can be done differently. Media releases of some of the success stories already achieved would be shared with the CEG members. CEG RECRUITMENT PLAN The plans were submitted to the group. DD suggested the target audience to include Suffolk Congress and Community Action. It was felt recruitment of councillors would not be appropriate. Church groups were also suggested as a suitable audience to approach. The plan was approved. CEG members were also invited to amend their ‘health interest’ section on the list of members paper (Appendix 5c).

JFo

JFo/HC

10. FEEDBACK FROM CEG MEMBERS MS made reference to an email he had sent to members of the Suffolk West CAB AGM to encourage a transport partnership, and his proposal for a meeting to discuss better access for Haverhill residents to West Suffolk Hospital. AN gave her thanks for comments on the 12 policies from the Clinical Oversight Group recently sent to the CEG members.

11. AOB

Request to re-instate Gluten Free to forward planner as had come off.

12. QUESTIONS FROM THE PUBLIC

None. 1240 – meeting closed.

13.

FUTURE MEETINGS 22 December Bury St Edmunds, West Suffolk House GFR14 1400-1630

FORWARD PLANNER 22 December 2016

Gluten-free food prescribing

GOVERNING BODY

Agenda Item No. 11



Title

Operational Plans

Lead Chief Officer(s)

Kate Vaughton – Chief Operating Officer

Author(s)

Andrew Eley – Deputy Chief Operating Officer

Purpose

This paper sets out:

For information, the national requirements for Operational Plans 2017-19;

For approval, the structure and core content of the Plan;

For approval, that responsibility for final approval of the Plan is delegated to the Finance & Performance Committee on 21st December 2016








Action required by Governing Body: For information and approval as set out above. It is recommended that members:

Note, for information; the national requirements for Operational Planning 2017-19;

Approve the structure and core content of the CCG’s Operational Plan; and

Approve that responsibility for final approval of the Plan be delegated to the Finance & Performance Committee on 21st December 2016.

1. Background 1.1 As part of the annual planning cycle, the CCG is required to produce an Operational ‘narrative’

Plan that sets out how it will accelerate delivery of the ‘NHS Five Year Forward View’. The Operational Plan covers two years (2017/18 - 2018/19) and sets out how the CCG will implement the next steps of the ‘Forward View’ and maintain a focus on delivering national priorities.

2. Key Issues 2.1 The CCG is currently developing its two-year organisational Operational Plan, which is regarded

as the delivery vehicle for the next two years of the STP and articulates a continued focus on quality and safety, together with plans to deliver financial balance.

2.2 The draft Plan is structured so as to reflect the direction of the ‘Forward View’ and its local

implementation, including the plans for system-wide transformation as detailed in the STP. In doing so, the Plan looks to address the three core priorities for the NHS:

Closing the health and wellbeing gap – tackling health inequalities, implementing the national Diabetes Prevention Programme, addressing obesity, and promoting self-care;

Driving transformation to close the care and quality gap – developing new models of care, sustaining and enhancing access to primary care, transforming urgent and emergency care, transforming cancer prevention, diagnosis and treatment, improving mental health services (including dementia), improving the quality of care and safety, ensuring responsible prescribing of antibiotics, rolling out seven-day services, delivering a fully interoperable health and care system, developing and retaining a skilled workforce, and implementing innovation and learning;

Closing the finance and efficiency gap – delivering the required annual efficiencies, tackling variation in demand, moderating demand growth, and improving workforce productivity.

2.3 The Plan also addresses a number of priorities (‘must dos’) that NHS England has mandated for

2017/18 and 2018/19:

1. Implement Sustainability & Transformation Plan (STP) milestones and trajectories; 2. Deliver financial system control; 3. Implement GP Forward View; 4. Implement urgent & emergency care plan; 5. Meet Referral to Treatment time requirements; 6. Implement cancer Taskforce Force report and deliver constitutional standards; 7. Implement Mental Health Forward View, improvements to Access to Psychological

Treatment, access standards, and dementia diagnosis rates; 8. Learning Disabilities – deliver Transforming Care plans including enhanced community

provision, reduced Inpatient bed capacity, annual health checks; 9. Improve quality.

2.4 The ‘narrative’ Plan is supported by further submissions to NHS England detailing activity plans,

performance trajectories to deliver the NHS Constitution targets, and financial plans.

2.5 A summary of the CCG’s draft Operational Plan is shown as a ‘Plan on a Page’ at Appendix ‘A’ which sets out the structure and approach to the Plan itself.

2.6 The full and final Operational Plan will be submitted to NHS England on 23rd December 2016.

2.7 However, the deadline for submission means that there will be no opportunity for the Governing Body to formally sign-off the Operation Plan and underlying activity plans, performance trajectories, and financial plans.

2.8 Thus, it is recommended that the Governing Body delegate formal sign-off to the Finance & Performance Committee at its meeting on 21st December 2016.

2.9 Full and final Operational Plan will be presented to the Governing Body in January 2017.

3. Public Engagement

3.1 The draft Operational Plan, in part, sets out how the first two years of the STP will be delivered. The development of the STP itself was informed by more than 40 separate pieces of public and voluntary sector engagement over the last two years to develop strategies focused on mental health and learning disabilities, primary care, end of life services, maternity, cancer and hospital plans. Thus, patients and the public have not only directed elements of the STP, but have shaped the content of the Operational Plan.

3.2 Furthermore, the CCG has established and embedded robust processes for continued

engagement with communities and patients. This has led to patient insight helping to develop services, which have also informed the development of the Operational Plan. The CCG continues to use the annual ‘Patient Revolution’ events to ensure stakeholders input into the planning and commissioning cycle.

4. Recommendation 4.1 The Governing Body is requested to:

Note, for information; the national requirements for Operational Planning 2017-19;

Approve the structure and core content of the CCG’s Operational Plan; and

Approve that responsibility for final approval of the Plan be delegated to the Finance & Performance Committee on 21st December 2016.

National Local

• Implement STP milestones and trajectories;

• Deliver financial system control;

• Implement GP Forward View;

• Implement urgent & emergency care plan;

• Meet Referral to Treatment times;

• Implement Cancer Five Year Forward View;

• Implement Mental Health Forward View;

• Learning Disabilities : deliver Transforming Care plans and enhanced community provision;

• Improve quality.

Self

-car

e &

ind

ep

en

de

nce

, an

d

com

mu

nit

y-b

ase

d c

are

GP Forward View

• Improving access;

• Supporting workforce & managing workload ;

• Developing the primary care estate, investing in technology.

Mental Health Forward View

• 7 day NHS; • integrating

mental and physical health;

• promoting good mental health;

Transforming Cancer

Services

• Implement-ing Cancer Taskforce Report;

• achieving earlier diagnosis;

• supporting people living with and beyond cancer.

• Every child has the best start in life

• Improving independent life for people with physical and learning disabilities

• Older people in Suffolk have a good quality of life

• People in Suffolk have the opportunity to improve their mental health and wellbeing

• Community safety & prevention; Empowering people to take responsibility for their own wellbeing; Building personal and social resilience for vulnerable people and their families; Delivering health and care services in the community and working with the

local community to support people before they tip into a crisis Moving care from hospitals to neighbourhood and community locations. • Integrated out-of-hospital care; Proactively identifying and supporting people at risk whilst removing

duplication of assessments and care planning and multiple access points; • Mentally healthy communities; Supporting people with mental health problems and learning difficulties who

have a lower life expectancy and health outcomes than the general population. • Primary care transformation: Supporting practices and primary care providers, ensuring General Practice is

fit for purpose and sustainable in the future to meet population needs.

Ho

spit

al r

eco

nfi

gura

tio

n a

nd

tr

ansf

orm

atio

n

• New models of care; Local hospitals working with community, social care, mental health and

primary care partners to design two “Accountable Care Organisations” to transform outcomes for patients. Care will be based around localities and neighbourhoods, rather than around organisations;

• Improving care pathways; Patients receiving the best clinical outcomes and high level of satisfaction,

ensuring that services are sustainable and follow best evidence.

• Hospital partnerships. Ipswich and Colchester hospitals working together to review partnership

opportunities.

Co

llab

ora

tive

wo

rkin

g ac

ross

th

e s

yste

m

• Managed care; Managing demand for services in a consistent and safe way that optimises use

of resources, and encourages patients and the public to take responsibility for their own wellbeing, and make wise choices when accessing care.

• Strategic commissioning & assurance; Developing and implementing a shared and consistent commissioning and

contracting approach, exploring options for future models for commissioning. • Business support functions. Reviewing current working arrangements and the identification of

collaborative opportunities.

1.

Clo

sin

g th

e h

eal

th a

nd

we

llbe

ing

gap

. 2

. Dri

vin

g tr

ansf

orm

atio

n t

o c

lose

th

e c

are

an

d q

ual

ity

gap

. 3

. Clo

sin

g th

e f

inan

ce a

nd

eff

icie

ncy

gap

.

Achieving system-wide financial balance

£

NHS Five Year Forward View

Sustainability & Transformation Plan

“ ...people across Suffolk and North East Essex live healthier, happier lives by having greater choice, control and responsibility for their health and wellbeing.” National

Priorities

CCG clinical priorities

Suffolk Health &

Wellbeing Strategy

• Develop clinical leadership;

• Demonstrate excellence in patient experience and patient engagement;

• Improve the health and care of older people;

• Improve access to mental health services;

• Improve health and wellbeing through partnership working;

• Deliver

financial sustainability through quality improvement.

Appendix A

of 5

GOVERNING BODY

Agenda Item No. 12



Title

Sustainability and Transformation Plan (STP)

Lead Chief Officer


Author(s)


Purpose

To update the Governing Body on the final published and next steps


1. Develop clinical leadership X

2. Demonstrate excellence in patient experience & patient engagement X

3. Improve the health & care of older people X

4. Improve access to mental health services X

5. Improve health & wellbeing through partnership working X

6. Deliver financial sustainability through quality improvement X

Action required by Governing Body: The Governing Body is asked to note the report.

1. Background 1.1 All health and care organisations within the Suffolk and North East Essex health and care

system have been working together since March 2016 to develop a shared vision, priorities for action and to explore benefits of partnership working through the production of the STP. It has become clear that there are benefits for our population if we align our goals and actions, and share knowledge and skills.

1.2 The STP shows:

How we will work together to improve the health and wellbeing of our population

How we will combine efforts to improve safety and quality of care within Suffolk and North East Essex

How we will value and motivate the staff delivering care across our footprint and make Suffolk and North East Essex an attractive and enjoyable place to work

How we will share and align our infrastructure, assets, land and technology to get the best out of them as we use them to deliver high quality care

How we will move towards a single system-wide financial control total to make best use of our shared financial resources

The STP is:

• A plan, and a direction of travel • A commitment by organisations to work together to improve the health and

wellbeing of our population • An opportunity to share knowledge and benefit from economies of scale • A programme of work built up from existing projects and programmes

The STP is not:

A “done deal” that is finished and perfect

A contract or commercial obligation in its current form

A new organisation or entity

Reinventing the wheel! The STP was published on 17 November.

2. Vision

Our vision is that people across Suffolk and North East Essex live healthier, happier lives by having greater choice, control and responsibility for their health and wellbeing Figure one below sets out a helpful summary of our collective vision for how we would like care to be provided over the next five years.

Figure One: STP Vision 3. Delivering Out Vision 3.1 We have established some key programmes of work to deliver our vision and improve the

health and care services provided for our citizens. These programmes build on existing schemes that Suffolk and North East Essex teams have been working on, and we have now been able to share ideas and plans across the footprint to maximise the benefits offered to our patients and the system.

Figure two below sets out the three programmes and at a high level what is included within each one.

Figure Two: STP Programmes

4. Financial Challenge 4.1 There is full agreement across the system that continuing to provide care using existing

models and form is not a sustainable option. Our financial modelling group has developed the ‘do nothing’ scenario which predicts a £248m health gap between forecast cost and funding in the financial year of 2020/21.

4.2 The “do nothing” system position is derived from assumptions relating to:

Increasing demand across the main points of delivery for the system particularly for the non-elective pathways

Demographic changes expected over the next 5 years

Inflation assumptions

Allocation assumptions 4.3 To achieve a sustainable financial position by 2020/21 we will need balance our income

and expenditure. This can be done through cost avoidance or cost reduction, which may or may not require some double running costs. There are a number of ways this could be done, and the areas set out in figure four below have been explored by project teams. A number of these examples will need consultation and engagement.

Figure Four: STP Financial Options 5. Communications and Engagement 5.1 We have organised ourselves across partners to build a strong narrative and a public facing

document will be published by end of November. Our main audiences are clinicians, the wider health and care workforce, public, patients, service users and carers, and the voluntary and community sectors. We benefit from the strategic leadership of Healthwatch Essex and Suffolk, and our plan requires the use of tailored engagement techniques oriented around programme priorities. These will be led by programme leads. Our aim is to generate meaningful insight to shape the planning and delivery of the STP.

5.2 Using the 2016 People and Communities Board “Six principles for engaging people and

communities” the Advisory Board has agreed these ambitious principles of engagement for use over the next two years: • Use lived experience and other insights to drive change, putting people at the heart of

care.

• We will identify and communicate best practice across the NHS – and also tackle areas of improvement.

• Use a network approach, pooling resources and sharing skills. • Use social marketing and trusted information to support change in behaviours

Figure five below sets out our communications and engagement timeline over the comings months.

Figure five: Communications and engagement timeline 6. Next Steps

Our immediate next steps are:

The following roles are being recruited on a fixed term basis: o Programme Director o Independent Chair

The STP intent will be part of the operational planning and contracting processes for the NHS to agree two years contracts covering 2017-18 and 2018-19.

Communication and engagement plans will be further developed and implemented – keen to work with you all on this

A project management office is being established to support organisation in mobilising the projects they have committed to deliver

GOVERNING BODY

Agenda Item No. 13



Title

Winter Plan 2016/2017

Lead Chief Officer

Kate Vaughton, Chief Operating Officer

Author(s)


Purpose

To provide the Governing Body with an update on the agreed Winter Plan for 2016/17 for West Suffolk








Action required by Governing Body: Governing Body is asked to consider and note the draft Winter Plan prior to recommending its approval by the A&E Delivery Board.

1. Background 1.1 The Winter Plan has been developed in collaboration with the West Suffolk ‘system’

and sets out a whole system approach to seasonal planning and arrangements for delivery for winter 2016/17. Based on lessons learned over recent years, and in particular, from winter 2014/15 & 2015/16 , the aim of this plan is to demonstrate the system will ensure the delivery of safe and high quality services to the population during potential periods of pressure.

1.2 The delivery of safe and high quality services, whilst maintaining delivery of key

performance targets, is supported by the Urgent Care Demand and Capacity Operational Escalation Plan. The CCG oversees delivery of the Plan which has been produced by, and on behalf of, the Suffolk Health and Care economy (referred to as the system):

• Ipswich and East Suffolk Clinical Commissioning Group (IESCCG)

• West Suffolk Clinical Commissioning Group (WSCCG)

• Ipswich Hospital NHS Trust (IHT)

• West Suffolk NHS Foundation Trust (WSFT)

• Suffolk Community Healthcare (SCH)

• Norfolk and Suffolk NHS Foundation Trust (NSFT)

• Adult Community Services (ACS)

• Care UK Out of Hours (OOH) and NHS 111

• East of England Ambulance Service NHS Trust (EEAST) 1.3 The full Winter Plan is appended to the report.

2. Recommendation 2.1 Governing Body is asked to consider and note the draft Winter Plan prior to

recommending its approval by the A&E Delivery Board in December 2016.

West Suffolk

System Winter Plan November 2016

Version 0.7

2

1: Winter Plan 2016/17 - Operational Winter Readiness

The CCG oversees delivery of the Urgent Care Demand and Capacity Operational Escalation Plan which has been produced by, and on behalf of, the Suffolk Health and Care economy (referred to as the system);

• Ipswich and East Suffolk Clinical Commissioning Group (IESCCG) • West Suffolk Clinical Commissioning Group (WSCCG) • Ipswich Hospital NHS Trust (IHT) • West Suffolk NHS Foundation Trust (WSFT) • Suffolk Community Healthcare (SCH) • Norfolk and Suffolk NHS Foundation Trust (NSFT) • Adult Community Services (ACS) • Care UK Out of Hours (OOH) and NHS 111 • East of England Ambulance Service NHS Trust (EEAST)

This plan sets out the A&E Delivery Board seasonal planning and delivery arrangements for winter 2016/17. The plan has been developed in collaboration with all members of the West Suffolk ‘system’ and aims to demonstrate how joint plans will ensure the delivery of safe and high quality services to the population during potential periods of pressure. The Winter Plan: -

• reflects a whole system approach to the delivery of services over the forthcoming winter period; • builds upon lessons learnt within west Suffolk over recent years and in particular, from winter 2014/15 & 2015/16; • Identifies the potential risks and sets out options and solutions to mitigate against them.

It is vital that the standard of care, quality of services and legal requirements are maintained even during the most challenging of situations. The potential impact on the patient experience is considerable and during the winter period we will aim to ensure: -

• no avoidable deaths, injury or illness; • no avoidable suffering or pain; • no unnecessary waiting or delays; • no inequality of access to our services;

The delivery of safe and high quality services, whilst maintaining delivery of key performance targets, is supported by the Urgent Care Demand and Capacity Operational Escalation Plan .

Introduction

Operational Winter Readiness

3

Each organisation has developed it own demand and capacity plan which details how they will manage surges in demand throughout the year and particularly over Winter. The System Urgent Care Demand and Capacity Operational Escalation Plan is intended to be used by operational managers who are responsible for the management of health and social care services. It is with this audience in mind that focuses this plan operationally however, it is strongly routed to strategic planning for business continuity, major emergencies, pandemic and other contingencies.

The system will be held accountable for the internal circulation and familiarisation of this plan, and for assuring the adequacy and accuracy of their individual plans.

This plan was revised in light of experience, lessons learnt from periods of increased demand and best practice. The plan is currently under review by all system partners in preparation for winter 2016/17 with a latest version attached at appendix one. However, since the review started the new national framework has been published which moves to a different categorisation system. This now involves a lot more work than originally anticipated and as such will entail a re-write of all local escalation plans and migrating to the new national framework. As such, we anticipate this work will not be completed until early December in time for the A&E Delivery Board on 14 December 2016.

In addition the system has developed an urgent care dashboard which includes indicators from the entire patient flow pathway. The purpose of the Suffolk Urgent Care Dashboard is to inform the Suffolk system of the current system wide position. The dashboard enables partners to access current performance information relating to all system partners from a single access point.

The Suffolk Urgent Care Dashboard forms part of the national web based Directory of Service Capacity Management System (DoS), hosted by the HSCIC. The DoS has recently been enhanced to feature a dashboard facility which has been utilised in the development of the Suffolk Urgent Care Dashboard.

The Suffolk Urgent Care Dashboard should be updated by each of the partner agencies/organisation a minimum of twice daily and ideally three or four times daily at times when the system is under pressure and information changes more frequently and the current information needs of partner agencies are greatest.

The CCG manage the administration function of the dashboard, each provider managers their service data and input. Each service / area updates their own entry on the dashboard, the CCG do not update provider information. A further review of the dashboard is currently underway with the revised version to be submitted to the December A&E Board.

2. Winter Escalation

4

2. Winter Escalation The Urgent Care Demand and Capacity Operational Escalation Plan (Appendix 1) has been produced by, and is owned by the Suffolk health and care economy.

Each organisation has developed a demand and capacity plan which details how it will manage surges in demand throughout the year.

The plan recognises that every organisation has:

a. a recognised capacity, based upon beds, workforce, equipmet, etc. as appropriate to that organisation; b. identified a range of additional capacity which can be accessed during surges in demand; c. a series of triggers that relate to an escalation level; d. a series of actions that relates to the relevant escalation level with a view to normalise as quickly as possible (see diagram on right); e. agreed to use a common approach to deal with demand and capacity surges; f. agreed that the CCGs will act as system coordinators; g. agreed to escalate issues that need resolution only where system partners have been unable to resolve issues between themselves; h. a 24 hour contact number for escalation use.

5

A significant amount of system-wide and Trust level collaborative planning and preparation work has been underway for several months in order to: •Predict and understand the requirements and associated impacts •Put plans in place to ensure the following objectives are met:

–Avoid unnecessary ED attendances and hospital admissions, treating patients in primary care wherever safe and possible to do so

–Delivery of safe clinical care to emergency patients within a 4 hour quality standard

–Reduction in the number of moves a patient makes - Right bed first time Right Pathway, keeping the pathway moving

–Minimising the impact of cancelling elective activity, based on heightened emergency activity

–No reduction in quality in the care of patients on all wards by ensuring we have the right resources and staff

Escalation Beds at West Suffolk Foundation Trust (WSFT) Winter 2015/16 proved a difficult period for WSFT with a key factor being the provision of additional bed based capacity during times of extreme pressure and when capacity in the Emergency Department was impacted. The core reason for this was the lack of escalation capacity/decant facility; the only available space being the emergency patient assessment areas to bed patients in during times of surge. To mitigate this risk over Winter the Trust will be opening a 25 bedded escalation ward on the 7th November, for patients awaiting discharge to provide alternative escalation capacity and reduce outliers within the Trust. Additional 20 step down community beds in Glastonbury Court, which is a care home setting were also opened in October to enable acute beds to be released for escalation purposes and implement the Discharge To Assess model. This has improved the patient journey and experience with positive feedback from users to date.

3. Short-term surge capacity planning

6

Protecting the elective activity

The anticipated increase in unscheduled activity during the winter period provides a significant challenge to managing elective activity, avoiding cancelations.

The patient experience and safety is equally important during this time and the hospital will endeavour to maintain elective work as far as possible during periods of surge however plans are now in place to mitigate this risk.

These include:

• A revised management plan is in place for OPD activity the week before Christmas and the first week after New Year to ensure sufficient physicians are available to support discharge.

• Major inpatient work will be limited from Friday 23rd December 2016 until Monday 2 January 2017 with the exception of cancer patients and urgent cases

• Elective work will re-commence on Tuesday the 2nd of January 2017 but with a 15% planned reduction in theatre work for this week • DSU will close between Christmas and New Year but will open to full activity on the 2nd of January • Staff resources are redeployed and work flexibly across departments to support activity during peak times • Cohort / buddy ward management of medical outliers is agreed with the appropriate Clinical Directors • Red to Green events will be held the week prior to Christmas and from the 2nd Jan the detail of which will be agreed at the A&E Board Operational

Group on the 28th November.

Enhanced Ambulatory Care Services

The Ambulatory Emergency Care Service will be fully open over the Christmas period including bank holidays, from 8am to 8pm, aiming to diagnose and treat patients within 12 hours, avoiding admission.

The opening of a dedicated escalation ward on the 7th November will safeguard against these beds being used as surge space and improve the impact of the new ambulatory care service on admission avoidance and flow.

This service aims to see 25% of all ED medical referrals with a 10% conversion rate to admission. This service is currently being promoted to GP’s via locality meetings and correspondence. We are also currently scoping a surgical AEC unit to assist with patient flow.


7


Local Authority Support: Suffolk County Council have committed to ensuring NHS delayed discharges will be minimised in the two weeks running in to Christmas (from 12 December) and throughout January as part of the system work underway around reducing DToCs. The will also provide additional social worker support where necessary during this period.

Finally primary care have been engaged with the CCG around planning for Winter with GP representation on the A&E Delivery Board.

Primary Care: The CCG has worked with the individual practices to ensure there is a clear plan over the Christmas two weeks period for what is available to ensure that the correct level of access is maintained. Appendix One

The local system is also fortunate to have the GP Plus scheme, which operates during weekday evenings up to 6.30pm to 9pm weekdays and 9am-1pm Saturdays and bank holidays enabling additional primary care capacity. This is monitored on a daily and weekly basis with appointments available to be booked via GP practices, 111, EEAST and redirecting patients from A&E.

8

4. Demand Management Early Intervention Team (EIT) has been further enhanced in advance of winter.

This integrated model of admission avoidance supports:

• up to 30 avoided admissions each week from community referrals or through turnaround from A&E • in-reaches into the assessment wards to support discharge to assess pathways

The EIT model brings together physical, social and mental health, care and voluntary care to provide a single response to people in crisis and at risk of an emergency admission. The team aim is to respond to requests for patient support within a 2 hour window to stabilize the crisis before transferring back to the community case manager. Work is in place to extend the model of delivery to support the discharge pathways. To increase the ability of the team to respond to and appropriately target patients at risk of presenting with respiratory issues the local COPD service has been enhanced by the addition of a new clinical nurse specialist who started at the beginning of September. This has enabled the admission prevention function of the COPD service to now be fully integrated with EIT. In addition to this From 1 October two EEAST Emergency Care Practitioners also joined EIT providing an enhanced clinical skillset to support urgent care needs and to improve the interface with ambulance crews to increase see and treat activity. The presence of a paramedic within the team enables them to more effectively work with EEAST to further improve their referral rates. The EIT team has also been visiting the GP locality meetings to promote the service and ensure that there is an improved understanding of their role in advance of winter.

9

Influenza Plan

West Suffolk implements the national guidance for increasing uptake of flu immunisation in the target at risk population groups, and across the NHS workforce. It is by increasing uptake that we best protect our population and our staff from infection, and the service from excessive demand. Our 2016/17 approach focuses on: -

• All children aged to two to seven on 31 August 2016 • All primary school-aged children in former school pilot areas • Those aged six months to under 65 years in clinical risk groups • Pregnant women • Those aged 65 years and over • Those in long stay residential care homes • Carers

Locally we aim to implement:

• a campaign to increase uptake in staff, to protect them and their patients and family. This will be supported by a comprehensive communication campaign. Nursing staff are asked to champion this approach and support delivery to colleagues.

• A local campaign to maximise uptake by healthcare workers to reach uptake to vaccinations of the 75% expectation. • 100% active invitation for invitation (by phone or letter) to all eligible children

Pneumococcal vaccine

West Suffolk continues to encourage the use of pneumococcal vaccine in those for whom it is recommended, and vaccine usage figures indicate that our uptake is similar to the number of people achieving their 65th birthday each year. We have ensured that GPs are sent messages reminding them of the value of this vaccine, and this is reinforced by our immunisation coordinator and prescribing advisers. CCG Communications Department has an established communications timetable and agreed communication messages that link with the national timetable and national messages.

5. Influenza and Pneumococcal Strategy

10

NHS England, Public Health England, the Department of Health, the NHS Trust Development Agency and Monitor are joining together to develop ONE campaign which will cover ALL winter messages including flu, keep warm keep well, slips trips and falls, catch it bin it kill it etc. The national team is asking for any local CCG expenditure on winter communications to be on things that can’t be arranged or done nationally, and to for this to all be in line with the national creative. The data and insight available nationally indicates main winter pressures and difficulties are caused by an increase in people who need to be admitted to hospital as an emergency, particularly those who arrive at A&E by ambulance. Campaign messages will focus on those actions that are most likely to prevent an emergency admission, for example:

• Take up the offer of flu vaccination • Self-care (for example using over-the-counter medicines) and pharmacy as a first point of call • For people who have long-term conditions, seeking prompt medical attention, so that minor illnesses do not escalate to the point where

hospitalisation is necessary • Keeping homes warm in cold weather • Avoiding falls (for example by stocking up on food and medicines so that it is not necessary to go outside in icy conditions) • Avoiding A&E except for emergencies (calling NHS 111 if in doubt)

The local Public Health communications team will lead on the flu messages, however the CCGs will support this through a range of communications including the monthly EADT health supplement, our websites and social media (promoting flu awareness, dates and locations of flu clinics), messages in parish magazines and partner publications from Age UK, Family Carers and Women’s Institute etc. The targeted winter activity is specifically aimed at:

• People living close to both the WSFT • Identified frequent users of the A&E services at the hospitals

6. Communications Strategy

11

7. Appendix One Primary Care Support over the Christmas Period – Draft to be confirmed 28.11.16

Day GP practice services Out of Hours

Medical Care

Out of Hours Dental

Care (Van)

GP Plus Pharmacies

Thursday 22nd Dec Normal operations

Plus three and a half hours

of extended hours

18.30 to 08.00 on

23rd

N/A 18.30 to 21.00 Normal operations

Friday 23rd Dec Normal operations

Plus two hours of extended

hours

18.30 onwards N/A 18.30 to 21.00 Normal operations

Saturday 24th Dec Twenty three hours and 45

minutes extended hours

across the surgeries

24-hours 10.00 – 16.30 09.00 to 13.00 To be advised by

NHSE

Sunday 25th Dec Closed 24-hours 10am to 1pm Closed To be advised by

NHSE

Monday 26th Dec

Boxing Day B/H

Closed 24-hours 10.00 – 16.30 09.00 to 13.00 To be advised by

NHSE

Tuesday 27th Dec. B/H Closed 24- hours 10.00 – 16.30 09.00 to 13.00 To be advised by

NHSE

Wednesday 28th

December

Normal operations

8.00 to 18.30


of extended hours

To 8am and then

18.30 to 08.00 on

29th


Thursday 29th December Normal operations

8.00 to 18.30


of extended hours

18.00 to 08.00 on

30th


of 2

GOVERNING BODY Agenda Item No. 16



Title

Declaration of Interests

Lead Chief Officer

Amanda Lyes, Chief Corporate Services Officer

Author(s)

Colin Boakes, Governance Advisor

Purpose

The report provides a public record of relevant and material interests declared by members of the Ipswich and East Suffolk CCG Governing Body, its sub-committees, staff and member practices.








Action required by Governing Body: The Governing Body is asked to review the current register, and consider whether any action in relation to non-responders might be required.

of 2

1. Background

1.1 Clinical commissioning groups (CCGs) manage conflicts of interest as part of their day-to-day activities. Effective handling of conflicts of interest is crucial to give confidence to patients, tax payers, healthcare providers and Parliament that CCG commissioning decisions are robust, fair and transparent and offer value for money. It is essential in order to protect healthcare professionals and maintain public trust in the NHS. Failure to manage conflicts of interest could lead to legal challenge and even criminal action in the event of fraud, bribery and corruption.

1.2 Conflicts of interest are inevitable in commissioning. It is how we manage them that

matters. Section 14O of the National Health Service Act 2006 (as amended by the Health and Social Care Act 2012) (“the Act”) sets out the minimum requirements of what both NHS England and CCGs must do in terms of managing conflicts of interest.

1.3 As a minimum, CCGs must have robust systems in place to identify and manage

conflicts of interest. This should involve creating an environment in which CCG staff, Governing Body and sub-committee members, and member practices feel able, encouraged and obliged to be open, honest and upfront about actual or potential conflicts. Transparency in this regard is expected to lead to effective identification and management of conflicts. The effect should be to make everyone aware of what to do if they suspect a conflict and ensure decision-making is efficient, transparent and fair. To this end, CCGs are now required to implement this statutory guidance in a manner that is clear and robust, but not overly prescriptive or complex

1.4 To further support CCGs in managing the risks of conflicts of interest, NHS England

has issued revised statutory guidance that supersedes Managing Conflicts of Interest Statutory Guidance, which was published in December 2014. The guidance has been further strengthened in light of findings of NHS England’s 2015/16 co-commissioning conflicts of interest audit, the National Audit Office’s (NAO’s) report on conflicts of interest management in CCGs and feedback received from a range of stakeholders and partners, including the BMA, RCGP, GMC, NHS Clinical Commissioners, CCGs, Healthwatch England, NHS Improvement, NHS Protect, and other organisations, as part of a public consultation exercise.

2. Key Points 2.1 As a result of the revised guidance CCG Officers, Governing Body members, GPs,

all staff, including students, agency and seconded staff, together with practice staff with involvement in CCG business are now required to complete declarations.

2.2 Declarations will be sought on a six-monthly basis and the register published on the CCG’s website. The current register is attached to the report at Appendix 1.

3. Recommendation 3.1 The Governing Body is asked to review the current register, and consider whether

any action in relation to non-responders might be required. Author: Colin Boakes, Governance Advisor

Interests of:

Governing Body and Sub-Committee MembersMember Practices

All CCG Staff

Register of Interests

West Suffolk CCG

October 2016

Financial Interests

Non Financial Professional

Interests

Non Financial Personal Interests

From To

Governing Body GP Member Simon Arthur Partner in Medical Practice and Executive Member of Suffolk GP Federation Direct 2016 Ongoing 30/10/2016 To declare when appropriate YesMedical partnership has contract with Suffolk Community Healthcare to provide GP serv Direct 2016 Ongoing 30/10/2016 To declare when appropriate Yes

Lay Member for Governance and Vice Chair CCG Bill Banks Nil 03/10/2016 YesGoverning Body Practice Manager Member Kevin Bernard Practice Manager Botesdale Health Centre. Health Centre is member of the Suffolk GP F Direct 2006 Ongoing 17/10/2016 To declare when appropriate Yes

Company Secretary and shareholder in Botesdale Rural Services Ltd trading as Botesdale Direct 2008 Ongoing 17/10/2016 To declare when appropriate YesCCG Chair Christopher Browning PMS Provider, Practice Partner Long Melford Direct Ongoing 11/11/2016 Yes

Chair, Hartest Parish Council Direct Ongoing 11/11/2016 YesWife is consultant geriatrician at West Suffolk Hospital Indirect Ongoing 11/11/2016 Yes

Lay Member for Patient and Public Involvement Jo Finn Previous Chief Executive of West Suffolk Hospital NHS Trust Direct 1993 2001 31/10/2016 None YesEx-husband was Consultant Obstetrician and Gynaecologist Indirect 1978 1993 31/10/2016 None YesPatient under care of neurologists and rheumatalogists at West Suffolk Hospital Direct 1998 Ongoing 31/10/2016 None Yes

Chief Officer Ed Garratt Chief Officer for Ipswich and East Suffolk CCG Direct Mar-16 Ongoing 03/10/2016 None YesGoverning Body GP Member Andrew Hassan Nil 06/10/2016 YesSecondary Care Doctor Crawford Jamieson Consultant in Gastroenterology at Ipswich Hospital

CBG lead for Gastroenterology, general and vascular surgery

Direct 03/03/2016 Ongoing 16/11/2016 Yes

Wife is consultant in Medicine for the Elderly at Ipswich Hospital Indirect Ongoing 16/11/2016 YesGoverning Body Practice Manager Member Peter Knights Partner Mount Farm Surgery Direct 01/10/2005 Ongoing 03/10/2016 To declare at relevant committees when in attendance Yes

Mount Farm Surgery is a member of Suffolk GP Federation Direct Ongoing 03/10/2016 To declare at relevant committees when in attendance YesChief Corporate Services Officer Amanda Lyes Chief Corporate Services Officer for Ipswich and East Suffolk CCG Direct Ongoing 20/10/2016 None YesInterim Chief Finance Officer Lesley MacLeod Interim Chief Finance Officer for Ipswich and East Suffolk CCG Direct May-16 Ongoing 07/10/2016 None Yes

Direct of Public Solutions Ltd Direct 2006 Ongoing 07/10/2016 None YesChief Nursing Officer Barbara McLean No responseGoverning Body GP Member Bahram Talebpour Nil 11/11/2016 YesChair of Community Engagement Partnership David Taylor Trustee of Charity Avenues East Direct 2009 Ongoing 31/10/2016 None YesChief Contracts Officer Jan Thomas Chief Contracts Officer for Ipswich and East Suffolk CCG Direct - Ongoing 03/10/2016 None YesChief Operating Officer Kate Vaughton Nil 04/10/2016 YesGoverning Body GP Member Firas Watfeh No responseChief Redesign Officer Richard Watson Chief Redesign Officer for Ipswich and East Suffolk CCG Direct Jun-16 Ongoing 24/10/2016 None Yes

West Suffolk CCG Governing Body and Sub Committee Members

Title First Name Last Name Direct or Indirect

Date of Interest Date of Receipt

Action Taken to Mitigate Consent to Publish

Declared Interest Type of Interest

Financial Interests

Non Financial

Professional Interests


From To

Angel Hill No responseBotesdale Health Centre Practice Manager Kevin Bernard Practice Manager Botesdale Health Centre. Health Centre is member Direct 2006 Ongoing 17/10/2016 To declare when appropriate Yes

Company Secretary and shareholder in Botesdale Rural Services Ltd tr Direct 2008 Ongoing 17/10/2016 To declare when appropriate YesGP Tim Cooke Owns a third share of Health Centre Direct Ongoing 03/10/2016 To declare at relevant committees when in attendance Yes

Owns 30% share of Botesdale Pharmacy Direct Ongoing 03/10/2016 To declare at relevant committees when in attendance Yes

Brandon Medical Practice GP Emmanuel Obiabo Nil 03/10/2016 YesGP Jacqueline Rae Nil 03/10/2016 YesPractice Manager Kathryn Spencer Nil 03/10/2016 Yes

Clements Christmas Maltings GP Fiona Andrews Member of Suffolk Accident Rescue Service Direct Ongoing 24/10/2016 None YesHusband works for East Anglian Air Ambulance Indirect Sep-14 Ongoing 24/10/2016 None Yes

Forest Surgery No responseGlemsford Surgery Asst Practice Manager Sharyn Baldwin Nil 07/11/2016 Yes

GP Mary Giblin Nil 07/11/2016 YesGP Guy Lesser Nil 07/11/2016 YesGP Matthew Piccaver Nil 07/11/2016 Yes

Guildhall Surgery GP Simon Whitehead Nil 14/10/2016 YesGP Jane O'Donnell Nil 25/10/2016 Yes

Guildhall and Barrow Surgery GP Heather Griffin Director/Shareholder in company providing pharmacy services Direct 2013 Ongoing 13/10/2016 To declare at all relevant committees when in attendance YesGP Lucy Hickson Director/Shareholder in company providing pharmacy services Direct 2013 Ongoing 13/10/2016 To declare at all relevant committees when in attendance YesGP Mark Hunter Director/Shareholder in company providing pharmacy services Direct 2013 Ongoing 13/10/2016 To declare at all relevant committees when in attendance YesPractice Manager Linda Johnston Director/Shareholder in company providing pharmacy services Direct 2013 Ongoing 13/10/2016 To declare at all relevant committees when in attendance YesGP Michael Jones Director/Shareholder in company providing pharmacy services Direct 2013 Ongoing 13/10/2016 To declare at all relevant committees when in attendance YesGP Peter Smye Director/Shareholder in company providing pharmacy services Direct 2013 Ongoing 13/10/2016 To declare at all relevant committees when in attendance YesGP Kate Wallace Director/Shareholder in company providing pharmacy services Direct 2013 Ongoing 13/10/2016 To declare at all relevant committees when in attendance Yes

Hardwicke House Surgery GP Rakesh Raja GP Partner in PMS Practice Direct Ongoing 03/10/2016 To declare at all relevant committees when in attendance YesProvides cover for rehab beds at Hazell Court Direct Ongoing 03/10/2016 To declare at all relevant committees when in attendance YesTrustee Brightstars Children's Charity Direct Ongoing 03/10/2016 To declare at all relevant committees when in attendance Yes

GP Bahram Talebpour Nil 11/11/2016 YesHaverhill Family Practice No responseLakenheath No responseLong Melford Practice GP Christopher Browning PMS Provider, Practice Partner Long Melford Direct Ongoing 11/11/2016 Yes

Chair, Hartest Parish Council Direct Ongoing 11/11/2016 YesWife is consultant geriatrician at West Suffolk Hospital Indirect Ongoing 11/11/2016 Yes

GP Mark Chambers Nil 01/11/2016 YesGP Tony Cipriani Nil 01/11/2016 YesGP Elizabeth Hornung Nil 01/11/2016 YesGP Tony Norris Nil 01/11/2016 YesPractice Manager Nicola Whitehead Nil 01/11/2016 Yes

Market Cross Surgery No responseMount Farm Surgery Practice Manager Peter Knights Partner at Mount Farm Surgery Direct 01/10/2005 Ongoing 03/10/2016 To declare at relevant committees when in attendance Yes

Mount Farm Surgery is a member of Suffolk GP Federation Direct Ongoing 03/10/2016 To declare at relevant committees when in attendance YesOrchard House Surgery Salaried GP Marianne Alderson Nil 20/10/2016 Yes

GP T Bailey Nil 20/10/2016 YesSalaried GP Kristie Bewers Nil 20/10/2016 YesGP Sarah Ladner Nil 20/10/2016 YesGP Judith Lomas Nil 20/10/2016 YesGP Tom McGonigle Nil 20/10/2016 YesGP J McLaren Nil 20/10/2016 YesGP Helen Pullan Nil 20/10/2016 YesGP Robert Wace Board Member of Anglia Community Leisure Direct 2010 Ongoing 20/10/2016 None YesPractice Manager Margaret West Nil 20/10/2016 YesBusiness Manager Gareth Whyte Owner of Hasslefree Computing Ltd Direct 2013 Ongoing 20/10/2016 To declare when appropriate Yes

Oakfield Surgery, Newmarket GP Simon Arthur Partner in Medical Practice and Executive Member of Suffolk GP Fede Direct 2016 Ongoing 20/10/2016 To declare when appropriate YesMedical partnership has contract with Suffolk Community Healthcare t Direct 2016 Ongoing 20/10/2016 To declare when appropriate Yes

Rookery Medical Centre Practice Manager Scott Burley Practice Manager 2009 Ongoing 14/10/2016 To declare when appropriate YesGP Partner Melanie Jackson GP Partner 2002 Ongoing 14/10/2016 To declare at relevant committees when in attendance YesGP Partner Daniel Knowles GP Partner 2011 Ongoing 14/10/2016 To declare at relevant committees when in attendance YesGP Partner Emma Ramsey GP Partner 2002 Ongoing 14/10/2016 To declare when appropriate Yes

Husband works for Anglia Community Eye Services Ongoing 14/10/2016 To declare at relevant committees when in attendance YesGP Partner Malini Wace Nil Ongoing 14/10/2016 Yes

Siam Surgery GP Naseer Ahmed Nil 16/11/2016 YesGP Piotr Bulacz Nil 16/11/2016 YesGP Shalini Cross Nil 16/11/2016 YesGP Malina Giusca Nil 16/11/2016 YesPractice Manager Sue Mitson Nil 16/11/2016 YesGP Carsten Soborg Nil 16/11/2016 Yes

Mount Farm Surgery GP Senior Partner Claire Giles Training Programme Director GP Training emplyed by HEEofE Direct Ongoing 07/10/2016 None YesExaminer for RCGP - occasional sessions Direct Ongoing 07/10/2016 None YesGP appraiser Direct Ongoing 07/10/2016 None Yes

GP Brian Ainsworth Nil 07/10/2016 YesGP Bethan Hughes Nil 07/10/2016 YesPractice Manager Peter Knights Nil 07/10/2016 YesGP M Polli Nil 07/10/2016 Yes

Swan Surgery GP Emma Derbyshire GP Partner Direct 1999 Ongoing 18/10/2016 To declare at all relevant committees when in attendance YesSwan Pharmacy Direct 2013 Ongoing 18/10/2016 To declare at all relevant committees when in attendance Yes

GP Crispin Dunne Non Executive Director of Suffolk GP Federation and shareholder in ph Direct 2014 Ongoing 18/10/2016 To declare when appropriate YesMember of LMC, GP Appraiser and Research Lead in practice Direct 2005 Ongoing 18/10/2016 To declare when appropriate Yes

GP John Gove Non Executive Director Swan Pharmacy, Bury St Edmunds Direct 2013 Ongoing 25/10/2016 To declare at all relevant committees when in attendnace YesGP Matthew Mailey Non Executive Director Swan Pharmacy, Bury St Edmunds Direct 2013 Ongoing 25/10/2016 To declare at all relevant committees when in attendnace YesGP Kirsty Reid Non Executive Director Swan Pharmacy, Bury St Edmunds Direct 2013 Ongoing 25/10/2016 To declare at all relevant committees when in attendnace YesGP Rosalind Tandy Employed as an associate by West Suffolk CCG Direct 2012 Ongoing 18/10/2016 None Yes

Employed on honorary contract with SCH to provide health assessmen Direct 2016 Ongoing 18/10/2016 None YesVictoria Surgery GP Victoria Hunter Shareholder in G&B Medical Services Ltd Direct 23/05/2016 Ongoing 10/11/2016 Yes

Husband is a GP at Guildhall and Barrow Surgery and also a director of G&B Medical Services Ltd

Indirect Ongoing 10/11/2016 Yes

GP Simon Lovegrove GP Principal Victoria Surgery Direct Ongoing 10/11/2016 YesDermatology GPSI West Suffolk Hospital Direct Ongoing 10/11/2016 YesClinical Assistant (bank of locums) St Nicholas Hospice Direct Ongoing 10/11/2016 Yes

Reynard Surgery GP G Hopkinson Nil 09/11/2016 YesWickhambrook Surgery No responseWoolpit Health Centre GP Will Ridsdill-Smith Director of Woolpit Medical Services Direct 2004 Ongoing 31/10/2016 To declare at relevant committees when in attendance Yes

Clinical Assistant in Dermatology West Suffolk Hospital Direct 2012 Ongoing 31/10/2016 To declare at relevant committees when in attendance Yes

West Suffolk Member PracticesPractice First Name Last Name Declared Interest Type of Interest Direct or

IndirectDate of Interest Date of

ReceiptAction Taken to Mitigate Consent

to PublishTitle

Declared Interest

Financial Interests

Non Financial

Professional Interests


From To

Miss Helen Abel Lead Contract Manager - Specialised Nil 30/09/2016 Yes

Mr. Adewale Abimbola Pharmacist Advanced Band 8a Bury St Edmunds (7) Nil 01/11/2016 Yes

Mrs. Joanne Agnew Nurse Coordinator Nil 31/10/2016 Yes

Mr. Angus Alamein Press Officer Nil 31/10/2016 Yes

Mrs. Frances Aldridge Clinical Systems Support Analyst Nil 30/09/2016 Yes

Miss Katie Allison Advanced Practice Support Pharmacist Nil 01/11/2016 Yes

Mr. Kristofer Apps Escalation Coordinator No response

Mr. Christopher Armitt Deputy Chief Finance Officer Nil 30/09/2016 Yes

Mr. Mark Armstrong Management Accountant Nil 30/09/2016 Yes

Miss Carrie Bacchus Contract Manager Nil 30/09/2016 Yes

Mrs. Clare Banyard Associate Director of Redesign Nil 30/09/2016 Yes

Mr. James Barrett Advanced Practice Support Pharmacist Nil 26/09/2016 Yes

Mrs. Dawn Barrick-Cook Transformation Lead Nil 20/10/2016 Yes

Mrs. Leanne Bartholomew Senior Medicines Management Technician Band 6 RBH Employed on casual basis by GP Practice Direct 2013 Ongoing 13/10/2016 None Yes

Mr. Martin Bate Redesign Project Manager Treasurer for Diabetes UK Local Group Direct Oct-15 Ongoing 25/10/2016 To declare when appropriate Yes

Mr. John Bayley Project Manager Nil 03/10/2016 Yes

Mr. Paul Belton Data Architect Wife works as pharmacist at West Suffolk Hospital Indirect 20/08/2005 Ongoing 30/09/2016 None Yes

Mrs. Ameeta Bhagwat Finance Manager Nil 26/09/2016 Yes

Mrs. Sally Bovey IT Training Coordinator Nil 26/09/2016 Yes

Mrs. Helen Bowles Transformation Lead Nil 01/11/2016 Yes

Mr. Alexander Briggs Head of Corporate Performance and QIPP Nil 30/09/2016 Yes

Mr. David Brown Deputy Chief Operating Officer Wife is partner in Horkstow GP solutions (dormant) Indirect N/A 14/10/2016 None Yes

Mrs. Nicola Brunning Lead Contracts Manager - Community Sister is a paediatric nurse at Ipswich Hospital Indirect - Ongoing 30/09/2016 None Yes

Mrs. Lois Rebecca Bull Patient and Public Engagement Officer Has Bank Physiotherapy contract with Ipswich Hospital NHS Trust Direct Oct-15 Ongoing 03/10/2016 None Yes

Mrs. Jill Burgess Reporting Analyst Nil 03/11/2016 Yes

Mrs. Jennifer Burman Implementation Administrator Nil 10/10/2016 Yes

Mrs. Valerie Butcher Head of Acute Commissioning Finance Nil 26/09/2016 Yes

Miss Catherine Butler Head of GP Prescribing Nil 26/09/2016 Yes

Mrs. Joanne Bye Senior Medicines Management Technician Band 6 RBH Employed as NVA Assessor & IQA for West Suffolk College Direct Sep-06 Ongoing 17/10/2016 None Yes

Employed as CPD reviewer for General Pharmaceutical Council Direct Mar-09 Ongoing 17/10/2016 None Yes

Mr. John Byrne Senior Co-ordinator Continuing Healthcare No response

Mrs. Eve Calderbank Finance Manager Nil 30/09/2016 Yes

Miss Gail Cardy Project Support Officer Volunteer for Extra Unique - Young People with LD Direct Jan-16 Ongoing 30/09/2016 None Yes

Mrs. Amelia Carroll Placement Support Officer No response

Mr. Martin Casbolt ITSM Programme Manager Nil 26/09/2016 Yes

Mrs. Sandra Chambers Business Support Manager Nil 08/11/2016 Yes

Mrs. Hayley Charman Communication & Engagement Officer No response

Mrs. Beaulah Chizimba Designated Nurse Safeguarding Children Director of Consultancy Ltd Company (non trading) Direct Ongoing 10/11/2016 Yes

Mrs. Deloris Clarke Administration Assistant - Ambulance Service/CommissioninNil 06/10/2016 Yes

Mrs. Susan Clarke Dietetic Advisor Nil 13/10/2016 Yes

Ms. Anna Cochrane Transformational Lead (WP&D) No response

Ms. Isabel Cockayne Head of Communications & External Relations Nil 26/09/2016 Yes

Miss Bethany Colby Business Support Officer Nil 31/10/2016 Yes

Mrs. Hayley Collins Patient Experience Officer Nil 30/09/2016 Yes

Mr. Paul Cook IM&T Project Manager Nil 31/10/2016 Yes

Mr. Mark Cooke Transformation Lead Nil 03/10/2016 Yes

Mr. Daniel Cox Clinical Systems Support Manager Nil 31/10/2016 Yes

Mr. Richard Cracknell Head of Operations Nil 13/10/2016 Yes

Miss Nina Crawford Executive Assistant No response - sick leave

Miss Emma Croome IFR Business Administrator Nil 03/10/2016 Yes

Mrs. Merele Cruz ICT & Informatics Support Officer Nil 03/01/2016 Yes

Mrs. Chloe Cummings Business Support Officer Nil 19/10/2016 Yes

Miss Elizabeth Davey Business Support Officer No response

Date of Receipt Action Taken to MitigateTitle First Name Last NameStaff List

Consent to PublishType of Interest Date of InterestPosition Title Direct or Indirect

Ms. Wendy Louise Dawson Nurse Coordinator No response

Mr. Mahmad Akta Deelawar Lead Contracts Manager Mental Health and LD Nil 30/09/2016 Yes

Mrs. Karen-Lynne Dowsing Transformation Lead Nil 26/09/2016 Yes

Mrs. Leonie Dozzell MASH:Business Support Officer No response

Mrs. Carina Drake Human Resources Officer Nil 26/09/2016 Yes

Mrs. Cindie Dunkling Designated Nurse Safeguarding Children Nil 01/11/2016 Yes

Mr. Andrew Eley Deputy Chief Operating Officer Nil 03/10/2016 Yes

Ms. Rebecca Ellwood Placement Support Officer No response

Ms. Amanda Estall Procurement Support Officer Daughter is a sister at Addenbrookes A&E Indirect 31/10/2016 30/14/17 01/11/2016 None Yes

Ms. Nerinda Evans Associate Director of Redesign Nil 26/09/2016 Yes

Miss Christine Eyers Clinical Review Nurse No response

Mrs. Beverley Farnish Nurse Coordinator Advisor for the Care Quality Commission - Mental Health Direct Ongoing 25/10/2016 None Yes

Mr. Ciaran Farrier-Dutton Redesign Project Manager Paramedic Bank contract with East of England Ambulance Service Direct Feb-16 Ongoing 01/11/2016 None Yes

Mrs. Helen Farrow Senior Executive Assistant Nil 26/09/2016 Yes

Miss Victoria Fennell Apprenticeship Coordinator No response

Mr. Jonathan Ford Communications Manager Nil 30/09/2016 Yes

Mrs. Marie Forster Continuing Healthcare Senior Business Administator Nil 19/10/2016 Yes

Miss Samantha Fowler Practice Support Manager - Band 7 - WSCCG (7) No response

Mr. Daniel Francis Finance Assistant Nil 30/09/2016 Yes

Mrs. Beata Francis Business Support Officer Nil 19/10/2016 Yes

Mrs. Tracey Frost Senior Medicines Management Technician Nil 13/10/2016 Yes

Mr. Christopher Fryer Placement Support Officer Nil 05/10/2016 Yes

Ms. Lynne Fuller Infection Control Lead Nurse Nil 13/10/2016 Yes

Mrs. Lucy Game Contracts Manager No response

Mr. Mark Game Head of Accounting and Control Nil 18/10/2016 Yes

Miss Jane Garnett Lead for Procurement CIPS Tutor for Essex and Suffolk School of Purchasing Direct 01/01/2014 Ongoing 30/09/2016 None Yes

Provides procurement advice to Ipswich Hospital NHS Trust Direct 01/04/2016 Ongoing 30/09/2016 Should not be involved in procurement decisions from Ipswich Hospital

Yes

Miss Gabrielle Gilhooly PALS Manager Nil 30/09/2016 Yes

Mr. Michael Gooch Emergency Planning & Resilience Officer Nil 26/09/2016 Yes

Miss Tracey Green MASH:Business Support Officer Felixstowe Town Councillor Direct 2015 Ongoing 10/11/2016 Yes

Suffolk Coastal District Councillor Direct 2015 Ongoing 10/11/2016 Yes

Ms. Tabitha Griffin Named Nurse Safeguarding in Primary Care No response

Mrs. Rebecca Halls Assistant Management Accountant Nil 30/09/2016 Yes

Mrs. Elizabeth Hallworth Clinical Executive & Chief Operating Office Operation ManNil 26/09/2016 Yes

Ms. Holly Hammond Business Support Apprentice Nil 01/11/2016 Yes

Mrs. Louise Hardwick Head of Operations Nil 03/10/2016 Yes

Mr. John Harris Head of Ambulance Commissioning Consortium No response

Mrs. Janet Harrison Individual Funding Request Officer Nil 03/10/2016 Yes

Miss Ella Harvey Continuing Healthcare Business Administrator Nil 01/11/2016 Yes

Mr. Benjamin Harvey Infection Control Lead Nurse Nil 30/09/2016 Yes

Ms. Julia Hather Clinical Coordinator Nil 01/11/2016 Yes

Miss Julie Hattrell Children's Contract Manager Nil 01/11/2016 Yes

Mrs. Doreen Hayden Clinical Coordinator No response

Mr. James Hayward Finance Assistant Nil 30/09/2016 Yes

Mr. Graham Hillson Informatics Coordination Manager Nil 30/09/2016 Yes

Mrs. Sarah Hobbs Nurse Coordinator Nil 01/11/2016 Yes

Mrs. Christine Hodby Lead Safeguarding Nurse Nil 30/09/2016 Yes

Mrs. Elizabeth Hogg Nurse Coordinator Nil 01/11/2016 Yes

Mrs. Hazel Hole Audit Committee Non-Executive Nil 03/10/2016 Yes

Mrs. Caroline Holt MASH:Specialist Nurse No response

Mr. Roger Holt Financial Accounts Manager Nil 06/10/2016 Yes

Mr. Chris Hooper Deputy Chief Nursing Officer Wife works for Community Services Provider in senior role Indirect 2013 Ongoing 13/10/2016 To be declared as appropriate. Should not be involved in community service procurement decisions

Yes

Mrs. Belinda Hume Head of Commissioning & Finance Husband is Director of Delivery Norfolk - NEL Indirect - Ongoing 03/01/2016 None Yes

Mrs. Lisa Hutchinson Medicines Management Technician No response

Mrs. Julie Irving Information Sharing Programme Manager Nil 26/09/2016 Yes

Ms. Gabrielle Irwin Head of Patient Safety and Clinical Effectiveness No response

Mrs. Melanie Jacobs Payments Officer No response

Miss Katie Jacobs Redesign Business Administrator Nil 30/09/2016 Yes

Mr. Martin Jarrett Redesign Project Support Manager No response

Mrs. Claire Jay Transformation Lead Nil 12/10/2016 Yes

Mrs. Jo John Transformation Lead Nil 30/09/2016 Yes

Mrs. Karen Johnson Senior Information Analyst Nil 30/09/2016 Yes

Miss Jessica Jones Continuing Healthcare Nurse Assessor Nil 30/09/2016 Yes

Mrs. Sharon Keeble Patient Safety and Clinical Effectiveness Administrator Nil 13/10/2016 Yes

Mrs. Chloe Keeling Continuing Healthcare Nurse Assessor No response

Mrs. Julie Kerridge Senior Management Accountant Nil 01/11/2016 Yes

Mrs. Claire Louse Krickova Nurse Coordinator Nil 01/11/2016 Yes

Mrs. Laura Krolik Commissioning Implementation Manager Nil 01/11/2016 Yes

Miss Tina Larter Patient Experience Officer Partner is Management Acct for Ipswich and East and West Suffolk CCGs Indirect 22/01/2013 Ongoing 30/09/2016 None Yes

Miss Nicole Lawes Finance Officer Nil 30/09/2016 Yes

Miss Sarah Learney Deputy Chief Contracts Officer (System Resilience) Director of 'Programme and Project Transformation Ltd' Direct 2015 Ongoing 14/10/2016 To declare as appropriate Yes

Mrs. Lucy Lillistone Patient Experience Officer Nil 30/09/2016 Yes

Mrs. Linda Lord Chief Pharmacist Nil 30/09/2016 Yes

Mrs. Jennifer Lynch Systems Administrator Nil 18/10/2016 Yes

Ms. Rachel Mabb Finance Manager Nil 30/09/2016 Yes

Mrs. Joanne Mael Corporate and Governance Officer Nil 26/09/2016 Yes

Mrs. Frances Ruth Manning-Brown Deputy Chief Finance Officer Nil 30/09/2016 Yes

Mrs. Lorna Marriott Redesign Project Manager No response

Mrs. Sandra Marsh Project Manager Nil 17/10/2016 Yes

Ms. Lynn Maskell Business Support Officer Nil 26/09/2016 Yes

Mrs. Marianne Mateer Medicines Management Technician Works on an ad-hoc basis for PrescQipp Direct Apr-16 Ongoing 30/09/2016 None Yes

Miss Debbie Meacle Chief Nursing Officer Bank No response

Mrs. Samantha AnnMelero Clinical Review Nurse CT Superintendent Radiographer at West Suffolk Hospital Direct Jul-00 Ongoing 03/10/2016 Should not be involved in procurement decisions involving West Suffolk Hospital

Yes

Ms. Shelley Mitchell Business Development Officer Nil 26/09/2016 Yes

Mrs. Crystal Moles Clinical Review Nurse No response

Mrs. Hannah Morgan Assistant Management Accountant Nil 30/09/2016 Yes

Ms. Jacqueline Morris Business Support Officer Nil 03/10/2016 Yes

Mrs. Gillian Mountague Redesign Project Manager Nil 30/09/2016 Yes

Miss Sophia Mowles Nurse Coordinator Nil 01/11/2016 Yes

Miss Sheila Murnion Head of High Cost Drugs Management Nil 30/09/2016 Yes

Mrs. Hannah Neumann-May Redesign Project Manager Nil 26/09/2016 Yes

Miss Victoria Newbery Clinical Assurance & Professional Lead Nil 31/10/2016 Yes

Mr. Dean Onno Transformation Lead Nil 26/09/2016 Yes

Mr. Sean O'Sullivan Senior Reporting Programmer Nil 30/09/2016 Yes

Mrs. Lorraine Parr Transformation Lead Husband works for Partnerships in Care Indirect Ongoing 30/09/2016 None Yes

Friend works for Norfolk and Suffolk NHS Foundation Trust Indirect Ongoing 20/09/2016 None Yes

Mrs. Lisa Parrish Transformation Lead Nil 26/09/2016 Yes

Miss Claire Pemberton Commissisoning Implementation Manager Nil 14/10/2016 Yes

Mrs. Elizabeth Mary Peters Nurse Coordinator Nil 30/09/2016 Yes

Mrs. Natasha Pickard Clinical Coordinator Nil 30/09/2016 Yes

Ms. Janice Pickett Placement Support Officer Nil 05/10/2016 Yes

Mrs. Joanne Laura Porter Information Analyst Vice Chairman Claydon Pre-School Committee Direct Jan-13 Ongoing 30/09/2016 None Yes

Mr. Norman Pottinger Information Governance Manager Nil 26/09/2016 Yes

Dr Peter Powell Designated Doctor for Safeguarding Children No response

Mrs. Caroline Procter Co-Commissioning Manager Nil 31/10/2016 Yes

Miss Julie Purnell MASH Senior Health Research Officer No response

Mrs. Linda Jane Putland Nurse Coordinator Bank Nursing Contract with Sanctuary Supported Living Direct Jul-16 Ongoing 30/09/2016 None Yes

Mr. Stuart Quinton Primary Care Contracts Manager Team Leader for Ipswich Winter Night Shelter Direct - Ongoing 30/09/2016 None Yes

Mrs. Michaela Rainbird Transforming Care Administrator Nil 03/10/2016 Yes

Mrs. Caroline Ratcliff Redesign Project Manager Nil 03/10/2016 Yes

Mr. Alexander Ratcliffe Clinical Systems Support Analyst No response

Miss Emma Ratcliffe Medicines Management Technician Nil 04/11/2016 Yes

Mrs. Emily Rawlinson Commissioning Implementation Manager Nil 26/09/2016 Yes

Miss Julie Rayner SIP Acceleration Programme Manager No response

Mrs. Carol Read Nurse Coordinator No response

Mrs. Jemma Redfern Senior Co-ordinator Continuing Healthcare No response

Mr. Jonathan Reynolds Deputy Chief Contracts Officer Nil 26/09/2016 Yes

Mrs. Catherine Ritson Nurse Coordinator Nil 30/09/2016 Yes

Mr. Andrew Robertson End of Life Administrator Nil 31/10/2016 Yes

Mrs. Sandie Robinson Head of Planning and Delivery Nil 17/10/2016 Yes

Mrs. Emma Rougier-Pirie MASH:Specialist Nurse Nil 03/10/2016 Yes

Mr. Christopher Rouse Nurse Coordinator Nil 30/09/2016 Yes

Mr. Darren Russell Redesign Project Manager No response

Mrs. Alison Sadler Redesign Project Manager Nil 04/10/2016 Yes

Mrs. Wendy Scott Children's Paediatric Continuing/Shared Care Reviewer Nil 03/10/2016 Yes

Mrs. Gemma Scruby Medicines Management Technician Nil 11/11/2016 Yes

Miss Divya Sebastian Finance Officer Nil 30/09/2016 Yes

Mrs. Gemma Shadbolt MASH:Specialist Nurse Nil 07/10/2016 Yes

Mrs. Denisa Shakya Website Development Officer No response

Mr. Amerjit Singh Information Analyst Nil 30/09/2016 Yes

Mr. Chris Singleton Head of PMO Registered in 'pool' of consultants for locality, part of DCLG Direct Feb-13 Ongoing 30/09/2016 None Yes

Mrs. Susan Smith Care Homes Clinical Support Manager Nil 30/09/2016 Yes

Mr. Martin Smith Audit Committee Non-Executive Nil 13/10/2016 Yes

Mrs. Karen Smith Head of Patient Safety and Clinical Effectiveness Nil 13/10/2016 Yes

Ms. Alison Soon Senior Medicines Management Technician Nil 01/11/2016 Yes

Miss Gemma Spall Clinical Coordinator Volunteer for St Elizabeth Hospice Direct 2013 Ongoing 30/09/2016 None Yes

Mr. Eugene Staunton Head of Planning and Delivery Nil 22/11/2016 Yes

Mrs. Victoria Stearn Clinical Review Nurse Nil 30/09/2016 Yes

Miss Patricia Stevens Redesign Project Manager - Band 7 - West CRO (7) Nil 04/10/2016 Yes

Mrs. Emma Taggart Continuing Healthcare Nurse Assessor Nil 30/09/2016 Yes

Miss Kelly Tatum Business Support Officer No response

Mrs. Anita Taylor Contract Manager Nil 26/09/2016 Yes

Mrs. Julie Taylor Transformation Lead Nil 31/10/2016 Yes

Mr. Lee Taylor Transformation Lead No response

Mrs. Jessica Taylor-Allum Information Analyst Nil 26/09/2016 Yes

Mrs. Emma Thackwray Senior Data Analyst Nil 30/09/2016 Yes

Mr. James Thompson Information Analyst Nil 30/09/2016 Yes

Mrs. Claire Tilbrook Medicines Management Technician No response

Mr. Edward Traylen Medicines Management Technician Nil 07/10/2016 Yes

Mrs. Rachael Trinder Finance Assistant Nil 12/10/2016 Yes

Mr. Giles Turner HR Business Partner Wife is physiotherapist at Ipswich Hospital NHS Trust Indirect - Ongoing 30/09/2016 None Yes

Mrs. Rebecca Turner Administrative Officer Nil 03/10/2016 Yes

Mrs. Lisa Wadey Finance Assistant No response

Mr. James Waites Account Manager (contracts) Nil 01/11/2016 Yes

Mrs. Sandra Walker Nurse Coordinator Nil 31/10/2016 Yes

Ms. Kate Walker Head of IM&T No response

Mrs. Katy Walton Complaints Manager No response - Maternity Leave

Miss Eleanor Ward Business Support Officer Nil 26/09/2016 Yes

Mr. Colin Webb Information Contracts Manager Nil 30/09/2016 Yes

Mrs. Anna Marie Webster Continuing Healthcare Nurse Assessor Nil 03/11/2016 Yes

Mrs. Melanie Webster Senior Co-ordinator Continuing Healthcare Nil 31/10/2016 Yes

Mrs. Jane Webster Deputy Chief Contracts Officer Nil 30/09/2016 Yes

Ms. Jacqueline Whelan Corporate Services Business Manager Nil 26/09/2016 Yes

Mr. Michael Wigg Senior Co-ordinator Continuing Healthcare Nil 08/11/2016 Yes

Ms. June Wingfield Nurse Coordinator No response

Mrs. Jacquelyn Wood MASH:Specialist Nurse No response

Mrs. Karen Wood Transformation Lead Daughter is self-employed speech therapist and contracts with NHS Indirect 2013 Ongoing 11/10/2016 To declare when appropriate Yes

Mr Keith Wood Ambulance Commissioning: Advisor 33% Director and shareholder in Elite Advanced Driver Training Ltd provider of blue light and C1/D1 driver training to NHS statutory ambulance services, including EEAST on a framework agreement.

Direct Apr-13 Ongoing 30/10/2016 To be declared to EEAST; advise to EEAST is expected to act against the interests of Elite.Non-disclosure/contact avoidance for duration of secondment and reasonable period thereafter. Avoidance of commerically sensitive information

Yes

Former Director of Thames Ambulance Service (private ambulance service provider to EEAST)

Direct Jun-11 Jul-13 30/10/2016 None Yes

Employee of NHS England (CCG Financial Assurance Manager) Direct - Ongoing 30/10/2016 None Yes

Spouse is Vice Chair of South Essex Partnership University NHSFT Indirect - Ongoing 30/10/2016 None Yes

Mrs. Rebecca Woods Nurse Coordinator No response

Mr. Stephen Woods Patient Safety Manager Nil 03/10/2016 Yes

Mrs. Amy Woodward Continuing Healthcare Business Administrator Nil 31/10/2016 Yes

Mrs. Trudy Woor Redesign Project Manager Nil 26/09/2016 Yes

Mrs. Lois Wreathall Head of Practice Support Trustee of Abbeycroft Direct Jul-16 Ongoing 30/09/2016 None Yes

Mrs. Elizabeth Wyatt Office Manager Partner is CEO of GPPC Indirect Feb-16 Ongoing 03/10/2016 None Yes

Meeting Date Committee/Body Individual Declaration Made Attendance Capacity27/04/2016 Joint Commissioning Committee Dr Christopher Browning As a GP within the West Suffolk area Remained in meeting

WEST SUFFOLK CCG - LOG OF DECLARATIONS

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GOVERNING BODY

Agenda Item No. 14



Title

Procurement Update: Summary of Activity 2016/17

Lead Chief Officer

Jan Thomas, Chief Contracts Officer

Author(s)

Jane Garnett, Procurement Lead

Purpose

To update the Governing Body on the procurements completed since the last procurement update and those currently in progress and planned for 2016/17.








Action required by Governing Body: To note the work being carried out in 2016 and the evolving work programme for 2016/17.

1. Background 1.1 The table below summarises the current health service procurement activity.

Procurement Name

PQQ Bidders

ITT Bidders Awarded to Contract Start

Peri-Diagnosis Dementia

TBC TBC TBC 01/04/2017

Integrated Urgent Care

TBC TBC TBC 01/10/2017

Community Services

Currently undertaking constructive dialogue to ascertain whether alliances are the most capable providers

01/10/2017

1.2 Peri Diagnostic Dementia Services NHS West Suffolk CCG is working with NHS Ipswich & East Suffolk CCG and Suffolk

County Council to determine the future shape of Post Diagnostic Dementia Services; this procurement has been undertaken as a restricted procedure and is due to start on the 1st April 2017. The award decision is to be presented to Governing Body for ratification in November 2016.

1.3 Integrated Urgent Care (OOH / 111)

This procurement started in October 2016 and is running jointly with West Suffolk CCG and North East Essex CCG as part of the Sustainability and Transformation Plan (STP). The service specification includes elements from the care coordination centre currently run as part of Suffolk Community Healthcare.

1.4 Community Services (Constructive Dialogue) Although technically not currently a tender process this is a period of negotiation and assurance which will mirror elements of a single tender action and most capable provider process.

1.5 There are conversations about service transformation and re-commissioning which may

materialise as procurements during 2017/18; such as: 1.5.1 Marginalised and Vulnerable Adult Services 1.5.2 Patient Transport Services 2. Recommendation 2.1 It is recommended that the Governing Body notes the work being carried out in 2016 and

the evolving work programme for 2016/17.

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GOVERNING BODY

Agenda Item No. 15



Title

Primary Care Commissioning - Model 3 - Full Delegation

Lead Chief Officer


Author(s)

Lois Wreathall, Head of Primary Care

Purpose

The purpose of this report is to update the Governing Body with the outcome of the due diligence process undertaken in respect of fully delegated primary medical care commissioning.








Action required by Governing Body: The Governing Body may be invited to make a final recommendation as to the application to apply for fully delegating commissioning, based on the outcome of the GP member practice vote, the results from which will be tabled at the meeting on the 30 November 2016

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1. Purpose 1.1 The purpose of this report is to update the Governing Body with the outcome of the due

diligence process undertaken in respect of fully delegated primary medical care commissioning. Additionally the executive decided on the 2nd November to ask for a member practice vote with a deadline for the ballot to close is the 25th November 2016. Due to the timings of the election a paper with the result and next steps will be tabled on the 30th November 2016.

2. Background 2.1 Simon Stevens, the Chief Executive of NHS England, announced on 1 May 2014 that NHS

England was inviting CCGs to expand their role in primary care commissioning and to submit expressions of interest setting out the CCG’s preference for how it would like to exercise expanded primary medical care commissioning functions. NHS England invited CCGs to take on an increased role in the commissioning of GP services through three co-commissioning models:

Model 1 - Greater involvement Model 2 - Joint commissioning Model 3 - Delegated commissioning

2.2 In April 2015 the CCG, following a membership vote and Governing Body approval, started to co-commission primary care services jointly with NHS England under Model 2 - joint commissioning.

2.3 In October 2015, the CCG was again invited to apply for fully delegated commissioning –

Model 3 from April 2016. Following a membership vote, it was agreed that the CCG remain at Model 2 as it was agreed that the current potential of joint commissioning had not yet been realised.

2.4 Since April 2015 the CCG and NHS England, under joint commissioning arrangements

have been effectively co-commissioning and operating a joint organisational decision making process for a number of primary medical care functions. However, processes and decision making are complex and sometimes inefficient for Commissioners and Practices, potentially hindering innovation and not delivering maximum possible benefits of current commissioning and service delivery. Financial risk is, however, effectively managed. All national requirements have been met and a ‘good’ level of annual assurance has been achieved.

3. Current Position 3.1 The CCG has been invited, by NHS England, to consider whether it wishes to move to

Model 3 in April 2017 or remain within the current joint commissioning arrangements (Model 2).

3.2 The deadline for CCGs to apply is 5th December 2016, by completion of the Delegated Commissioning checklist 2017/18. See Appendix A.

3.3 Following a Governing Body proposal in July 2016, the CCG undertook a thorough and robust process of due diligence. Initial areas of focus were identified through the CCG Clinical Executive and the Joint Commissioning Committee.

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3.4 The process has been supported by the Deputy Chief Finance Officer, Deputy Chief Operating Officer, NHS England’s Head of Finance, NHS England’s Contract Manager and CCG Finance Manager, with the support of the CCG teams.

3.5 Areas identified for due diligence have been scrutinised robustly, including a detailed

breakdown of the financial implications associated with model 3, clarification of some key areas and a better understanding of the level of risks and possible benefits involved.

3.6 The CCGs identified a number of areas that required a greater level of assurance; for

example, where there is the expectation that processes currently undertaken by NHS England would be delegated to the CCG under model 3. These areas continue to be worked through with relevant CCG and NHS England teams.

3.7 The CCG has undertaken the process of due diligence in conjunction with Ipswich and East

Suffolk CCG. 4. Due Diligence findings to date 4.1 Following joint NHS England and CCG finance meetings, clarification has been received on

a number of areas. The in-depth financial scrutiny has also highlighted some potential opportunities for the CCG and has afforded a degree of confidence. The outcome of these discussions has confirmed the following;

4.1a A Primary Medical Care budget (includes PMS and GMS) is still awaiting

confirmation of 17-18 allocation.

4.1b Possible benefits identified from national QIPP programmes that relate to local growth. For example schemes that have been put in place 2016/17 but savings start to accrue during 2017/18.

4.1c Funding for Enhanced Services will transfer based on maximum potential payment

to practices who have signed up as opposed to actual spend; based on 2016/17 uptake.

4.1d A share of the general reserve will be transferred based on weighted list size. This

includes an element of emergency preparedness as well as budget for bank holiday working, cost to cover practices converting from PMS to GMS, QOF, List size increase, Planning assumptions, rent impact and unallocated 1% reserve.

4.1e Capital payments will be retained by NHS England and the CCG will follow the

current process. Development Grants (Estates) form part of capital spend.

4.1f Any additional costs due to rent review (pre-delegation) will be met up by NHS England. Post delegation it is the CCG responsibility but NHS England will offer support, the level of which is to be confirmed. The CCG will pick up the District Valuer fees for rent reviews post delegation. The funding for this function is to be confirmed with NHS England.

4.1g Disputes/Claims and liabilities – the confirmed position with the NHS England’s

Head of Finance is that any liabilities identified pre-delegation will remain the responsibility of NHS England including any associated financial and legal consequences. The CCG and NHS England Primary Contract Manager have confirmed the current known potential disputes are:

Further detail has been requested on any outstanding rent review challenges

and possible rent abatement dispute. NHS England reports difficulty in quantifying actual cost at the present time.

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Out of Hours Service could incur unquantifiable legal costs as part of the contract.

4.1h Corporate running costs, including any transfer of staff to the CCG is still to be

agreed. Different options are available with varying levels of devolved staff and responsibilities; options are currently being worked through with the relevant teams.

4.1i Confirmed position from the NHS England’s Head of Finance that where staff costs

transfer to the CCG, the associated functions will also transfer. Where staff costs are retained by NHS England, e.g. access to the Medical Director or Management Accountant, these functions will also be retained. The CCG and NHS England will work to develop a Memorandum of Understanding (MOU) to support the agreed arrangements.

4.1j A full financial breakdown, by practice, as at month 5 position has been shared with

the CCG and will continue to be shared on a monthly basis. 4.2 NHS England has offered to shadow the financial operation and reporting of the budgets

during the current year so that the CCG can get an understanding of the budget, spend and any issues.

4.3 NHS England has identified the following potential financial risks;

Additional practices signing up to Enhanced Services’. Currently the budget allocation is based on full achievement for those practices that have signed up for the Enhanced Service in 2016/17. The risk occurs if more practice’s subsequently sign up than have been budgeted for. The CCG and NHS England will continue to encourage practice uptake of Enhanced Services where these enhance the quality of service for the patients. Typically in West Suffolk the uptake has been high and hence the risk is limited.

QOF payments. The delegated budget is allocated on last years’ achievement. Typically in West Suffolk the QOF achievement by GP Practices is higher than national average in most clinical areas and hence the financial risk is limited. The CCG have been unable to fully quantify the level of risk until QOF 2015/16 is published.

Practices reverting from PMS to GMS and potential double running costs. In WSCCG this is mitigated due to the Transitional Relief Scheme no longer being available. This could have potentially allowed practices to claim for providing services under the Local Enhanced Services (LES) and the PMS Development Framework.

Procurement of APMS practices if a GP practice serves notice. Generally APMS contracts are of higher value than GMS/PMS. From experience elsewhere it is known that the procurement exercise invariably results in a higher cost per patient pending a longer term solution. The CCG is developing plans in the event that a GP practice serves notice. WSCCG has one APMS practice currently, who has applied to NHSE to extend their contract.

4.4 The CCG has been in discussion with NHS England Primary Care Commissioning team

and has received support relating to GP Member engagement, case studies, and webinars. The CCG, where possible, has fully utilised these resources as they become available.

4.5 The CCG has updated its governance documentation in line with NHS England (on

constitutional amendments). Draft Model Terms of Reference have been issued by NHS England.

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4.7 Conflicts of interest policy has been reviewed and updated in line with national guidance. 4.8 The CCG has met the minimum requirement of level 2 for the Information Governance

Toolkit 5. Quality 5.1 Overall the quality of services provided by general practice remains high; this is

demonstrated through the Care Quality Commissions (CQC) visits, historic QOF achievement (2015/16 QOF is yet to be published), the PMS Development Framework and National Patient Survey.

5.2 A review of the QOF exception reporting, has highlighted that the west practices have

higher than national average exception rates on the whole. The CCG and NHS England continue to work with these practices to further provide the necessary assurances.

5.2 CQC’s reports to date continue to show that the quality of primary medical care services is

“good”. To date 17 of the 24 practices have now been inspected; leaving seven practices yet to be inspected. Three practices “Require Improvement” the others are rated ‘Good’. The Inspectors have not identified any whole scale areas for improvement but highlighted individual needs and opportunities for improvement.

5.3 The PMS Dashboard for 2015/16 demonstrates the overall the position remains good; identified by the contractual indicators within the PMS Development Framework.

5.4 National patient survey results show that the majority of practices have scored highly for the

six Timely Access to a Registered Health Professional indicators. 6. Summary of Opportunities, Benefits and Risks 6.1 Delegated Commissioning arrangements give CCGs full responsibility for commissioning

general practice services. Legally NHSE retains the residual liability for the performance of primary medical care commissioning and as such NHSE will require assurance that its statutory functions are being discharged effectively by the CCG.

6.2 Delegated responsibilities include:

Contractual practice performance management

Budget management

GMS and PMS contracts (including the design and monitoring of PMS contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract)

Newly designed enhanced services (“Local Enhanced Services” and “Directed Enhanced Services”)

Design of local incentive schemes as an alternative to the Quality Outcomes Framework (QOF)

Decision making on whether to establish new GP practices in an area, including practice mergers

Making decisions on ‘discretionary’ payment (e.g., returner/retainer schemes)

6.3 Exclusions are:

Any individual GP performance management, administration of payments and performer’s list management.

Section 7A (Public Health) functions and funds

Capital expenditure functions and funds.

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6.4 Opportunities and benefits that exist within full delegation arrangements include:

Local patients would have greater opportunities to input and influence the shape of primary care

CCG would be better placed to commission primary, community and secondary care in an holistic and integrated manner

CCG would have more opportunity to drive forward the development and implementation of the GP Forward View and Sustainability and Transformation Plan (STP) goals

CCG could consider more innovative commissioning approaches including ‘at scale’ primary care.

CCG would be able to support more local commissioning of primary care services, tailoring national approaches to a Suffolk context

CCG would be able to ensure additional resources available through the GP Forward view would be spent in Suffolk

6.5 Risks associated with adopting the fully delegated approach include:

CCG has full accountability and financial risk

Performance management could introduce tension between the CCG and its Members

Expectation from NHS England in contract management and complaints handling will increase

Failure to deliver effective commissioning plans may undermine the primary care transformation plan

Insufficient staff capacity to undertake this set of commissioning tasks 7. Recommendation 7.1 The Governing Body may be invited to make a final recommendation as to the application

to apply for fully delegating commissioning, based on the outcome of the GP member practice vote, the results from which will be tabled at the meeting on the 30th November.

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Appendix A

Delegated commissioning application process and checklist for 2017/18

Introduction

NHS England’s Board has committed to support the majority of CCGs to assume delegated responsibilities for the commissioning of primary medical services from 1 April 2017. Giving CCGs more control over general practice is part of a wider strategy to support the development of place-based commissioning and a key enabler of the development of new care models. The delegated commissioning model is delivering a number of benefits for CCGs and local populations. It is critical to local sustainability and transformation planning (STP), supporting the development of more coherent commissioning plans for healthcare systems and giving CCGs greater ability to transform primary care services. CCGs have also reported that delegated commissioning is giving them greater insight into practice performance issues, greater opportunities to develop a more sustainable primary care workforce and is helping to strengthen relationships between CCGs and practices. In 2016/17, 114 CCGs have delegated commissioning responsibilities. NHS England has invited the remainder of CCGs operating under joint or the “great involvement” co-commissioning models to apply for full delegation between now and 5 December 2016. CCGs are encouraged to have an early conversation about their delegated commissioning application with their NHS England local team and finance leads to ensure that all the necessary documentation is updated and approved in advance. We request that CCGs and the NHS England Director of Commissioning Operations (DCO) jointly complete the delegated commissioning checklist and finance template for delegated budgets for submission nationally. The completed templates should be signed by the CCG and the relevant NHS England DCO and emailed to [email protected], with a copy to regional leads for co-commissioning, details are as follows

Region Regional lead for co-commissioning

Contact email address

North Richard Armstrong [email protected]

Midlands and East Vikki Taylor [email protected]

London Christina Windle [email protected]

South Sarah Khan [email protected]

Following submission of the checklist, your application will be reviewed by NHS England as part of a short approvals process. We will inform CCGs of the outcomes of this process by early January 2017.

mailto:[email protected]






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Please note we will consider applications from CCGs with directions or in special measures on a case-by-case basis. If you require any further information, please contact your regional co-commissioning lead in the first instance, followed by [email protected].

Delegated Commissioning Application Checklist

This checklist and finance template should be completed jointly by the CCG and the relevant NHS England DCO. All supporting documentation should be submitted to the NHS England DCO and not the national co-commissioning team.

Delegated Commissioning Application Checklist

<CCG Name> has set out clearly defined objectives and benefits of the delegated arrangement.

Y / N

The CCG’s constitution or proposed constitutional amendment has been updated in line with the guidance1 (and this has also been approved by the NHS England regional office with confirmation sent to [email protected] - constitutional amends can be confirmed by 1 April 2017).

Y / N

The CCG has updated its governance documentation in line with the NHS England guidance (on constitutional amendments).

Y / N

The CCG has reviewed its conflicts of interest policy in line with NHS England’s revised statutory guidance on managing conflicts of interest for CCGs https://www.england.nhs.uk/commissioning/pc-co-comms/coi/. The CCG confirms that they will be fully compliant with the conflicts of interest guidance by 1 April 2017.

Y / N

The CCG’s IG Toolkit meets level 2 criteria as a minimum. Y / N

The CCG’s Year End Assurance rating is <please insert>

The DCO confirms that there are no performance, finance, leadership or governance issues that prevent the CCG taking on the function.

Y / N

Finance template for delegated budgets completed in full (include completed table below): Notes for completing the finance template:

1. Double click into the table to complete the excel template.

Y / N

1 Constitutional changes will be required if the CCG takes on delegated commissioning because the CCG will need to

establish a new committee to manage the delegated functions and to exercise the delegated powers. In the CCG Model

Constitution, the references to this committee will need to be added to sections referenced in 6.4.1.a. and 6.6.3.c. unless

there is already a clause permitting new committees without additional direct references. These will also need to refer

to the Terms of Reference for this committee.




http://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2014/11/annx-f-delgtd-comms-mod-tor.pdf

https://www.england.nhs.uk/commissioning/pc-co-comms/coi/

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2. Please enter the notified numbers for your CCG and how the primary care allocation is split between GP Services and other primary care services for 2016/17 (below)

3. This will be reconciled back to the area team allocation for primary care and subsequent in year adjustments. Where possible M6 2016/17 figures should be used.

PART II

Finance Template for delegated budgets

Notified

delegated

Budget

(1)

Movement

out of GP

Services

(2)

Movement

Into GP

Services

(3) Total

£'000 £'000 £'000 £'000

GP Services + - + +/-

General Practice - GMS 0

General Practice - PMS 0

Other list based services (APMS) 0

Premises cost reimbursements 0

Other premises costs 0

Enhanced services 0

QOF 0

Other GP services 0

Primary care NHS property services - GP 0

Sub Total GP services 0 0 0 0

N/A + - +/-

Acute services 0

Mental health services 0

Community health services 0

Primary care services 0

Continuing care services 0

Other care services 0

Sub total CCG programme costs 0 0 0

Total 0 0 0 0

Please provide a description in the change in spend detailed above

The DCO confirms the CCG demonstrates appropriate levels of sound financial control and meets all statutory and business planning requirements.

Y / N

The DCO confirms the CCG is capable of taking on delegated functions Y / N

Three scanned / electronic signatures provided at the foot of this email. Typed names unfortunately cannot be used.

Y / N

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I hereby confirm that <CCG Name> membership and governing body have seen and agreed to all proposed arrangements in support of taking on delegated commissioning arrangements for primary medical services on behalf of NHS England for 2017/18. NHS England is requested to progress the application to the regional panels for consideration. Signed by <CCG Name> Accountable Officer Signature (scan/electronic version required): Print Name: Position: Date: Signed on behalf of <CCG Name> Audit Committee Chair Signature (scan/electronic version required): Print Name: Position: Date: Signed by NHS England Director of Commissioning Operations Signature (scan/electronic version required): Print Name: Position: Date:

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GOVERNING BODY Agenda Item No. 17



Title

Health and Safety and Risk Committee

Lead Chief Officer


Author(s)

Norman Pottinger, Information Governance and Risk Manager

Purpose

To update the Governing Body on current Health and safety issues








Action required by Governing Body: The Governing Body is asked to note the content of the report.

1. Purpose 1.1 To advise the Governing Body of work currently being undertaken in relation to Health &

Safety.

2. Background 2.1 The Health and Safety and Risk Committee, chaired by the Chief Corporate Services

Officer, continue to meet on a quarterly basis.

2.2 The committee review the H&S annual plan at these meetings to ensure that the CCGs remain compliant with current H&S legislation.

2.3 Also fire marshal and first aid cover is reviewed and reports tabled showing compliance (or otherwise) in these areas.

3. Key Points

3.1 The last meeting of the committee was on 14 November 2016.

Issues reviewed included:

An update of outstanding FM issues at Rushbrook House. This included an update on the access to the Farm Car Park. Also included an update regarding the fixing of barriers to windows with low sills which presented a potential risk of falling to staff and visitors.

Progress against the H&S annual plan was discussed. In all areas activities are up to date with the exception that the planned SLA review which was due to take place in October is overdue. This will be addressed in the near future.

New guidance has been issued by the HSE in relation to manual handling. This is to be reviewed and if necessary current training will be changed to reflect this.

Sickness and absence figures were reported. These show an overall increase in the percentage of staff reporting sick.

3.2 The meeting was due to receive an update by NHS Protect regarding the Security

Standards for Commissioners. Unfortunately the representative did not attend. This will be followed up and any actions or issues will be reported to the Governing Body as they become known.

4. Recommendation 4.1 The Governing Body is asked to note the content of the report.

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GOVERNING BODY

Agenda Item No. 18



Title

Governing Body Assurance Framework

Lead Chief Officer

Amanda Lyes Chief Corporate Services Officer

Author(s)

Norman Pottinger Information Governance and Risk Manager

Purpose

To provide the Governing Body with the updated CCG Governing Body Assurance Framework (GBAF) document for November 2016.








Action required by Governing Body: The Governing Body is requested to review and approve the updated GBAF for November 2016.

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1. Background

Content of the GBAF is reviewed by the Chief Officers Team every month and by the Governing Body and Audit Committee at each of their meetings.

2. Key Points 2.1 The risk relating to CHC (number 14a) is under review by the Chief Contracts Officer and is

likely to be removed from the December GBAF. It will then continue to be monitored within the Chief Contracts Officer’s local risk register.

2.2 Further to review by the Chief Officers Team, the following amendments/additions have

been incorporated:

Risk 27a Potential impact of service quality delivered by NSFT Revised risk description

Additional actions (numbers 11 and 12) added Risk 27b Poor performance of mental health services Actions 1 and 2 revised

Governing Body Assurance Framework and

Action Plan

2016 - 2017

Version Control:

MONTH

VERSION No

REVIEWED BY

SUMMARY OF CHANGES

April 2016

37

COT 18 April 2016 Clinical Scrutiny Committee 27 April 2016

Approved

May 2016

38

COT 16 May 2016

Governing Body 25 May 2016 Audit Committee 7 June 2016

Approved

June 2016

39

COT 20 June 2016

Approved

July 2016

40

COT 18 July 2016 Governing Body 27 July 2016

Approved

August 2016

41

COT 15 August 2016

Clinical Scrutiny Comm’ 24 August 2016 Audit Committee 6 September 2016

Approved

September 2016

42

COT 15 September 2016

Governing Body 28 September 2016 Audit Committee 4 October 2016

Approved

October 2016

43

COT 10 October 2016 Clinical Scrutiny Comm’ 19 October 2016

November 2016

44

December 2016

45

January 2017

46

February 2017

47

March 2017

48

Board Assurance Framework

Overview

The Governing Body Assurance Framework (GBAF) provides the NHS West Suffolk Clinical Commissioning Group (CCG) with a simple but comprehensive method for the effective and focused management of risk. Through the GBAF the CCG Governing Body gains assurance that risks are being appropriately managed throughout the organisation. The GBAF identifies which of the organisation’s strategic objectives may be at risk because of inadequacies in the operation of controls, or where the CCG has insufficient assurance. At the same time it encompasses the control of risk, provides structured assurances about where risks are being managed and ensures that objectives are being delivered. This allows the Governing Body to determine how to make the most efficient use of resources and address the issues identified in order to improve the quality and safety of care. The GBAF also brings together all of the evidence required to support the Annual Governance Statement. The GBAF should be seen as a working document and will be updated regularly by the Chief Officers Team, monitored by the Audit Committee and reported to the Governing Body at each of its meetings. The GBAF is linked to the CCG Risk Register, the content of which is also provided for review by the Chief Officers Team. A flow chart setting out how risks are identified and managed is set out overleaf. In order to ensure consistency in the risk assessment process, the likelihood and consequences of all risks on the Risk Register are assessed against the former National Patient Safety Agency (NPSA) 5X5 risk matrix and those scoring 15 and above migrate to the GBAF and thereby inform the Governing Body agenda. Once added to the GBAF, a risk should remain in place until its RAG rating has been mitigated to a score of 1-6 when it is considered manageable and therefore no longer a strategic concern. The 5X5 risk matrix and subsequent red, amber, green (RAG) score identify the level at which identified risks will be managed within the organisation. It also assigns priorities for remedial action, and determines whether risks are to be accepted on the basis of the colour bandings and risk ratings. In terms of evaluation of effectiveness, the RAG rating system is also used to present how well the agreed controls are operating.

RISKS IDENTIFIED THROUGH:

External Assessment &

Audit + Guidance & Alerts

Serious Incidents, Complaints, Public Health &

Quality Issues

Public & Stakeholder

Engagement

Business & Service Delivery

Plans

CCG Governing

Body Own & Manage Risks & the Chief

Officers Team Reviews the Risk

Register/GBAF

Governing Body

Assurance Framework

Overview & Scrutiny by

the Audit Committee

Assurance to the

Governing Body

Individual Risks Jointly Managed by Designated Chief

Officers & Clinical Leads

Work Stream Risk

Assessments

Review by Clinical

Scrutiny Committee

RAG Score Framework

Likelihood score → 1: Rare 2: Unlikely 3: Possible 4: Likely 5: Almost Certain

Consequence score ↓

5: Catastrophic 5 10 15 20 25

4: Major 4 8 12 16 20

3: Moderate 3 6 9 12 15

2: Minor 2 4 6 8 10

1: Negligible 1 2 3 4 5

The subsequent red, amber, green (RAG) scores identify the level at which identified risks will be managed within the organisation. It also assigns priorities for remedial action, and determines whether risks are to be accepted on the basis of the colour bandings and risk ratings. In terms of evaluation of effectiveness, the RAG rating system is also used to present how well the agreed controls are operating within the following classifications:

In order to determine the likely consequence arising from an identified risk and using the 5X5 matrix:

RAG Score

Progress

Risk Assessment

Revising Risk Ratings

CRITICAL (15-25)

There may be significant gaps in controls to ensure effective management.

Controls are in place but insufficient resources

Controls are in place but external forces may be preventing progress.

There are insufficient controls in place to address the cause or source of the risk

Controls are considered insubstantial or ineffective

Controls are being implemented but are not yet in place

If this risk were to materialise, the situation could be irrecoverable in terms of the CCGs reputational/financial well being and or service continuity.

If controls are inadequate then the revised risk rating increases

If controls are uncertain, the revised risk rating stays the same as the original risk rating

If they are perceived as adequate, then the revised risk rating decreases

CHALLENGING (8-12)

Progress is being made but there is concern that the objective may not be achieved. Additional controls or management action is being taken to improve the likelihood of success.

There are few controls in place, which are considered substantial and/or effective and address the cause of the risk. The consequences of the risk materialising, though severe, can be managed to some extent via contingency plans.

MANAGEABLE (1-6)

Progress is being made in accordance with plans. There are no significant concerns.

The risk is considered to be small and there are sufficient controls in place which address or substantially effective the cause of the risk. The consequences of the risk materialising can be managed via contingency plans.

Define the risk explicitly in terms of the adverse consequence or consequences that might arise

Use the table below for examples, by risk domains, to determine the consequence score relevant to the risk identified

Consequence score (severity levels) and example of descriptions

1 2 3 4 5

Risk Domains Negligible Minor Moderate Major Catastrophic

1. Impact on the safety of patients, staff or public (physical/psychological harm)

Minimal injury requiring no/minimal intervention or treatment. No time off work

Minor injury or illness, requiring minor intervention Requiring time off work for >3 days Increase in length of hospital stay by 1-3 days

Moderate injury requiring professional intervention Requiring time off work for 4-14 days Increase in length of hospital stay by 4-15 days RIDDOR/agency reportable incident An event which impacts on a small number of patients

Major injury leading to long-term incapacity/disability Requiring time off work for >14 days Increase in length of hospital stay by >15 days Mismanagement of patient care with long-term effects

Incident leading to death Multiple permanent injuries or irreversible health effects An event which impacts on a large number of patients

2. Quality/complaints/audit

Peripheral element of treatment or service suboptimal Informal complaint/inquiry

Overall treatment or service suboptimal Formal complaint (stage 1) Local resolution Single failure to meet internal standards Minor implications for patient safety if unresolved Reduced performance rating if unresolved

Treatment or service has significantly reduced effectiveness Formal complaint (stage 2) complaint Local resolution (with potential to go to independent review) Repeated failure to meet internal standards Major patient safety implications if findings are not acted on

Non-compliance with national standards with significant risk to patients if unresolved Multiple complaints/ independent review Low performance rating Critical report

Totally unacceptable level or quality of treatment/service Gross failure of patient safety if findings not acted on Inquest/ombudsman inquiry Gross failure to meet national standards

3. Human resources/ organisational development/staffing/ competence

Short-term low staffing level that temporarily reduces service quality (< 1 day)

Low staffing level that reduces the service quality

Late delivery of key objective/ service due to lack of staff Unsafe staffing level or competence (>1 day) Low staff morale Poor staff attendance for mandatory/key training

Uncertain delivery of key objective/service due to lack of staff Unsafe staffing level or competence (>5 days) Loss of key staff Very low staff morale No staff attending mandatory/ key training

Non-delivery of key objective/service due to lack of staff Ongoing unsafe staffing levels or competence Loss of several key staff No staff attending mandatory training /key training on an ongoing basis

4. Statutory duty/ inspections

No or minimal impact or breech of guidance/ statutory duty

Breech of statutory legislation Reduced performance rating if unresolved

Single breech in statutory duty Challenging external recommendations/ improvement notice

Enforcement action Multiple breeches in statutory duty Improvement notices Low performance rating Critical report

Multiple breeches in statutory duty Prosecution Complete systems change required Zero performance rating Severely critical report

5. Adverse publicity/ reputation

Rumours

Potential for public concern

Local media coverage – short-term reduction in public confidence Elements of public expectation not being met

Local media coverage – long-term reduction in public confidence

National media coverage with <3 days service well below reasonable public expectation

National media coverage with >3 days service well below reasonable public expectation. MP concerned (questions in the House) Total loss of public confidence

6. Business objectives/ projects

Insignificant cost increase/ schedule slippage

<5 per cent over project budget Schedule slippage

5–10 per cent over project budget Schedule slippage

Non-compliance with national 10–25 per cent over project budget Schedule slippage Key objectives not met

Incident leading >25 per cent over project budget Schedule slippage Key objectives not met

7. Finance including claims

Small loss Risk of claim remote

Loss of 0.1–0.25 per cent of budget Claim less than £10,000

Loss of 0.25–0.5 per cent of budget Claim(s) between £10,000 and £100,000

Uncertain delivery of key objective/Loss of 0.5–1.0 per cent of budget Claim(s) between £100,000 and £1 million Purchasers failing to pay on time

Non-delivery of key objective/ Loss of >1 per cent of budget Failure to meet specification/ slippage Loss of contract / payment by results Claim(s) >£1 million

8. Service/business interruption

Loss/interruption of >1 hour

Loss/interruption of >8 hours

Loss/interruption of >1 day

Loss/interruption of >1 week

Permanent loss of service or facility

9. Environmental impact

Minimal or no impact on the environment

Minor impact on environment

Moderate impact on environment

Major impact on environment

Catastrophic impact on environment

RISK NUMBER: 02 DATE RISK ADDED:

A

CC

OU

NT

AB

LE

OF

FIC

ER

& G

P O

WN

ER

DESCRIPTION OF STRATEGIC RISK

GRANULAR OPERATIONAL RISKS

INIT

IAL

RA

G R

AT

ING

(L

IKE

LIH

OO

D x

CO

NS

EQ

UE

NC

E)

KEY CONTROLS ESTABLISHED

ASSURANCE OF CONTROLS

RAG RATING OF

GAPS IN CONTROLS

RA

G

RA

TIN

G L

AS

T M

ON

TH

R

EV

ISE

D R

AG

RA

TIN

G

ACTION POINTS & TARGET DATES FOR

COMPLETION

L

M +

CB

Failure to achieve financial balance in 2016-17, secure financial sustainability from 2017/18 and deliver optimum service from the financial resources available

Failure to achieve financial balance in 2016-17.In 2015-16 the CCG delivered the mandated surplus through the use of a number of non-recurrent items such as Contingency and Transformation funding. The CCG has not addressed the underlying recurrent deficit.

In 2016-17 the CCG have a QIPP target of approximately £13.98m, of which £5.6m was unidentified at the beginning of the financial year.

Addenbrookes move to National Tariff increases the risk of failure to deliver.

Increasing demand in acute Trusts activity. Providers require extra financial support to maintain or meet clinical quality and contractual standards.

Increase in prescribing costs.

Cost pressures from Continuing Healthcare activity specifically the nationally agreed 40% increase in Funded Nursing Care prices.

4x5

20

Project management approach to delivery of the QIPP plans. PMO in place

Continue to benchmark and horizon scan to identify further QIPP opportunities.

Focus on activity levels at acute provider with clear actions to mitigate against over performance

West Suffolk FT maximum contract value agreed reduces the level of risk in year only

Close monitoring of the delivery of QIPP initiatives through KPI’s

Encourage innovative changes to improve efficiency

Participation in regional and national discussions

Clinical Executive and Governing Body review of expenditure and significant investments

Market Management Workstream

Review progress on the system implementation on a regular basis through Finance & Transformation Meetings with WSFT. Any escalated issues will be raised at the contract monitoring meeting /

COT

Project managers appointed

GP engagement

Governing Body

NHS England performance reviews

Internal & External Audit

Monthly SLA provider meetings

Finance & Performance Committee

Turnaround Director Appointed

CCG PRIORITY:

Deliver financial sustainability

Integrated performance report area. Finance and Performance

█

CHALLENGING

4x5

20

4x5

20

1. Finance Risk Summit to identify further QIPP and prioritise work

Target: End of April 2016 Completed

2. Prioritise work 16/17

Target: End of April 2016 Completed:

3. QIPP project management, tracking and prioritisation

Target: Tracking part of monthly reporting process Completed:

4.Prioritisation CHC Project board milestones

Target: Monthly review Completed:

5. Monthly identification of risks and opportunities

Target: Monthly review Completed:

6. Financial Recovery Plan Target: Plans in place by end of June then ongoing monthly reporting

Target: June 2016 Completed: Draft Completed

CEO: CEO meeting.

Draft Financial Recovery plan submitted to NHS England to mitigate overspends.

8. Negotiate contract values with WSFT and Addenbrookes to reduce risk.

Target: Resolve before the end of the April 2016 Completed

9. Develop short term and medium term Financial Recovery Plans

Target: Mid July 2016 Completed: Draft Completed

See following sheet for next risk

RISK NUMBER: 06 DATE RISK ADDED: NOVEMBER 2012

AC

CO

UN

TA

BL

E O

FF

ICE

R

& G

P O

WN

ER



INIT

IAL

RA

G R

AT

ING

(L

IKE

LIH

OO

D x

CO

NS

EQ

UE

NC

E)



RAG RATING OF

GAPS IN CONTROLS

RA

G

RA

TIN

G L

AS

T M

ON

TH

R

EV

ISE

D R

AG

RA

TIN

G


COMPLETION

BM

+ C

B

Failure to achieve national mandatory local reduction trajectories for Clostridium difficile as set out in NHS England: Clostridium difficile objectives for NHS organisations in 2016/17 and guidance on sanction implementation. (Failure to achieve outcome ambition 7: ‘making significant progress towards eliminating avoidable death in our hospitals caused by problems in care’ set out in : NHS England Everyone Counts: Planning for patients 2014/15 to

Primary Care Staff ownership of non-acute episodes of CDI for clinical review and shared learning for practice improvement and across all CCG Primary Care Providers.

Lack of Community IPC Lead

Lack of capacity in acute provider to cover implementation of IPC standards within the community provider

The CCG IPC Lead conducting themes and trend analysis of non-acute episodes of CDI

CCG IPC Lead attendance at all acute onset PIRs

CCG Medicines Management Team in collaboration with the IPC Lead in supporting antibiotic prescribing in Primary Care CCG IPC Lead monitoring antibiotic prescribing in Acute

4x4

16

Robust RCA/PIR process for each provider case and submitted to CCG for assessment.

Audit programme of CQC recommended IPC standards (to include antibiotic prescribing) in all CCG commissioned services

CCG attendance at PIR reviews and IPC Committee meetings

Provider delivery of targeted infection control education and audit in all CCG commissioned services.

16/17 trajectory agreed in SLA – ceiling for 16 Acute cases and 29 non-acute cases (45 in total)

Bi-monthly reviews of PIR findings at Infection Prevention Network

External scrutiny provided

Monitoring of PIR process and audit results at QRG evidencing the standards are being met

Minutes of HCAI Reduction Network available to Chief Nursing Officer

System wide action plan updated in line with PIR outcomes with bimonthly review at HCAI Reduction Network, demonstrating implementation of detailed actions

CCG scrutiny of CDI cases reported within the PHE data capture system

INTERNAL AUDIT PLAN:

4.2 Monitoring of Contracts ; 1.4 Clinical Quality – Overview

Work in collaboration with system to implement recommendations from C diff PIRs.

█

CHALLENGING

3x4

12

3x4

12

1. Annual Review of CCG Infection Prevention Strategy

Target: May 2016 Completed: June 2016

2. Annual Review of HCAI Reduction Network priority focuses. Awaiting HCAI Network approval

Target: July 2016 Completed: July 2016

3.Annual review of IPC Lead work plan


4. CDI Reduction plan to be reviewed and updated. Delay pending meeting.

Target: July 2016 Completed: September 2016

5. CDI Reduction plan to be implemented Updated, now out for consultation Implementation Target now October 2016

Target: October 2016 Completed:

6. Develop information pack for GP in collaboration with prescribing work stream and pass to Medicines Management for progression

Target: January 2016 Completed: February 2016

Care via PIR process audit results and minutes of Antimicrobial Stewardship Committee

by Public Health England

Key learnings shared at primary care training sessions

Acute providers sharing learning from PIRs with relevant clinicians.

CCG PRIORITY:

To ensure high quality local services

Integrated performance report area. Clinical Quality and Patient Safety

6 Roll-out of CDI RCA Tool for community onset CDI

Target January 2016 Completed: February 2016

7. Roll out of IP training for PBIP Leads


8. PBIP Lead Network to be set up to share learning from RCAs and other IP issues.

Target: October 2016 Completed: September 2016

9. Development and piloting of an Antibiotic Stewardship Audit Replaced with submission of ABX CQUIN Part B

Target: September 2016 Completed: September 2016


RISK NUMBER: 14a DATE RISK ADDED: APRIL 2013

AC

CO

UN

TA

BL

E O

FF

ICE

R

& G

P O

WN

ER



INIT

IAL

RA

G R

AT

ING

(L

IKE

LIH

OO

D x

CO

NS

EQ

UE

NC

E)



RAG RATING OF

GAPS IN CONTROLS

RA

G

RA

TIN

G L

AS

T M

ON

TH

R

EV

ISE

D R

AG

RA

TIN

G


COMPLETION

JT

+ S

L

Compliance with NHS Continuing Health care Framework

Quality/complaints/audits Domain

Access to Social Workers for CHC assessments and reviews has been limited, resulting in high % of new referrals into CHC not meeting the gold-standard 28 timeframe for assessment for CHC/FNC eligibility. There is a risk of increasing new 'waiting list' of cases. Potential impact on CHC Reviews and clearance of backlog.

Limited capacity to complete CHC 3 & 12 month and fast track 3 month reviews (QIPP)

Timely development of CHC Discharge to Assess model aligned to A&E Delivery Board (90% of CHC assessments undertaken outside of an acute setting)

4x5

20

- 03/06/16- DCCO met ACS Deputy Director to discuss issues with lack of social care support to CHC. Agreed plan to dedicate 6 SW and/or CCPs to CHC within next 3 months. 08/09/16- ACS Deputy Director confirmed recruitment of 6 social care workers/ staff to support CHC. 4 post holders now in role and linked to CHC time; new referral, backlog and review cases are being allocated

- QIPP Invest to save (review of CHC patients) business case approved by IESCCG CEE on 07/06/26 but not tabled at WSCCG Exec. All recruitment stopped at vacancy approval panel. 13/09/16- Revisiting QIPP opportunities aligned to CHC and fast track reviews. Business case to be discussed with CCO and CFO to agree next steps. - DCCO joined system wide D2A strategic and working groups to work up new

Monthly CHC finance and activity report to Market Management workstream Fortnightly ‘data quality and finance improvement’ meetings between CHC, finance and information Monthly CHC performance and activity report (including QIPP) produced to support reporting across organisation. CHC performance routinely reviewed at Audit Committee, Clinical Scrutiny Committee, Clinical Executive, COT and monthly market management workstream Regular meetings with social care to monitor integrated working around CHC and scope future opportunities i.e. alignment across CHC, CCG redesign and social care around development of

█

CHALLENGING

3x4

12

3x4

12

1. Rollout telephone triage for fast track reviews

Target: March 2016 Completed: On hold until dedicated clinical resource available to complete full assessments post initial telephone triage. Directly linked to wider ‘CHC review’ business case

2. Implement staged fast track review programme

Target: April- June 2016 Completed: Fast track reviews underway at 12 weeks, but scope for significant service improvement i.e. dedicated resource to review at 6 weeks

3. Recruitment of additional clinical and administrative posts linked to organisational restructure

Target: June 2016 Completed: On hold- linked to wider CHC review business case

4. Recruitment of additional clinical posts linked to QIPP 2016/16

Target: June 2016 Completed: On hold- see above


pathway and bimonthly NHSE CHC DToC group to share best practice.

integrated Discharge to Assess model CCG PRIORITY: To ensure high quality local services Integrated performance report area. Clinical Quality and Patient Safety

RISK NUMBER: 20 DATE RISK ADDED: MAY 2014

AC

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ICE

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INIT

IAL

RA

G R

AT

ING

(L

IKE

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D x

CO

NS

EQ

UE

NC

E)



RAG RATING OF

GAPS IN CONTROLS

RA

G

RA

TIN

G L

AS

T M

ON

TH

R

EV

ISE

D R

AG

RA

TIN

G


COMPLETION

RW

+ S

A

Failure to redesign and commission services covered by the Urgent Care and Health and Independence reviews within required timescales

Potential for services to fall out of contract

Risk that the full potential benefits of a transformational redesign are not met leading to patient care being adversely affected and inefficiencies in the system

Reputational damage to commissioners

4x4

16

Contracts in place with the Consortium (West Suffolk Hospital, Ipswich Hospital and Norfolk Community Services) for adult and children’s community services plus extension of contract to 111 and Out of Hours with Care UK all running to October 2017.

Redesign of core components of the Urgent Care and Health and Independence Review underway since mid-2015 such as development of Connect East Ipswich, creation go Crisis Action Team and Frailty Assessment Base at Ipswich Hospital.

Clinical Executive considered and agreed approach to wider redesign of services for commissioning by October 2017 in November 2015.

Programme staff recruited to and project

COT review

Executive Group review

Health & Wellbeing Board review

Governing Body Review

Area Team Strategic Plan Review

CCG PRIORITY:

Demonstrate excellence in patient experience and patient engagement

Improve the health and care of older people

Improve access to mental health services

Improve health and wellbeing through partnership working

Deliver financial sustainability through quality improvement

Integrated performance report area.

█

CHALLENGING

3x4

12

3x4

12

1. Contingency plans to be developed and approved

Target: September 2014 Completed: Yes Sept 2014

2. Contingency plans to be implemented

Target: December 2014 Completed: Yes December 14

3. Complete 1+1 procurement and extensions

Target: June 15 (On track) Completed: Yes July 2015

4. Submit vanguard bid for collaborative arrangement

Target: Feb 2015 Completed: Yes Feb 2015

5. Agree next steps on vanguard work with system

Target: April 2015 Completed: YES April 2015

6. Develop Shadow ICO Board

Target: Oct 15 Completed: Yes

7. Agree scope and approach to redesign of 1+1 contracts

Target: Nov 15 Completed: Yes Nov 15

8. Develop project plan for redesign of 1+1 services by Oct 2016

T

plan in development.

Associate Director Redesign leads agreed for each component part of the work programme and a fortnightly delivery group meeting involving all parts of the two CCGs in place.

Task and finish groups set up with wider system partners for each of the component parts of the programme to develop the clinical models and specifications.

Clinical Workstream Target: Mid Jan 2016 Completed: Yes

9. Commence clinical workshops for development of models of care for – children, proactive services and reactive services

Target: February 2016 Completed: Commenced Jan 2016

10. Development of financial model and business case

Target: September 2016 Completed: Yes Sept 2016

11. Approval of clinical models , financial model and commissioning approach by the Clinical Executive

Target: October 2016 Completed: Yes Oct 2016

12. Approval of contract award for Integrated Urgent Care Service

Target: April 2017 Completed:

13. Approval of contract award for community services

Target: September 2017 Completed:


RISK NUMBER: 24 DATE RISK ADDED: JANUARY 2015

A

CC

OU

NT

AB

LE

OF

FIC

ER

& G

P O

WN

ER



INIT

IAL

RA

G R

AT

ING

(L

IKE

LIH

OO

D x

CO

NS

EQ

UE

NC

E)



RAG RATING OF

GAPS IN CONTROLS

RA

G

RA

TIN

G L

AS

T M

ON

TH

R

EV

ISE

D R

AG

RA

TIN

G


COMPLETION

JT

+ S

A

A&E failing to meet 4 hour standard presenting a potential risk to patient safety and experience.

Clinical risk of patients not being seen in appropriate timescales or insufficient beds to accommodate appropriate environments.

Risk of patient experience deterioration due to long waits.

Risk of breaching constitutional obligations.

4x3

12

Where required, daily system wide teleconferences designed to ensure all actions to improve patient flow are taken

Team of escalation managers in place to support system and directors on call.

Service review completed - on site - transformation programme

Implementation of new A&E Board as per NHSE guidance

Daily performance information monitored, regular discussions and monthly formal contract meetings.

CCG PRIORITY:

Improve health and wellbeing through partnership working

Integrated performance report area. Contractual Performance

█

CHALLENGING

3x4

12

3x4

12

1. Continued close working across the health system with the intention of improving 95% performance for future months throughout 2016/17 contract year

Target 95% to be met monthly: Completed: Remedial Action Plan with recovery trajectory and associated actions in place with WSFT to enable achievement of target by October 2016

2. A&E Delivery Board to lead systemwide delivery and oversight of A&E target Delivery

Target: SRG to ensure delivery of action plan Completed:

3. . Contracting to seek assurance at SLA meetings

Target: Review monthly Completed: contract query issued June 2016 and RAP now in place: RAP actions being monitored and risks/mitigations identified where necessary. No significant risks for delivery currently identified

4. New A&E Board to replace SRG

Target: September 2016 Completed: First meeting taken place

T

RISK NUMBER: 27a DATE RISK ADDED: July 2015 (Renumbered January 2016)

AC

CO

UN

TA

BL

E O

FF

ICE

R

& G

P O

WN

ER



INIT

IAL

RA

G R

AT

ING

(L

IKE

LIH

OO

D x

CO

NS

EQ

UE

NC

E)



RAG RATING OF

GAPS IN CONTROLS

RA

G

RA

TIN

G L

AS

T M

ON

TH

R

EV

ISE

D R

AG

RA

TIN

G


COMPLETION

BM

cL

+

RT

Potential impact of service quality delivered by NSFT CQC Inspection report February 2015 highlighted serious concerns in service quality and rated the Trust inadequate overall Trust internal mock CQC inspection report identifies that the Trust has failed to make significant improvement in areas of concern identified in the CQC inspection report of February 2015 Monitor concluded investigation into Trust finances in June 2015 and notes breach of license – Potential for actions to address presenting compromise to quality of services CQC Re-inspection report October 2016 gave the Trust an overall rating of requires improvement,

Reduction in quality of service and inability to meet performance and clinical quality targets

Maintaining safer staffing levels in accordance with NICE & NQB guidance

Adverse financial position may impact adversely on the quality of care delivered

Potential increase in contract issue log referrals

4x4

16

Monthly meetings to review / challenge quality performance

On-going development of quality dashboard

Attendance at monthly stakeholder assurance meetings led by NHS Improvement / CQC

Oversight of quality improvement plans (trust / local) and monthly monitoring of progress by quality team and workstream

Support for NSFT mock CQC inspections and feedback

Announced and Unannounced quality improvement visits

Sign off provider CIPs and associated QIAs

Monitor primary care contract issues and Trust response

Demonstrated improvement against identified contractual key performance indicators evidenced through quality dashboard escalation of issues via SLA meetings

Confidence that NSFT have structures in place to deliver the required quality improvements

Assurance that actions detailed in the quality improvement plan have been implemented

Test that actions detailed in the quality improvement plan have resulted in changes at an operational level

To ensure that CIP schemes do not have an adverse impact on quality

Timely response to

█

CHALLENGING

4x4

16

4x4

16

1. Regular quality review meetings to review performance against defined key performance indicators throughout 2016/17

Target March 2017 Completed: August 2016

2. Support NSFT to develop a visual quality dashboard promoting visual assessment of performance against agreed thresholds and allowing trends to be identified. Scrutiny on data quality/accuracy (Lorenzo implementation at monthly QRG)

Target: : Monthly Completed: June 2016

3. CCG attendance at monthly stakeholder assurance meetings to review and challenge progress to deliver quality improvements

Target: Monthly Completed: March 2016

4. Review of progress against quality improvement plans (Trust / Local) prior to each quality review meeting throughout 2016/17

Target: March 2017 Completed: August 2016

T

however “Are services safe” continued to be rated as inadequate.

contract issues with effective learning reducing numbers

Joint review of plans to act on the areas of concern identified in the Trust mock CQC inspection report.

CCG PRIORITY:



5. Schedule quality improvement visits to Suffolk based NSFT services organised and currently ongoing review programme

Target: May 2016 Completed: May 2016

6. Schedule meeting to gain assurance of robust process to sign off CIPs and to review QIAs associated with the CIPs to assess potential negative impact on quality

.

Target: September 2016 Completed: July 2016

7. Provide clarity of CCG Mental health / Learning disabilities commissioning strategy, implement Transforming Care Programme, Review in June 2016

Target: June 2016 Completed: March 2016

8. Support NSFTs mock CQC inspections planned for 2016, review June 2016

Target: June 2016 Completed:

9. Alignment of quality and SLA meetings to allow lead GP attendance – review June 2016

Target: June 2016 Completed: June 2016

10. Gain assurance that the trust has robust plans to improve the concerns identified through the mock CQC inspections, in a timeframe to ensure compliance before the next CQC inspection, Monitor Work Plan and review June 2016

Target: June 2016 Completed: June 2016

11. Expand contractual reporting requirements based on findings of October 2016 CQC report

Target: November 2016 Completed:

12. Monitor progress against Trust quality improvement plan post October 2016 CQC report.

Target: November 2016 Completed:


RISK NUMBER: 27b DATE RISK ADDED: January 2016

A

CC

OU

NT

AB

LE

OF

FIC

ER

&

GP

OW

NE

R



IN

ITIA

L R

AG

RA

TIN

G

(LIK

EL

IHO

OD

x C

ON

SE

QU

EN

CE

)



RAG RATING OF

GAPS IN CONTROLS

R

AG

R

AT

ING

LA

ST

MO

NT

H

R

EV

ISE

D R

AG

RA

TIN

G


COMPLETION

JT

/ E

G

Poor performance of mental health services

There was an absence of performance data between May and September due to the roll out of Lorenzo, the Trust’s new information system

Performance against a number of key areas has fallen significantly in this period

Key areas such as the access and assessment team (AAT), 7 day follow up for inpatients, memory assessment services, care plan reviews and overall waiting times have deteriorated

Service Users are not receiving timely interventions impacting on their health and wellbeing.

4x4

16

Contract Performance

Notices for AAT, 7 day follow up and care plans issued. RAPs to be agreed

Information Notices issued on data completeness and data quality

Exception Notices issued for AAT, CMAS, CPA (completion date column amended to reflect this)

Reported to the

workstreams, Clinical Executive and Governing Body as appropriate

CCG PRIORITY:



█

CHALLENGING

3x4

12

3x4

12

1. AAT Recovery

Target: December 2016 Update 11/16: Performance improving, revised RAP agreed. Joint diagnostic underway.

2. CMAS Joint Review

Target September 2016

Update 10/16: Underway, timeline extended and due to report Oct 2016 Completed: Review complete recommendations being reviewed

3. CPA 12 Month Review

Target: November 2016

Update 11/16: CPA reviews at standard. Non CPA reviews improvements on track Completed:

T

RISK NUMBER 31 DATE ADDED October 2016

AC

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FF

ICE

R

& G

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DESCRIPTION OF

STRATEGIC RISK

GRANULAR

OPERATIONAL RISKS

INIT

IAL

RA

G R

AT

ING

(L

IKE

LIH

OO

D x

CO

NS

EQ

UE

NC

E)

KEY CONTROLS

ESTABLISHED

ASSURANCE OF

CONTROLS

RAG RATING

OF

GAPS IN

CONTROLS

RA

G

RA

TIN

G L

AS

T M

ON

TH

R

EV

ISE

D R

AG

RA

TIN

G

ACTION POINTS &

TARGET DATES FOR

COMPLETION

BM

c

High risk that patient

safety standards will

be compromised due

to issues that have

been experienced by

West Suffolk

Hospital NHS

Foundation Trust

following the

implementation of e-

care.

WSFT have experienced

more patients exceeding

referral to treatment

standards:

18 weeks

2 week wait – cancer

patients

31 / 62 day standards –

cancer patients

Since e-care

implementation.


more patients exceeding

the 4 hour wait standard

in A&E since the

implementation of e-care

and have reported that

more neutropenic

patients failing to receive

antibiotics within 1 hour of

arrival and that they are

failing to meet certain

stroke standards due to

4 x 4

16

WSFT internal reporting

reviewed to gain

oversight of all

reportable quality

metrics.

Referral to treatment

times regularly

discussed at contractual

meetings

RCA’s completed for all

patients breaching

referral to treatment time

standards (2ww, 31/62

day standards, 18

weeks)

Detailed RCA’s

completed for all cancer

patients waiting over 100

Reporting to WSFT

those quality metrics

that have not been

reported.

Number of patients

waiting in excess of

the referral to

treatment standards

decreases

Patients are not

experiencing harm as

a result of waiting in

excess of the

standard waiting

times

Patients are not

experiencing harm as

a result of waiting in

excess of the

█

CHALLENGING

3 x 4

12

3 x 4

12

Issue raised at quality

meeting in September and

WSFT stated all the efforts

regarding providing a

validated position

Target: Sept 2016

Completed: Sept 2016

RCAs reviewed at each

monthly quality meeting

Target: Sept 2016


Review of complaints /

PALs issues at each

monthly quality meeting

Target: Sept 2016


Continued failure to produce

data to confirm risk to be

escalated as per contractual

routes

Target: October 2016

Completed:

T

issues operational issues

within A&E.


issues reporting against

all the contractual quality

indicators. They are

therefore unable to

provide assurance

internally or to the CCG

that patient safety and

quality standards are

being robustly monitored

and maintained.

days to receive definitive

treatment

As per NHSE guidance.

Review of complaints /

PALs issues to monitor

for patient harms

resulting from delays in

treatment

Contractual performance

levers

standard waiting

times

No evidence that

patients are reporting

experiencing harm

due to prolonged

waiting times

Priority - To ensure

high quality local

services

IPR – Contractual

Performance

3.If RTT failure confirmed

then formal remedial action

to be requested and

performance managed.as

per contractual terms

Target: November 2016

Completed:

of 37

GOVERNING BODY

Agenda Item No. 19



Title

Minutes of Meetings

Lead Chief Officer


Author(s)

Jo Mael, Corporate Governance Officer

Purpose

The report incorporates for endorsement, minutes and decisions from the following meetings;

a) Audit Committee

The unconfirmed minutes of a meeting held on 4 October 2016.

b) Finance and Performance Committee The confirmed minutes of meetings held on 21 September 2016 and 19 October 2016.

c) Remuneration and HR Committee


d) Clinical Scrutiny Committee The unconfirmed minutes of a meeting held on 19 October 2016

e) CCG Collaborative Group


f) Commissioning Governance Committee

Decisions from meetings held on 19 October 2016 and 16 November 2016








Action required by Governing Body: To endorse the minutes as attached to the report whilst noting that ‘unconfirmed’ minutes remain subject to change by the relevant Committee/Group.

Unconfirmed Minutes of a Meeting of the West Suffolk Clinical Commissioning

Group Audit Committee held on Tuesday 4 October 2016 PRESENT Bill Banks - Lay Member for Governance (Chair) Kevin Bernard - Governing Body Member IN ATTENDANCE Neil Abbott - Head of Internal Audit Mark Game - Head of Accounting and Control Mark Hodgson - Ernst and Young: External Audit Kevin Limn - Tiaa Lesley MacLeod - Interim Chief Finance Officer Norman Pottinger - Information Governance and Risk Manager 16/085 WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed everyone to the meeting and apologies for absence were noted from: Lisa George - TIAA Sarah Learney - Continuing Healthcare Programme Manager Peter Knights - Governing Body Member Amanda Lyes - Chief Corporate Services Officer Melanie Richardson - Ernst and Young: External Audit Jan Thomas - Chief Contracts Officer


No declarations of interest, additional to those already published were received.

16/087 MINUTES OF THE PREVIOUS MEETING

The minutes of the West Suffolk CCG Audit Committee held on 6 September 2016 were approved as a correct record.

16/088 MATTERS ARISING AND REVIEW OF ACTION LOG

Matters Arising 16/069 – Internal Audit Report and Internal Audit Recommendations – having been advised of the number of outstanding recommendations, the Chief Officer Team had concluded that, going forward, outstanding recommendations would be escalated to the Chief Officer in order to hold other Officers to account. 16/075 – Continuing Healthcare – the need to ensure the clarity of presented information and that finances tallied, was emphasized. The action log was reviewed and updated with comment as follows; 16/008 – Internal Audit Review Reports – the Head of Accounting and Control brought the Committee’s attention to the following update on the action log in respect of prescribing budgets;

‘After further discussion with the Finance lead responsible for the prescribing budgets the

previous statement needs to be revised. Although the overall GP prescribing budget is

based on actual outturn, the individual GP practice budgets are actually based on a ‘fair

share’ of this total budget and not the individual practices actual outturn. Therefore

practices are not rewarded with higher budgets if they have overspent in the previous year’.

16/077 – Governing Body Assurance Framework – the Chief Contracts Officer had advised that, in light of continued poor performance by Norfolk and Suffolk NHS Foundation Trust, it was not appropriate to reduce the risk at present.

16/089 EXTERNAL AUDIT BRIEFING

The Committee noted that work had commenced on development of the audit timetable, with the expectation that it be presented to the Committee in December 2016 or February 2017.

16/090 INTERNAL AUDIT REPORT INCLUDING PROGRESS IN RESPECT OF

INTERNAL AUDIT RECOMMENDATIONS The Head of Internal Audit reported that following discussions with the Interim Chief Finance Officer and Chief Contracts Officer the audit plan had been revised to accommodate the inclusion of a QIPP quarter three review. Narrative associated to outstanding recommendations would also be reviewed in order to assist with their future escalation to the Chief Officer for action. In response to a suggestion, the Head of Internal Audit agreed to sort recommendations via audit area for future reports. The Committee noted the content of the report.

16/091 INTERNAL AUDIT REPORTS

The Committee received the following reports from internal audit: Review of GP Payments Arrangements The assurance assessment for the review of both CCGs arrangements resulted in an overall reasonable assurance level being achieved. The Committee was advised that whilst, Ipswich and East Suffolk CCG’s process for the approval of local enhanced schemes (LESs) via its Commissioning Governance Committee was good, the case was not the same for West Suffolk CCG. Following review, it had been identified that two LESs’ had not been approved by West Suffolk CCG’s Commissioning Governance Committee and the Deputy Chief Operating Officer would be taking them to the next Committee for approval. Having recognised that a joint review report had been completed, in light of Ipswich and East Suffolk CCG’s processes being good, it was questioned whether the CCG should have received ‘substantial’ assurance on an individual basis. To that end the Head of Internal Audit agreed to revise the narrative within the report. The Committee accepted the report. Review of Payroll The overall assurance assessment for the review resulted in a substantial assurance level being achieved. The Committee accepted the report.

16/092 CONTINUING HEALTHCARE The Chair advised that apologies had been received from the Chief Contracts Officer and Continuing Healthcare Manager for today’s meeting. The presented report sought to provide an update on progress and risks in relation to the continuing healthcare transformation programme. Having reviewed the report, comments included;

It was queried whether submission of the NHS England continuing healthcare assurance toolkit had been completed by the 30 September 2016 deadline, and also whether both remaining cases in the PUPoC cohort of 01/04/04 – 31/03/12 had been completed by the end of September in accordance with the mandated NHS England deadline. The Head of Accounting and Control was able to confirm that both PUPoC cases had been completed and it was agreed that the Chief Contracts Officer be asked to respond in respect of the toolkit, together with progress in respect of received complaints as detailed within paragraph 3.6 of the report.

A lack of clarity in respect of financial information contained within the report was highlighted. Whilst the Interim Chief Finance Officer was able to provide assurance that ‘deep dive’ financial information recently reported to the Finance and Performance Committee had been consistent, the need to ensure that the right people were present at future meetings to respond to questions was highlighted.

Significant progress had been made in respect of clearance of the backlog from 924 cases at 31 July 2015 to that of 110 at 30 September 2016.

It was noted that PUPoC cases assessed as ‘not eligible’ had a six month right of appeal which could be challenging for the CCG going forward should availability of NHS England’s risk pool cease in the interim period. It was also anticipated that NHS England might open a new PUPoC cohort period and there was concern at the developing risk and potential backlog of appeals.

The Committee noted the report and requested that it receive a further update to its December 2016 meeting

16/093 NHS ENGLAND DATA SECURITY LETTER TO AUDIT CHAIRS

The Committee was in receipt of a report from the Chief Corporate Services Officer which detailed the key points of the national data guardian’s review of data security. It was explained that of the twenty recommendations contained within the review, only five applied to CCGs, those being; 1) Ownership by leadership of the organisation 2) Technical ‘tools’ to identify vulnerabilities – to be taken forward with the CCG’s

new ITSM provider, NEL. 3) Cyber security – already identified on local risk register and being addressed

with NEL. 4) Security audits – it is intended to discuss with NEL and internal auditors the

scope such audits should take. 5) Explicit consent to process data about individuals – currently where no other

legal basis exists for the CCG to process personal patient information, such as within the continuing healthcare and individual funding request teams, explicit consent was obtained. Processes would be reviewed to ensure compliance with the new recommendations.

The Chief Officer Team was to be updated regularly on progress against the

recommendations. Having questioned whether there was a need for staff to receive specific data security training, it was explained that all staff were currently required to complete information governance training and additional training could be facilitated on an ad-hoc basis from the Information Governance and Risk Manager if required. Having noted from the document that ‘opt-out’ would not apply where there was a mandatory legal requirement or an overriding public interest, it was explained that it would be the responsibility of the CCG’s Caldicott Guardian to define ‘public interest’ at a local level. The Committee noted the content of the report agreed that it receive a further update to its February 2017 meeting.

16/094 GOVERNING BODY ASSURANCE FRAMEWORK (GBAF)

The Committee was in receipt of the current version of the GBAF for review. Amendments and additions were detailed within Section 3 of the report. The Committee noted the report.

16/095 POLICIES FOR APPROVAL

The Committee was in receipt of the Standards of Business Conduct and Conflicts of Interest Policy for approval which, it was explained, had been updated in light of the issue of new national guidance. Having reviewed the policy in line with the revised national guidance, it was queried whether the new guidance expected CCGs to manage the declaration of receipt of hospitality and sponsorship within its member practices, and clarification from the CCG’s Governance Advisor was requested. The Committee approved the Standards of Business Conduct and Conflicts of Interest Policy as appended to the report, subject to clarification of the CCGs’ responsibility in respect of managing the declaration of hospitality and sponsorship within its member practices by the Governance Advisor.

16/096 WAIVERS OF COMPETITIVE TENDERING

No waivers of competitive tendering were received.

16/097 ANNUAL PLAN OF WORK

The Committee reviewed and agreed the annual plan of work as presented.

16/098 ANY OTHER BUSINESS AND REFLECTION

No other items of business were raised. It was felt that the meeting had been conducted satisfactorily and all agenda items dealt with effectively.


The next meeting of the CCG’s Audit Committee was to be held on Tuesday 6 December 2016 at 2.00pm in the Paddock Meeting Room at Rushbrook House.

_____________________________ ______________________ Chairman (Bill Banks) Date

Minutes of WS CCG Finance & Performance Committee held on Wednesday 21 September 2016 from 0900 – 1100

Room 14, Ground Floor, West Suffolk House

PRESENT: Ed Garratt, Chief Officer

APOLOGIES:

Chris Armitt. Deputy Chief Finance Officer Kevin Bernard, Governing Body Member Dr Christopher Browning, GP Governing Body Member and CCG Chair Dr Andrew Hassan, Governing Body Member Peter Knights, Governing Body Member Amanda Lyes, Chief Corporate Services Officer Lesley Macleod, Interim Chief Finance Officer Dr Bahram Talebpour, Governing Body Member Dr Firas Watfeh, Governing Body Member Dr David Kanka, Public Health Deputy Jan Thomas, Deputy Chief Officer/Chief Contracts Officer Bill Banks, Lay Member - Governance Jo Finn, Lay Member – Patient and Public Involvement Barbara McLean, Chief Nursing Officer IN ATTENDANCE: Dr Gail Newmarch, Turnaround Director MINUTES: Gail Cardy, Redesign Support Officer, WS CCG

Andy Eley, Acting Chief Operating Officer Dr Simon Arthur, GP Governing Body Member Dr Andrew Yager, Governing Body Member Richard Watson, Chief Redesign Officer

Item Action 1. WELCOME & APOLOGIES

The Chair welcomed all to the meeting and apologies were noted.

2. DECLARATIONS OF INTEREST

There were no new declarations of interest expressed.

3. MINUTES OF F&P COMMITTEE – 17/08/16

The minutes of the Finance & Performance Committee held on 17/08/16 were reviewed and agreed as a true and accurate record of the meeting.

4. MATTERS ARISING

There were no matters arising from the meeting of 17/08/16 or in regards to matters not covered on the agenda.

5. ACTION LOG – 17/08/16

All complete apart from practice packs, Lois Wreathall and AH made changes and packs now signed off and are being used in discussions with practices.

6. MONTH 5 FINANCIAL POSITION

The DCFO presented the month 5 financial position and members noted the following headlines:

The organisation has submitted a Financial Recovery Plan to NHS England which outlines the steps which are being undertaken to meet the CCG financial target.

At month 5 the CCG is the CCG is behind plan by £1,330k.The key adverse variances are QIPP schemes under development (£2,349k), Continuing Healthcare (£189k) and Prescribing (£178k).These have been partially offset by the use of contingency (£628k) and underspends in Mental Health (£227k), Other Programme Costs (£156k), Community (£148k), Other Primary care (£85k) and Corporate Running Costs (£119k).

The CCG is now reporting a balanced risks and opportunities position which is an improvement of £4,498k from month 4.

Underlying financial position shows a deficit of £3,326k which is an improvement from the previous month by £614k.

QIPP Delivery of £3,622k against £5,826k plan (62.1%)

The CCG is fully engaged in delivery of the STP plan and is working towards negotiating 2 year contracts with its main providers

The following top 10 variances were noted:

Acute Services – IHT. Over performance mainly driven by elective and devices spend

Acute Services – Commissioning Reserve. Prior Year benefit from Offender Health accrual for Q4 15/16 is £34K. Neurology transfer costs included in acute contract actuals so no additional accrual needed - £95K. Diabetes investment not needed - £47K

Acute Services – Extra Contractual Referral. Savings against planned budget. No St Andrews Healthcare patients in 16/17. IVF value lower than plan.

Acute Services - Minor Surgery – BMI. Over performance in M1-M4, Electives over by £91k, OP £7k and Day Cases £4k under

Mental Health and LD Services – Other MH placements and Pooled fund. Prior year accrual release - £272K. St Andrews placement left 26.04.16 £54K. Liaison Psychiatry full budget not required in 16/17 - £39K

Prescribing - GP Prescribing incl QIPP. Includes overspend against plan of £133k and YTD QIPP variance of £306k.

Other Primary Care - Local Enhanced Services. Prior year benefit of £76k plus lower spend against planned budget

CHC - Variance net of QIPP target of £373k and mainly due to lower number of cases assessed.

CHC – Funded Nursing Care. Increase in rates from April - £312k and a higher than budgeted number of FNC cases.

Corporate Running Costs – Finance Corporate Costs. Savings from reduction in RAIDR and DSCRO costs

It was noted that Addenbrooks had made significant improvements despite the financial challenges they are faced with. It was noted that NEL CSU will still be able to undertake the invoice validation work for month 5 on behalf of the CCG. This will enable the finance team to focus on other areas. It was also noted that in the west the PUPOC deadline had been met. NEL CSU have recruited additional staff for this process across both CCGs and are looking at ways to retain these staff and not having to re-hire the next time they are needed for PUPOC work. IHT have an adverse variance, JT advised that her team need to understand the month 5 trends and look at the block contract. CCG is not currently investing in any more CHC staff there are 37 in the team, JT is looking at the business case with Sarah Learney and Gail Newmarch which focuses on short term staff at the moment, but in time this will cover long term. They are also looking at Interserve and having a nurse within CHC for a specific short term project. SL is monitoring sickness, leave and staff being asked to fill other areas. SL is also writing to every CCG to ask what their staffing and productivity is and is pulling together a report with the findings. JF asked if the level of staff still had to be so focused on finance and if some could go back to their previous projects such as ‘Connect’. It was also asked if the CCG had seen results in this focused way of working. The CO advised that the focused work had resulted in significant financial savings across the organisation and that although the projects such as ‘Connect’ were important to the organisation they could not take priority over the financial situation of the organisation. It was also noted that that staff need to remain engaged in this work. The Committee also agreed that the MDT approach needs to continue to ensure staff stay focused and work together as this has proven to be invaluable. It was noted that that a balance of this and ‘business as usual’ needs to be found with the support of both executives. It was also noted that in the west there had been the most impact as many personal were working at Rushbrook and AE has been in the PMO role. However KV is now in post as COO in the West and AE will also be returning to the West as Deputy COO. The Committee agreed that until the financial situation was resolved, any changes would need to support financial delivery, building on the positives of joint working. The CO noted that in the west the community service alliance was successful. Risks & Opportunities The risk and opportunities which would be presented to NHSE were discussed in detail. This included discussions around mitigation. It was agreed to discuss and focus on these in more detail at future meetings. The CNO advised that at a recent quality meeting she attended there was a discussion around TPP, in relation to Hertfordshire insufficient resource which carried risk and greater cost across the board. C&PCCG are also unaware of this. The CNO is still waiting the terms of the review to understand more about the risks involved. It was agreed that summaries of these discussions will be pulled together to inform the Governing Body. It was noted that C&PCCG who are leading this piece of work, were themselves in a worse financial situation than other CCGs and needed to be supported. Any financial

discussion should be handled very carefully. Underlying Position The underlying position was discussed in detail. The Chair asked if corporate running costs could be reduced any further. It was advised that there were plans to reduce corporate costs further with the vacancy freeze remaining and discussed weekly at business critical meetings to agree only the necessary posts. Work to look at the potential to keep the currently reduced teams as they are, was being investigated. The CCSO advised the potential move from Rushbrook to Endeavour House would also have savings. The CCSO and her team continue to explore the opportunities to reduce corporate costs. Statement of Financial Position 2016/17 The statement of financial position was discussed in detail, it was noted that this was also discussed in detail at the finance monthly meeting to see if there were any significant changes and to look at any risk. Cash Flow – Month 5 WSCCG closed the month with a balance of £1,307k in the bank account at 31st August 2016. This has been adjusted to £1,167k on the Statement of Financial Position after accounting for unpresented cheques and BACS payments clearing in the following month. The Chair thanked the DCFO for the report. The Executive noted the report.

7. QIPP

The ICFO presented a report on QIPP delivery at month 5; it now shows a RAG rating for project delivery and finance with a named lead for each area. Areas showing red were discussed; Contract Management

Price re-negotiation/service changes Contract negotiation work continuing. MDT meetings will now take place weekly to unblock any issues supported by the additional weekly MDT-lead calls to hold leads accountable for financial saving delivery. Prescribing Management

Medicines management Opportunity to equalise across Suffolk continues to be established. An additional six projects were due for approval at IESCCG Clinical Executive on 23/08; this will increase the number of QIPP schemes in the East to 18 and 10 in the West, with one of the 10 West schemes (Prescribing Recommendations) subdivided into a further 17 schemes. Month three data shows above performance delivery.

Supplies management New scheme, go live September 2016 CHC Management

Price management Following communications from the CCG to all care home providers in July, the CHC team is actively promoting the 'standard' rate of £750 for all Nursing home placements and £700 for all residential care home placements; the 'commissioning' staff are being encouraged to negotiate with providers.

Separate targeted negotiations continue around 'batching' high cost patients with domiciliary care packages and individuals in specialist care home placements. An alternative CHC fast track pilot is being scoped with St Elizabeth hospice (IESCCG only) - with potential to rollout to West - to enable timely discharge from hospice into a patients preferred place of EoL care. A domiciliary care portal is being developed to enable providers to bid for care packages; this will increase capacity of placement officers and streamline the commissioning process.

CHC Fast Track Fast Track continuing to increase with 70% of referrals from the community. Analysis has shown there are a considerable number of patients receiving FT for several months. BAU – Budget Management

Budgetary control Chief Officer sign off of expenditure over £5k has been in place since 01/08/16. Confirmation needed that monthly budgets are sign off by Directors. Month four sign off of budget performance by budget holders being undertaken Schemes Requiring Consultation

Prescribing over the counter medications (OTC) Analysis of OTC medicines that are prescribed is to be undertaken to show which drugs should be targeted for a further campaign to promote self-care. In the West, self-care is already a QIPP scheme with an estimated saving of £30,000. Savings of £9,420 have been achieved to date; The Chair thanked the ICFO for the report. The Executive noted the report.

8. ANY OTHER BUSINESS

There were no further matters of business discussed.

9. DATE AND TIME OF NEXT MEETING Wednesday 19 October 2016, 0900 – 1100, Room 14, Ground Floor, West Suffolk House

Minutes of WS CCG Finance & Performance Committee held on Wednesday 19 October 2016 from 1030 - 1230 Room 14, Ground Floor, West Suffolk House

PRESENT: APOLOGIES: Dr Simon Arthur, GP Governing Body Member Kevin Bernard, Governing Body Member Bill Banks, Lay Member – Governance (Chair) Dr Christopher Browning, GP Governing Body Member and CCG Chair Andy Eley, Deputy Chief Operating Officer Jo Finn, Lay Member – Patient and Public Involvement Ed Garratt, Chief Officer Dr Andrew Hassan, GP Governing Body Member Peter Knights, Governing Body Member Amanda Lyes, Chief Corporate Services Officer Barbara McLean, Chief Nursing Officer Lesley Macleod, Chief Finance Officer Dr Bahram Talebpour, GP Governing Body Member Jan Thomas, Deputy Chief Officer/Chief Contracts Officer Kate Vaughton, Chief Operating Officer Dr Firas Watfeh, GP Governing Body Member Richard Watson, Chief Redesign Officer Dr Andrew Yager, GP Governing Body Member IN ATTENDANCE: Chris Singleton, Head of PMO MINUTES: Jo Wyatt, Office Manager and EA to Chair, COO & DCOO

Item Action 1. WELCOME & APOLOGIES

The Chair welcomed all to the meeting and apologies were noted.

2. DECLARATIONS OF INTEREST

There were no new declarations of interest expressed.

3. MINUTES OF F&P COMMITTEE – 17/08/16

The minutes of the Finance & Performance Committee held on 21/09/16 were reviewed and agreed as a true and accurate record of the meeting.

4. MATTERS ARISING

There were no matters arising from the meeting of 21/09/16.

5. TERMS OF REFERENCE

The CCSO presented a revised draft of the Terms of Reference, following discussions at the Finance & Performance Committee on 17/08/16 and in relation to the PWC report. The CCSO referred members to section 6 of the ToR which pertains to the revised membership of the committee. She advised that I&ES CCG have also agreed to revise the membership of their Finance & Performance Committee. It was noted that at the Clinical Scrutiny Committee which preceded this meeting, it was also agreed that the membership of that committee be revised. Members agreed with the revisions to the ToR, noting the comments made at the Clinical Scrutiny Committee on 19/10/16. The Chair thanked the CCSO for the paper. The Executive noted the paper.

6. MONTH 6 FINANCIAL POSITIONS

The CFO presented the month 6 financial position, advising that the purpose of the pack is so that the committee understand finance, performance and risk going forward, as well as the delivery of QIPP. The following headlines were noted:

Variance from Plan At month 6 financial performance is behind plan by £1.45m but ahead of the FRP trajectory by £1.3m. Key adverse variances are QIPP schemes in development (£2.8m), CHC (£0.3m) and Prescribing (£0.1m). These are mitigated by the use of Contingency (£0.8m), and underspend in Mental Health & LD services (£0.2m), Other Programmes (£0.2m), Corporate costs (£0.8m) and Community (£0.2m).

Forecast Risks and Mitigations Based on the FRP, the CCG currently has a balanced forecast position. Key risks are QIPP under delivery (£3.5m), Funded Nursing Care national price increase (£0.7m), additional ambulance costs (£0.2m), Property Services Market Rents (£0.8m). These are mitigated by Contingency (£1.5m), Central Property Services Funding (£0.8m), 15/16 Quality Premium (£0.2m), further prior year benefits (£0.2m) and Other Mitigations which the CCG is currently in the process of pursuing (£2.3m).

Underlying Surplus / (Deficit) Key drivers are potential under-delivery of QIPP shown as a risk in the current year and therefore at risk recurrently (£4.5m), risks to the current year position that are deemed to be recurrent in nature such as Funded Nursing Care price increase (£0.8m), plus any mitigations in the current year deemed to be non-recurrent such as prior year benefits (£0.9m), Quality Premium (£0.2m).

QIPP Delivery At month 6 the CCG has delivered £4.5m of QIPP against a target £7.0m. The forecast delivery is £10.5m against a target of £14.0m. Key forecast variances from plan are Budgetary Control (£1.4m), Prescribing (£0.6m), Over the Counter Meds (£0.8m) and Market Management (£0.5m). This represents a significant improvement from the level of QIPP historically delivered (PwC assessment of 15/16 was £3.6m for the full year) With regards to recurrent funding, the Chair queried that if more recurrent savings are found then the deficit figure would be lower that £3.5m; the CFO confirmed this.

With regards to progress against the recovery trajectory, the CFO advised that the trajectory indicated that the position would continue to deteriorate to a low point of a £2.77m in year deficit at month 6. From month 7 onwards the trajectory shows a stabilisation and steady improvement to a £1.96m deficit by month 9 as the benefits of the additional QIPP schemes and recovery actions are realised with a further acceleration towards breakeven in the final quarter. With regards to progress to date, the CFO advised that the month 6 position is significantly better than the recovery trajectory due to the impact of the recovery actions and improved QIPP delivery which has begun to stabilise costs in a number of areas. If the current variance is extrapolated to the end of the financial year the closing position would be an in year deficit of £2.9m which is an improvement of £2m from the month 3 risk adjusted forecast deficit of £4.9m. As the impact of the recovery actions is expected to increase throughout the year this will improve further. The CFO advised that the recovery trajectory submitted to NHSE has been achieved and that we are ahead of trajectory. The Chair queried if the remainder of the year goes as planned, and the CCG comes in with a balanced position, what will be the size of the QIPP target next year? The CFO advised that if we deliver in year there will be a target of £14m. However, due to the STP system wide implications, and our current underperformance, the £3.5m deficit will be added to that target, increasing it to £17.5m. The CFO advised that STP work is pertinent, as the footprint is for the period from now to 2020/21. She added that there is a financial gap across the STP of £232m, and that all parties are working on financial solutions to mitigate. To this end there are 12 solutions to bridge this gap, and to this end a Workstream has been set up. It was agreed that the STP Plan, once approved, be shared with both the Finance & Performance Committee and the Governing Body. It was noted that the STP Plan be knitted in to the Operational Plan, and that the financial implications are understood. The Chair commented that he would like to see what next year will look like, adding that we will struggle with QIPP next year given the deficit. He suggested that the sooner the committee have sight of this the earlier steps can be taken to address the issues. The CO agreed, adding that this be played into the contractual negotiations as a lot hinges on this. The CFO reminded members that the commissioning intentions were previously discussed and agreed at the Executive. Discussions took place in regards to flat cash and in-year savings. The CFO raised a concern in respect of STP and operational planning. She advised that two meetings have taken place with key providers, and all are committed to working in conjunction with the STP. The question is, however, which take priority; the STP or the operational plan? With regards to the financial model within the STP, there is an impact on local providers; WSFT in 2017/18 are allocated £500k more than the contractual sum for 15/16. The CFO stressed that there has to be consistency in the principles. It was noted that there has been provider discussion level at a high level, and that they prescribe to the concept of managing demand, however they are scared of the risk and where that risk lies.

The DCO/CCO commented that the providers do not want to take on that risk. She added that a capped contract will, through an uplift of approx. £2m work in a way to fix demand through transformation and redesign. 1118 – CB joined the meeting It was noted that one of the conditions of the block contract, was that the CCG and the Trust set up a Transformation Board so that more confidence can be given that demand management will be worked on together. It was noted that providers have acknowledged the message that there is no additional money, and that it is all about collaboration and managing demand. It was agreed that at the next Finance & Performance Committee, scheduled for 16/11/16, next year’s financial plan, including the best forecast of QIPP and where money will come from be presented. The CFO advised that all contracts have to be signed by 23/12/16, including the mediation process. She added that the first financial plan has to be submitted by 01/11/16, which means that the plan will be submitted prior to the next Finance and Performance Committee. The DCO/CCO added that this is the problem with the planning and contracting round; if plans are not submitted and contracts are not signed by the end of 11/16, the CCG will immediately be placed under mediation. The Chair commented that the operational plan should be seen by the Governing Body as the decision making body before it is submitted to NHSE. The CFO advised that the timetable had been shared at a previous Executive, adding that she is happy to share the plans virtually as there is no Executive scheduled on 26/10/16. AY queried that in regards to QIPP and the contract with WSFT, if they are both agreed will it mitigate against QIPP? The CFO confirmed that it would, as there will be an in-year benefit this financial year. She added that month 5 activity data shows underperformance of circa £700k, therefore the CCG is entitled to pull back 75%. However, the Trust feel that it is harsh for the CCG to ask for reimbursement, citing that e-Care and the backlog have been the cause, and that they are confident that they will have caught up with the backlog by month 6. She advised that it has therefore been agreed that Q1 & 2 will be agreed in signed off in month 6, and that after that any monies will be claimed back accordingly. Further discussions took place in regards to the blocked contract and benefits. AY informed members that LL had advised him that prescribing had gone back into the red last month. It was noted that the improved figures were down to category M drugs, which ceased in 10/16. The CO advised that I&ES are £130k over budget in respect of prescribing. CB commented that the underlying fluctuations need to be looked at terms of trends, as there are so many factors at play. The CFO referred members to graph 3a (all expenditure trend) and 3b (total expenditure trend), requesting feedback on how helpful they are. It was noted that in regards to the all expenditure trend, historically the overall expenditure pattern has been heavily influenced by changes in Prescribing and Acute expenditure as can be seen here where the peaks and troughs are consistent. While the introduction of a fixed contract for West Suffolk should reduce the level of variation to a planned profile, the movement of Addenbrooke’s onto National Tariff means there will still be a level of variation.

LM

It was noted that in regards to the total expenditure trend, at the beginning of 2015/16 there was a significant swing into the red but for the remainder of the year expenditure as a whole remained in the green with the exception of February when the settlement with WSFT would have been recognised. So far in 2016/17 expenditure has risen above the allocation increase with only 08/16 and 09/16 being below the average allocation which highlights the continuing importance of retaining focus on cost control and QIPP delivery. It was agreed that more narrative is required on what is driving spikes. JF commented that it would be useful to have a longer term analysis available to look at from previous years. The CFO advised that this can be done, as well as the trends forward. The Chair commented that there are bursts of activity in 06/15, 06/16 and 06/17, querying if there is data to explain this. The CFO advised that the graphs refer to expenditure and that they could be large payments for the CHC risk pool. The DCO/CCO informed member that the Trust is incentivised through the Strategic Transformation Fund (STF) by hitting milestones every quarter. She advised that the STF provides additional funding should the Trust meet all their performance targets, which is paid out on a quarterly basis. This means that the Trust will achieve their targets for the first three quarters of the year, but there is a concern that in quarter four it is in the financial interests of the provider to fail as what they can gain is less than the contract value. She added that this has to be considered through the STP process too, as this could be quite a risk going forward to next financial year. The CFO provided further clarification on STF funding, following a query from CB that suggested that the Trust receives a reward for failing. The DCO/CCO that the Ambulance Trust and NSFT do not get access to the same funding as Acutes. She added that we need to consider timing how we support the Trust in securing the STF money, but we need to be achieve our aims. The CFO advised that it is in our interest to work collaboratively with providers as we need to secure funding for the local system. It was noted that potentially the quarter 4 payment is to be paid through the Commissioner rather than directly to the provider. AY queried that as Addenbrooke’s figure is shown as being in the black, is this evidence that repatriation is working. The CO commented that the reason could be due to invoice validation. The DCO/CCO advised that a meeting has taken place with Addenbrooke’s regarding the CCG having our own contract with them, rather than going through C&P CCG. She added that Cardio is being moved to IHT as WSFT did not respond to Addenbrooke’s enquiries. It was noted that the Executive had previously agreed to fund an additional Cardio Suite at WSFT in order to accommodate repatriated work from Addenbrooke’s. Members were informed that invoice validation is being agreed and a repatriation process is being put in place. AY queried if the pathology results are rolled in to the block contract, or is it part of the TPP PbR contract. The DCO/CCO advised that this contract is not a cost and volume contract, adding that the total value of the contract is £25m for the five CCGs. It was noted that the CFO would clarify this.

The DCO/CCO suggested that this be picked up through the “One Clinical Community” so that patients are only tested once, as it is costing practices a lot of money testing the “worried well” in regards to annual blood tests. The CNO advised that WSFT are refusing to take post-trauma head injury patients, advising that there are a number of St Andrew’s patients. With regards to risks and opportunities, the CFO advised that these remain the same as at month 5, but added that there is a potential risk going forward. Although is not a risk for the CC, there is risk in relation to NHSPSC services in relation to the level of debt. The DoH is now debt collecting, and the West Suffolk Consortium has debts of £10m. It was noted that this will be going to arbitration, and the CCG may be required to give evidence and it may have future consequences. With regards to the underlying position, it was noted that there is a slight deterioration from month 5 due to reduction in QIPP under delivery. The Chair commented that the financial position is progressing compared to where we were, and better than forecast. However we are not out of the woods yet. With regards to the CHC risk and EOL (£0.5m) it was noted that this is not an additional risk for month 7, but it is a mitigated risk or liability therefore it is flagged red. It was agreed that we need to be clear on what we are going to deliver. SA commented that this would automatically put a cost pressure on CHC A key message in regards to EOL and CHC, not all patients are automatically fast tracked. SA stated that he felt he should have been advised as the Lead for EOL, and that he needs to be involved and be made aware of the process. The Chair thanked the CFO for the paper. The Committee noted the paper.

7. QIPP

Chris Singleton (CS), Head of PMO was introduced to the meeting. CS presented members with the QIPP position as at month 6, providing an update in respect of the main QIPP domains. It was noted that the PMO are meeting with each project manager and undertaking a health check and that all schemes are measurable. CS stressed that the focus will be on the content not on the template. CS provided an explanation in regards to the project delivery RAG versus the finance RAG; the former relates to the plan being approved and accepted, and milestones set. If these milestones are delivered, and all is going to plan, then the RAG rating will be green. If the scope or timetables change, then the RAG rating will be green, and change control will be undertaken. The latter relates to the forecast outturn of schemes and what is delivered. Should the PDR be green and the Finance RAG be red, then change control is undertaken. The CFO confirmed that some schemes have had money taken out due to the contracting round. CB queried why demand management and prior approval are green, when demand management has not been achieved, and prior approval had a difficult start. With regards to the MSK single point of access, it was noted that this is going to plan, and that work is ongoing with WSFT and is on track. This reflects the

guaranteed income contract and is therefore locked in. AY referred to the schemes ‘requiring consultation’, adding that a scheme regarding the prescribing of over the counter drugs by GPs was never approved. BT reminded members that the response from the GMC did not provided appropriate back-up. AH added that there is a scheme, and there is publicity, but it is difficult to deliver. The Chair commented that everything heard today indicates that those areas rated red are vulnerable and are open to more slippage, and queried what actions should be taken to stop this happening. The CFO advised that the list currently indicates circa £5m mitigation across both CCGs, adding that at month 7 risks will be switched to liabilities and mitigated accordingly. The CFO stressed that budget holders need to be held to account. The CO commented that more has been delivered in the past six months than the CCG has ever done. The Chair queried in respect of the position that is reported monthly to the area team, what evidence to they require. The CFO advised that the area team want to see delivery of trajectory and will look at risks. It was agreed that a paper on a deep dive on CHC be brought to the committee on 16/11/16. It was agreed that the first draft financial plan for 2017 and beyond be brought to the committee on 16/11/16. The Chair thanked CS for the report. The Committee noted the report.

JT

LM

8. ANY OTHER BUSINESS

There were no further matters of business discussed. The meeting closed at 1218.

9. DATE AND TIME OF NEXT MEETING Wednesday 16 November 2016, 0900 – 1100, Room 14, Ground Floor, West Suffolk House

Unconfirmed Minutes of a meeting of the West Suffolk Clinical Commissioning

Group Remuneration and Human Resources Committee Meeting held on Tuesday, 18 October 2016

PRESENT: Bill Banks Lay Member for Governance (Chair) Jo Finn Lay Member for Patient and Public Engagement IN ATTENDANCE: Jo Mael Corporate and Governance Officer Giles Turner HR Business Partner

16/048 WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed everyone to the meeting and apologies for absence were

received from; Amanda Lyes Chief Corporate Services Officer


No declarations of interest, other than those already published, were received. 16/050 MINUTES OF THE PREVIOUS MEETING

The minutes of the West Suffolk CCG Remuneration and Human Resources

Committee meeting held on 19 July 2016 were reviewed and confirmed as a correct record.

16/051 MATTERS ARISING AND REVIEW OF THE ACTION LOG

There were no matters arising and the action log was reviewed and updated

with comment as follows: 16/036 – Directorate update – Communications – the Chief Corporate Services Officer continued to provide support to communications with the situation being due for review in the near future. 16/036 – Directorate update – Redesign – Bids had been reviewed by NHS England and communications were currently being prepared. 16/038 – Workforce Forum update – whilst, to date, there had been some clinical representation in the connect project, it was anticipated that representation be extended for future meetings with the project also becoming linked to the Sustainability and Transformation Plan (STP).

16/052 DIRECTORATE UPDATE

The Committee was in receipt of a written general overview of the key

headlines of activity within each directorate with key points highlighted from the report including; Corporate Services

Part One

The human resource team had informed staff about changes to national pension and NI contributions.

The human resource team was planning communication with SERCO Pension over Total Reward Statements for CCG staff due to be issued in the autumn of 2016.

The CCGs’ payroll system had been audited and received ‘substantial assurance’.

The human resource team was supporting the Sustainability and Transformation Plan (STP). A workforce STP group which included Union representation was being chaired by the Chief Corporate Services Officer.

Transition to the CCGs’ new IT service provider continued to give cause for concern, with improvement to service now being pursued at Chief Officer level within both organisations.

During July to September both CCGs had held a widespread engagement process on plans to reduce access to IVF services and the refocusing of services delivered to marginalised and vulnerable adults. 580 comments had been gathered on outreach service proposals and 794 on IVF. Comments had been gathered from face to face events, online survey and social media.

Having questioned whether narrative associated to the engagement process, together with evidence from the independent report had been made available to members of the CCGs’ Governing Bodies, the HR Business Partner agreed to investigate and report back. Nursing Directorate

Peer reviews for Norfolk and Suffolk NHS Foundation Trust had taken place and the CCG was joining them on mock inspections.

A care home review had commenced with the feasibility of carrying out a review across both CCGs being explored.

The number of out of county placements for learning disability patients in transforming care had been reduced.

The Children and Adult Safeguarding Designate teams had been joined to ensure cohesion across the county.

Finance

An Interim Chief Finance Officer was in place and the finance team was working towards an alignment of the team to maximise efficiency and effectiveness.

Financial plans had been submitted to NHS England and a formal financial recovery plan developed to address the QIPP challenge.

Financial plans continued to be developed across the Sustainability and Transformation Plan (STP) area. The STP had predicted a £362m system (health and social care) gap between forecast cost and funding in the financial year 2020/2021.

Contracts

The Contracts Team had worked closely with the turnaround office and 16 multi-disciplinary teams (MDTs) had been established to support the market management review.

The continuing healthcare team had been actively reviewing its working practices for potential savings.

A member of the nursing office had been seconded to West Suffolk Hospital for a period of six months in order to assist with the management of A&E.

Chief Operating Office and Redesign WSCCG

Kate Vaughton had now commenced in the role of Chief Operating Officer.

Redesign programme teams across both CCGs had been integrated under the leadership of Associate Directors.

The Committee noted the content of the report.

16/053 WORKFORCE REPORT – QUARTER 2

The Committee was in receipt of a report from the Chief Corporate Services

Officer which provided information on a wide range of key HR performance indicators and sought to benchmark where possible against national and local performance data. Key points highlighted during discussion included;

There had been a rise in sickness/absence to 2.88% with reported causes detailed on page six of the report. As a number of the occurrences had been reported as ‘cause unknown’ the need for accurate identification of causes of absence was to be reiterated to line managers. Wellbeing initiatives were also to be explored in an attempt to reduce sickness levels.

In light of the time of year and the prevalence of viruses, it was suggested that thought be given to the facilitation of hand hygiene awareness sessions etc.

The HR Business Partner reported management costs for both CCGs and advised they would be included within future reports. The Committee requested that actual spend per head be included within future reports and that finance be asked to confirm why the budget had been set at the same level as the statutory ceiling.

The Committee was disappointed at the reported appraisal completion rates with some directorates. Whilst being assured that the situation was being addressed, the Committee advised of the need to see improvement in future reports.

Having questioned differences in the rates of pay of sessional pharmacists, the HR Business Partner agreed to clarify the matter outside of the meeting.

The Committee noted the content of the report.

16/054 WEST SUFFOLK COMMUNITY EDUCATION PROVIDER NETWORK

The Committee was in receipt of a report which provided an update on

opportunities available through the GP Five Year Forward View. Health Education England (HEE) had recognised the workforce challenges in primary care and the need for a wider multi-professional clinical workforce. The introduction of Community Education Provider Networks (CEPNs) was the start of that development. CEPNs aligned with the emerging Sustainability and Transformation Plans and HEE had established three pilot sites; West Suffolk, Great Yarmouth & Waveney and Essex. West Suffolk CEPN was established in October 2015 and the following workstreams agreed:

Pilot pre-registration student nurse placements in primary care

Increase mentorship capacity in primary care

Upskilling the primary care workforce

Raise awareness of careers in primary care Detail in respect of current progress was set out with section 3 of the report and future work included;

A webpage to provide a central place for practices to access information on all of the training and education opportunities available to their workforce; this is to be launched in November.

A quarterly e-newsletter for practices is being created and will be circulated in October.

Exploring ways to introduce clinical/pharmacists into practice.

Exploring the possibility of developing a module for nurses who wish to enter primary care from another setting to ensure they are competent in the skills they will need in general practice.

Exploring the possibility of supporting practices in developing the role of a medical assistant to relieve pressure and workload from GPs

The HR Business Partner advised that the work of Suffolk’s CEPN had been recognised by Dr John Howard, Head of Education and Quality for Primary and Community Care and Postgraduate GP Dean at Health Education England. It was highlighted that, in order to maintain emphasis and momentum, additional support at a senior level might be required. The Committee was informed that Suffolk GP Federation was involved in the CEPN and it was expected that, when communicated more widely, practices would be enthusiastic and supportive of the network. The Committee noted the content of the report.

16/055 APPRENTICESHIP PROJECT EVALUATION REPORT

The purpose of the report was to explore how Apprenticeships had helped the

wider Health and Social care system to upskill its existing workforce and support young people in entering the sector in Suffolk. The outcomes from the document would ensure that any further planning for the project was strategically aligned to the emerging Sustainability and Transformation plan priorities across Suffolk and North East Essex to assist Health and Social Care organisations to continue to upskill and develop their workforce to accommodate the growing needs of the local population. Health Education East of England had funded the role of Apprenticeship Coordinator from January 2015 to assist the development of the non-registered workforce across the wider Health and Social care system in Suffolk. A target of 100 Apprenticeship starts across Suffolk by 31st March 2016 was set. Since January 2015 there had been 174 apprenticeship starts in Ipswich and East Suffolk and 66 in West Suffolk. The outcomes of those apprenticeships were detailed within Section 5 of the report and benefits to the wider health and social care system set out in Section 6. Future work included;

Looking at ways to utilise apprenticeships to their full potential to support the expansion of the primary care workforce, and;

Exploring opportunities to collaborate with North East Essex.

It was suggested that evaluation of the views from apprentices might be beneficial in shaping the programme going forward. The Committee noted the content of the report, whilst requesting the clarification of figures set out within paragraph 5.1.

16/056 HEALTH AND SAFETY

The Health and Safety and Risk Committee, chaired by the Chief Corporate

Services Officer, continued to meet on a quarterly basis. The last meeting of the Committee had been held on 8 August 2016 with key issues reviewed including;

HSE publication “Helping Great Britain Work Well”, which set out aims under six themes to keep the working population of Britain safe whilst in the workplace. It fitted in well with the CCGs “values and behaviours” and would be discussed in more detail at later meetings.

Update on risk registers and the need to refresh the “risk buddies” network.

The issues regarding the track to the farm car park at Rushbrook House continued to “rumble on” and efforts were being made to engage property services in facilitating repairs.

There was general discussion about pedestrian and vehicle safety entering both the farm car park and the main car park at Rushbrook House. A reminder had been issued to staff about taking care when driving and walking.

Sickness absence figures were presented.

The new NHS Protect circular “challenging behaviours” was discussed particularly in relation to lone workers.

Following previous concern from the Remuneration and HR Committee at the situation regarding the potential risk arising from window openings, particularly within the third floor meeting rooms at Rushbrook House, it was reported that the Information Governance and Risk manager had met with a representative of NHS property services to discuss a way forward. After further assessment it had been concluded that the risk to staff and visitors was fairly low. Window openings in office areas did not present an undue risk as those areas were not generally visited by the public or service users. The NHS had issued specific guidance for clinical settings where mental health patents might present an increased risk of falling or jumping from windows above ground floor level where there was no restriction to the size of opening presented. That did not apply to the CCG offices.

Where the public and visitors accessed meeting rooms there was an issue with the height of the window sills and the possibility of falling from height if someone fell against a window (open or closed). Restricting the opening arc would serve little or no purpose as devices used for that purpose were generally not strong enough to prevent a fall if a person fell against an open window. The resolution was fitting of a secondary barrier across the openings. Property services are currently obtaining a quote for the work which would have to be at the CCGs expense. We cannot arrange the work ourselves as property services are responsible for all changes to the structure of the building, which might require the landlord’s permission. The Committee noted the content of the report.


The Remuneration and HR Committee was in receipt of the following policies

for approval;

Whistleblowing and Public Disclosures Policy

Equal Opportunities and Diversity Policy

The Committee reviewed each policy in turn with comment as follows;

Whistleblowing and Public Disclosures Policy

Page 6, paragraph 7 (Confidentiality) – definition of ‘appropriate organisations outside of the CCGs’ as stated within the final paragraph was questioned and it was suggested that those organisations either be defined or the policy be revised to state ‘following discussion with line manager’.

Page 7 – paragraph 9 (Gardening Leave) – circumstances of its use were questioned and the need for there to be no barriers to staff raising concerns was emphasized.

The Committee subsequently approved the Whistleblowing and Public Disclosures Policy, subject to the above points being addressed and the revised policy being subject to the CCGs’ policy approval process.

Equal Opportunities and Diversity Policy

The Committee approved the Equal Opportunities and Diversity Policy, as presented.

16/058 JOINT STAFF PARTNERSHIP COMMITTEE

The Committee was in receipt of a report from the Chief Corporate Services

Officer that summarised the main issues discussed and outcomes to emerge, from the Joint Staff Partnership Committee meeting held on 2 September 2016. The Committee noted the content of the report.

16/059 SELF-ASSESSMENT

In line with the annual self–assessment process carried out by other

Committees, the Remuneration and HR Committee, was being asked to consider the carrying out of a similar assessment for 2016. The Remuneration and HR Committee approved the carrying out of a self-assessment exercise via use of the attached questionnaire

16/060 ANNUAL PLAN OF WORK

_____________________________ ______________________ Chairman (Bill Banks) Date

The Committee noted its current annual plan of work. 16/061 ANY OTHER BUSINESS

No items of other business were received. 16/062

DATE AND TIME OF NEXT MEETING

The next meeting was scheduled to take place on Tuesday, 13 December 2016 in Room F1R05, West Suffolk House, Western Way, Bury St Edmunds, Suffolk.

Unconfirmed Minutes of WSCCG Clinical Scrutiny Committee held on

Wednesday 19 October 2016 from 0830 – 1030hrs Ground Floor Room 14, West Suffolk House, Western Way,

Bury St Edmunds, IP33 3YU PRESENT: Bill Banks Lay Member – Governance (Chair) Dr Simon Arthur GP Governing Body Member Kevin Bernard Governing Body Member Jo Finn Lay Member – Public and Patient Engagement Ed Garratt Chief Officer Dr Andrew Hassan GP Governing Body Member Peter Knights Governing Body Member Amanda Lyes Chief Corporate Services Officer Barbara McLean Chief Nursing Officer Lesley MacLeod Chief Finance Officer Dr Bahram Talebpour GP Governing Body Member Jan Thomas Chief Contracts Officer Kate Vaughton Chief Operating Officer Dr Firas Watfeh GP Governing Body Member Dr Andrew Yager GP Governing Body Member IN ATTENDANCE: Andy Eley Deputy Chief Operating Officer Jo Mael Corporate Governance Officer Eugene Staunton Associate Director, Redesign 16/039 WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed everyone to the meeting and apologies for absence were noted

from; Dr Christopher Browning GP Governing Body Member and CCG Chair (Chair) Dr Crawford Jamieson Secondary Care Lead David Kanka Assistant Director of Public Health Richard Watson Chief Redesign Officer


No declarations of interest were received.

16/041 MINUTES OF PREVIOUS MEETING

The minutes of the meeting held on 24 August 2016 were reviewed, and approved, as a correct record.

16/042 MATTERS ARISING & REVIEW OF ACTION LOG

There were no matters arising and the action log was reviewed and updated.

The Chair advised that as the Clinical Scrutiny Committee was not a decision making body it could only make recommendation in relation to item 6 (Business case for integrated community health and care services including integrated urgent care service).

16/043 TERMS OF REFERENCE

The Committee was reminded that, at its previous meeting, it had asked the Chief

Corporate Services Officer review the Committee’s terms of reference in light of the original internal audit report and forthcoming committee structure review. As a result of that review revised terms of reference, as appended to the report, had been developed with key changes being;

That the Clinical Scrutiny Committee membership be reduced in order to ensure a renewed focus upon clinical governance and clinical quality with greater scrutiny and challenge.

That the new Lay Member, when appointed, should become chair of the committee.

It was also recommended that, rather than providing another forum for scrutiny over all areas of WSCCG’s business, that the agenda and work plan should be refocused on clinical governance with report to the Governing Body. During discussion, comments included;

There was support for the Committee membership to be reduced in number.

The membership should be more independent, with members being sought from the wider GP community, providers and community engagement partnership.

Practice manager members of the Governing Body and the Secondary Care Doctor could be members.

As the Committee would be scrutinising the work of the CCG, the CCG Chair should not be a member of the Committee.

Whilst the Chief Officer should be a member, other Chief Officers would only attend when invited to present reports and provide advice.

At its inaugural meeting, at which the Chief Nursing Officer should be present, the Committee should draw up a plan of work and identify areas that it might like to review in more depth.

Following discussion, the Committee agreed in principle the role of the Committee as set out in the presented terms of reference, whilst requesting that membership of the Committee was further reviewed in respect of the above comments. The Chief Corporate Services Officer agreed to bring further revised terms of reference back to the next meeting.

16/044 BUSINESS CASE FOR INTEGRATED COMMUNITY HEALTH AND CARE

SERVICES INCLUDING INTEGRATED URGENT CARE SERVICE.

The current community services, NHS 111 and GP Out of Hours contracts were due to expire in October 2017, which provided opportunity for the Ipswich and East Suffolk and West Suffolk CCGs to deliver the Integrated Health and Care Review recommendations of procuring a dynamic age inclusive 24/7 out of hospital care model. It was anticipated that services would move from a reactive/crisis management approach, to a proactive locality based service model concentrating on self-managed care, shared and personalised care. The presented report set out to describe the new service model and the commissioning framework that would be used to deliver the new service model. The Clinical Scrutiny Committee was being asked to endorse the commissioning approaches outlined and the indicative contract values. The Chief Contracts Officer reported that the new contract would be a flat cash contract over five years. Whilst the service specification clearly included the provision of Care Coordination Centre services, there was opportunity for providers to introduce that provision later and not from day one of the contract.

Work was currently taking place to refine key performance indicators associated to the contract. After consideration and having recognised that the Committee was only able to recommend to a decision making body, it subsequently recommended that the Governing Body approve; 1. That the contract value for the proposed models of care should be kept at the

same levels as paid to the current providers of community services, 111 and GP out of Hours in 2016/17 for the duration of the proposed contracts.

2. The preferred procurement arrangement of a mixed approach consisting of:

Procurement of community services through a Most Capable Provider process, local to Ipswich and East Suffolk and West Suffolk, with an alliance partnership of local providers to be concluded by the end of November 2016. That would enable a decision to be made by the Clinical Scrutiny Committee to proceed further or revert to open market tender.

Tendering the Integrated Urgent Care service (111, GP Out of Hours and the CCC) across Ipswich and East Suffolk, West Suffolk and North East Essex (111 and GP Out of Hours only).

16/045 INTEGRATED PERFORMANCE REPORT

The Committee was in receipt of the Integrated Performance Report, the format of

which had been revised to incorporate a 15 page executive summary and supporting appendices. Key points highlighted included; Clinical Quality and Patient Safety

Transforming Care - the trajectory for transforming care would be included within future reports.

Care Homes - the report now identified the number of beds that had been lost to the system. The Care Quality Commission had advised that, going forward, there was likely to be an increased number of ‘good’ inspections, as those homes where concern had been raised had been targeted for early inspection.

The Committee welcomed the revised format of the report that, considering it was more informative. Having previously discussed development of a plan of work for the Committee it was recognised that areas to review in more depth might be infection control, the absence of robust data from West Suffolk Hospital and serious incidents. The need to seek the acquisition of data from West Suffolk Hospital in order to gain assurance with regard to performance levels was emphasized. It was suggested that, in the absence of robust electronic data, some manual audits be pursued. The Chief Finance Officer said that the Trust had recently been asked to provide evidence for service level agreement meetings that could be extended to include clinical safety information. It was questioned whether action taken to address the occurrence of C.Difficile infection was satisfactory in light of the decreased performance. The Committee agreed that it receive examples of root cause analysis and post infection reviews for consideration. Finance As the finance section of the report was now subject to consideration by the new Finance and Performance Committee that was due to meet immediately after today’s Clinical Scrutiny Committee, only other aspects of the report, such as the quality

premium, were reviewed. Redesign Key points highlighted included;

Work continued on the Sustainability and Transformation Plan with final submission required by 21 October 2016.

The One Plus One service specification and outline business case had been finalised and agreed.

The West Suffolk A&E delivery plan had been submitted to NHS England following consultation with the health and care system. Feedback had included a need for the timely despatch of referrals from primary care. The plan was to be revised for re-submission on 21 October 2016. It was highlighted that evidence from previous work associated to primary care referrals had identified little impact and that many issues were due to transport. The need to discuss at a local level was recognised.

West Suffolk Hospital and the CCG Portfolio Board continued to focus on a joint cost improvement programme with focus on reducing emergency admissions, delayed transfers of care and outpatient activity.

The IAPT and Wellbeing Service had been launched on 1 September 2016. There was concern at the amount of time patients were waiting to access the service and the need to obtain data was emphasized.

Contracts West Suffolk Hospital – A&E performance continued to be the key area of concern and a remedial action plan was in place. Norfolk and Suffolk NHS Foundation Trust – performance levels were of major concern and meetings with the Trust were difficult. Work was to commence on development of a plan of action across CCGs. East of England Ambulance Service Trust – performance continued to be of concern and the remedial action plan focused on Red 1 performance with the Trust being held to account in respect of Red 2 performance. It was highlighted that following review, it appeared that those providers with significant financial challenge seemed to have better performance levels. The Committee noted the content of the report.

16/046 CONTINUING HEALTHCARE (CHC) UPDATE

The Clinical Scrutiny Committee was in a receipt of a report from the Chief Contracts

Officer that provided an update on the progress of Continuing Healthcare. Key points included;

The PUPoC trajectory had been met and the backlog had now declined to 94 cases.

Financial challenge remained and initiatives being explored included exploration of the Discharge to Assess ‘5Q Care Test’ model.

The CCG currently ranked high in respect of its number of packages and funded nursing care packages. Work was taking place to investigate and identify those individuals that should be the responsibility of social care.

£16m of continuing healthcare savings had been identified across the STP over the next five years and learning was currently being shared across CCGs.

Exploratory work, with less focus on price, was to take place with the care home market.

The Committee was informed that continuing healthcare information on the CCG’s website had been revised to improve access for the public and patients and a continuing healthcare nurse was working within the hospital to discuss the process with families face to face at an early stage. Financial information was reviewed every month and a ‘deep dive’ to mitigate risk going forward was to take place. That work would be especially important in light of expectation that the national risk pool would cease to exist at the end of the financial year. Work to get finances back on track also included redirection of backlog team staff to focus on the carrying out of reviews, and a review of package costs. The Committee noted the report.

16/047 SELF-ASSESSMENT

The Committee was presented with feedback from its recent self-assessment

exercise with key themes being;

That greater challenge was required together with papers that focused on actions to address issues.

That there might be benefit from discussing the Committee’s role, together with a review of its function and membership.

That the length of papers should be limited.

That there should be more focus on clinical priorities. The Committee felt that themes identified by the self-assessment reflected those highlighted in the earlier terms of reference discussion. The Committee noted the feedback and members were thanked for their participation.


The Committee was in receipt of the following policy for approval;

NMC Revalidation – policy and procedures After review, the Committee approved the policy as presented.

16/049 GOVERNING BODY ASSURANCE FRAMEWORK

The Committee received the current version of the CCG Governing Body Assurance

Framework (GBAF) that was reviewed by the Chief Officer Team every month and by the Governing Body and Audit Committee at each of their meetings. Amendments/additions were set out within paragraph 3.2 of the report. Comments included;

That the risk associated to C.Difficile might require review in light of recent performance levels.

GPIT continued to be a cause of concern and although on the Corporate Services Risk Register it was questioned whether it should now be entered onto the GBAF. The Chief Corporate Services Officer reported that a lot of work had been carried out in relation to concerns raised and the provider had reviewed its management arrangements and attempted to improve its engagement with pilot sites. GPs were reminded that any clinical risks should be entered onto the GP log. Issues were to be discussed at the IT Strategic Board meeting to be held on 20 October 2016 and the CCG’s Executive was to receive a report in the near future.

The Committee approved the GBAF as presented.

16/050 ANY OTHER BUSINESS

As today was Dr Andrew Yager’s final meeting, the Committee thanked him for his

innovation and work associated to cancer and planned care services over his period as a Governing Body member.


Wednesday 14 December 2016, 0900-1100 hrs, Ground Floor room 14, West

Suffolk House, Bury St Edmunds, IP33 3YU.

Ipswich & East Suffolk Clinical Commissioning Group

West Suffolk Clinical Commissioning Group

Unconfirmed Minutes of the CCG Collaborative Group meeting held on Thursday, 13 October 2016, 11.00am in the Pavilion, Rushbrook House

PRESENT Martin Smith (MS) CCG Collaborative Group Chair Bill Banks (BB) Lay Member (Governance) West Suffolk CCG Dr Christopher Browning (CB) Chair, West Suffolk CCG Governing Body Dr Mark Shenton (MS) Chair, Ipswich and East Suffolk CCG Governing Body Ed Garratt (EG) Chief Officer, Ipswich & East Suffolk and West Suffolk CCGs IN ATTENDANCE Jo Mael (JM) Corporate Governance Officer Minute

Action

16/039 Welcome and apologies The Chairman welcomed everyone to the meeting and apologies for absence were noted from; Graham Leaf, Lay Member (Governance) Ipswich & East Suffolk CCG

16/040 Declarations of Interest

No declarations of interest were received.

16/041 Minutes of meeting held on 23 August 2016

The minutes of a meeting held on the 23 August 2016 were considered and agreed as a correct record.

16/042 Matters arising and review of action log

There were no matters arising from the previous minutes and the action log was reviewed and updated.

16/043 Chief Officer Update

The Collaborative Group was in receipt of a paper from the Chief Officer which identified key updates since the previous meeting. Key points highlighted and comments included; Finance

At month six Ipswich and East Suffolk CCG had a £400k surplus and West Suffolk CCG a £1.4m deficit. Whilst West Suffolk CCG was currently ahead of its trajectory to address the deficit but the situation remained challenging.

Regional escalation had been ‘stepped down’ and, going forward there were monthly ‘informal’ assurance meetings being held, together with the formal quarterly meetings.

Public engagement in respect of the financial position had gone well.

Both CCGs had published their commissioning intentions for the

next two years. Alliance Working

‘Constructive dialogue’ in respect of community services was progressing well.

East and West alliances were progressing with Suffolk County Council seeking a parallel approach from both CCGs. Funding options to facilitate delivery were being explored.

Both acute hospitals have provided commitment to continue with guaranteed income contracts.

The next version of the Sustainability and Transformation Plan (STP) was due for submission next week.

Primary Care

The single partnership continued to be developed across both East and West Suffolk. The partnership aimed to provide good quality care whilst making the best use of available resources.

Vulnerable practice funding had been obtained to assist Ipswich practices.

Member practices were to be consulted on pursuance of primary care commissioning Model 3. The Chief Officer agreed to investigate progress and report back.

GP IT was a growing concern and an action plan was in place. An improved response from the provider was anticipated.

Performance

A&E performance at West Suffolk Hospital had dipped since introduction of its new e-care system.

Collaborative working between Ipswich Hospital and Suffolk County Council was vital to address delayed transfers of care. Healthwatch was to commence some qualitative work which should incorporate review of a patient owned discharge plan.

The recent Care Quality Commission inspection report in relation to Norfolk and Suffolk NHS Foundation Trust had awarded ‘required improvement’ status. The Trust’s performance continued to give cause for concern and it was suggested that thought should perhaps be given to carrying out a review of who was best equipped to provide certain aspects of the mental health service.

The transforming care programme was progressing well and a number of patients had been successfully moved back into Suffolk from out of county placements.

Organisational Development

Staff had been informed of the intention to move to Endeavour House in December 2017.

A recent Ipswich and East Suffolk CCG Governing Body away day had been successful and identified a number of new ways of working. It was hoped that a similar day could be organised for West Suffolk CCG’s Governing Body.

Kate Vaughton had commenced in the role of Chief Operating Officer for West Suffolk CCG.

A Chief Officer and Deputy Chief Officer session had been convened to take place on 17 October 2016, it was suggested that ‘the benefit of appraisal’ be incorporated as an agenda item.

Work had been commenced to review succession planning.

EG

Ambulance

A remedial action plan and reference costs deal had been agreed in respect of the East of England Ambulance Service Trust.

The Collaborative Group noted the content of the report which it felt highlighted key issues in a useful format.

16/044 Service Performance Review Report

The Collaborative Group was in receipt of the most recent Service Performance Review report which provided more detailed information to support the Chief Officer update. Comments included;

Recruitment of a new lay member to operate across both CCGs was underway.

The need for a revised MVA model of care to be presented to the Governing Body before February 2017 was highlighted.

The Sustainability and Transformation Plan Programme Director post was currently out to advert.

The Collaborative Group noted the report.

16/045 Individual Funding Request (IFR) Team Update

It was explained that the item had been put on the agenda in order to seek assurance, following recent change of Chief Officer responsibility and recommendations from an internal audit report that the team was functioning well. The Audit Committee would continue to track progress against the internal audit recommendations. The Collaborative Group noted the update and requested that the Chief Officer provide a further update to the next meeting, together with including IFR within the Chief Nursing Officer’s key performance indicators for report at future meetings.

EG

16/046 Annual Review of Terms of Reference

The Collaborative Group approved its terms of reference as fit for purpose.

16/047 Any Other Business

No items of other business were received. 16/048 Date of next meeting

Dates 2016

22 December 2016 The Pavilion 11.00am

WEST SUFFOLK CCG COMMISSIONING GOVERNANCE COMMITTEE

Decision Record 19 October 2016

Commissioning Governance Committee Members:

COMMITTEE: Bill Banks Lay Member: Governance (Chair) Johanna Finn Lay Member: Patient and Public Engagement Ed Garratt Chief Officer Jan Thomas Chief Contracts Officer

1 Enhanced Services (ES) To receive and approve a report from the Chief Operating Officer.

WSCCG/CGC 16-06a

The Commissioning Governance Committee was in receipt of a report seeking approval of the Enhanced Services (ES) for Gonodrenalin (GMS practices only) and DVT offered to West Suffolk CCG GP practices for 2016/17.

It was explained that an Internal Audit “Review of GP Payments Arrangements” had highlighted that the Commissioning Governance Committee had not yet approved the ES’s for 2016/17 due to omission and oversight.

Decision

The Commissioning Governance Committee subsequently approved the Enhanced Services for Gonodrenalin (GMS practices only) and DVT offered to West Suffolk CCG GP practices for 2016/17.

2 Support for Primary Care at Scale

To receive and approve a report from the Chief Operating Officer.

WSCCG/CGC 16-07

The Committee was in receipt of a report from the Chief Operating Officer which sought approval to £16,714 being used in 2016/17 to facilitate the development of primary care at scale. Monies would be deducted from the £3 a head the CCG was to receive in 2017/18 to promote primary care at scale.

Decision

After discussion, the Committee approved the payment of £16,714 to the Suffolk GP Federation to support development of primary care at scale for the first phase of practices, subject to the Executive being briefed on the matter.

WEST SUFFOLK CCG COMMISSIONING GOVERNANCE COMMITTEE

Decision Record 16 November 2016

Commissioning Governance Committee Members:

COMMITTEE: Bill Banks Lay Member: Governance (Chair) Johanna Finn Lay Member: Patient and Public Engagement Ed Garratt Chief Officer Lesley MacLeod Chief Finance Officer Jan Thomas Deputy Chief Officer/Chief Contracts Officer

1 Podiatry Service Cost and Service Improvement Proposal – Suffolk Community Healthcare

WSCCG/CGC 16-08

Decision The Committee was in receipt of a report which sought support for

proposed changes to the community podiatry service. Suffolk Community Healthcare (SCH) and the CCGs were developing a joint cost and service improvement plan and SCH had identified benefits in reconfiguring the podiatry service. SCH had estimated the proposed changes would increase efficiency by 5%, creating 100 additional appointments per month. The proposal had been reviewed by the CCG’s community MDT and a Quality Impact Assessment and Equality Impact Assessment completed. SCH’s Provider Management Group had approved the proposal, pending CCG review. The proposal had also been considered by the CCG’s Executive Committee. It was explained that the matter had been brought before the Committee due to the potential for conflict of interests from the transfer of service provision to/from practices. The Chair asked why the paper had been brought to the Committee, when a decision had not yet been made with regard to there being a public consultation in respect of the transfer of services. The Chief Officer commented that it was good practice to consult, as the public had the right to know when there was a change. The Committee agreed that, subsequent to a decision being made on whether there was to be a public consultation and subject to the outcome of any such consultation, a virtual or attended meeting of the Commissioning Governance Committee could be held to make a formal decision on the proposal.

2 Polypharmacy LES

WSCCG/CGC 16-09

Decision The Committee was in receipt of a report which evaluated the value of the

polypharmacy LES as a tool/enabler in tackling inappropriate polypharmacy from 01 April 2016 - 30 September 2016 and to decide if the LES should continue. The Committee was asked to decide on whether the revised version of the LES should be funded from 01 December 2016 to 30 March 2018. That would be with a formal review in January 2018 and with on-going periodic monitoring via the Prescribing Workstream during the duration of the LES. The LES could be terminated earlier if insufficient savings were being achieved It was noted that the continuation of the LES was discussed at the Prescribing Workstream on 09/11/16. The proposal had also been considered by the CCG’s Executive Committee. The Chair commented that the clinical benefits of polypharmacy appeared to be at least as important as the financial benefits and that the longer term aim should be for it to become business as usual rather than an additional task. The Committee also queried the variable outcomes between Practices in their implementation of Polypharmacy. It was confirmed that the updated LES proposal contained procedures (including samples of structures and a requirement for provision of evidence) to better monitor performance, The Committee approved the continuation of the LES from December 2016 to March 2018.

Meeting of the West Suffolk CCG Governing Body...Nov 30, 2016 · 4. Matters Arising and Action Log...

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Transcript of Meeting of the West Suffolk CCG Governing Body...Nov 30, 2016 · 4. Matters Arising and Action Log...