NHS LIVERPOOL CLINICAL COMMISSIONING GROUP … · 11/10/2015 · Approvals Panel - 22nd October...

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NHS LIVERPOOL CLINICAL COMMISSIONING GROUP

GOVERNING BODY TUESDAY 10 NOVEMBER 2015 AT 1PM

Blundell Suite, Blue Coat School Church Road Wavertree L15 (lunch to be provided at 12.30pm)

Part 1: Introductions and Apologies 1.1 Declarations of Interest All 1.2 Minutes and action points from the meeting Attached

on 13th October 2015 All

1.3 Ratification of decisions taken 13th October 2015 All 1.4 Matters Arising All Part 2: Updates 2.1 Feedback from Committees: Report no: GB 77-15

Quality Safety & Outcomes Committee - Dave Antrobus

20th October 2015 Healthy Liverpool Programme Board – Tom Jackson

21st October 2015 Approvals Panel - 22nd October 2015 Prof Maureen Williams Finance Procurement & Contracting Committee Dr Nadim Fazlani

- 27th October 2015 Committees in Common – 4th November 2015 Dr Nadim Fazlani

2.2 Feedback from CCG Network - 4th November 2015 Report no: GB 78-15 Katherine Sheerin 2.3 Feedback from the Joint Commissioning Group - Report no: GB 79-15

2nd November 2015 Katherine Sheerin

2.4 Chief Officer’s Update Verbal Katherine Sheerin 2.5 NHS England Update Verbal

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Clare Duggan 2.6 Public Health Update Verbal Dr Sandra Davies 2.7 Update from Health & Wellbeing Board Verbal Dr Nadim Fazlani Part 3: Performance 3.1 CCG Performance Report Report no: GB 80-15 Stephen Hendry Part 4: Strategy and Commissioning 4.1 Healthy Liverpool Engagement Presentation Report no: GB 81-15

on Activity Summer 2015 Carole Hill

Part 5: Governance

5.1 Corporate Risk Register Report no: GB 82-15

Prof Maureen Williams

5.2 Complaints, Subject Access Requests, Report no: GB 83-15 Freedom of Information Requests and Stephen Hendry MP Enquiries `

6. Questions from the Public

7. Date and time of next meetings: Tuesday 8th December 2015 at 1pm Blundell Suite, Bluecoat School

For Noting: Approvals Panel – 28th April 2015 Quality Safety & Outcomes Committee – 18th August 2015 Primary Care Commissioning Committee Extraordinary meeting - 21 August 2015 Healthy Liverpool Programme Board – 17th September 2015 Finance Procurement & Contracting Committee – 6th October 2015 Committees in Common – 7th October 2015

Exclusion of Press and Public: that in view of the confidential nature of the business to be transacted, members of the public, press and non voting members be excluded from the

meeting at this point.

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Report no: GB 77-15 NHS LIVERPOOL CLINICAL COMMISSIONING GROUP

GOVERNING BODY TUESDAY 10TH NOVEMBER 2015

Title of Report Feedback from Committees Lead Governor Dr Nadim Fazlani, Dr Rosie Kaur, Dave Antrobus,

Prof, Maureen Williams Senior Management Team Lead

Cheryl Mould, Head of Primary Care Quality & Improvement, Tom Jackson, Chief Finance Officer, Jane Lunt, Head of Quality/Chief Nurse, Katherine Sheerin, Chief Officer

Report Author(s)

Cheryl Mould, Head of Primary Care Quality & Improvement Tom Jackson, Chief Finance Officer Jane Lunt, Head of Quality/Chief Nurse

Summary The purpose of this paper is to present the key issues discussed, risks identified and mitigating actions agreed at the following committees: Quality Safety & Outcomes Committee - 20th

October 2015 Healthy Liverpool Programme Board –21st

October 2015 Approvals Panel - 22nd October 2015 Finance Procurement & Contracting Committee -

27th October 2015 Committees in Common – 4th November 2015

This will ensure that the Governing Body is fully engaged with the work of committees, and reflects sound governance and decision making arrangements for the CCG.

Recommendation That Liverpool CCG Governing Body: Considers the report and recommendations from the

committees Impact on improving health outcomes, reducing inequalities and promoting financial sustainability

As per each Committee’s Terms of Reference

Relevant Standards or targets

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QUALITY SAFETY AND OUTCOMES COMMITTEE

TUESDAY 20TH OCTOBER 2015 3PM TO 5PM ROOM 2 4TH FLOOR ARTHOUSE SQUARE

A G E N D A

1. Welcome & Introductions ALL 2. Declaration of Interests ALL 3. Minutes and Action notes from 18th August 2015 Chair 4. Matters Arising

5. Care Home Sector – Quality and Safety Overview QSOC 33-15

Kerry Lloyd 6. Trust Contract Quality - Early Warning Dashboard QSOC 34-15

Kellie Connor

7. Safeguarding Service Report QSOC 35-15 Esther Golby

8. Management of Allegations Policy and Procedures QSOC 36-15 Tracy Forshaw 9. Serious Incident Framework 2015 QSOC 37 -15

Denise Roberts 10. Risk Register QSOC 38-15

Jane Lunt

11. Any Other Business – Dates for 2016 Verbal All

Date & Time of next meeting Tuesday 1st December 2015 3pm to 5pm Meeting Room 2 Arthouse Square For Noting - CPQG Finalised minutes: Mersey Care – 30th July 2015 Spire – 15th May 2015 Alder Hey – 24th July 2015 RLBUHT – 21st August 2015 Liverpool Women’s – 28th August 2015 LCH – 6th August 2015

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LIVERPOOL CCG CORPORATE GOVERNANCE TEMPLATE – COMMITTEE MINUTES Committee: Quality, Safety & Outcomes Committee

Meeting Date: 20th October 2015 Chair: Dave Antrobus

Key issues: Risks Identified: Mitigating Actions: 1. Overview report of Care Homes sector

highlighted the programmes of work delivered to monitor the quality and safety of care provided.

• Lack of alignment of programmes of work with LCC creates gaps in knowledge and understanding of quality issues in the Care Home sector.

• Clarity re leadership within CCG. • Alignment of programmes of work

between Liverpool CCG and LCC ongoing.

• Regular oversight of quality and safety

issues via Quality Safety & Outcomes Committee and Quality Surveillance Group.

2. Serious Incidents update highlighted disproportionate impact on LCCG for managing process as coordinating commissioner for 7 trusts.

• Review of some Root Cause Analyses not able to be undertaken within nationally mandated timescales.

• Challenge from partner CCGs re this.

• Potential reputational risk to CCG re

this..

• Work closely with partner CCGs and NHS England to ensure clarity of roles and responsibilities.

• Explore alternative models of clinical

review of Root Cause Analysis reports.

• Explore alternative options to management of Serious Incidents (and other quality issues) in Mersey, such as pooling of CCG resources.

Recommendations to NHS Liverpool CCG Governing Body: 1. Note the issues and the actions to mitigate risks.

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Healthy Liverpool Programme Board

Wednesday 21st October 2015

3:00pm to 4:30pm

Room 1, 4th Floor Arthouse Square

AGENDA

1. Welcome and Introductions

2. Minutes of the last meeting TJ

3. Programme Highlight reports (attached) SROs

4. Blueprint Document - update CH

5. Decision Making Process (paper to follow) CH

6. Programme Plan (attached) CH

7. Engagement update CH

8. Clinical Assembly update All

9. Risk Register review All

10. Any Other Business All

11. Date and time of next meeting – Wednesday 25th November, 3pm to 4.30pm

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LIVERPOOL CCG CORPORATE GOVERNANCE TEMPLATE – COMMITTEE MINUTES Committee: Healthy Liverpool Programme

Meeting Date Wednesday 21st October 2015

Chair: Tom Jackson

Key issues:

Risks Identified: Mitigating Actions:

1. Embedding the Bain Decision Effectiveness Tool

• Inconsistent decisions, lacking an evidence base could impact on the effectiveness of the Healthy Liverpool programme. Projects and programmes may not provide value, which would jeopardise the achievement of health outcomes.

• The Bain decision-effectiveness tool will be used to support investment decisions. The tool provides a higher level of assurance about the value of projects and programmes; with value measured in terms clinical outcomes, quality and safety, patient experience, population health, social value, workforce, cost and financial sustainability.

2. Programme Plans

• Ineffective programme management and performance monitoring could lead to uncoordinated or ineffective delivery and a poor understanding of risks and opportunities.

• Robust governance arrangements in place for each of the 5 transformation programmes and the overarching programme, with standardised programme reporting and management. Issues, risks and delivery status are reported systematically in a monthly cycle.

3. Community Clinical Assembly

• Lack of awareness and engagement with stakeholders who could influence or who are delivering the community model could lead to failure in implementation of the model. Lack of awareness and management of the interface between community and hospital stakeholders would also impact on the implementation of the model.

• A series of quarterly Healthy Liverpool Clinical Summits are intended to build clinical awareness and involvement in the programme. The next summit, on 27th November, will focus on the community model, involving community and hospital clinicians.

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Recommendations to NHS Liverpool CCG Governing Body: 1. To note that the Bain decision-effectiveness tool is being implemented for all investment decisions, in an appropriate manner with varying approaches depending upon the size of the investment and an assessment of risk. 2. The Healthy Liverpool programme management and governance arrangements provide assurance around ongoing delivery of the programme.

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APPROVALS PANEL

FRIDAY 22ND OCTOBER 2015 8.30AM – 9.30AM

ARTHOUSE SQUARE

A G E N D A

1. Welcome and apologies

2. Enhancing access to primary care scheme 2015/16

a) Winter Scheme Applications Summary b) Review of Bids

3. Discretionary payments to practices a. Fulwood Green MC

4. Any other business

5. Date of next meeting

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LIVERPOOL CCG CORPORATE GOVERNANCE TEMPLATE – COMMITTEE MINUTES Committee: CCG Approvals Panel

Meeting Date: 22nd October 2015

Chair: Maureen Williams

Key issues:


1. Enhanced access to primary care scheme 2015/16 – approval of 5 additional applications

• Enhanced access scheme continues to demonstrate impact on outcomes agreed for scheme

• Learning from scheme is not aligned to the ongoing work around 7 day access and GP Specification developments

• Further interim report to be presented to Primary Care Commissioning Committee

• Proposal to improve access included within GP specification from April 2016 and a full review of access into general practice is to be undertaken in line with 7 day access in primary care

Recommendations to NHS Liverpool CCG Governing Body:

1. Notes the key issue, risk identified and actions to be taken.

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FINANCE, PROCUREMENT AND CONTRACTING COMMITTEE TUESDAY 27TH OCTOBER 2015 10:00AM – 12:30PM

ROOM 2 – ARTHOUSE SQUARE

AGENDA

1. Welcome and Introductions All 2. Declaration of Interests (form available) All 3. Minutes and action notes of previous meeting

held on 06 October 2015 Chair

4. Contract Waivers Summary Report no:FPCC60-15 Derek Rothwell

5. Contracts Month 5 Update Report no:FPCC61-15 Derek Rothwell

6. Finance and KPI update Report no:FPCC62-15 Alison Ormrod

7. Specialised Commissioning Update Verbal update Tom Jackson

8. Any Other Business All Date of next meeting(s): 2015 monthly meetings: 4th Tuesday of the month 10am – 12:30pm

Room 2 – Arthouse Square

Tuesday 24 November 2015 10am-12.30pm

VENUE TO BE CONFIRMED (was Room 2 Arthouse Square)

Tuesday 22 December 2015 10am-12.30pm


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Tuesday 26 January 2016 10am-12.30pm


Tuesday 23 February 2016 10am-12.30pm


Tuesday 22 March 2016 10am-12.30pm


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LIVERPOOL CCG CORPORATE GOVERNANCE TEMPLATE – COMMITTEE MINUTES Committee: Finance, Procurement & Contracting Committee

Meeting Date: Tuesday 27 October 2015

Chair: Dr Nadim Fazlani

Key issues:


1. Migration of specialised services from NHS England to Liverpool CCG both in the current financial year and 2016/17.

• Uncertainty regarding services to transfer.

• Potential financial pressure arising from inadequate resource transfer

• NHS England working through Clinical Reference Groups on amendment to identification rules for specialist services to increase clarity around responsible commissioner.

• Close partner working across the local health economy.

2. LCH notification to the CCG

that they will temporarily cease to accept new referrals for paediatric speech and language therapy.

• Inadequate service provision resulting in delays with detrimental impact to patients.

• CCG programme leads to work with LCH to develop an action plan to address this issue.

Recommendations to NHS Liverpool CCG Governing Body: 1. To note the above issues, risks and mitigating actions.

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HEALTHY LIVERPOOL PROGRAMME

RE-ALIGNING HOSPITAL BASED CARE

COMMITTEE(S) IN COMMON (CIC) KNOWSLEY, LIVERPOOL AND SOUTH SEFTON CCGS

WEDNESDAY 4th NOVEMBER

Runcorn Town Hall, Heath Road, Runcorn WA7 5TD

Time 4:00pm – 5:30pm

1. Welcome, Introductions and apologies All

2. Declarations of Interest All

3. Notes / Actions from the previous meeting held on 7 October, 2015 All

4. Interdependencies across Sefton, Knowsley and Liverpool

• Shaping Sefton • Knowsley Joint Health & Wellbeing Strategy

F Taylor D Johnson

5. Feedback from clinical discussions F Lemmens

6. Strategic Estates Programme (Presentation attached)

7. Strategic Options Appraisal – report from RLUBHT & AUHFT

8. Public Engagement / Consultation (Paper attached)

9. Any other business All

10. Date of Next Meeting – Wednesday 2 December 2015 4:00pm - 5:30pm (venue same as the CCG Network)

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LIVERPOOL CCG CORPORATE GOVERNANCE TEMPLATE – COMMITTEE MINUTES Committee: Committees in Common Meeting Date: 4 November 2015 Chair: Dr Nadim Fazlani

Key issues: Risks Identified: Mitigating Actions: Alignment of transformation plans across Liverpool, Sefton and Knowsley where there are co-dependencies.

• Unforeseen consequences of commissioning decisions in community services impacting on hospital services.

• Learning/skills not shared across

CCGs.

• Sefton plan shared at CIC. • I Davies/C McCluskey to map areas of

co-dependency and ensure alignment.

• Knowsley plan to be shared at the next CIC meeting.

Public engagement and consultation

• Lack of clarity regarding the driving issues resulting in poor understanding of need for change across Liverpool, Sefton and Knowsley.

• Comms and engagement group across Liverpool, Sefton and Knowsley CCGs and LAs to be established to jointly drive this work.

Recommendations to NHS Liverpool CCG Governing Body: 1. To Note the issues and the actions to mitigate risks.

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Report no: GB 78-15

NHS LIVERPOOL CLINICAL COMMISSIONING GROUP GOVERNING BODY

TUESDAY 10TH NOVEMBER 2015

Title of Report Feedback from Merseyside Clinical Commissioning Groups Network

Lead Governor Dr Nadim Fazlani, Chair

Senior Management Team Lead

Katherine Sheerin, Chief Officer

Report Author

Katherine Sheerin, Chief Officer

Summary The purpose of this paper is to present the key issues discussed, risks identified and mitigating actions agreed at the Merseyside CCG Network on 4th November 2015. This will ensure that the Governing Body is fully engaged with the work of the Merseyside CCG Network and reflects sound governance and decision making arrangements for the CCG.

That Liverpool CCG Governing Body: Considers the reports and recommendations

from Merseyside CCG Network

Impact on improving health outcomes, reducing inequalities and promoting financial sustainability

By working collaboratively with CCGs across Merseyside we will ensure that opportunities are maximised for Liverpool patients and the consequence of commissioning services understood and managed.


Standards of Good Governance Putting Patients First 2014 – 16 Everyone Counts: Planning for Patients 2014/15

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JOINT CHESHIRE & MERSEYSIDE CCG NETWORK

Wednesday 4th November 2015, 12.30 pm to 16.00pm Civic Suite, Runcorn Town Hall, Heath Road, Runcorn, WA7 5TD

Lunch available from 12.30pm.

Time Item No

Item Verbal/ Report

Lead 12.30

15/155

Devolution

Verbal

Steve Cox

13.45

15/154

Notes & Actions from Last meeting

Verbal

Simon Banks

13.55

15/156

Contracting & Delegated Services

Verbal

John Develing

14.05

15/157 Cheshire and Merseyside Women’s and Children’s

Services Partnership

Verbal

Simon Banks

14.15

15/158

Urgent & Emergency Care

Verbal

Cliff Richards

14.25

15/159 Specialised Services and Contracts and Planning

2016/17

Verbal

All

14.35

15/160

Support for commissioning wheelchair services

Report

Simon Banks

14.45

15/161

Review of Work Plan

Report

All

14.55

15/162

Schedule of meetings for 2016

Report

Simon Banks

15.05

15/163

Drugs – Shared Care

Report

Ian Campbell St Helens CCG

Apologies

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LIVERPOOL CCG CORPORATE GOVERNANCE TEMPLATE – COMMITTEE MINUTES Committee: CCG Network

Meeting Date: 4 November 2015

Chair: Simon Banks

Key issues:


1. Joint working across CCGs.

• That commissioning is not maximised across the LCR footprint leading to fragmentation and duplication.

• That CCGs are not placed to

collectively lead the direction for health services across the LCR

• Paper previously agreed at CCG Network now being reviewed by each CCG to determine future governance arrangement s for the Network (by December 2015)

• New work plan being developed to

contain areas the Network will drive forward.

• Specialised Services – LCR footprint to

be footprint for co-commissioning. To be confirmed with NHSE.

• Specialised Services – TJ to work with

colleagues to confirm key issues and responsibilities.

Recommendations to NHS Liverpool CCG Governing Body:

1. To note the progress regarding joint working across CCGs.

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Report no: GB 79-15



Title of Report Feedback from the Joint Commissioning Group of the Health & Wellbeing Board/Liverpool CCG

Lead Governor Dr Simon Bowers


Tony Woods, Head of Strategy and Outcomes

Report Author

Tony Woods, Head of Strategy and Outcomes

Summary The purpose of this paper is to present the key issues discussed, risks identified and mitigating actions agreed at the Joint Commissioning Group on 2nd November 2015. This will ensure that the Governing Body is fully engaged with the work of the Joint Commissioning Group and reflects sound governance and decision making arrangements for the CCG.

Recommendation That Liverpool CCG Governing Body: Considers the reports and

recommendations from Joint Commissioning Group


• Reduction of health inequalities in the city • Improve the physical and mental health and

well-being of the population of residents in Liverpool


Preventing people from dying prematurely Helping people to recover from episodes of ill-health or following injury Ensuring that people have a positive experience of care

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JOINT COMMISSIONING GROUP OF THE LIVERPOOL HEALTH AND WELLBEING BOARD

Monday, 2 November 2015

3.00 P.M.

AGENDA

1. Welcome and Introductions

For the Chair to welcome attendees to the meeting and lead introductions

2. Declarations of Interest

To provide an opportunity for Officers to declare any pecuniary or significant prejudicial interests they may have in any item on the agenda

3. Notes of the Last Meeting

th To receive the notes of the last meeting, which took place on 7

September 2015

(Pages 1 - 5) 4. Better Care Fund

(a) Better Care Fund - DOH Letter

To receive and consider a letter in relation to the Better Care Fund from Rt. Hon. Alistair Burt MP Minister of State for Community and Social Care

(Pages 6 - 7) (b) Better Care Fund Update

(Pages 8 - 14)

5. Local Integration Support Fund

(Pages 15 - 20)

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6. Update on Public Health Budget Cuts (Verbal) 7. Public Health Procurements Update (Verbal)

8. Home Care Services (Verbal Update)

9. Delayed Discharges / Winter Preparedness (Verbal Update)

10. Other Relevant Items

To consider other relevant items

11. Date and Time of the Next Meeting

To note the date and time of the next meeting, as – Monday 21st December at 3pm in the Queen Mary Suite, 6th Floor Cunard Building Water Street.

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JOINT COMMISSIONING GROUP OF THE LIVERPOOL HEALTH AND WELLBEING BOARD

Monday, 2 November 2015

3.00 P.M.

AGENDA

12. Joint Performance Report October 2015

(Pages 1 - 19)

13. Support Services

(a) Current Domiciliary Care Services (Verbal Update)

(b) New Liverpool Help to Live at Home Service (Verbal Update)

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LIVERPOOL CCG CORPORATE GOVERNANCE TEMPLATE – COMMITTEE MINUTES Committee: Joint Commissioning Group of the Liverpool Health and Wellbeing Board

Meeting Date: 2nd November 2015 Chair: Katherine Sheerin, Samih Kalakeche

Key issues: Risks Identified: Mitigating Actions: 1. Better Care Fund

• Effective governance in place to manage scheme implementation.

• Delivery of planned benefits.

• Joint review (LCC/LCCG) of existing schemes and governance arrangements in place to inform 16/17 Better Care Fund and delivery.

2. Review of Public Health budget reductions and planned procurements.

• Impact on outcomes for population and delivery of Healthy Liverpool Programme objectives.

• Risk of alignment of Public Health

procurement plans with Healthy Liverpool Programme plans.

• Public Health to produce potential options and impact of budget plans for review in November 2015.

• Joint meeting between Liverpool City

Council and Liverpool CCG officers to review procurement plans and identify risks and review options.

3. Update on Care Home provision.

• Increased demand on care home provision.

• Wider system wide issues relating to

admissions and discharges.

• Joint work between CCG/LCC colleagues to identify key risks, both short-term (winter) and medium/long term requirements

• Detailed paper to be provided to Joint

Commissioning Group on current market issues and opportunities for improvement.

4. Update on delayed discharges/winter preparaedness.

• Lack of social care capacity over winter period.

• Wider impact on whole system relating

to admissions and discharges.

• Internal plan (LCC) for social work delivery produced and to be discussed at System Resilience Group.

• Increased joint working between

Liverpool CCG/Liverpool City Council colleagues to review plans and ensure cohesive delivery..

Recommendations to NHS Liverpool CCG Governing Body: 1. To note the issues and mitigating actions from the JCG

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Report no: GB 80-15


GOVERNING BODY


Title of Report CCG Corporate Performance Report

Lead Governor Dr Nadim Fazlani


Stephen Hendry, Acting Head of Operations and Corporate Performance

Report Author

Stephen Hendry, Acting Head of Operations and Corporate Performance

Summary The purpose of this paper is to report to the Governing Body key aspects of the CCG’s performance in delivery of quality, performance and financial targets for month 6 (September) 2015/16.

Recommendation That Liverpool CCG Governing Body: Notes the performance of the CCG in delivery

of key national performance indicators and the recovery actions taken to improve performance


The report provides evidence of the progress being made across the organisation at both an organisational and individual service provider level.


NHS Outcomes Framework 2015/16; The Forward View Into Action: Planning for 2015/16; CCG Assurance Framework 2015/16

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LIVERPOOL CCG PERFORMANCE REPORT NOVEMBER 2015 1. PURPOSE The purpose of this paper is to report to the Governing Body key aspects of the CCG’s performance against delivery of quality, performance and financial targets for the financial year 2015/16. 2. RECOMMENDATIONS That Liverpool CCG Governing Body: Notes the performance of the CCG in delivery of key national performance

indicators and the recovery actions taken to improve performance, if required. 3. BACKGROUND The CCG is held to account by NHS England for corporate performance against delivery of key indicators within the CCG Outcome Indicator Set (NHS Outcomes Framework 2015/16) and operational standards expected from the NHS Constitution. For the financial year 2015/16, the CCG also has to demonstrate how it is to fulfil the vision set out in the NHS Five Year Forward View whilst continuing to deliver high quality and timely care for the people of Liverpool. The CCG therefore has to be assured that the services we commission are delivering the required quality standards and that any risks and issues relating to service quality and patient safety are identified; with positive action taken to address areas of sub-optimal performance. The CCG has established robust governance frameworks and committee structures in order to monitor performance and provide assurance to the Governing Body that key risks to the organisation are being identified and effectively managed. For example, the Quality, Safety and Outcomes Committee has responsibility for quality and performance issues within its commissioned services, whereas the Finance, Procurement and Contracting Committee has responsibility for financial monitoring and contract activity. The Performance Report for the financial year 2015/16 will provide a summary of CCG performance in relation to the NHS Outcomes Framework 2015/16 (including newly

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introduced Mental Health access waits quarterly indicators) and performance analysis against key Public Health/local outcomes; providing the Governing Body with an integrated report structure which maps progress against statutory reporting requirements and measurement across the priority programme areas of Mental Health; Healthy Ageing; Long Term Conditions; Children; Learning Disabilities, Urgent Care and Cancer. Due to the way in which these indicators are measured, a high proportion of these elements will be reported on a quarterly and annual basis, or as and when key data is made available/refreshed. Due to NHS England aligning the publication dates of performance data (and transitional arrangements in place with the current CSU provider for corporate performance reporting), the timing and accuracy of some data flows continue to present challenges in terms of maintaining the consistency and continuity with previous reports presented this financial year (i.e. monthly reporting of RTT and A&E 4hr target). The CCG Business Intelligence (BI) Team continue to work closely with CSU and healthcare providers to ensure the stability of key information areas. The structure, content and presentation of the Corporate Performance report will continue to develop in 2015/16 with the aim of presenting the Governing Body with an accurate and robust level of measurement against ‘constitutional’ performance objectives and improved health outcomes for the people of Liverpool. This report is based on the published and validated data available as at 30th September 2015. As a consequence of the timing of submissions to meet NHS Liverpool CCG’s governance reporting and data schedules, this report updates the Governing Body with a combination of data up to the end of August and/or September 2015. 4. NATIONAL PERFORMANCE MEASURES NHS Liverpool CCG is committed to ensuring that patient rights under the NHS Constitution are consistently upheld. National Performance Measures are reflective of the key priority areas detailed in the NHS Outcomes Framework 2015/16 and include measurements against Quality (including Safety, Effectiveness and Patient Experience) and Resources (including Finance, Capability and Capacity). In addition to analysing local performance against these indicators, CCGs are expected to achieve improvements against indicators across the five domains as detailed in the NHS Outcomes Framework and NHS Operational Planning Measures 2015/16 which represent the high-level national outcomes the NHS is expected to be aiming to improve. Headline commentary is provided below to draw the Governing Body’s attention to specific areas of performance which represent risks to delivery, and to the relevant assurances on internal control measures in place to mitigate those risks.

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4.1 NHS Constitution – Access & Waiting 4.1.1 Good Performance

Indicator Narrative Referral To Treatment Incomplete pathway (18 Weeks) Referral to Treatment Incomplete pathway (52 Weeks) GREEN

Liverpool CCG’s performance in September 2015 remains at ‘Green’ across both RTT measures. Despite Liverpool achieving ‘zero’ tolerance against 52 week standard in September, one patient had waited more than 52 weeks in August 2015. Due to timeliness of reporting this breach was not included in the October 2015 report. The breach related to a patient who was on the waiting list at University of Leicester Hospital. At provider level, September 2015 performance exceptions include the following:

• Liverpool Heart and Chest Hospital, Failed to achieve 92% threshold for patients waiting less than 18 weeks for treatment in August 2015 achieving 90.66%. However, unvalidated data reported for September 2015 shows the trust are now achieving threshold reporting 93.5%.

*Commissioner level data is historically published one month ahead of provider level data.

Indicator Narrative Diagnostics - Percentage of Patients waiting for more than 6 weeks for a diagnostic test (target – 1%) GREEN

CCG performance against diagnostics is below the 1% threshold for the fifth consecutive month, with August 2015 figures reported at 0.44%. At provider level all providers are achieving <1% plan for patients waiting no more than 6 weeks for diagnostic test. Provisional data for September 2015 shows that all Liverpool providers have achieved <1% plan. *Commissioner level data is historically published one month ahead of provider level data.

Indicator Narrative A&E Waits - % of patients who spend 4 hours or less in A&E (cumulative) 95% threshold – all types GREEN

Performance for August 2015 remains above 95% with the CCG achieving 96.44% (all types). Exceptions at provider level are as follows: Aintree Hospitals - despite improved performance earlier on the year, Aintree failed to achieve 95% threshold in August 2015 reporting 94.1%. 729 patients waited longer than the standard in August. Provisional data reported for September 2015 reports a further reduction in performance at the trust of 92.6%.

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Indicator Narrative Cancer Waiting Times (All measures) GREEN (with alert)

At CCG Level all cancer waiting time targets have been achieved in August 2015. Continued achievement against all cancer measures has provisionally been reported in September 2015. However two providers have reported performance below plan in August 2015;

Maximum two-week wait for first outpatient appointment for patients referred urgently with breast symptoms (where cancer was not initially suspected):

• Royal Liverpool Hospital failed to achieve the 93%

threshold in August 2015, achieving 92.8%. Of the 235 patients referred, 17 patients waited more than two weeks for referral.

Maximum two month (62-day) wait from urgent GP referral to first definitive treatment for cancer • Liverpool Heart and Chest Hospital Failed to achieve the

85% threshold in August 2015, achieving 83.9%. Of the 16 patients treated, 3 patients waited more than 62 days to start treatment.

Assurance on CCG control measures The Royal Liverpool Hospital continues to face challenges in achieving the measure for two week waits for breast symptoms due to patient cancellations and re-booking. Mitigating actions for the Trust include seeking closer working arrangements with primary care in relation to patient cancellations. The Trust has also been reviewing performance in ‘real time’ to seek resolution (although early indications are that September 2015 performance is following a similar trajectory). Liverpool Heart and Chest Hospital have longstanding issues in relation to lung pathways, and the Lung Pathway Group continues to critically review and analyse lung pathways and promote best practice at Network level. Performance is regularly reviewed between the Trust and the CCG with a focus on reducing time from referral to treatment and understanding variation across the Network. The numbers of patients breaching are relatively small and due to variation across the network in terms of speed of referral. Indicator Narrative Ambulance Response Times. GREEN

CCG performance continues to be achieved in August 2015 against the following national standards;

• Red 1: 8 minute response 88.1% against 75% target • Red 2: 8 minute response 85.1% against 75% target • All Reds: 19 minute response 98.4% against 95% target

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4.3 IAPT Access, Recovery Rates & Referral to Treatment Times (RTT) 4.3.1 Good performance Indicator Narrative - % of patients who received their first appointment within 6 weeks of referral (Target 75%) GREEN

The new waiting time standard requires 75% of adults diagnosed with common mental health conditions to be referred to the Improved Access to Psychological Therapies (IAPT) programme and treated within 6 weeks of referral. The CCG has achieved 80% for Quarter 2 against this measure, exceeding the 75% target set. This only represents a slight reduction in performance when compared to the previous quarter.

4.3.1 Areas for improvement Indicator Narrative IAPT -% of people who receive psychological therapies Access - Quarterly Measure 3.25%) RED (Quarter 2)

The CCG has failed to achieve the quarterly measure of 3.25% with performance in Quarter 2 at 2.97%, slight improvement in performance compared to previous quarter. Performance rates continue to be heavily influenced by a backlog of patients waiting which were detected only following transfer to the new provider (Mersey Care) from 1st April 2015. Although 'New' patients/referrals are monitored against IAPT standards separately from those on the inherited waiting list (to ensure proportionate provider delivery against standards) it has impacted on overall compliance in both Quarter 1 and Quarter 2 of 2015/16.

Assurance on CCG control measures Agreement has been reached with the Trust that payment will be made on a ‘cost per case’ basis for waiting list activity over and above contracted activity. The CCG issued a ‘Contract Performance Notice’ to the Trust in September 2015 which continues to be monitored via established contract review meetings; providing assurances that all actions are being actively progressed and measured.

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Indicator Narrative IAPT - % of people who finish treatment having attended at least two treatment contacts and are moving to recovery (Recovery plan of 50% - Quarterly) RED (Quarter 2)

As with IAPT access rates above, CCG has also underperformed against the quarterly plan of 50% with performance in Quarter 2 at 34%.

Assurance on CCG control measures As above, a remedial action plan has been agreed between the Trust and the CCG to address access, recovery and waiting times which includes increasing clinical capacity within the Talk Liverpool Service, Sub-contracting to address the waits for counselling; an increase in group therapy (in both choice of groups and the numbers) and an increase in computerised CCBT. Indicator Narrative Referral - % of patients who received their first treatment appointment within 18 weeks of referral (Target 95%) RED

The new waiting time standard requires that 95% of people with common mental health conditions referred to the Improved Access to Psychological Therapies (IAPT) programme will be treated within 18 weeks of referral. This standard applies to adults. The CCG has marginally underperformed against the plan of 95% with Quarter 2 performance at 94%.

Assurance on CCG control measures CCG control measures as detailed above.

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4.4 NHS Outcomes Framework - Ensuring People Have a Positive Experience of Care 4.4.1 Areas for improvement Indicator Narrative Mixed Sex Accommodation – zero tolerance of breaches RED

There were two breaches of the standard allocated to Liverpool CCG in September 2015. The breaches were recorded at Liverpool Heart and Chest Hospital. The breaches occurred due to a shortage of beds, which prevented the patients being transferred from Critical Care to another ward.

Assurance on CCG control measures The Trust has experienced continued issues with patient flow out of Critical Care (which were initially reported to the LHC Board in May 2015). Financial penalties will continue to be applied where appropriate and progress against the Trust Action Plan will be monitored through the Clinical Quality and Performance Meetings. 4.5 Health Care Acquired Infection (HCAI) 4.5.1 Good Performance Indicator Narrative Incidence of Healthcare Acquired Infections – MRSA Monthly plan tolerance of 0 Annual plan of 0 for 2015/16 GREEN

There were zero cases of MRSA reported in September 2015, maintaining the ‘Green’ status for 2015/16.

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4.5.2 Areas for Improvement Indicator Narrative Incidence of Healthcare Acquired Infections – C.difficile Monthly plan tolerance of 12 Annual plan of 138 for 2015/16 RED

There were 11 new cases of C.Diff reported in September 2015 bringing the year to date total to 74. The CCG is below the monthly plan of 12 and equal with the year to date plan of 74. Of the 11 cases reported in September, 4 have been reported as Acute acquired and 7 reported as Community acquired. C.diff cases reported on LCCG Patients at provider;

• 6 of the cases were assigned to the Royal Liverpool & Broadgreen (1 acute, 5 community)

• 4 cases were assigned to Aintree, (2 acute and 2 community) • 1 case was assigned to Liverpool Heart and Chest Hospital.

(1 acute case). Year to date 46 of the 74 cases have been reported at Royal Liverpool and Broadgreen. C. diff cases reported by provider Royal Liverpool & Broadgreen The Trust has recorded 1 case in September which brings the year to date total to 16 compared with a plan of 22. The infection recorded in September related to a Liverpool CCG patient. Aintree Hospital The Trust recorded 8 new cases in September which brings the year to date total to 25 compared to a plan of 23. Of the infections recorded in September, 2 cases related to Liverpool CCG patients. Liverpool Heart and Chest The Trust recorded 1 case in September which brings the year to date total to 2 which equals the year to date plan of 2. The infection recorded in September related to a Liverpool CCG patient.

Assurance on CCG Control Measures The CCG continues to adopt a multi-faceted approach to tackling C.diff. As reported previously, a working group has been established to focus on Antimicrobial Prescribing in the community and the HCAI Quality Lead is now in post (as at 3rd November 2015) and will be crucial to leading and supporting this development work. All C.diff Root Cause Analysis (RCA) reports sent to the CCG are undergoing thematic analysis; in particular where cases are attributed to the community so as to target interventions and remedial/composite action plans accordingly. C.diff Panels are consistently scheduled throughout the calendar year with Liverpool CCG working closely with South Sefton CCG to support the process where relevant.

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Indicator Narrative Incidence of Healthcare Acquired Infections – MRSA Monthly plan tolerance of 0 Annual plan of 0 for 2015/16 RED

The CCG had no new cases of MRSA in September 2015 but remains as ‘Red’ however due to 6 cases reported year-to-date.

Assurance on CCG Control Measures Each MRSA case reported is subject to robust Post Infection Review (PIR) processes with wide stakeholder engagement and appropriate remedial action plans put in place to address any gaps in quality or safety and prevent recurrences. Although is acknowledged that some elements of these cases are difficult to performance manage due to the numbers of (independent) providers involved in incidents, the CCG is currently undertaking a review of all MRSA cases for 2014/15 and 2015/16 to identify common themes which will in turn inform an improvement /reduction plan (a HCAI risk summit is scheduled to take place during November 2015 and key actions from this will be summarised in the December 2015 Performance Report. 4.6 NHS Outcomes Framework - Treating and Caring for People in a Safe Environment 4.6.1 Good Performance Indicator Narrative Never Events (Plan of Zero) GREEN

The CCG is rated as ‘Green’ for the month of September 2015 and for year-to-date 2015/16 against a ‘zero tolerance’ for Never Events. At provider level no never events were reported in September 2015.

Assurance on CCG Control Measures All providers who report Never Events triangulate each incident where there is evidence of non-compliance of the WHO checklist. The CCG works closely in partnership with providers to ensure that all Serious Incidents/Never Events result in organisational and system-wide learning from their Root Cause Analysis. At a system-wide and regional level, NHS England has established a Quality & Safety Forum/Patient Safety Collaborative which has recently focused on Never Events and the learning from these incidents (Liverpool Community Health recently presented their findings from internal reviews of community dental Never Events to the Forum to disseminate learning across the wider health economy).

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4.6.2 Areas for Improvement Indicator Narrative Serious Incidents – reporting within 48 hours (national target) The 48 hour national timescale is in place to ensure that providers of healthcare services alert commissioners to each event where a patient has suffered significant harm or death as a result of their care. The early detection and reporting of Serious Incidents is essential for both providers and commissioners in order to agree immediate actions to prevent further harm occurring. It is proposed that future reporting of Serious Incident activity and performance is on a Quarterly basis to enable a more thorough analysis. AMBER

Serious Incidents Allocated to Liverpool CCG A total of 29 Serious Incidents (SIs) were assigned to Liverpool CCG in September 2015, bringing the CCG year-to-date total to 120. Out of the 21 incidents recorded for September, 21 (72.41were reported within the 48hr target (72.41%). This is a notable improvement on August performance of 57.89%. These incidents are apportioned as follows at provider level: • Aintree University Hospital - reported two incidents, both outside

of the 48hr target (0%); • Liverpool Community Health (LCH) – total of 13 incidents,

seven within 48hr target (53.85% compliance); • Mersey Care – 11 incidents reported for September, all within the

48hr target (100% compliance) • Royal Liverpool – total of two incidents reported, both within the

48hr target (100%) • Liverpool Women’s – one incident reported which was within

48hrs (100%); At provider catchment level (i.e. Serious Incidents reported and allocated to multiple CCGs) the following activity was recorded for August 2015: • Royal Liverpool – 2/2 within 48hrs, YTD total = 27; • Alder Hey –2/2 YTD total = 10; • Liverpool Women’s – 2/2 within 48hrs, YTD total = 11; • Mersey Care – 11/11 within 48hrs, YTD total = 65; • LCH –18/29 within 48hrs, YTD total = 99; • Spire - 0 incidents in Sept, YTD total = 1 • Liverpool Heart & Chest – 0 incidents, YTD= 2

Assurance on CCG control measures (Serious Incidents) This indicator was intended to provide the Governing Body with a measurable level of assurance that all Serious Incidents are reported within nationally determined timescales and that provider investigations into the root causes are commenced at the earliest possible opportunity. It is recognised, however that this level of reporting does not facilitate the ‘thematic review’ of Serious Incidents. It is therefore proposed that Serious Incident activity and performance should be on a quarterly basis, and will be included in the January 2016 Corporate Performance Report.

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Indicator Narrative Serious Incidents –Submission of investigation reports within 60 days (national timescale) The 45 day national timescale is in place to ensure that providers of healthcare services conduct timely and thorough Root Cause Analysis (RCA) investigations into Serious Incidents. Within this standard is the requirement for providers to submit outcomes-based action plans to improve the quality and safety of services and to limit or eliminate recurrences of incidents. Where extensions of time have been agreed with the provider the new deadline is used as the performance measure. RED

Serious Incidents/RCA Allocated to Liverpool CCG A total of 29 RCA Reports allocated to Liverpool CCG were due for submission during the month of September 2015. Out of the 29 cases 12 were submitted within the 60 day timeframe (41.38%). This does represent a slight improvement on August’s performance of 29%. At provider level, this is distributed as follows: • Royal Liverpool - 6 reports due in-month, 4 received within 60

days (66.67%) • 5 Boroughs Partnership – 1 report due in month, submitted

outside of 60 day timescale; • Liverpool Community Health – 14 RCA reports due in-month, 3

meeting the 60 day deadline (21.43%); • Liverpool Heart & Chest - 1 report due in month, submitted

outside of 60 day timescale; • Mersey Care – 7 reports due in-month, 5 received within 60 days

(71.73%)

As with previous months, performance in this area continues to be influenced by Liverpool Community Health Serious Incidents ‘closed’ by commissioners during the month of September 2015 totalled 186 (177 of these were LCH cases ‘closed in-month).

Assurance on CCG control measures This indicator was intended to provide the Governing Body with a measurable level of assurance that all Root Cause Analysis reports are submitted within nationally determined timescales and that provider investigations into the root causes are commenced at the earliest possible opportunity. It is recognised, however that this level of reporting does not facilitate the ‘thematic review’ of Serious Incidents or their Root Causes as a measure of quality. It is therefore proposed that Serious Incident activity and performance should be on a quarterly basis, and will be included in the January 2016 Corporate Performance Report. 5. INTEGRATED PERFORMANCE OUTCOMES INDICATORS Integrated CCG Outcomes Indicators have been developed from NHS Outcomes Framework and Public Health indicators and are intended to provide clear and comparative information on progress against local priorities for quality improvement

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and to demonstrate where the CCG is achieving gains in health outcomes for the population of Liverpool. Data for these outcomes are generally refreshed on a quarterly basis and are therefore not included in the November 2015 reporting schedule. 6. CCG QUALITY PREMIUMS The Quality Premium will be paid to Liverpool CCG in 2016/17 to reflect the quality of the health services we commission, improvements in health outcomes and reduction in health inequalities during 2015/16. Payments will be made based on CCGs’ achievement of the following measures, which cover a combination of national and local priorities. The updated Quality Premium Dashboard is included as Appendix 3. Due to the revised data flows and reporting schedule of the Quality Premium, the updated Dashboard will be routinely included in the report appendices each month, but will only be accompanied by a more detailed analysis/narrative on the CCG’s position on a quarterly basis. Quality Premium Quarterly Reporting for the remainder of the financial year 2015/16 is presented below:

• Q3 2015/16 - February 2016 Governing Body • Q4 2015/16 - May 2016 Governing Body (includes final position for measures

where CCG can provide a final position) 7. NHS TRUST CLINICAL QUALITY AND NHS CONSTITUTIONAL RIGHTS In line with the recommendations of the National Quality Board (NQB) the Quality, Safety and Outcomes Committee have established a Quality Early Warning Dashboard. The purpose of this dashboard is to provide the CCG with a system to identify any issues and risks relating to patient quality and safety; particularly for those areas identified by the NQB as potential indicators of quality and safety issues. The dashboard covers all NHS Trusts within the Merseyside area and includes Risk Profiles for each organisation issued by the Care Quality Commission (CQC) and Monitor Risk and Financial Ratings. Where risks have been identified they will be actively managed through CCG governance arrangements overseen by the Quality, Safety and Outcomes Committee, Trust Clinical Quality and Performance Meetings and collaborative commissioning arrangements with Merseyside CCGs. 7.1 Care Quality Commission and Monitor Warning/Issue Notices & Inspections Where providers are not meeting essential standards, the CQC has a range of enforcement powers to protect the health, safety and welfare of people who use the service (and others, where appropriate). When the CQC propose to take enforcement

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action, the decision is open to challenge by the provider through a range of internal and external appeal processes. The following updates are provided in relation to recent CQC inspection activity locally: 7.2 Mersey Care NHS Trust – Overall Rating ‘Good’ The Trust underwent inspection during the period 1st June – 5th June 2015 and 16th & 17th June 2015 with the subsequent report published on 14th October 2015 and providing an overall rating of ‘Good’. Mersey Care achieved ‘Good’ ratings across the dimensions of ‘Effective’, ‘Caring’, ‘Responsive’ and ‘Well Led’, but was assessed as ‘Requiring Improvement’ against the ‘Are Mental Health Services Safe?’ Overall, the CQC found that Mersey Care was well led and had some exceptional leaders managing in very challenging circumstances. The board was regarded as ‘highly aspirational’ and committed to delivering services which were of high quality and where every person matters. The report stated that the majority of staff across the organisation understood (and were committed to) the vision and values of the organisation, which were well communicated. Staff at all levels of the organisation were able to articulate the drive for zero tolerance of suicides and understood the ‘No Force First’ initiative (which was noted as having a real impact in reducing incidents of restraint where it had been implemented). The report also described how key stakeholders, including clinical commissioning groups and local authorities were positive about the Trust and how relationships were transparent, open and honest with a good degree of challenge occurring. Trust Monitoring systems for assessing safety and quality through Governance of Quality Framework had also evidenced success in identifying very clearly those services which require improvement (which had detailed actions in place to address any areas of risk or concern). Other areas where good/positive practice was noted were:

• The trust had good systems in place which helped them understand what was happening on the frontline;

• The CQC noted the employment of ‘quality practice alerts’, which enabled other services to learn from serious incidents and complaints through effective dissemination;

• The structure of meetings and committees were found to provide the board with assurance and were well embedded with the majority having non-executive director oversight;

• The Trust had robust policies in place to support staff in their work and ensure that staff received relevant training and support. An exception to this was the Rathbone Unit, where staff had not completed mandatory training and had not been adequately supervised or received an appraisal.

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• Not all wards ensured that people were cared for in a safe environment. Men and

woman were not always appropriately separated in Older People’s ‘inpatient’ services and on one particular ward, it was found that the environment was not conducive to reducing levels of distress amongst patients, some of whom were observed wandering in a confused and anxious state;

• On a rehabilitation ward, risks associated with ligature points in the garden had not been taken into account, nor did all staff seem to be aware of how to access the ligature cutters. No assessments of the risks posed in the garden through ligatures were highlighted;

• Staff did not always meet the communication needs of individuals and during meal times it was observed that food was not presented in what would be considered as acceptable manner (for example, wrapped sandwiches were left on a table for patients to help themselves);

• In forensic services there were concerns raised relating to some seclusion rooms which were not fit for purpose and did not comply with the Mental Health Act Code of Practice. The Trust responded immediately to our concerns and closed two seclusion rooms.

It was found, however that a good understanding of safeguarding and compliance with safeguarding policy and processes was evident all services, with safe management of medicines and good practice in relation to hygiene and infection control. Mersey Care are now expected to complete a report for the CQC explaining what actions the Trust will take to meet those areas which have been assessed as ‘Requiring Improvement’. The full inspection report can be downloaded from the Care Quality Commission website at http://www.cqc.org.uk/sites/default/files/new_reports/AAAD5292.pdf 7.3 CQC Inspections of Liverpool GP Practices In July/August 2015 a total of six Liverpool practices were scheduled to have a CQC inspection. All reports have since been published into the public domain. 7.3.1 Dr S Dharmana Family and General Practice – Overall rating Inadequate The CQC conducted a follow-up visit on 30th July 2015 to assess if improvements had been made since the initial visit of October 2014. Overall, the practice was rated ‘Inadequate’ as insufficient improvements had been made. The report findings are summarised as follows:

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http://www.cqc.org.uk/sites/default/files/new_reports/AAAD5292.pdf

• The practice did not have an effective system in place for dealing with Incoming patient related correspondence;

• Significant amount of correspondence had not been read coded or annotated by the GP working in the practice;

• No effective plan to address the backlog of correspondence; • Nurse had not been booked onto essential update training on delivery of

Immunisations and Vaccinations; • Patients who had been seen by A&E had not received appropriate Intervention

and Support from the practice. Since publication of the CQC inspection report the practice sent a request to terminate the contract and the surgery will be closed on 31st December 2015. The full inspection report can be downloaded from the Care Quality Commission website at http://www.cqc.org.uk/sites/default/files/new_reports/AAAE1500.pdf 7.3.2 Stanley Road Medical Centre (SSP Health Ltd) – Overall rating ‘Good’ The practice received an overall rating of ‘Good’ and received an ‘Outstanding’ against the ‘Are Services Caring’ domain. The report findings are summarised as follows:

• Staff understood and fulfilled responsibility to raise concerns; • Risks to patients were assessed and well managed; • Patients were treated with care, compassion, dignity and respect; • Information about services and how patients could raise a complaint were

available; • The practice staff had worked at the practice for a long time providing continuity

of care. There was evidence of a high level of satisfaction with care and patient experience as a whole.

The full inspection report can be downloaded from the Care Quality Commission website at http://www.cqc.org.uk/sites/default/files/new_reports/AAAD8606.pdf 7.3.3 Marybone Health Centre (SSP Health Ltd) – Overall rating ‘Good’ The practice received an overall rating of ‘Good’ but was assessed as ‘Requiring Improvement’ against the ‘Are services safe?’ line of enquiry. The report’s key findings are summarised as follows:

• Staff had received training appropriately to their roles; • Patients commented that they were treated with compassion, dignity and respect; • There was a clear leadership structure and staff felt supported by management;

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http://www.cqc.org.uk/sites/default/files/new_reports/AAAE1500.pdf


• The practice was asked to ensure that spirometry equipment used by nurses who review patients with COPD was appropriately serviced;

• The practice should conduct a risk assessment on the need for a defibrillator in the surgery.

The full inspection report can be downloaded from the Care Quality Commission website at http://www.cqc.org.uk/sites/default/files/new_reports/AAAD8572.pdf 7.3.4 Parkview Medical Centre (SSP Health Ltd) – Overall rating ‘Good’ The practice received an overall rating of ‘Good’ and achieved the same rating across the domains of ‘Safe’, ‘Effective’, ‘Caring’, ‘Responsive’ and ‘Well Led’. The report’s key findings are summarised as follows:

• There are systems in place to mitigate safety risks including analysing significant events and safeguarding;

• The practice use their own pharmacy advisor to ensure the practice was prescribing in line with current guidelines. The practice carries out regular monitoring and audits of high risk medications;

• The practice nurse proactively sought to education their patients to improve their lifestyles by having regular invites to patient health assessments;

• The practice doesn’t have a PPG at present, although it was noted that they had sought to attract members and aimed to set up a PPG for the practice;

• Information about services and how to complain were available and easy to understand.

The full inspection report can be downloaded from the Care Quality Commission website at http://www.cqc.org.uk/sites/default/files/new_reports/AAAD8570.pdf 7.3.5 Fiveways Medical Centre (SSP Health Ltd) – Overall rating ‘Good’ The practice received an overall rating of ‘Good’ but was assessed as ‘Requiring Improvement’ against ‘Are Services Safe?’ area of inspection. The report’s key findings are summarised as follows:

• Staff were aware of procedures for reporting significant events. However one Significant Event had not been followed up;

• There were appropriate systems in place to reduce risks to patients safety; • A number of ‘sessional’ GPs were supporting the practice which did not

promote continuity of care; • The practice sought patients views about improvements that could be made to

the service and acted on patient feedback;

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• Improvements need to be made to access medications required in the event of an emergency;

• The practice should ensure that a contact person for GPs to approach for support around clinical issues or safety incidents is clearly available for staff to refer to.

The full inspection report can be downloaded from the Care Quality Commission website at http://www.cqc.org.uk/sites/default/files/new_reports/AAAD8560.pdf

7.3.6 Netherley Medical Centre (SSP Health Ltd) – Overall rating ‘Good’

The practice received an overall rating of Good and achieved the same rating across the five domains of ‘Safe’, ‘Effective’, ‘Responsive’, ‘Caring’ and ‘Well-led’. The report’s key findings are summarised as follows:

• The practice was clean and had good facilities including disabled access and a ‘low level’ reception desk;

• Systems were in place to mitigate safety risks including analysing Significant Events and Safeguarding;

• Information about services and how to complain was available; • The practice sought patient views about improvements that could be made to

the service, including having a PPG; • The practice was asked to consider having a notice advising which GPs were

available on which day.

The full inspection report can be downloaded from the Care Quality Commission website at http://www.cqc.org.uk/sites/default/files/new_reports/AAAD8579.pdf 7.3 CQC Hospital Monitoring Intelligence Reports The CQC developed this set of indicators through consultation and testing to replace Quality Risk Profiles. ‘Intelligent Monitoring’ uses a set of indicators for monitoring risks to the quality of care and measure outcomes that have a high impact on people who use services (and relate to the five key questions that are asked during CQC inspections, namely are services safe, effective, caring, responsive, and well-led? The CCG, through individual Clinical Quality and Performance Groups (CQPGs) maintains a focus on those areas that are not included in the Quality Schedule and are highlighted within the Hospital Monitoring Intelligence Reports. Each report contains a dashboard which provides a rating of ‘risk’ or ‘elevated risk’ to the five key questions. The most recent dashboards were published in 29th May 2015 (which were reported to the Governing Body in the July 2015 Performance Report).

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Summaries of updated dashboards will be presented to the Governing Body as and when new Hospital Monitoring Intelligence Reports are made available. 8. CCG FINANCIAL POSITION The financial statements for the month ended 30th September 2015 showed an under spend against budget totalling £1.7m. This position reflects a reduction in the year to date surplus, as budget profiling has been reviewed and amended as a result of short term delays to the commencement of planned investments. No significant risks to the achievement of the planned £14m surplus have been identified in the year to date. As at 30th September 2015 the CCG total allocation was £850.0m, of which £62.3m is in respect of Primary Care Co-commissioning. Total Running Cost Allowance is £10.4m and the remaining allocation of £839m relates to programme funding. The summary position is described in the tables below:

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Operating Cost Statement - 30th September 2015

YEAR TO DATE POSITION

Annual Budget

Year to Date

Budget Actual Variance Varianc

e

£'000 £'000 £'000 £'000 % Total

Allocation 850,082 404,380 404,380 0 0.00

Total Programm

e Costs 825,609 392,274 390,773 -1,501 -0.38

Running Cost

Allowance 10,429 5,084 4,878 -206 -4.05

Total Expenditu

re 836,038 397,358 395,651 -1,707 -0.43

The

Better Payment Practice Code targets have been achieved for both NHS and Non- NHS:

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9. SUMMARY Where performance is at variance to plan action is underway with Trusts to deliver corrective action to improve performance in 2015/16 with contractual levers utilised to support improvements. These improvements are actively led by CCG Clinicians.

Stephen Hendry Acting Head of Operations & Corporate Performance

3rd November 2015

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APPENDIX 2 - PROVIDER CORPORATE DASHBOARD

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APPENDIX 3 - QUALITY PREMIUM DASHBOARD

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Report no: GB 81-15



Title of Report Healthy Liverpool Engagement Presentation on Activity

Summer 2015

Lead Governor Dave Antrobus


Carole Hill, Healthy Liverpool Integrated Programme Director

Report Author

Sarah Dewar, Social Value and Engagement Manager

Summary The purpose of this paper is to support a presentation to the Governing Body of the Healthy Liverpool Engagement summer 2015 and highlight timelines for next steps.

Recommendation That Liverpool CCG Governing Body: Notes the contents of the report Ensures that appropriate action is taken to incorporate

the findings of the full report into the next phase of Healthy Liverpool planning.


Effective use of engagement and equalities information improves the quality of services and empowerment of patients, leading to reduced inequalities and greater value from investment. The engagement approach itself promotes empowerment and self care.


Health and Social Care Act – duty to involve Equalities Act – PSED

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HEALTHY LIVERPOOL ENGAGEMENT

SUMMER 2015

1. PURPOSE The purpose of this paper is to support a presentation to the Governing Body of the Healthy Liverpool Engagement summer 2015 and highlight timelines for next steps. 2. RECOMMENDATIONS That Liverpool CCG Governing Body: Notes the contents of the report Ensures that appropriate action is taken to incorporate the findings of the full

report into the next phase of Healthy Liverpool planning. 3. BACKGROUND From June to August 2015 a public engagement took place regarding the case for change and principles of Healthy Liverpool. 2.1 The aims of the engagement were to…

a) Increase understanding of CCG role and intent b) Raise awareness of Healthy Liverpool aims/benefits c) Raise awareness and understanding of why there is a need and

opportunity for change d) Present thoughts so far and seek views on

the need to make changes the priority areas for change people’s approach to priorities and resource allocation

e) Build capacity for detailed discussion and community empowerment to collaborate in healthcare design

f) Gather knowledge, experience, information and perspectives to help improve proposals

g) Ensure diverse communities of Liverpool consider proposals and improve content so that they are appropriate to support reduction in health inequalities

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h) Ensure no service is designed without input from people with patient

experience i) Make the engagement activity a positive experience for health and

wellbeing

2.2 The objectives of the engagement were as follows:

a) To share information in clear and accessible ways b) To engage people in the issues, using a range of appropriate techniques,

generate debate and illicit views about the need and opportunity for change and the priority areas

c) To capture the knowledge, experience, information and perspectives shared by local communities

d) To identify individuals/groups who may wish to be involved in further discussion

The engagement included the following elements:-

A) Online discussions, videos, information and survey which was circulated widely and involved

B) 15 community organisations carried out wide ranging and varied discussions within their communities, including addressing public sector equality duty requirements.

C) 60 roadshows were held by the Commissioning Support Unit in areas of high footfall.

The new online engagement platform was launched for the Healthy Liverpool engagement and generated significant engagement with lots of good feedback about the facility. The following indicate levels of activity starting from scratch with the site. Total Visits 3.48 k Video views 279 Document Downloads 632 Maximum Single Day Visitors 210 Visited Multiple Project Pages 750 Contributed to a tool (engaged) 489

In total 487 people contributed their views to an online tool, 1420 actively downloaded information such as documents and 2719 people viewed at least

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one page. The key engagement document was translated into 11 languages and 145 downloads of these were made from the website. During the summer engagement activity a total of 2,566 surveys were returned: 996 came from participants at the roadshows. Many of the community engagement partners also distributed questionnaires alongside their other activities and high numbers were returned from Faiths4Change, KAALMO, Somali Women’s Group and ABBC. Over 20 different community organisations and social enterprises were named on the questionnaire as having distributed the surveys. John Moores University were commissioned to analyse the results of the various engagement activities. This report reflects some of the quantitative findings. The meeting will consider a presentation of the overall engagement, including qualitative analysis which is still being concluded. The full report of all activity will be circulated the week following the Governing Body meeting and will be considered by each of the Healthy Liverpool Programme Boards. Adjustments to planning and programmes will be made as required and ahead of the next phase of engagement January – March 2016. 4. QUANTITATIVE FINDINGS SUMMARY The survey sought to assess whether people recognised the issues Healthy Liverpool sets out for our city and aims to address and 75% agreed with them, 17% agreed with some of them. 80% also agreed that changes are needed to the way healthcare services are provided in order to improve health and 88% supported the following Healthy Liverpool benefits.

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86% supported the five priority areas as the right ones to address. There was a large majority of support for the high level principles set out for the 5 programme areas. The presentation and final report will provide more detailed findings from the community organisations engagement, qualitative issues captured and any findings particular to any communities and groups. 5. PROPOSALS The final report will be considered at the Healthy Liverpool Programme Boards during November and December. Learning and implications will be set out in the presentation and final report and built in to the next phase of engagement January-March. This engagement period will cover all five of the programmes areas and bring forward more detail on a range of key topics. A full report setting out the engagement plan will be presented for consideration at the December meeting of the Governing Body and, reflecting the areas of shared commissioning

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interest that will be included in the engagement, will also be shared with the Committee in Common. 6. CONCLUSIONS AND RECOMMENDATIONS RECOMMENDATIONS

That Governing Body: Notes the contents of the report and the presentation Ensures that appropriate action is taken to incorporate the findings of the

full report into the next phase of Healthy Liverpool planning. Considers full proposals for Healthy Liverpool Engagement January –

March 2016 at the December meeting of the Governing Body. __________________________________________________________ Sarah Dewar Third Sector and Environmental Sustainability Lead 3/11/15 ENDS

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Report no: GB 82-15


GOVERNING BODY


Title of Report Corporate Risk Register Update November 2015

Lead Governor Maureen Williams


Stephen Hendry, Acting Head of Operations & Corporate Performance

Report Author

Joanne Davies, Corporate Services Manager (Governance)

Summary The purpose of this paper is to update the Governing Body on the changes to the Corporate Risk Register for November 2015

Recommendation That the Governing Body: Notes the risks (CO29b, CO32, CO47 and

CO49) recommended for removal from the Corporate Risk Register;

Notes the two new risks added to the Corporate Risk Register (CO24b, CO51);

Satisfies itself that current control measures and the progress of action plans provide reasonable/significant internal assurances of mitigation, and;

Agrees that the risk scores accurately reflect the level of risk that the CCG is exposed to given current controls and assurances.


The Corporate Risk Register provides evidence of the progress being made across the organisation in the management of operational and strategic risks against achieving improved health outcomes, reducing health inequalities and financial duties/sustainability.

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The Health and Social Care Act states that: “The main function of the governing body will be to ensure that CCGs have appropriate arrangements in place to ensure they exercise their functions effectively, efficiently and economically and in accordance with any generally accepted principles of good governance that are relevant to it.”

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Corporate Risk Register Update (November 2015) 1. PURPOSE The purpose of this paper is to highlight updates and amendments to the CCG’s Corporate Risk Register and the key organisational responsibilities for the mitigation of risks to the delivery of strategic, quality, performance and financial objectives for the financial year 2015/16 and risks carried over from the financial year 2014/15. 2. RECOMMENDATIONS That the Governing Body: Notes the risks (CO29b, CO32, CO47 and CO49) recommended for

removal from the Corporate Risk Register; Notes the two new risks added to the Corporate Risk Register

(CO24b, CO51); Satisfies itself that current control measures and the progress of action

plans provide reasonable/significant internal assurances of mitigation, and;

Agrees that the risk scores accurately reflect the level of risk that the CCG is exposed to given current controls and assurances.

3. BACKGROUND NHS Liverpool CCG aims to achieve its overall objectives, ambitions and maintain its reputation via effective and robust risk management procedures. As a public body, the CCG has a statutory commitment to manage any risks that affect the safety of its employees, patients and its commissioned, financial and business services by adopting a proactive approach to the management of risk. The Corporate Risk Register is a structured framework underpinned by concepts of effective governance and other systems of internal control that enable the identification and management of acceptable and unacceptable risks. Opportunities for improvement in controls and assurances are translated into action plans under specific named lead/managerial control so that monitoring, tracking and reporting can be supported, with clear target dates and milestones identified where appropriate.

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4. OVERVIEW OF THE CORPORATE RISK REGISTER: OCTOBER

2015 As at 31st October 2015 a total of 30 risks are recorded on the CCG’s Corporate Risk Register. The CCG’s risk profile (low – extreme) is summarised below:

Risk Category

Score Range Total Risks

Change +/-

Extreme 15-25 5 -4 High 8-12 21 +5

Moderate 4-6 3 -4 Low 1-3 1 +1

Analysis of the direction of travel for risks since the last Governing Body update (September 2015) can be summarised as follows:

Total ▲ Risk increased 0 ▼ Risk reduced 14 ► No change (static) 14 New risks 2

Total 30 A total of 10 risks out of the 14 ‘static’ entries as at 31st October 2015 carry an ‘unacceptable’ risk status, which is a marginal decrease (1.3%) from the September 2015 update. The CCG’s tolerance of risk continues to be relatively low, with 6 out of the total of 30 risks (20%) considered as acceptable with the highest scoring risk in this category at 12 (High). As with previous reporting periods, no ‘Extreme’ risks carry an acceptable rating. 4.1 Overview of ‘Extreme’ Risks as at 31st October 2015 As the above table shows, a total of four risks carry residual score ranges of 15-25, placing them in the ‘Extreme’ category of risk against achievement of

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CCG objectives. As two of these risks are ‘new’ inclusion (and therefore the effectiveness of controls measures unknown), a summary analysis of the three existing ‘extreme’ risks is presented as follows: CO14b – Resolution of current and new CCG commissioned (2015 – 2016) Continuing Healthcare review and appeal cases Residual Risk Score 16 Trajectory ▼ Review Date: Dec 2015

The above risk was first placed on the Corporate Risk Register on 16th April 2015 and relates to the (lack of) capacity within the Commissioning Support Unit to deliver the core CHC Service; presenting risks to the CCG’s statutory delivery of this function, a high potential for complaints/claims, remedy instruction from the Parliamentary & Health Service Ombudsman and subsequent reputational damage. Assurance of CSU delivery against core service/contract is reviewed bi-monthly by the Finance, Procurement and Contracting Committee, with the principle ‘control measure’ of established monthly contract review meetings between the CCG and CSU. The risk level (likelihood) has decreased since the September 2015 Governing Body update, as the process for procurement under the Lead Provider Framework (LPF) is now in its final stages with a new provider appointed and a decision due to be made public on 5th November 2015. Whilst this presents risks of transition from previous provider to new, it is expected that the mobilisation of the new service will commence by mid-November 2015. Until this process is complete and appropriate risk assessments of the mobilisation are analysed, the ‘corporate risk’ will therefore be reviewed in December 2015 and a decision made as to whether it is appropriate to recommended removal at the January 2016 Governing Body meeting. CO24a – Safe and effective delivery of health services by Liverpool Community Health (LCH) to meet commissioning requirements Residual Risk Score 15 Trajectory ▼ Review Date: Dec 2015

This risk was added to the Corporate Risk Register in March 2014 following a CQC inspection in October 2013 (and subsequent follow-up inspection in May 2014) which raised significant quality and safety issues and resulted in enforcement action being taken against the Trust. Since initial placement on the Corporate Risk Register, the risk to the CCG has been quite dynamic, resulting in a separation into two risks, with CO24a relating specifically to ‘quality’. The Trust withdrawal from the Foundation Trust pipeline in February 2015 created a more significant risk in terms of uncertainty of

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sustainable provision and is now included as a new risk (CO24b). The risk in terms of quality has also increased as the Trust was the subject of a number of NHS England Risk Summits and Quality Surveillance Groups (pressure ulcer reporting levels were subjected to particular scrutiny). There are a number of control measures and governance structures in place which have continued to act as a ‘first line of assurance’ of remedial action plans and maintained an overview of aggregated risks relating to the provider; the Collaborative Commissioning Forum, established with other local commissioners such as South Sefton CCG, has maintained the strategic focus on the sustainability of delivery of community health services whilst internal CCG groups, such as the Clinical Performance and Quality Group have continued to work closely with the Trust to establish and analyse the root causes of specific areas of concern and assure the robustness of remedial action plans. Since the September 2015 Governing Body update, the likelihood score of the residual risk has decreased as a result of the Trust Development Agency (TDA) approval of the Transition Plan at their October 2015 Board meeting which will ultimately lead to the transfer of services currently provided by LCH to a new provider/providers by the end of March 2017. CO39 – Alder Hey ‘Red’ rating against Safeguarding Standards during 2013/14 Residual Risk Score 16 Trajectory ► Review Date: Dec 2015

This risk has been included in the CCG Corporate Risk Register since December 2014 and has remained static due to the continued ‘underperformance’ of the Trust against key Safeguarding Standards. The risk (and continued inclusion in the Corporate Risk Register) is essentially driven by the Trust’s quarterly performance data. A review of Quarter 1 data for 2015/16 has shown little or no improvement and in mid-October 2015 a Contract Performance Notice was subsequently issued to Alder Hey by Liverpool CCG. Contract performance will continue to be closely monitored along with trust remedial action plans, and the Contract Performance Notice will remain in place until there is evidential assurance of sustained improvement against Safeguarding Key Performance Indicators (KPI). The risk will therefore be reviewed in December 2015 following analysis of Quarter 2 data.

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4.2 Risks recommended for removal by the Governing Body Four risks are recommended for removal by the Governing Body as at 31st October 2015. These are:

• CO29b – The contract query with the Trust has now been lifted (as at 22/10/2015).

• CO32 – The event (over-performance at RLBUHT) has happened and negotiations around the impact of the event are ongoing.

• CO47 – The transition work is now complete. Contract monitoring of service by LCC will take account of any cross border issues arising and the impact.

• CO49 – Monitor advised the CCG that they will not be opening a formal investigation in to the pricing enforcement complaint regarding the pricing of CHC care home services. The CCG can consider the matter closed and no further action will be taken at this time.

5. SUMMARY The Corporate Risk Register continues to be monitored on a monthly basis. Action plans put in place against each risk identified are reviewed monthly by the appropriate sub-committee of the CCG Governing Body with first-line assurance of controls and actions conducted by the Senior Management Team on a bi-monthly basis. Strategic risks to corporate objectives are monitored on a monthly basis by the Senior Management Team. Where legal issues arise from individual risks the Corporate Risk Register will include plans to mitigate them. There are no inherent legal implications associated with the Corporate Risk Register in October 2015.

Joanne Davies Corporate Services Manager (Governance) 03 November 2015.

Ends

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1

LIVERPOOL CCG: CORPORATE Risk Register October 2015 (Nov GB) Version: v2.0

RefOrganisational Values & Objectives

Date Entered

Objective Description of Risks Current Controls Assurance in Controls L CCurrent

Risk (score)

Current risk

accepted

Management Actions re gaps in controls and assurance or unacceptable risk rating

L CResidual

Risk (score)

Lead Officer

Completion Date

Review Date

Progress since last update

C011GB

To hold providers of commissioned services to account for the quality of services delivered

11/06/2013 Delivery of commissioned services to patients by Aintree University Hospital NHS FT meets commissioning requirements (service and quality) and compliance with Monitor 'operating licence'

Some aspects of patient care and service delivery falling below an acceptable and safe standard and commissioner expectations /standards. Trust in potential breach of Monitor 'operating licence'

Formal collaborative commissioning arrangements in place with South Sefton and Knowsley CCGs. AED and mortality monitored via CPQG (holding provider to account for service delivery).

NHS England continue to monitor via 'STAR Chamber' on a monthly basis.

Mortality Action Plan remains in place monitored via CQPG/ Collaborative Commissioning Forum (CCF).

Monthly reporting to Governing Body; regular reporting through Regional Quality Surveillance arrangements;CCF reviews action plans at each meeting.

Single Item Quality & Safety Group actions and reports from QSG continue to be monitored by Collaborative Commissioning Forum & reported to Governing Body by exception.

4 5 20 N Monthly meetings now in place to address Star Chamber Action Plan / Tripartite. DTOC and medically optimised patients remain problematic. Operational issues identified in Clock View - Completion of Mental health Assessments and delays in AED as a consequence. System Resilience Group taking this issue forward. The national CQUIN for AED will also support mental health and acute providers in understanding the challenges and barriers when patients attend AED as the first point of call. A&E performance - massive improvement in AED 4 hour target. Type 1 achieved 94% which is a vast improvement from the previous month. The figure for all types is around 95% although the Trust has not demonstrated achievement against the entire quarter. Medworks system to be commissioned for Aintree - funding under discussion at contract review meeting.

CCG has part funded the implementation of Medworks and this is in progress.

Linked to Risk CO37

2 4 8 KS Monthly review via

CPQG/ QSG

Dec-15 ▼

9191

2


Date Entered


Risk (score)

Current risk

accepted


L CResidual

Risk (score)

Lead Officer

Completion Date

Review Date


CO14 We will act with honesty and transparency in all our actions. We are committed to a teamwork environment, where every member of the CCG is valued, encouraged to contribute and recognised for their efforts.

29/07/2013 Resolution of all outstanding Continuing Health Care restitution, review and appeals cases

Financial risk from cases (financial settlements and interest); reputational risk due to significant delays to resolution; Formal Ombudsman investigation into delays. 'Remodelling' has seen increase of 52% in likely 'panel' cases and potential increase in financial liability from £2.4M to £4M. (under current rules CCG liability is limited to £2.8M, subject to change

CSU commissioned to manage all outstanding cases and to clear the backlog/legacy cases - it is now expected that all claims will not be cleared before 2016/17

The CCG continues to work with the CSU to ensure that the current work plan and performance target for processing claims is met whilst a long-term solution is sought.

Monthly progress reports from CSU, complaints monitoringRisk reviewed bi-monthly with exception reporting to Governing Body via FPCC if risk increases/ decreases.

Monitored and assured via monthly contract meetings with CSU; oversight by CCG Chief Nurse)

4 5 20 N Liverpool CCG is currently going through a procurement process to determine the new provider for the CHC service.

As part of the Lead Provider Framework being undertaken by NHS England LCCG along with all other C&M CCGs have approved a bidder for CHC services. This is currently in alcatel period (standstill) and decision will be made public on 5/11/2015. After this period mobilisation to the new provider will commence with service transition being completed by 01/03/2016.

Monthly contract meetings continue. There has been significant improvement in recent months that means that if current trajectory is maintained, the backlog cases will be resolved by July 2016, in line with other CCGs.

3 4 12 JL / ID Mar-17 Dec-15 ▼

9292

3


Date Entered


Risk (score)

Current risk

accepted


L CResidual

Risk (score)

Lead Officer

Completion Date

Review Date


CO14b We will act with honesty and transparency in all our actions. We are committed to a teamwork environment, where every member of the CCG is valued, encouraged to contribute and recognised for their efforts.

16/04/2015 Resolution of current/new (2015/16) CCG commissioned Continuing Health Care review and appeals cases under core service

CSU lacks capacity and adequate resources to deliver core CHC service, with significant reliance on bank staff temporary bank staff and lack of leadership capacity. High potential of increasing backlog of cases for financial years 2014/15 and 2015/16 leading to poor service delivery, complaints and criticism and/or financial remedy instruction from Health Service Ombudsman

Linked to Risks CO14, CO40

Monthly Contract Meetings with CSU

Monthly progress reports from CSU, complaints monitoring; CCG has initiated an on-going review of Health Service Ombudsman findings (nationally) to identify areas for learning and improvement of internal processes.

Risk reviewed bi-monthly with exception reporting to Governing Body via FPCC if risk increases/ decreases.

5 4 20 N Liverpool CCG is currently going through a procurement process to determine the new provider for the CHC service.

Procurement process nearly completed - new provider will be appointed and decision made public 05/11/2015.

Weekly meetings continue with the CSU, however capacity and service levels fluctuate and this is discussed and addressed at these weekly meetings. Mobilisation of new provider will commence in mid November and an urgent meeting will be requested in order to identify current issues and an agreed way forward that addresses the known issues will be sought.

4 4 16 JL on-going Dec-15 ▼

9393

4


Date Entered


Risk (score)

Current risk

accepted


L CResidual

Risk (score)

Lead Officer

Completion Date

Review Date


CO15 To hold providers of commissioned services to account for the quality of services delivered

06/08/2013 CCG use and reliance upon quality and timely performance data

Poor quality data leading to inaccurate monitoring and assessment of providers, operational and financial risk

CSU is commissioned to provide business intelligence support including data processing and validation. CSU held to account for delivery of data required standard quality matters raised at monthly performance meeting with CSU leadershipData issues with individual providers being taken up via contract meetings.

'in house' analyst capacity increased to review data accuracy and mitigate risk

Monthly performance meetings with CSU - escalation to Finance & Procurement Committee by exception with oversight by Governing Body

4 5 20 N Specifications for the 'new' service have been released and through the lead provider framework a new provider is currently being procured.

Data issues continue to be experienced during this transition period and the CCG in house team continues to take action to mitigate this impact.

As part of the Lead Provider Framework being undertaken by NHS England LCCG has in-house aspects of reporting to the BI Team. This has now been completed and the member of staff has TUPE across to the CCG from 01/10/2015.

Linked to risk number CO40

3 3 9 TJ/ID on-going Dec-15 ▼

9494

5


Date Entered


Risk (score)

Current risk

accepted


L CResidual

Risk (score)

Lead Officer

Completion Date

Review Date


CO18 We accept responsibility for our actions. We make and support business decisions through experience, evidence and good judgement, and we will deliver against our promises

01/10/2013 Deliver the transformation of health and health & care services across the city through the Healthy Liverpool Programme

Failure to agree model of care; establishment of programme leads and infrastructure; delivery of the transformational programme; failure to communicate and engage with stakeholders and to gain understanding and support for the programme; reputational risk due to high profile of NHS change and reconfiguration programmes.

Programme Advisory Board established; Governing Body commitment to HLP; officer-led delivery group in place; Additional senior resource sourced to manage communication, stakeholder management and engagement. Clinically-led settings and programme groups in place;

List of Programme roles necessary to mobilise produced with prioritisation of roles assessed to mitigate risks to delivery.

HLP governance infrastructure formally approved by Governing Body and all groups established. CCG Governing Body, Programme Advisory Board maintain assurance links

NHS England service change and reconfiguration tracker (formal assurance process)

MiAA review of governancearrangements to oversee the delivery of the Healthy Liverpool programme included in CCG Audit Plan 2015/16

2 5 10 Y Enhanced arrangements have been put in place (effective 1st June 2015) that significantly galvanise the support to HLP. Key developments include the designation of Clinical Leads and Senior Responsible Officers (SRO) for each Transformational Programme and creation of Programme Management Office (PMO) model. Strategic Direction Case (SDC) is currently being finalised and will be submitted to the Extraordinary September Body meeting on 22nd Sept 2015. Work is continuing to finalise the draft SDC which will now be formally presented to an extraordinary Governing Body meeting on the 29th September 2015. Recruitment has commenced to strengthen the programme teams and the PMO.

SDC completed and approved at Governing Body on 29/09/2015. Mayoral health summit planned for 16/11/2015. Engagement report and next steps will be presented to the November Governing Body for approval.

2 5 10 NF, KS On-going Dec-15 ►

CO19 To maximise value from our financial resources and focus on interventions that will make a major difference

01/12/2013 To agree with Liverpool City Council the 'Better Care Fund' (formally Integration Transformation Fund) for 2014-16, including individual schemes, outcomes and performance.

Failure to agree with the City Council the investment schedule and associated outcomes, including the performance element of the Fund, threatening: 'retention' of the BCF resources in the City; service delivery and continuity; and relations with the City Council

Section 75 agreement in place with LCC

National guidance published & embedded in CCG.

Negotiations with LCC led by the Chief Finance Officer, regular updates to SMT and, briefings to Governing Body.

The CCG plan has been externally assessed and "Approved with Support" by NHS E and determined as putting the CCG in a strong position to meet the challenges in delivery with no high areas of risk.

2 5 10 Y Risk continues to be monitored/managed as a strategic risk in 2015/16 due to the continued challenges and risks faced by CCG in reducing Emergency Admissions.

1 5 5 KS, TJ & TW

On going Dec-15 ►

9595

6


Date Entered


Risk (score)

Current risk

accepted


L CResidual

Risk (score)

Lead Officer

Completion Date

Review Date



06/01/2014 To deliver effective information governance processes

Failure to comply with requirements of the Information Governance Toolkit leading to restrictions placed on the CCG on the handling of weekly pseudonymised data, adversely affecting key business functions

MIAA is supporting the CCG in meeting the level 2 requirements of the Toolkit.

IG Steering Group in place with formal & approved Terms of Reference - exception reporting to Governing Body via minutes.

1 4 4 Y MiAA review of adequacy of policies, systems and operational activities to complete, approve and submit the IG Toolkit scores included that CCG has demonstrated a reasoned approach to the collation of its IG Toolkit return for 2014/15. Overall assurance rating of 'Significant'.

Remains on CRR as a strategic risk until end of financial year 2015/16 & submission of IG Toolkit

1 4 4 TW Mar-16 Dec-15 ►

CO24a To hold providers of commissioned services to account for the quality of services delivered

01/11/2015 Delivery of commissioned services to patients by Liverpool Community Health meets commissioning requirements (service and quality)

Provider unable to deliver safe and effective services to local residents (concerns raised in CQC Inspections in Oct 13 and May 14)

CCG Collaborative Forum established with other commissioners of services from LCH, CPQG has new GP chair and format of agenda includes 'deep dives' into areas of potential concern and oversight of the remedial action plan. Regular assurance updates to Merseyside QSG (inc. pressure ulcer reporting levels)

CPQG, reporting to Governing Body and Chief Officer; regular reporting through Regional Quality Surveillance arrangements

Trust remedial actions monitored and followed up through the regular Clinical Quality and Performance meetings - exception reporting to QSOC & Governing Body.

4 5 20 N CCG continues to gain assurance against the delivery of the service improvement plans and resolution of specific quality/safety issues through established control mechanisms.

The recent cessation of referrals into the SALT service is a matter of concern and officers are working with LCH to assess the scale and scope of the problems in the service and to explore urgent remedial action.

4 5 20 JL Monthly review via CPQG/ QSG

Dec-15 New Risk

9696

7


Date Entered


Risk (score)

Current risk

accepted


L CResidual

Risk (score)

Lead Officer

Completion Date

Review Date


CO24b To hold providers of commissioned services to account for the quality of services delivered

01/11/2015 Delivery of commissioned services to patients by Liverpool Community Health meets commissioning requirements (service and quality)

Uncertainty of future service provision as a consequence of withdrawal from the FT pipeline and the need to transact services to a new provider(s) by 01/04/2017

TDA have assumed lead responsibility for planning and transacting the transfer of services to an alternative provider(s). LCCG has been a full member of the Sustainability Board which reported to the TDA Board in Oct 2015. This has now been replaced by a Transactional Board charged with implementation of the plan to transact services to a new provider(s)

CCG Chief Officer / Chief Finance Officer are full members of the TDA led Transactional Board

4 5 20 N The SMT are coordinating the necessary steps and actions to define the future needs of the CCG (taking in to account HLP Community), with leads identified to work alongside the TDA as the transactional process goes forward

3 5 15 DR Monthly review

Dec-15 New Risk

CO26 QSOC

To hold providers of commissioned services to account for the quality of services delivered

12/03/2014 Delivery of commissioned services to patients by Alder Hey NHS FT meets commissioning requirements (service and quality) and compliance with Monitor operating licence

Concerns raised as to the safe and effective delivery of services to local residents from Whistleblowing allegations regarding theatre staffing and sickness levels and from recent CQC inspection.

Specialist Commissioners and CCGs working together to understand the concerns raised and determine with the Trust a sustainable improvement plan.

LCCG part of Collaborative Commissioning Forum CCF) which oversees workstreams to address quality and safety concerns

Specific issues re: Theatre and Whistleblowing have now been addressed and sustainability of improvement continue to be monitored through CQPG

4 4 16 Y Follow-up visit by CQC took place in June 2015 - currently awaiting the published report which will be reviewed at relevant CCF (still awaiting publication of the CQC report as at 1st Sept 2015).

Risk score will remain unchanged until publication of CQC report & consideration of findings.

Publication of CQC report delayed - date of publication unknown (at time this was written). Knowledge of outcome of CQC inspection report will inform future assessment of risk and action.

2 currently contract performance notices in place with regards to CAMHS and Safeguarding.

2 4 8 JL Ongoing - Monthly

review via CPQG/ QSG

Dec-15 ►

9797

8


Date Entered


Risk (score)

Current risk

accepted


L CResidual

Risk (score)

Lead Officer

Completion Date

Review Date



01/06/2014 Delivery of the commissioned 4 hour target in AED to patients by Royal Liverpool & Broadgreen University Hospitals NHS Trust meeting the commissioning requirements (service and quality) and compliance with TDA requirements

Failure to meet the 95% 4 hour target in AED 2014/15, leading to patients potentially receiving delayed care and treatment.

Remedial Action Plan in place; previous 'contract query' remains open and subject to fortnightly review.

Contract Query remains open as Type 1 A&E performance continues to be challenged. The CCG continues to work closely with the Trust in order to secure sustainable delivery of the 4hr Target (including Type

CCG internal Trust oversight group and contract review meetings continue in 2015/16 as per established control measures.

Current remedial action plan monitored through the formal contract query process and by the TDA.

Agreement with NHS England that RLBUHT performance can take into account Walk-in Centre activity

Governing Body Corporate Performance Report provides updates/assurance on CCG controls on a monthly basis

4 4 16 N We are receiving early indication that the Trust will be allowed to include current type 2 and 3 performance in its overall figure. If direction on this matter is confirmed by NHS England this could mean the contract query may be lifted by end of 2015/16.

Following agreement with NHSE/UNIFY, the Trust now incorporates, type 2 and 3 activity into it's performance (overall performance is the published figure, not solely type 1). RLBUHT achieved 95.95% for Q2 and is currently at 95.34% for October and to date 95.34% for Q3. Financial year to date is 95.13%. Type 1 performance overall to date remains below 95% and will continue to be subject to ongoing scrutiny. In view of the fact it is the overall combined figure which is published, the current contract query will be closed during the month of November 2015. The trajectory for the remainder of the year remains positive for delivery by year end.

2 4 8 ID Ongoing Dec-15 ▼

9898

9


Date Entered


Risk (score)

Current risk

accepted


L CResidual

Risk (score)

Lead Officer

Completion Date

Review Date


CO29b We accept responsibility for our actions. We make and support business decisions through experience, evidence and good judgement, and we will deliver against our promises

01/05/2015 To support operational resilience and performance within LCCG Emergency & Urgent Care System

Contract Query issued to LCCG by RLBUHT on 17/03/2015 in relation to increase in A&E attendances and increase in patients ready for discharge but unable to be discharged. Trust cites these two factors as impacting on their ability to deliver A&E 4hr standard. Reputational risk for LCCG reputation and negative impact on Healthy Liverpool Programme strategic direction.

Standard NHS Contract 2015/16 (General Condition 9.LCCG has been invited to undertake a Joint Investigation (JI) with RLBUT to understand issues behind increased A&E attendances and reasons for impeding patient flow/discharge of patients ready to go. Terms of Reference for JI to be negotiated between parties

Direct formal engagement between Contracts Management Team, Urgent Care Team & Finance - reporting to Governing Body by exception.

3 4 12 N Liverpool CCG due to meet with Trust in September 2015 to take receipt of findings of joint investigation. Initial findings still relate mainly to issues out of the CCG's control.

Contract query meeting to be held on 4th September 2015

It is recommended that this risk is removed as the contract query was lifted on 22/10/2015

3 4 12 JK/DR Sep-15 Nov-15 ►


19/08/2014 To manage RLBUHT over performance against contracted levels for 2014/15

The forecast outturn for RLBUHT is £11.5m over performance as at M3 2014/15, 50% of over performance relates to Non Elective admissions, 25% for diagnostics and 25% over planned care and high cost drugs . This is significantly over planned levels for 2014/15 and continued performance at the current levels will add pressure to LCCG finances.

LCCG are utilising contract levers to understand the drivers behind the over performance. An Activity Query Notice has been issued and the Trust are providing a response to set out for the reasons for the increase in over performance. There has been clinical involvement throughout the contract query process.

LCCG utilising NHS standard contract levers to manage performance as a standard process.

5 4 20 N The external audit review of emergency activity has been concluded with the final report being evaluated. The CCG is currently in dispute with the Trust as to financial extrapolation of the findings of the audit to the 2014/15 performance with discussions ongoing.

A further re-audit is scheduled for early September. RLBUHT still to agree to the terms of reference.

Audit now taking place November 2015. Terms of Reference agreed. Ongoing discussions with the Trust re limited funding increase in 2014/15. Accruals and resolution is expected in the next few weeks.

It is recommended that this risk is removed as the event has happened and negotiations around the impact of the event are ongoing.

3 4 12 TJ/DR Ongoing Nov-15 ▼

9999

10


Date Entered


Risk (score)

Current risk

accepted


L CResidual

Risk (score)

Lead Officer

Completion Date

Review Date



29/08/2014 Delivery of RTT waiting times in line with NHS Constitution and contractual requirements at Alder Hey NHS Foundation Trust

Failure to agree and implement elective care operational resilience and capacity plan

Elective care operational resilience and capacity plan submitted to NHS England by the Trust as required.

Trust plan has been subject to external review by the NHS IMAS Elective Intensive Support Team

Governing Body receipt of monthly Corporate Performance Report provides oversight of provider performance and assurances of CCG controls

4 3 12 N Trust was meeting RTT targets as at June 2015 - July 2015 data won't become available until second week of October 2015 due to NHS England alignment of data flows. From October 2015 changes to RTT measures will also take place.

Risk should remain on the LCCG risk register until after the Trust move from their current premises to the new build in September 2015 and there is evidence that performance has stabilised and is sustainable.

Trust moved in to new premises early October 2015. No initial difficulties indicated to the CCG. To be reviewed in November following month of operation of the new site.

3 3 9 JL/DR Ongoing Dec-15 ►


13/10/2014 Delivery of the commissioned 4 hour target in AED to patients by Aintree University Hospital NHS Foundation Trust meeting the commissioning requirements (service and quality) and compliance with Monitor requirements

Failure to meet the 95% 4 hour target in AED 2015/16, leading to patients potentially receiving delayed care and treatment.

Remedial Trust plans in place;

Contract Query remains in place as at Jul 15 and is subject to fortnightly review.

Trust performance reviewed by Collaborative Commissioning Forum and System Resilience Group to gain assurance for improved 4hr performance for 2015/16

Current remedial action plan monitored through the formal contract query process, Collaborative Commissioning Forum (CCF) and by Monitor

NHS England continue to monitor via 'STAR Chamber' on a monthly basis.

4 4 16 N Trust performance against 4hr A&E standard during Q1 has improved although improvements week on week have not been sustained. The CCG and Collaborative Commissioning Forum continue to support the Trust.

We are receiving early indication that the Trust will be allowed to include current type 2 and 3 performance in its overall figure. If direction on this matter is confirmed by NHS England this could mean the contract query be lifted by end of 2015/16.

Trust performance against 4hr A&E standard during Q1 and Q2 has improved although improvements week on week have not been sustained. The CCG and Collaborative Commissioning Forum continue to support the Trust.

We are receiving early indication that the Trust will be allowed to include current type 2 and 3 performance in its overall figure. If direction on this matter is confirmed by NHS England this could mean the contract query be lifted by end of 2015/16.

3 4 12 ID Ongoing Dec-15 ►

100100

11


Date Entered


Risk (score)

Current risk

accepted


L CResidual

Risk (score)

Lead Officer

Completion Date

Review Date



13/10/2014 Delivery of commissioned services is able to meet likely adverse weather and 'winter' demands 2015/16 (risk from 2014/15 financial year transferred to current)

Failure to meet patient demand leading to a fall in performance and a potential adverse impact upon service responsiveness and quality

Additional national and local resources released to enhance and strengthen service resilience and capacity.

North Mersey SRG has agreed the allocation of baseline resources for winter 2015/16.

Oversight of the plans via the CCG Urgent Care Team and the North Mersey System Resilience Group.

Mersey Internal Audit Agency (MiAA) commissioned by CCG to strengthen performance management and monitoring of winter schemes in-year. Risk score remains unchanged for 2015/16 financial year and will be reviewed in Sept/Oct 2015.

3 4 12 Y The North Mersey System Resilience Group is currently undertaking an assurance assessment (as required by NHS England) to review preparedness and risk. This will be submitted to NHS England by early September 2015.

The North Mersey System Resilience Group which LCCG hosts and is a member of is currently undertaking an assurance assessment (as required by NHS England) to review preparedness and risk as of October 30th 2015. Prior to 30th October submission, North Mersey SRG received an overall assessment status from NHSE as 'Not Assured'. Further local planning for winter is underway to improve this level of assurance and LCCG is hopeful that North Mersey will achieve 'Partial Assurance' or 'Fully Assured' during the end of October review period

3 4 12 ID Ongoing Dec-15 ►

C038 To hold providers of commissioned services to account for the quality of services delivered

09/12/2014 Delivery of commissioned services to patients by Liverpool Women's NHS Trust meets the required standard in terms of quality & safety in compliance with safeguarding standards

The Trust had an overall Red RAG rating on Safeguarding Standards during the last 3 quarters of 2013/14 contractual year.

On-going reporting to CQPG;Reporting by CCG Safeguarding Service into QSOC;Trust required to report against safeguarding KPIs on a quarterly basis to the CCG Safeguarding Team with remedial actions agreed by group.

Exception reporting from QSOC to Governing Body;Chief Nurse Update standing agenda item for all Governing Body Meetings ;Safeguarding supervision provided to the Head of Safeguarding via the CCG Safeguarding Service Leads. Regular monthly meetings with LWH shows progress in addressing the issues: new head of safeguarding in post with support staff and complete review of systems, processes and governance re safeguarding

5 4 20 N Improvements observed for Quarter 4 positions for Trust. CCG is awaiting Quarter 1 position for evidence of sustained improved performance in relation to Safeguarding Standards. Risk remains unchanged until Quarter 1 position is known (expected August 2015)

Continues to be standing agenda item for CQPG (next meeting scheduled for 16th July 2015).

Quarter 1 position showed improvement, although the Trust acknowledges improvements still need to be made.

LCCG / safeguarding service continue to work closely with the Trust to sustain improvement trajectory.

3 4 12 JL On-going Dec-15 ►

101101

12


Date Entered


Risk (score)

Current risk

accepted


L CResidual

Risk (score)

Lead Officer

Completion Date

Review Date


C039 To hold providers of commissioned services to account for the quality of services delivered

09/12/2014 Delivery of commissioned services to patients by Alder Hey Children's Hospital NHS Foundation Trust meets the required standard in terms of quality & safety in compliance with safeguarding standards

The Trust had an overall Red RAG rating on Safeguarding Standards during 3 quarters of 2013/14 contractual year.

On-going reporting to CQPG;Reporting by CCG Safeguarding Service into QSOC;Trust required to report against safeguarding KPIs on a quarterly basis to the CCG Safeguarding Team with remedial actions agreed by group.

Exception reporting from QSOC to Governing Body;Chief Nurse Update standing agenda item for all Governing Body Meetings ;Safeguarding supervision provided to the Head of Safeguarding via the CCG Safeguarding Service Leads.

5 4 20 N Awaiting review of Q1 data which may show improvement.

Quarter 1 data showed little or no improvement. Contract performance notice issued mid October and LCCG will work with the Trust to support improvement.

4 4 16 JL On-going Dec-15 ►


27/01/2015 Effective provision of commissioning support services to the CCG

The NWCSU has failed to secure a place on the national framework agreement. This has the potential effect of their services ceasing to be available to the CCG by the end of 2015/16 and the CCG required to find alternative means of providing the support services commissioned from the CSU.

Service Level Agreement / Contract in place with the NWCSU to provide support services including (Business Intelligence, continuing and complex heath care management, EPRR, comms, UCAT)CCG has reviewed commissioning support service requirements going forward and Transition Plan is now in place.

Monthly performance monitoring of current service delivery, including monthly 'scoring' of individual service delivery elements.

Mersey CCGs are continuing to work collaboratively to ensure delivery in the short term.

5 2 10 Y Specifications for the 'new' service have been released and through the lead provider framework a new provider is currently being procured with a likely implementation date of November 2015.

Data issues continue to be experienced during this transition period and the CCG in house team continues to take action to mitigate this impact.

As part of the Lead Provider Framework being undertaken by NHS England LCCG has identified and appointed a new provider and service transition will commence in November and will be completed by December 2015.

3 2 6 DR Ongoing Dec-15 ▼

102102

13


Date Entered


Risk (score)

Current risk

accepted


L CResidual

Risk (score)

Lead Officer

Completion Date

Review Date


CO41a To hold providers of commissioned services to account for the quality of services delivered

27/01/2015 Effective provision of commissioning support services to the CCG and primary care contractors.

National outsourcing of primary care support services from 1st July 2015 will leave a gap in provision which is detrimental to the CCG and local primary care contractors with regard to delegated commissioning of primary care medical services.

Standing agenda item for Finance, Procurement & Contracting Committee and Primary Care Commissioning Committee

Limited assurance on control measures due to uncertainty in terms of gaps.

Minutes of committee meetings & exception reporting to Governing Body

NHS England awarded contract (22 Jun 2015) to Capita to establish a 'single provider framework' for primary care administrative support functions

3 3 9 N Primary Care Team strengthened in anticipation of increased workload.

LMC and Head of Primary Care Quality and Improvement attending local stakeholder forum monthly.

Head of Primary care Quality and Improvement was put forward and has been accepted for the expert panel for PCS.

Arranging stakeholder sessions with practices early 2016 with LMC.

Representatives of LCCG Finance and NHS England Finance Teams meet regularly to discuss the provision of financial data and address queries which the CCG may have.

3 3 9 AO/ CM Ongoing Dec-15 ►


01/04/2015 Effective provision of commissioning support services to the CCG and primary care contractors.

National outsourcing of primary care support services due to take effect from 1st July 2015; new contract restrictions took effect from 1st April 2015. will leave a gap in provision which is detrimental to the CCG and local primary care contractors with regard to payments for local enhanced services.

Standing agenda item for Finance, Procurement & Contracting Committee and Primary Care Commissioning Committee

Limited assurance on control measures due to uncertainty in terms of gaps.

Minutes of committee meetings & exception reporting to Governing Body

5 3 15 N Primary Care Transition Group in place. Action plan includes quantification of impact of out of scope functions

LCCG is attending the Merseyside Primary Care Finance Transition Group with other CCGs and NHS England.

LCCG Finance Team have set up payment methods for contingency purposes to make payments locally as appropriate.

3 3 12 AO/ CM Jul-15 Nov-15 ►

103103

14


Date Entered


Risk (score)

Current risk

accepted


L CResidual

Risk (score)

Lead Officer

Completion Date

Review Date


CO42 To maximise value from our financial resources and focus on interventions that will make a major difference. To hold providers of commissioned services to account for the quality of services delivered

27/01/2015 To accept from NHS England delegated responsibility for the commissioning of primary care medical services

That the CCG acceptance of delegated authority to commission primary care medical services progresses without a full and proper due diligence exercise to assess the potential risks including financial, staffing and any pre-existing liabilities to the detriment of the CCG.

Transition Group in place with approved Terms of Reference and meeting on weekly basis.

Primary Care Co- Commissioning Manager in post

Exception reporting to the Governing Body through Transition Group and Primary Care Commissioning Committee

CCG has signed the Scheme of Delegation with NHS England and confirmation assurances from the Director of Finance, NHS England Cheshire & Merseyside Sub-Regional team that there is sufficient resource.

4 4 16 N The Primary Care Commissioning Committee is fully established and has formally convened twice in Q1. Process and guidance in relation to delegated commissioning responsibilities continues to evolve. Risk will be re-assessed in Nov 2015.

3 4 12 KS / TJ Ongoing Nov-15 ▼


16/04/2015 To accept from NHS England delegated responsibility for the commissioning of primary care medical services

Acceptance of delegated authority to commission primary care medical services potentially does not allow for necessary timescales for re-procurement of 12 Liverpool APMS practices (current provider SSP) once contract expires on 31st March 2016. Risks are that decision to either extend or cease the contract without full and proper consultation could impact negatively on service delivery to patients

Standing agenda item on Primary Care Commissioning Committee

Exception reporting from PCCC to Governing Body

Practice contracts continue to be monitored via normal reporting processes

5 4 20 N An Interim Provider Policy has been developed approved by the Primary Care Commissioning Committee (June 2015).

5 practices being extended until April 2017. 7 practices require interim provider by April 2016 and plans are in place to ensure robust provider in place by that date.

Communications sent to all SSP practices to inform them of the plans. Task and Finish Group has been set up to manage the transition. Options for procurement of contracts are being presented to the November Primary Care Committee.

Interim provider policy successfully implemented for 1 practice which demonstrates the document is fit for purpose. Inviting expressions of interest for the 7 practices December 2015 to become interim providers. Procurement Task and Finish group will be convened following primary care committee meeting in November.

3 4 12 CM/DR on-going Dec-15 ▼

104104

15


Date Entered


Risk (score)

Current risk

accepted


L CResidual

Risk (score)

Lead Officer

Completion Date

Review Date



16/04/2015 Mental Health Access Waits - waiting time standards for people entering a course of treatment in adult IAPT services.

Transfer of service to new provider on 1st April 2015 revealed inherited backlog of an estimated 1,700 patients waiting for IAPT treatment. Patients waiting to be seen at Step 2 and Step 3 (the majority are Step 3) and although clinical risk is relatively low, it is unlikely that the CCG will be able to deliver against IAPT waiting time contract standards for this cohort of patients, which could result in negative impact on individual patients and lead to public/media/ MP scrutiny. The waiting list also needs to be addressed effectively to ensure the CCG is compliant with 2015/16 IAPT waiting

d d

Data cleansing exercise immediately commenced by new provider to quantify backlog for commissioners

New' patients/referrals will be monitored against IAPT standards separately from those on inherited waiting list to ensure proportionate provider delivery against standard and monitor progress of recovery plan to address backlog.

Contract Review Meetings with exception reporting to Governing Body on key risks & progress with actions to reduce waits

CCG working collaboratively with NHS England IAPT Intensive Support Team to ensure robust recovery plan is delivered

4 4 16 N The CCG has agreed the approach to address the waiting list following an options appraisal from the Trust. Negotiations about payment are ongoing between the Head of Contracts and Procurement and Mersey Care Director of Finance. NHS England have also agreed some additional funding to assist with cleansing the waiting list and the CCG is able to bid for additional funds to support clearance in preparation for delivering waiting standards by April 16.

Agreement has been reached that the Trust will be paid on a cost per case basis for waiting list activity over and above its contracted activity.

There was a contract performance notice issued on 28th September in respect of the Talk Liverpool performance. Following this a remedial action plan has been agreed to address access, recovery and waiting times which includes but is not limited to:• Increasing clinical capacity within the Talk Liverpool Service• Sub-contracting to address the waits for counselling• Increase in group therapy – choice of groups and the numbers • Increase in computerised CCBTThis is monitored via the contract review meetings and will provide assurances that all actions are being actively progressed and that the impact of those actions can be measured.

MOU for release of additional funds from NHSE has been signed the first payment due early Nov.

3 4 12 JL Mar-16 Dec-15 ▼

105105

16


Date Entered


Risk (score)

Current risk

accepted


L CResidual

Risk (score)

Lead Officer

Completion Date

Review Date


CO46 To build successful partnerships which promote system working and integrated service delivery

16/04/2015 Maintain safe & effective Vaccination & immunisation provision for local patients

Transfer of Vaccination & Immunisation provision to General Practice could lead to reduced uptake across the city as not all General Practice staff are adequately trained or prepared to access transfer.

Audit underway of General Practice preparedness to take on transfer

Standing agenda item on Primary Care Quality Committee, oversight conducted by PCCC

Primary Care Quality Team continuing to work with Locality/N'hood teams to quantify risk and establish capacity gap.

Exception reporting from PCCC to Governing Body

5 3 15 N Options for service delivery of vaccinations/immunisations post April 2016 will be agenda item for Primary Care Commissioning Committee in September 2015. Practices alerted to the need to undertake necessary training ASAP; CCG planning to mitigate risks of non transfer by costing up a contingency model

Audit undertaken of General Practice preparedness to take on transfer Fortnightly working group since July 2015 to track progress and identify practices not trained/without agreed go live date Training packages for nursing/admin staff, mentoring/shadowing opportunities with HV team, PNDT support to practices without a nurse all available to practices

The management actions re gaps in controls (column L) can be refreshed to:

Delivery of childhood V&I to be included within GP spec from 1st April 2016 to ensure city wide delivery of routine vaccination programme and support uptake rates to achieve national target of 95% Contingency model will be available to support transition and ensure optimised uptake rates for period Jan – June 16

3 3 9 CM/JL on-going Dec-15 ▼

CO47 To build successful partnerships which promote system working and integrated service delivery

16/04/2015 Delivery of comprehensive Health Visiting service to all practices & registered patients across the city

Local Authority led commissioning of Health Visiting Services is restricted to patients resident within city boundaries of Liverpool, as opposed to patients registered with a Liverpool GP but who live in other Local Authority areas.

National Specification for Health Visitors

Local Authority Contracting Strategy

LCC Director of Social Care attendance as non-voting member of Governing Body ensures effective reporting/ assurance

Director of Public Health attendance as non-voting member of Governing Body has DoPH report as standing agenda item

3 4 12 N Transition of Health Visiting service delivery to Local Authority resident footprints commenced on the 1st July 2015 in Merseyside. All Merseyside Local Authorities continue to collaborate at this early stage to ensure an effective solution so that Health Visitor Provision matches patient's registered practice & removes the need for GP practices to potentially engage with multiple Local Authorities regarding provision. Transition work is ongoing.

It is recommended that this risk is removed as the transition work is now complete. Contract monitoring of service by LCC will take account of any cross border issues arising and the impact.

3 4 12 JL On-going Nov-15 ►

106106

17


Date Entered


Risk (score)

Current risk

accepted


L CResidual

Risk (score)

Lead Officer

Completion Date

Review Date



06/07/2015 To secure a new Headquarters premises for the CCG

That the building works to fit out the new HQ are delayed beyond the deadline at which the CCG must vacate the current Arthouse Headquarters.

Letter of instruction sent to the developer to commence construction works on the 29/05/15 which would allow sufficient time for the works to be completed; funding for the works lodged with Hill Dickinson LLP in an 'escrow' account to be released upon phased completion of the works

Legal Advisers and Liverpool Sefton Health Partnership both acting on behalf of the CCG to expedite matters; NHS Property Services as current landlord supporting the process. Briefing provided to the Finance, Contracting & Procurement Committee June 2015.

3 4 12 N Teleconference held on the 18th June 2015 with the developer and financial backers for the new development to expedite matters and seek to develop contingency plans in the event that the building works are further delayed. Further meetings to be held to explore the options available w/c 6th July, position then to be reviewed.

Building works have now fully commenced with a scheduled completion date of 13th November 2015, occupation of the new premises to follow thereafter. Negotiations continue with the Receiver to allow the CCG to remain in Arthouse Square to the end of November. The latter is however subject to NHS Property Services securing agreement on the outstanding dilapidations. Contingency measures are being explored if the latter is not resolved.

Agreement reached with official receiver for Arthouse that the CCG remain in the building until the end of November to facilitate the completion of fit out works in new HQ. Current progress to date shows building work on schedule for completion by middle of November with CCG expected to relocate into new HQ week commencing 16/11/2015 after which Arthouse will be decommissioned.

1 4 4 ID Nov-15 Nov-15 ▼


31/07/2015 Respond to Monitor Pricing Enforcement complaint regarding the pricing of CHC care home services

Financial risk - potential of penalty fine from Monitor if an investigation finds in providers favourFinancial risk - impact of having to back date payments to providers from 1 April 2014 if investigation finds against LCCGReputational - impact if

Immediate Review of all CHC payments for patients in care homes to assess financial impact. Legal advice sought to support response to Monitor. Current re-procurement CHC NW framework services to commence mid

Regular review of CHC payments.

4 4 16 N LCCG Compliance statement submitted to Monitor. Now await response from Monitor to confirm if an investigation will be undertaken.

It is recommended that this risk is removed as on 26/10/2015 Monitor advised they will not be opening a formal investigation. The CCG can consider the matter closed and no further action will be taken at this time.

3 4 12 DR/JL Ongoing Nov-15 ▼

107107

18


Date Entered


Risk (score)

Current risk

accepted


L CResidual

Risk (score)

Lead Officer

Completion Date

Review Date


CO50

We accept responsibility for our actions. We make and support business decisions through experience, evidence and good judgement, and we will deliver against our promises.

23/07/2015 Stability of commissioning support services during re-procurement

Timescale and potential loss of service up to transition and during mobilisation

Robust transition plan from new provider and exit plan from incumbent

Weekly transition board meetings to monitor progress and highlight any risks. Monthly steering group meetings

3 4 12 N LPF tender issued submissions due to be return 28th September - award of new supplier November 2015.

From November 2015 the CCG focus will be on mobilisation of the new provider and supporting the transition of staff from the NWCSU to the new provider during this period. Services will be monitored to ensure no reduction in service levels.

3 4 12 DR Ongoing Dec-15 ►


03/11/2015 Effective provision of nursing home beds to the residents of Liverpool

Total bed capacity within independent nursing homes is less than 2% at 1.1% of the total bed capacity. (This is equivalent to 6 out of 524 beds being available). This is limiting patient choice, delaying discharge from Acute Care, increasing the demand on community resources supporting nursing home beds. The average length of stay in a nursing home bed is 3 years.

Professional revalidation required of nurses including those working in the care home sector.

Current nursing home bed availability is updated and shared across the system (Liverpool) on a daily basis.

Limited assurance in controls due to lack of influence on market.

Nursing Home integrated dashboard will create a single point of access for information and to highlight early warning signs and areas of concern.

Further development of the performance dashboard to maximise the intelligence and information available to commissioners, providers and the general public.

5 4 20 N Development of intermediate care pathways to prevent admission to permanent / temporary care.

LCCG has purchased toolkit to assist nurses to revalidate which will be marketed through the City Centre care home forum.

More robust assessment processes being implemented.

Joint project group developing long term care home strategy to shape the future market to ensure sustainability of care home market.

Developing new care home clinical model in order to prevent closure due to poor quality and relocation of residents.

Continued adoption and refinement of the fair cost of care methodology used by LCC

More accurate long term forecasting of supply and demand - market position statement

Establish a more streamlined process for understanding real time capacity and pressures

Work with the sector to improve recruitment, retention and training of care and nursing staff

Work with partners to improve existing estate and identify opportunities for new developments to meet current gaps in both the standard older people market and the specialist residential and nursing market.

5 4 20 JL Ongoing Dec-15 New Risk

108108

19


Date Entered


Risk (score)

Current risk

accepted


L CResidual

Risk (score)

Lead Officer

Completion Date

Review Date


KEY:

Updates to existing risks in 'blue' new risk Recommended for removal

► Risk Unchanged

▲ Risk increased

▼ Risk decreased

109109

110110

Report no: GB 83-15



Title of Report Complaints, Subject Access Requests, Freedom of Information Requests and MP Enquiries

Lead Governor Nadim Fazlani.


Stephen Hendry, Acting Head of Operations & Corporate Performance

Report Author Joanne Davies, Corporate Services Manager

Summary The purpose of this paper is to bring to the Governing Body’s attention the breadth, scale and response to complaints, subject access requests, Freedom of Information Act requests and MP enquiries.

Recommendation That Liverpool CCG Governing Body: Receives and note the contents of this six

monthly summary report. Impact on improving health outcomes, reducing inequalities and promoting financial sustainability

Analysis of complaints, requests and enquiries can provide a useful source of insight and intelligence into the quality and delivery of provided and commissioned services, informing and stimulating further service improvement and development for the benefit of local people.


Department of Health and NHS England Complaints Management Guidance; Parliamentary and Health Service Ombudsman best practice guidance; The Freedom of Information Act.

Page 1 of 8 111111

Report: Complaints, Subject Access Requests, Freedom of Information Requests and MP Enquiries

From: 1st April to 30th September 2015

Page 2 of 8 112112

1. Background This report presents Liverpool Clinical Commissioning Group’s activity against MP enquiries, Subject Access Requests, Freedom of Information Request and Complaints for the period of 1st April 2015 to 30th September 2015. All such requests or enquiries are managed through the Operations & Corporate Performance Team who receive, investigate and process such enquiries. Figures in brackets throughout the report show the comparison to the same time period during 2014/15. 2. MP Enquiries Liverpool CCG has received a total of 12 MP enquiries between 1st April and 30th September 2015 compared to 26 received last year during the same time period. There are currently 3 enquiries recorded as open. There has been no trend identified in the topic of the letters received from MPs on behalf of their constituents. 3. Subject Access Requests There have been no Subject Access Requests received between 1st April and 30th September 2015. 4. Freedom of Information Act Requests FOIs are received into the team primarily via a dedicated email account, although direct personal contact and telephone enquiries are made on occasion. All such requests are recorded in an excel spreadsheet that is used to track and manage the progress. Initial screening of the request will then determine if the request has been properly directed to the CCG or needs to be redirected elsewhere for a response. The number of freedom of information requests received by Liverpool CCG from 1st April to 30th September 2015 is shown in the table below:

Month Number received Total number of questions / elements in the requests

April 20 (18) 151 (62)

May 20 (27) 147 (177)

June 26 (26) 154 (108)

July 31 (21) 226 (90)

August 27 (23) 103 (91)

Page 3 of 8 113113

September 20 (33) 117 (114)

Sub total 144 (148) 898 (642)

Analysis of the 144 requests received in the period shows the following key themes:

Theme Number of requests

Contact details for members and/or officers 6 (10)

Details of specific treatments or services (28)

Drug /medicines/prescribing management policy 12 (14)

Investment / finance questions 25 (17)

Contracts 22 (30)

Overt media enquiries 10 (4)

IT / Telecommunications 8 (5)

Mental Health / Learning Disability / CAMHS 5 (15)

GP related 14

IVF 5

Primary Care and Pharmacy Rebates 4

Personal Health Budgets 3

Other 30 (25)

5. Complaints 5.1 Complaints received by Liverpool CCG Liverpool Clinical Commissioning Group aims at all times to provide local resolutions to complaints and takes all complaints seriously. When dealing with complaints the main purpose for the CCG is to remedy the situation as quickly as possible and ensure the individual is satisfied with the response they receive. It is important that individuals feel that they have been fairly listened to, treated with respect and any issues raised have been satisfactorily resolved within agreed timescales. The time limit for making a complaint as laid down in the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 is currently 12 months after the date on which the subject

Page 4 of 8 114114

of the complaint occurred or the date on which the matter came to the attention of the complainant. An acknowledgement of the received complaint is made within 3 working days, to acknowledge the complainant’s concerns. The CCG aims to provide a formal response to complaints received within 35 working days, however depending on the complexity of the complaint longer may be required. Any time extensions are agreed jointly with the complainant and the complainant is kept informed of progress throughout the investigation. The CCG aims to remedy complaints locally through investigation and meetings if appropriate, however if the complainant remains dissatisfied they have the right to refer their complaint to the Parliamentary and Health Service Ombudsman (PHSO) as the second stage. Complaints received From April 2014 to September 2014, NHS Liverpool CCG recorded a total of 72 complaints. From 1st April to 30th September 2015, NHS Liverpool CCG has recorded a total of 35 complaints and 6 informal complaints that have been treated as a PALS query. Of the 35 complaints recorded 11 complaints are currently open. The 24 complaints Liverpool CCG has accepted from the 1st April to 30th September 2015 that are now closed can be summarised as follows:

Number of complaints

Provider Reason for complaint and status of complaint

6 (12) Continuing Health Care • 6 x complaints with regards to retrospective CHC funding. All closed and not upheld. (2 of these complaints were closed as no letter of authority received).

2 (5) Aintree • 1 x complaint re delay in diagnosis and results of tests. Complaint closed as local resolution achieved between the Trust and the complainant.

• 1 x complaint re treatment of family member. Complaint managed through the duty of candour route between the Trust and the family.

2 (13) RLBUHT • 1 x complaint regarding treatment of terminally ill father whilst patient at the Trust. Complaint closed and not upheld as complainant was abusive to staff and other family members were happy with their father’s care.

• 1 x complaint about systems in place for deaf patients. Complaint closed and not upheld as signed consent not received from the complainant.

Page 5 of 8 115115



2 (4) Mersey Care • 1 x complaint from patient wishing to be treated at 5BP Trust instead of Mersey Care. Complaint upheld and patient advised he can choose his provided and was provided with the contact details for the advocacy service as requested.

• 1 x complaint about medication. Complainant contacted and asked for clarity about whether the complaint was actually against Mersey Care. Complaint closed and not upheld as no further contact received from the complainant.

1 (6) LCH • 1 x complaint about the treatment provided to a child at the WIC out of hours. Complaint received by LCH directly and liaised with family directly so CCG file closed.

1 (4) Alder Hey • 1 x complaint regarding waiting time to see an ophthalmologist. Complaint upheld and an emergency appointment offered to the family.

2 (4) UC24 (OOH) • 1 x complaint re service provided. Complaint not upheld and closed as signed consent not received from the patient.

• 1 x complaint about the OOH for a child. UC24 had already received this complaint directly and was liaising with the family so the CCG file was closed.

8 (8) Other • 1 x complaint re IVF treatment not being expedited due to woman’s age. Complaint not upheld as investigations etc commenced prior to age limit.

• 1 x complaint against Liverpool PCT. Complaint not upheld and managed through HR route.

• 1 x complaint medication no longer being able to be prescribed as now blacklisted. Complaint not upheld.

• 1 x complaint re discharge of a patient to Mossley Manor Care Home and care home then being closed down. Complaint not upheld as all NHS procedures followed.

• 1 x complaint re needle found on ground outside close to GP Practice. Complaint not upheld. Practice Manager explained to complainant that there was no evidence the needle was from the practice and also explained their sharps disposal procedures.

• 1 x complaint re weight management service as family member felt child’s care was not being coordinated across a number of services. Complaint not upheld as family not engaging with

Page 6 of 8 116116



services offered. • 2 x complaint re eating disorder service as

dietician is not available as part of the eating disorder service and the service is disjointed and lacking in areas of care compared to other areas of the country. Complaint upheld and issues are being taken forward through the HLP.

5.2 Complaints themes Analysis of the complaints received to date does not show any major trends, themes or areas emerging. However the majority of CHC complaints are about the length of time it is taking to process retrospective reviews and the lack of communication from the team during the process. 5.3 Lessons Learnt Continuing Health Care NHS Liverpool Clinical Commissioning Group continue to work with the North West Commissioning Support Unit who manage Continuing Health Care cases to ensure they provide regular updates to patients, carers and relatives to try to avoid complaints being made when patients become frustrated with timescales. Dietetic Service The eating disorder service remains on our list of priorities in the Mental Health Workstream. The Programme Delivery Manager for Mental Health has met with the service who are compiling a business case to support service development with some additional support for a dietician, with a fuller review of the pathway to take place in 2016/17. Action Plans To support the CCG’s updated Complaints Policy, all providers are now being asked to provide an action plan and lessons learnt with regards to all complaints that we escalate to them. 5.4 Parliamentary and Health Service Ombudsman At the start of the year, the Ombudsman requested copies of a complaint and associated CHC file that had been referred to them by the complainant as he remained unhappy with the PCT and CCG’s decision not to reimburse his company for care provided to a patient. At the time of the original complaint, the care company in question was not a recognised provided for the PCT.

Page 7 of 8 117117

However, on review of all the evidence, the Ombudsman has recommended that the CCG provide full reimbursement to the care company.

Joanne Davies Corporate Services Manager

Stephen Hendry Acting Head of Operations & Corporate Performance

26 October 2015

Page 8 of 8 118118

MINUTES OF THE APPROVALS PANEL MEETING Tuesday 28 April 2015

Meeting Room 1, 4th Floor, Arthouse Square

Present:

Prof Maureen Williams (MW) Panel Chair Katherine Sheerin (KS) Chief Officer Jane Lunt (JL) Head of Quality/Chief Nurse Dave Antrobus (DA) Lay Member Governing Body Tom Jackson (TJ) Chief Finance Officer

In attendance:

Michelle Urwin (MU) Transformational Change Manager, Dementia Carol Hughes (CH) PA/Minute Taker

Apologies:

Dr Donal O’Donoghue (DO) Secondary Care Doctor Governing Body Cheryl Mould (CM) Head of Primary Care Quality & Improvement

1 Welcome and Apologies:

The Chair welcomed everyone to the meeting and apologies were noted as above.

2 Extension to the Winter Resilience and Older Peoples Framework Schemes for 2015-16. A report was presented by Michelle Urwin (MU) to set out the process to extend the winter resilience and older people’s initiatives in primary care into 2015-16, following agreement at the March Governing body to temporarily continue schemes into 2015/16 with financial agreement from the Approvals Panel. Professor Williams (MW) advised that this had been discussed in great detail at the Finance Procurement and Contracting Committee earlier when it was made clear that Governing Body had approved funding as an extension up to 30 September. MW noted that it was perfectly correct for the panel to make decisions as to whether or not they wish to allocate funding within that which has been approved. The FPCC further confirmed that the Over 75 Funding was not an increase in funding but merely an extension of time and that had also been agreed at the Governing Body. A report was presented by MU who updated on the two local initiatives ‘ A Local Framework for Older People’ and ‘Healthy Ageing’ both of which aimed to optimise care of people aged 75+ and maximise capacity of general practice over the winter period.

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An update on both schemes was given by MU who confirmed: Winter Resilience Scheme: Monthly monitoring of the scheme had indicated that of the total extra capacity offered to the end March 2015 88.4% of appointments had been booked with a DNA rate of 4.5% and there were 11.5% of appointments unfilled. The total number of appointments offered equated to 95% of the total expected when the scheme was established with a shortfall reported to be due to availability of resources to deliver extra capacity. Funding to end March 2015 was highlighted with £1,237,320 invoiced to date, with £2,066.022 allocated and £293,978 not allocated against a budget of £2.36m. MU confirmed that as the scheme was due to end on the 31 March 2015 all 80 practices involved had been invited to participate in the extension through a written response and had confirmed that they would participate in the extended scheme to 30 September delivering the same level of extra capacity per week as per the original bid. MU highlighted that to extend the scheme for 26 weeks from 1 April to 30 September 2015, based on current costs would require a budget of £2,522.832 and investment for this scheme equal to £1.181m was approved at the March Governing Body. Older Peoples Framework Scheme: Monthly monitoring and review of this scheme indicated that at February 2015 half of the planned GCAs and less than half of the medication reviews were expected to be completed by the end March 2015. A review of the financial position for 2014-15 had identified that a cost of approximately £1m was required for practices to finish off or complete planned activity already agreed under the scheme, and it was noted that the best approach would be to extend the scheme to offer more time for practices to complete their existing plans. An extension was applied to this framework with practices being informed that agreed and existing plans would need to be delivered by the 31 July deadline. MU advised that guidance based on feedback from practices had been sent out to practices and it was expected that funding would be under the £2.5m envelope as agreed by Governing Body. MW noted that a full review of the 2 schemes was planned based on when data would be available and that the paper originally submitted to Governing Body recognised that an interim paper was required for Governing Body to signal what recommendations would be. An evaluation would then go to the Primary Care Quality Committee to review feedback. MW queried if the interim report was being done in June and how much detail would be available for a detailed review in July. In response, MU advised that the cut-off date was 31 March for full evaluation rather than extension. It was noted that a qualitative review was currently being undertaken to look at schemes and an audit of schemes has been planned.

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KS noted the importance of the review and advised that 2 separate reviews, one for each scheme, would be undertaken. KS further noted that reports for all resilience schemes would be provided for Governing Body which would include a breakdown for each scheme and patient feedback. The National Survey over this period of time would also be used to provide a comparison to last year. An extension for a maximum of 70 or 80 appointments as requested was approved and the proposals for review and feedback including data was endorsed. A discussion about robustness of the report to be submitted to the Governing Body will be discussed outside of the meeting.

3 Minutes from the previous panel: Subject to the following amendment: Top of page 3: to include £95.28 PMS The minutes from the previous panel held on the 14 April 2015 were agreed as a true and accurate reflection.

4 Any other business: MU advised that there had been some changes in terms of planned activity with the Older Peoples Scheme as opposed to what is being claimed for and requested approval to sign off additional funding. MU gave various examples including Mere Lane Practice planned activity which was 224 Medication Reviews and an additional 7 had been done requiring an additional cost of £210 and the rationale given was that from submitting the plan to undertaking reviews numbers had changed in terms of numbers of patients. MW confirmed by e mail that MU had been given approval to flex up to a maximum of £1k where evidenced and reasonable and noted that this is not a precedent in terms of delegating authority down. It was AGREED that providing a record would be kept by MU to confirm there was no conflict of interest then authority could be given without awaiting approval by this panel.

5 Date of next meeting: Tuesday, 26 May, 2015 4 – 5 pm Meeting Room 3, Arthouse Square

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QUALITY SAFETY & OUTCOMES COMMITTEE Minutes of meeting held on Tuesday 18th August 2015 at 3pm

Room 2 4th Floor Arthouse Square

Present Dave Antrobus (DA) Chair/Lay Member Katherine Sheerin (KS) Chief Officer Jane Lunt (JL) Head of Quality/Chief Nurse & Vice

Chair Fiona Lemmens (FL) GP Governing Body Member In attendance Mavis Morgan (MM) Healthwatch Volunteer Esther Golby (EG) Deputy Designated Nurse Safeguarding

Children – Safeguarding Service Margaret Goddard (MG) Named GP for Safeguarding Denise Roberts (DR) Clinical Quality & Safety Manager Kellie Connor (KC) Clinical Quality & Performance Manager Kerry Lloyd (KL) Deputy Chief Nurse Stephen Hendry (SH) Acting Head of Operations & Corporate

Performance Claire Sanders (CS) Discharge Development Manager (item

16 only) Paula Jones PA/Minute taker Apologies Tom Jackson (TJ) Chief Finance Officer Rosie Kaur (RK) GP Governing Body Member Donal O’Donoghue (D’OD) Secondary Care Consultant Helen Smith (HS) Head of Safeguarding Adults –

Safeguarding Service Shamim Rose (SR) GP Governing Body Member Cheryl Mould (CM) Head of Primary Care Quality &

Improvement Tony Woods (TW) Head of Strategy & Outcomes Alexis Macherianakis (AM) Public Health Consultant

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1. WELCOME & INTRODUCTIONS

The Chair welcomed everyone to the meeting. It was agreed to take item 16 as the first item on the agenda.

2. DECLARATIONS OF INTEREST

None

3. MINUTES AND ACTIONS FROM 2ND JUNE 2015

The minutes from the meeting held on 2nd June 2015 were approved as an accurate record of the discussions which had taken place subject to the following amendments:

• Page 6 item 6 Safeguarding Reviews – MG noted that there was a network of Named GPs for the Cheshire & Merseyside CCGs.

• Page 7 Safeguarding Service Report third bullet, re Care Homes it was noted that “DA expressed concern about relatives/patients being made aware of the suspension.”

4. MATTERS ARISING NOT ALREADY ON THE AGENDA:

4.1 Safeguarding Capacity Flow Chart – MG had circulated the

Safeguarding Children Flowchart with the papers along with a contacts sheet. It was pointed out that the Flowchart contained the new early health agenda information and was used by Sefton as well as Liverpool but the contact details were Liverpool. The contacts sheet contained all contact information although the Knowsley numbers were not yet available. MG confirmed that the flowchart had been sent out to practices.

4.2 All other action points were on the agenda.

5. TRUST CONTRACT QUALITY – EARLY WARNING DASHBOARD

– REPORT NO: QSOC 22-15

KC presented the Early Warning Dashboard to the Quality Safety & Outcomes Committee and highlighted:

• VTE Risk assessments March 2015 – Royal Liverpool Hospital had improved dramatically. This had been a national CQUIN

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last year, was now local therefore there was no data until September 2015. It was being discussed at the Clinical Performance & Quality Group.

• MRSA/C Difficile: MRSA - two cases at Alder Hey year to date

(against zero tolerance) – there was a paper on healthcare acquired infections later on the agenda which would give more detail on assurance.

• Incident reporting – shift for Alder Hey, Liverpool Heart & Chest

Hospital/Royal Liverpool Hospital were making improvements in reporting but not as much as we desired. There were a number of cases reported at Liverpool Heart & Chest Hospital so they were above the national average but they were below the national average in confidence to report therefore they were being observed closely by the Quality Team.

• Mixed Sex Accommodation – Liverpool Heart & Chest Hospital

had reported no breaches in July, the issues around patient flow were being rectified (a CQUIN was in place this year therefore this was identified as a priority).

• National CQUINS:

o trusts had struggled to meet the Dementia Measure targets – NHS England had changed the responsibilities for Care Plans – the national CQUIN applied to the Royal and Aintree but not Mersey Care where the plans were drawn up. This issue would be taken back to the Clinical Performance & Quality Group in January 2016. The concern was highlighted by the committee members over the provider who diagnosed dementia needing to draw up the care plan (i.e. usually Mersey Care). JL however noted that staff in acute trusts also needed to be aware of how to recognise patients with dementia and how to treat them whilst in an acute trust for a physical condition. KC noted that care plans should be shared with the patient’s GP. DA at this point referred to Mersey Care and serious incident reporting – Liverpool CCG had responsibility for all residents in Liverpool and some patients were registered with GPs outside the city so there was an issue of incidents not being on our radar. DR assured that all Serious Incidents were reported back on to the commissioner and NHS England North but Liverpool CCG would be copied in to the report for

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Liverpool patients and kept informed although not asked for a view.

o Friends & Family Test – DA noted that the Royal had a

high number of “would not recommend” responses but scored very positively in other areas and queried how this was possible. KC responded that the results were used to give an indication of where to look closer for possible issues and that nothing was considered in isolation.

• Never Events – there had been two at Alder Hey (wrong site

surgery) and a root cause analysis was being carried out. The Quality Safety & Outcomes Committee members commented:

• DA raised the issue of mortality at Aintree and the use of the Summary Hospital-level Mortality Indicator (‘SHMI’). KC noted that work was ongoing with the Trust via the Clinical Performance & Quality Group and the Mortality Working Group which was attended by Dr Paula Finnerty.

• KS commented that the Early Warning Dashboard was an

excellent report and showed the depth of analysis being carried out by the Quality Team. JL responded that this was all part of building up a complete picture and developing relationships with the trusts and their staff, the interaction with them via the Clinical Performance & Quality Groups and contracting meetings felt extremely positive. Also the value of the wide range of “soft intelligence” from improved relationships/regular contact was not to be underestimated.

• MG referred to sickness absence at trusts, KC responded that a

holistic approach to performance was taken including complaints and then sickness absence considered to see if it was a factor i.e. staff pressure of work and sickness due to anxiety/depression. Sickness absence fluctuated during the year, the important issue was to ensure patient safety and this could be evaluated using the Clinical Performance & Quality Groups at a very early stage.

• FL asked how issues could be escalated – JL responded that

this was via the Clinical Quality & Performance Groups and if further escalation was required the contract requirements for performance would be involved as a tool.

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The Quality Safety & Outcomes Committee: Noted the performance of the CCG in delivery of key

national performance indicators and the recovery actions taken to improve performance.

6. LIVERPOOL COMMUNITY HEALTH – PRESSURE ULCER

REPORTING AND THE MANAGEMENT OF SERIOUS INCIDENTS - REPORT NO: QSOC 23-15 DR presented a paper to the Quality Safety & Outcomes Committee to update on the current position of Pressure Ulcer investigations within Liverpool Community Health and to discuss the proposal for future management of investigations. Liverpool Community Health had identified Pressure Ulcers across the system which had shown a significant level of harm. Last year 167 had been reported classified as grade 3 or 4 of which 150 were reported by Liverpool Community Health whether they were attributable to the trust or not. A thematic review had been carried and the same issues arose for all in that the learning was missing.. For this reason the Quality Safety & Outcomes Committee was asked to give permission to enable a different approach and pull together an Action Plan for the Trust which had already been agreed by the Chief Nurses of South Sefton, Knowsley and Liverpool CCGs. A workshop would be held in early September to develop the Action Plan and would report directly to the Liverpool Community Health Clinical Quality & Performance Group. DA asked if Continuing Healthcare patients in nursing homes were included. JL responded that it was imperative that care home/nursing home staff were fully confident and competent in dealing with pressure ulcers and that they received the appropriate training, with possibly training from Liverpool Community Health being offered to wider staff. Nurse Validation was another route into nursing home staff to ensure their skills and competencies were up to date. Also CQUINs could be used to support care homes with a care homes dashboard produced to assess data around pressure ulcers, healthcare acquired infections etc to help manage the market better. KL stressed the need to encourage openness and transparency in Liverpool Community Health for them to feel confident to report all cases.

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KS commented that this was an excellent paper and showed how the issues needed to be managed tightly by commissioners.

The Quality Safety & Outcomes Committee: Noted the contents of the report Agreed the proposal for future management of the

Pressure Ulcer Serious Incidents Agreed the next steps and to receive update reports as

appropriate

7. LIVERPOOL COMMUNITY HEALTH QUALITY REVIEW (JULY 2015) – REPORT NO: QSOC 24-15

KL presented a report to the Quality Safety & Outcomes Committee to provide an update on the ongoing assurance processes in pace to monitor the quality and safety of commissioned services at Liverpool Community Health, noting that the Care Quality Commission report from November 2013 was contained in Appendix 1 of the paper. The recent Quality Review held on 21st July 2015 had wanted to gain assurance on progress re the Action Plans put in place by the Care Quality Commission and the Trust Development Authority and noted that the Trust was no longer pursuing NHS Foundation Trust status and the impact of this decision. The Quality Review had been organised by NHS England, chaired by Clare Duggan, Director of Commissioning NHS England, and involved multiple stakeholders and looked at the issues of workforce, safety, governance, culture and access. The Action Plan contained three phases of first “must dos”, secondly “could/should dos” and thirdly service transformation. The organisation had now recruited to full establishment with a new Leadership Team in place. The issue of sickness management had been addressed by a less punitive approach from Human Resources and changes to sickness/absence rules which had resulted in a decrease. Enhanced Surveillance was to be kept and NHS England had asked for a report back in six months’ time. A Quality Profile Tool was being developed by NHS England North which Liverpool Community Health would possibly pilot. The five areas had been broken down into a GP Clinical Lead, Managerial Lead and Trust Lead being assigned to each.

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The Quality Safety & Outcomes Committee: Noted the content of the report Requested updates as required

8. HEALTHCARE ACQUIRED INFECTION (HCAI) IN LIVERPOOL HEALTH ECONOMY (2015-2016 YTD) - REPORT NO: QSOC 25-15

KL presented a paper to the Quality Safety & Outcomes Committee to update on the prevalence of healthcare acquired infections across the Liverpool health economy and to provide assurance of the on-going work to reduce avoidable infection within and between Trusts. She highlighted:

• MRSA: three cases in total “trust acquired” (one at the Royal Liverpool Hospital, two at Alder Hey). The Royal Liverpool Hospital was working to an Infection Prevention and Control Improvement Plan. The two cases at Alder Hey had happened in quick succession and had come as a surprise. The trust was being open an honest in asking for support on how to manage and this had been flagged as an issue at the Clinical Quality & Performance Group. An action plan was in place and improvement should be seen.

• C Difficile: the Royal and Aintree were both under trajectory –

the issues were around community acquired C Difficile. The Liverpool CCG Transformational Change Manager for Prescribing and the Commissioning Support Unit Lead on Infection Prevention & Control had met that day to think about the huge issue of anti-microbial resistance re over-prescribing of antibiotics and how to take this forward. A small steering group had been set up.

The Quality Safety & Outcomes Committee: Noted the content of the report. Requested updates as required.

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9. SAFEGUARDING SERVICE REPORT– REPORT NO: QSOC 26-15

The Safeguarding Service presented a report to the Quality Safety & Outcomes Committee to provide an assurance that Liverpool CCG was discharging its duties in relation to safeguarding children and adults and to give an analysis of the Safeguarding Key Performance Indicators Quarter 4 data received from commissioned health services. It also provided a briefing on legislation re Female Genital Mutilation and Looked After Children. • Part One - Key Performance Indicators

EG updated: This was the end of year performance for safeguarding from

all commissioned providers. Rag rating page 6 of report by provider. Liverpool Women’s Hospital – limited assurance. Work had

been carried out in relation to the Peer Review a year ago – the action plan had been drawn up which had resulted in the development and employment of key staff such as Head of Safeguarding. The Action Plan was progressing well.

Royal Liverpool and Broadgreen University Hospital - only

quarter 1 data submitted, quarters 2 to 4 submitted late therefore red. The Trust had brought in an external review to carry out a Peer Review (January 2015) and now had an action plan. They had put in place key personnel such as an Assistant Chief Nurse (to be in post September 2015). The Safeguarding Service attended the monthly Royal Strategy Meeting and the Trust had submitted on time for quarter 1 2015 but were not consistent in their improvement.

• Part Two – Domestic Homicide Reviews and Serious

Case Reviews

EG updated: Serious Case Reviews – results published in June 2015

(Appendix one contained the themes). Each provider

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involved in the care programme was included in the Action Plan but some actions required comment from the Health Economy, therefore a presentation would be made at the Health Sub Group of the Liverpool Safeguarding Children’s Board in order to determine an over-arching action plan. A Task & Finish Group was already looking at mental health trust assessments and the role of Adult and Children’s Safeguarding and acute providers.

• Part Three – Female Genital Mutilation

EG updated: Changes in legislation were being brought about which would

make it mandatory to report incidents of Female Genital Mutilation. However there were discrepancies around reporting pathways (Police or Safeguarding responsibility?).

A Female Genital Mutilation Pathway was to be developed. Additional requirements re information gathering to be added

to the dataset that must be captured and centrally returned – however not all providers were signed up as yet and this was being followed up by the Safeguarding Service.

MM raised the issue of cultural practice in the light of equality and diversity, however JL noted that Female Genital Mutilation had been an offence since 1985 but had not been strongly pursued until now. Also it was child abuse and illegal which superseded the cultural viewpoint. MG added the need for sensitivity in order to promote education rather than drive the practice underground.

• Part Four – Mersey Internal Audit Agency Reviews

A further review of Safeguarding had been proposed to take place in October 2015 focussing on the roles and responsibilities re safeguarding including the CCG and NHS England as co-commissioners or primary care.

• Counter-Terrorism and Security Bill had received Royal Assent

in February 2015 and had safeguarding implications.

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• Safeguarding Service Review - successful recruitment had taken place for all positions.

• Looked After Children – an update on statutory guidance was

provided in Appendix Three. The requirement was to have a Designated Nurse for Looked After Children and Carmel Farmer was now in post. In response to a question from DA it was confirmed that there were about 1,000 Looked After Children at any time, not all were placed in Liverpool and some were outside of borough. MM question the age at which they left the system as they would still be classed as vulnerable. EG noted that they could stay in the system until the age of eighteen and that there was a service to accommodate the needs of those over eighteen.

KS noted that this was again an excellent report and referred to the safeguarding reporting from trusts and these not being submitted to the correct deadline and what the next steps would be to enforce compliance. JL replied that Activity Query Notices could be served as a lever, noting that the Safeguarding Service provided extensive support to the trusts. The Quality Safety & Outcomes Committee: Noted and approved the content of the document.

10. UPDATE REGARDING CARE QUALITY COMMISSION

INSPECTIONS –REPORT NO: QSOC 27-15

KC presented a paper to the Quality Safety & Outcomes Committee to update on the latest Care Quality Commission Inspection for Liverpool Women’s Hospital Trust. There had been an unannounced inspection in early June 2013 and the report and related action plan had been discussed at regular Clinical Performance and Quality meetings – action was required around care and welfare of service users, staffing and supporting workers. The recent February 2015 inspection had resulted in an overall “good” report although the community midwifery service required improvement. Maternity In-patient and gynaecology surgery also required improvement but were rated safe.

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The Quality Surveillance Group in July 2015 had stepped the trust down from Enhanced Surveillance, thus acknowledging the changes implemented and the progress made.

The Quality Safety & Outcomes Committee: Noted the contents of the report Noted the on-going work with both trusts to improve quality.

11. CARE ACT 2014 UPDATE – REPORT NO: QSOC 28-15

The Quality Safety & Outcomes Committee considered a paper which had been prepared by the Head of Safeguarding Adults to give a briefing on the Care Act 2014 on the transition from children’s to adult services. DA noted that it did not mention Looked After Children, EG acknowledged this and noted that there was no clear definition as yet on transition in the Care Act. A key provision of the Act was that it was the duty for the Local Authority to carry out a transition assessment for young people under 18 with care support needs approaching adulthood, young carers under 18 approaching adulthood and adult carers of young people approaching adulthood. The implication for CCGs was that although the Local Authority had the duty, the CCG and Local Authority needed to work in partnership – cultural and whole system change was required. JL noted that the SEND (Special Educational Needs & Disability) Reforms should help and support in this.

The Quality Safety & Outcomes Committee: noted the contents of the paper

12. LIVERPOOL CLINICAL LABORATORIES – VERBAL

DR gave a verbal update to the Quality Safety & Outcomes Committee:

• Four isolated incidents at Liverpool Clinical Laboratories on the recording or non- recording of results on the IT systems.

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• Work was on-going – the safety net appeared to be working catching issues as they arose.

• A spreadsheet had been sent to all practices concerned with

results for the last four months, co-ordinated by Dr Paula Finnerty, in order to identify any possible harm to patients. A paper would come to the Quality Safety & Outcomes Committee in due course.

• JL stressed the need for the CCGs involved to undertake a

review of the process in case held to account and to identify the wider learning.

The Quality Safety & Outcomes Committee: Noted the verbal update.

13. NHS LIVERPOOL CCG COMPLAINTS, CONCERNS AND

COMPLIMENTS POLICY (AUGUST 2015) – REPORT NO: QSOC 29-15

SH presented a paper to the Quality Safety & Outcomes Committee to give an overview of the revised NHS Liverpool CCG Complaints Policy for noting and approval. The Policy had already been reviewed by the Patient Engagement & Experience Programme, and once approved by the Quality Safety & Outcomes Committee would be referred to the Liverpool CCG Governing Body for ratification. The previous Policy had been drawn up in 2013, was out of date and not fit for purpose. Mersey Internal Audit Agency had carried out a review of the complaints system and had highlighted gaps which the new Policy addressed. The changes were highlighted:

• Process was now patient centred and a customer relationship lead appointed.

• More description of individual and committee reporting, i.e. it

referred to Chief Nurse and Quality Safety & Outcomes Committee.

• The new Policy prepared for the receipt of Primary Care

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• Timescales would be proportionate to the severity of the

complaint (not the standard 35 working days) due to the complexity of complaints being received which would be based on negotiations with the individual concerned.

• More rigour would be applied to lessons learnt and their

identification/application, as done with Serious Incidents, and the complainant would be kept informed.

• There would be stronger links with Healthwatch.

Overall the process was more bespoke – this was a significant change for providers and a new post would be created to deal with this. It was noted that the Appendices to the paper were A and B not 1 and 2. KL commented on the more personalised and approach and that this was much better for patients. DA asked about the interface with the acute trusts if a patient complained to the CCG as commissioner rather than the acute trust itself. SH responded that the complainant needed to authorise the CCG to share information with the provider which was the current issue. This would be even more problematic when dealing with GP practice complaints as well. In summary JL welcomed the new approach and noted that if we expected our providers to be open and transparent and behave ethically then the CCG needed to model this behaviour. KS commented that this was a much improved Policy and noted the need to strengthen learning and to share that with the complainants. She referred to Appendix D and habitual and unreasonably persistent complaints and noted that this should be “complainants” rather than “complaints”.

The Quality Safety & Outcomes Committee: Noted the contents of the report and the accompanying

policy; Approved the August 2015 Complaints Policy as a corporate

policy for Governing Body ratification and implementation; Endorsed the embedding of the revised Complaints Policy

2015 in the CCG’s wider quality assurance process

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14. RISK REGISTER – REPORT NO: QSOC 30-15

KL introduced the Risk Register paper which was discussed at every meeting. Following previous discussions on how the Register should be presented and what should be contained in the narrative, KL, DR and KC had spent time revising the document and the rag rated exception report. It was noted that there was a formatting blip at the end of the Register which DR would resolve. DA referred to the risk around the North West Commissioning Support Unit and the impact on the Corporate Risk Register. JL responded that there had been extensive involvement in the service specification for Business Intelligence and the Quality Team had been managing the impact of the destabilisation in issues such as the quality of information coming through. The new provider would be in place from 1st November 2015. SH noted that as a strategic risk this would remain for a few years and would be closely scrutinised.

The Quality Safety & Outcomes Committee: Noted the content of the risk register and on-going actions

against medium and high risk areas. Added any additional risks identified at the meeting.

15. LIVERPOOL CCG QUALITY STRATEGY 2015-2017 – REPORT NO:

QSOC 31-15

KL presented the Liverpool CCG Quality Strategy for noting and for endorsement for wider circulation. The Strategy had already been discussed and approved at the April 2015 meeting when slight revisions had been requested. These had been made and it was now ready for wider circulation. KS noted that this was another excellent document and requested that it be sent to the September 2015 Governing Body meeting. DA commented that patient engagement seemed to have lost its “home” in the organisation and that the two elements of experience and engagement might have different reporting routes. SH noted that

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he was meeting with Sarah Dewar to discuss this. JL added that patient experience was vital in order to resolve issues real time and should be factored into the longer term commissioning, engagement was different. MM clarified that patient experience was what happened to a patient when they visited a hospital or their GP, engagement was about finding out what patients (the “consumer”) wanted. KS noted that the reporting from the Clinical Quality & Performance Groups to the Quality Safety & Outcomes Committee, via template format summarising minutes, which had been discussed at the June 2015 meeting, should be included in the Strategy.

The Quality Safety & Outcomes Committee: Noted the content of the strategy Endorsed the strategy for wider circulation

. 16. DISCHARGE PLANNING – INTERNAL HOSPITAL STANDARDS –

REPORT NO: QSOC 32-15

CS presented a paper to the Quality Safety & Outcomes Committee to outline the standards required by key personnel within the acute trust to enable discharge planning to be managed and co-ordinated at ward level, the support required by the acute organisation in order to achieve this and the commitment from Liverpool CCG to support the move towards ‘Discharge to assess’. In the past discharge had been deemed a specialist function resulting in ward staff being disempowered. The operational guidance in the paper outlined key personnel and made everyone responsible not just a specialist discharge planner. This was for utilisation across Liverpool acute beds and move to community. The Royal Liverpool Hospital had gone live with this in 2011, Aintree would do so in October 2015. There was a strong evidence base for the move towards the social care assessment to be carried out within community rather than the acute setting as patients performed better at home. Currently social workers could not carry out an assessment of the patient until they were deemed fit for discharge which resulted in extended bed days, patients could be “stepped down” or assessment carried out at home (average wait time for assessment phase was 2.7 days). The package of care waiting time was 4.4 days so it was

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possible to incur 7 days’ worth of loss of service. An additional paper was tabled giving more detailed information. DA was concerned about the extra time involved in liaising with potentially three Local Authorities for the Aintree Hospital catchment area and that this might complicate matters. CS responded that the aim was for a standard assessment process across Liverpool, South Sefton and Knowsley. DA was also concerned about Liverpool patients at Whiston Hospital. JL noted that Liverpool CCG was working closely with its neighbouring CCGs and Local Authorities. From September 2015 the process for patients referred to Whiston should be as smooth. In particular the Committees in Common as part of the Healthy Liverpool work would give the opportunity to iron out the complexities. KL added that Continuing Healthcare was already a commissioning challenge, CS responded that the Checklist would contain fewer items and would be later in the patient journey. In response to a query from MG about how patients with dementia were defined as “fit” for discharge, CS noted that there were two sides, being medically fit and being safe for discharge.

The Quality Safety & Outcomes Committee: Approved the Hospital Based Discharge Standards.

17. DATE AND TIME OF NEXT MEETING Tuesday 20th October 2015 – 3pm to 5pm

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PRIMARY CARE COMMISSIONING COMMITTEE Minutes of the Extraordinary meeting held on

Friday 21 August 2015 at 1pm – Boardroom, Arthouse Square Present: Voting Members: Dave Antrobus (DA) Governing Body Lay Member – Patient

Engagement (Chair) Nadim Fazlani (NF) GP Governing Body Chair Katherine Sheerin (KS) Chief Officer Dr Rosie Kaur (RK) GP Governing Body Member/Vice Chair Prof Maureen Williams (MW) Lay Member for Governance (Vice-Chair) Dr Simon Bowers (SB) GP/Governing Body Member Jane Lunt (JL) Chief Nurse/Head of Quality Non voting Members: Moira Cain (MC) Practice Nurse Governing Body Member Sarah Thwaites (ST) Healthwatch Samih Kalakeche (SK) Director of Adult Services and Health (Health

& Wellbeing Board Non-voting Member) Dr Sandra Davies (SD) Interim Director of Public Health In attendance: Carol Hughes (CH) PA/Note taker Apologies: Tom Jackson (TJ) Chief Finance Officer Rob Barnett (RB) LMC Secretary Cheryl Mould (CM) Head of Primary Care Quality and

Improvement Dr Adit Jain (AJ) Out of Area GP Advisor Scott Aldridge (SA) Neighbourhood Manager - North

Locality/Local Quality Improvement Schemes and Veteran Health Lead

Tom Knight (TK) Head of Primary Care - Direct Commissioning, NHS England

Phil Jennings (PJ) NHS England Public: 1

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PART 1: INTRODUCTIONS & APOLOGIES The Chair welcomed everyone to the meeting and introductions were made. It was highlighted that the public were in attendance but any questions they wished to raise needed to be done via the public Governing Body meeting.

1.1 DECLARATIONS OF INTEREST

As members of the Liverpool GP Provider Organisation declarations of interest were made by Dr Rosie Kaur, Dr Simon Bowers and Dr Nadim Fazlani. As a co-opted member of the Federation an interest was also declared by Samih Kalakeche.

PART 2: STRATEGY & COMMISSIONING 2.1 DEVELOPMENT OF THE LIVERPOOL GP PROVIDER

ORGANISATION A paper was presented by K Sheerin to seek approval for investment from the CCG to enable recruitment of a General Manager to support the establishment and development of the GP Federation. The post will assist in the improvement of primary care services including set up for delivery of services and will provide depth, strength and accessibility which could not be provided through the 93 practices so a different mechanism is required to enable this to happen. Dedicated support will enable the organisation to focus, respond to opportunities, and will ensure the right governance and infrastructure is in place to respond to HLP and ensure that general practice can deliver going forward. KS highlighted that the proposal was to set aside investment in order to create a band 8d post, employed by, and with accountability to LCCG, with objectives agreed with the GP Federation and reporting to the Federation. A copy of the Job Description was provided and the key points and working relationships were highlighted. Discussion and support to invest £102k to pay for an 8d post plus on cost for 12 months was requested.

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MW noted that the argument for the GP provider organisation in Liverpool has been well made elsewhere. When discussed at Governing Body it was seen as getting ahead, being in control and being able to shape primary care in line with the HLP agenda. MW noted her total support of the organisation and work that LCCG can do to support it. In summary, it was noted that approval was required for LCCG to agree a new post, the purpose of which was to work with the provider organisation on behalf of LCCG which would be seen not as an external investment, but an internal fixed term appointment in the CCG.

After much discussion it was agreed that the following amendments would be made to the Job Description and paperwork: • Reference to SHA and London to be removed

• Fundamental emphasis on business skills is required. The

clinical knowledge of the Federation was noted and the need to understand how to create business, horizon scanning, looking at opportunities and aligning strategic priorities was highlighted.

• The valuable points made about skill sets for this post were

acknowledged and it was agreed that the recruitment pool should be broader than health.

• JL highlighted that reference should be made to review going

forward as a different skill set may be required for the next phase.

It was noted that for an applicant from within the NHS on a 12 month fixed term contract then redundancy would need to be paid after 12 months, dependent upon previous experience, however, an applicant from outside of the NHS could be employed on a 12 month fixed term contract. It was agreed that the post would be advertised so LCCG is not at risk of substantial redundancy costs. Advice to be sought from HR.

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The Primary Care Commissioning Committee:

Agreed to approve the recommendation for investment of £102k for 12 months

Agreed amendments to the job description/recruitment process as noted above.

Agreed that advice would be sought from HR to ensure that LCCG is not at risk of substantial redundancy costs

PART 3: GOVERNANCE 3.1 ANY OTHER BUSINESS:

None

4 DATE AND TIME OF NEXT MEETING Tuesday 15 September 2015 at 10.00 am Boardroom, Arthouse Square

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Minutes of the Healthy Liverpool Programme Board Room 2, 4th Floor, Arthouse Square

Thursday 17th September 2015 1:00pm – 3:00pm

Present: Members Tom Jackson (Chair) Kathrine Sheerin Carole Hill Dr Janet Bliss Fiona Lemmens Ian Davies Jane Lunt Tony Woods Sue Lavell Chris Grant Julie Byrne Apologies: Dr Nadim Fazlani Dave Antrobus Dr Simon Bowers Dr Maurice Smith Sandra Davies

Chief Finance Officer / Integrated Programme SRO Chief Officer Integrated Programme Director Clinical Director, Community Clinical Director, Hospitals & Urgent Care Programme Director, Hospitals and Urgent Care Chief Nurse / Head of Quality / Governing Body Member Programme Director, Community and Digital Programme Management Office Manager Clinical Advisor PA / Minutes Chair / GP Lay Member / Patient Engagement / Vice Chair GP / Clinical Lead, Digital GP / Governing Body Member Director of Public Health

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1.0

1.1

1.2

Welcome, Introductions and apologies Chair welcomed all and noted apologies as above. There was no delegation of interest.

2.0

2.1

2.2

2.3

Minutes of the last meeting (24th June 2015) C Hill addressed the actions from the last meeting: 3.3 – Provide an overview of the five annexes of the SDC to GB Members – It was also agreed to include staff, sessions will be introduced at each Friday floor meeting. 4.2 – Report to include an investment tracker – this is ongoing and will be circulated tomorrow. 7.1 – Include stakeholder engagement as a standard item on the agenda – this will commence from next month, as it will include an integrated report from John Moors University which will include the listening event / community engagement. 5.0 – Hospital Programme Discussion – it was agreed to include “Discussions took place regarding this”. C Hill informed the Board that Helen Shaw the Communication’s Director at the Royal Liverpool Hospital will commence working at Liverpool CCG three days a week starting on the 26th October for a 12 month period to help with the stakeholder and workforce engagement work within the Healthy Liverpool Programme. With subject to the change to 5.0, the minutes were agreed as an accurate record of the 24th June 2015 meeting.

3.0

3.1

3.2

3.3

Programme Highlight reports C Hill updated the Board regarding the recent clinical summit. One of the issues raised from the summit was the dependencies; this was also raised at the SMT away day. It was agreed that T Woods, C Mould, J Lunt, I Davies and C Hill will meet on a monthly bases to review the HLP plan and ensure connection to the workstreams take place and to also develop a dependency map, so that programme managers and staff had a clear view of this. ACTION: SRO’S to meet on a monthly basis. K Sheerin highlighted that the clinical programmes, either it be changes or investments, need to be clear what they are and this principal needs to be addressed to all five programmes, which will also be an enabler for other models i.e. digital was an enabler for the diabetes model. C Hill informed the Board that proposals will be in place next month to determine which projects need to go through the Bain tool for both Healthy Liverpool and non-

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3.4

3.5

3.6

3.7

3.8

3.9

3.10

3.11

3.12

3.13

Healthy Liverpool decisions. Board requested that the project plan be presented at the next meeting. ACTION: Bain’s project plan to be presented at the next HLP S. Lavell. C Hill also mentioned that K Sheerin and N Fazlani are currently meeting with each Trust Board to update them regarding the SDC. Living Well – apologies were received from the SRO S Davies and Clinical Director M Smith for this meeting. It was highlighted that the programme leadership for this programme was not as effective as the others; this is because it is missing a senior manager to deal with the day to day business. S Davies is aware of the situation and this has been flagged as a risk in the risk register. It was suggested a meeting with S Davies be arranged to see how this can be resolved. ACTION: Arrange meeting with S Davies and C Hill to look at programme leadership. Community – T Woods updated the Board on the progress of the Community programme. The second Community programme board is taking place after this meeting; the governance arrangements have been established. Work continues on developing the SDC to present at the Governing Body session next week. Sessions with the locality leadership teams are continuing, there is a much clearer understanding on the neighbourhood collaborative work. Work continues with LCH to develop service lines for the future, although Alison Picton is leading on this, there is a lot of strain on resources within the organisation. The Board had a lengthy discussion regarding neighbourhood development. £28m is a radical transformation of services with this amount of money, there will be challenges ahead, and we need to articulate a model for the outcome of services for this City. It was agreed to organise a community summit, similar to the hospitals summit. A date has been scheduled for the 27th November. Hospital Transformation – I Davies updated the Board on the current progress of the Hospital Transformation programme. The draft hospital SDC is currently in production, with final draft to be presented at the extra-ordinary GB meeting on the 29th September. The six month secondments will expire on the 31st October 2015 for the five clinical advisors who were appointed to work on the Healthy Liverpool Programme. The secondment will be extended for a further period of six months. A Follow-up meeting was arranged on the 4th September 2015 to update the Non-Executive Directors. Due to the lack of response the meeting was cancelled. A further meeting has now been arranged for the 15th January 2016. Urgent Care – The Workstream Programme Board scheduled for the 28th August was cancelled due to resources prioritising the SDC. A role for a programme manager post has been advertised internally with no applications received. This has now been

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3.15

3.16

advertised nationally. The lack of support continues to be a concern. Digital Care & Innovation – The first digital business case was approved by the Governing Body on the 8th September. Neighbouring CCGs including South Sefton, Southport & Formby and Knowsley have all signed up to the information sharing framework. Finalisation of the SDC is progressing well. Communications – Communications activity to support the recent engagement activity has been completed. This included a social media campaign which focussed on each of the five programme areas. A full communications plan to support the Mayoral Summit in November is underway, along with the launch of the public engagement in January. Engagement – The launch of the new engagement website was very successful. Planning for the physical activity is well advanced.

4.0

4.1

4.2

4.3

4.4

4.5

Programme Plan C Hill updated the Programme Plan to the Board and reviewed the current timelines. A list of options is required for each of the key areas, the options need to be identified and clarity was also required around the process. It was agreed that a decision making process was required and that the Bain decision effectiveness tool process could be used. It was suggested to use Neonate as an example to develop a short list of options and then put the options through the Bain process. It was further agreed to arrange Bain sessions so the key people have a better understanding of the process. ACTION: C Hill to schedule staff sessions. F Lemmens raised concerns regarding getting the right people to the relevant workshops, each list has a lot of options and trying to timetable workshops with key people’s diaries was proving difficult, although having the clinical advisors was a huge help. The Board discussed each stage of formal sign off and the governance around this. Clinical decisions from each workshop should be presented to the Hospital Stakeholder Group for review, then to the Leadership Group and then to the Committees in Common for final sign off. It was suggested that pre-consultation business case’s would be presented to this Board and then to the Governing Body for final approval. K Sheerin suggested that a process paper should be produced for the Committees in Common formalizing each process. ACTION: Programme Office to look at this and bring suggestions back to this Board in October.

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5.1

Strategic Direction Case - Progress C Hill updated the Board on the current progress off the Strategic Direction Case. The draft SDC is currently in production, with final draft to be presented at the extra-

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ordinary GB meeting on the 29th September.

6.0

6.1

Programme Issues To be discussed at the next meeting due to time constraints.

7.0

7.1

Risk Register Review New risk to be discussed at the next meeting.

8.0

8.1

Any Other Business There was no further business.

9.0

9.1

Date and Time of Next Meeting Date and time of the next meeting - Friday 21st October 3pm – 4.30pm, Room1, 4th Floor, Arthouse Square.

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FINANCE PROCUREMENT AND CONTRACTING COMMITTEE TUESDAY 6 OCTOBER 2015 9:00am – 12:00 noon

ROOM 2 ARTHOUSE SQUARE

FINAL MINUTES Members Nadim Fazlani (NF) Chair/GP Maureen Williams (MW) GB Member - Lay Member Dave Antrobus(DA) GB Member – Lay Member Katherine Sheerin (KS) Chief Officer Tom Jackson (TJ) Chief Finance Officer Tina Atkins (TA) GB Member - Practice Nurse In Attendance Ian Davies (ID) Programme Director – Hospitals &

Urgent Care Derek Rothwell (DR) Head of Contracts and Procurement Alison Ormrod (AO) Interim Deputy Chief Finance Officer Phil Saha (PS) Head of Programme Finance Simon Bowers (SB) GP/GB Governing Body Member Jane Fradley (JF) Senior Project Manager – Healthy

Ageing Michelle Urwin (MU) Transformational Change Manager -

Dementia Antoinette Egan (AE) Senior Project Manager – LD Scott Aldridge (SA) Project Manager - Primary Care

Team Lynne Hill (LH) PA/Minute Taker Apologies Maurice Smith (MS) GP/GB Member 1 Welcome and Introductions Introductions were made and all welcomed to the meeting.

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2 Declarations of Interest Dr Nadim Fazlani, Dr Simon Bowers and Tina Atkins all declared an interest in item FPCC52-15a GPIT Investment Proposal. It was noted that Tina Atkins is a non-voting GB member and Dr Simon Bowers was presenting at this Committee and not a member of the Committee. 3 Minutes of the previous meeting held on 25 August 2015 Minutes of the meeting agreed as an accurate record with minor amends to be actioned. It was agreed that the reference to the practices should be removed. The Committee approved the minutes.

4 Actions from the meeting held on 25 August 2015 3b6 Mental Health Clustering TJ reported that Merseycare are undertaking a baseline costing exercise to analyse all Merseycare costs against contract income. The scope of contract income excludes that commissioned centrally for ‘secure’ and that the currency to be used would be clusters. The costs should be granular and include direct, indirect and overheads identifying main cost drivers e.g. wte or apportionment methodology, the outcomes will be reported to the November 2015 FPCC. Action: TJ Mental Health Clustering agenda item November

2015 FPCC 3b7 Information Governance ID confirmed that the policies have been shared with Staff Side. 3b8 Professions Review (support to CCG) MW confirmed that the Audit, Risk and Scrutiny Committee will be discussing this at their meeting on 6 October 2015(pm). Action: There should a panel in place by December 2015 an

update will be presented at the December 2015 FPCC.

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Action: MW agenda item Professions Review (support to CCG) agenda Item December 2015.

3b9 Escrow Account ID confirmed the 1st payment has been actioned and interim payment is due the end of this month and final payment in December 2015. St Helens and Knowsley Overperformance PS confirmed there will be additional information available in December 2015 and will be reported to the December 2015 FPCC Action: PS agenda item St Helens Knowsley Overperformance

December 2015. 3b10 Finance and Contract Performance Update – CLAHRC Matched Funding PS confirmed that Liverpool CCG has committed cash match funding of £300k per annum and also in-kind match funding over the 5 year period. PS has supplied MW with a breakdown of the in-kind match funding and MW will look at the information outside of the meeting and will bring back to the Committee if there are any issues.

Action PS/MW to meet to discuss the details. 3b11 Specialised Commissioning Rules TJ stated that Specialised Commissioning is to be added back to the FPCC agenda. TJ outlined the Mersey Pilot and that Specialised Commissioning is envisaged to be delegated to CCGs. Initial delegations for 2015/16 are;

• Adult specialist neurosciences services: the commissioning of all neurology outpatients from NHS England to CCGs, except where these have been referred by a consultant.

• Specialist services to support patients with complex physical disabilities (all ages) and wheelchair services. There are two risks; transfer of responsibilities and funding. TJ confirmed that the majority of specialised commissioning is city level (Liverpool) and others that are nationally commissioned (i.e. not enough local providers) and are on a regional footprint (i.e. Burns).

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Allocations are being discussed and ‘place based’ allocation is being preferred. Action: TJ to share the ‘place based’ information that he is

currently working on with HMFA. All other actions have been completed. 4 Investment Proposals (FPCC52-15) 4a GPIT Investment Proposal A declaration of interest in relation to the GP IT investment proposal was declared and MW advised that where there is no individual benefit then the FPCC GPs / practice members do not have to leave the room but it was not appropriate for NF to chair the Committee. MW chaired the Committee for this item. SB provided the details for GPIT procurement and talked through the paper in relation to GPIT core services and non-core services for IT. The paper lists the individual risks and it was acknowledged that the FPCC are not agreeing carte blanche for investment. DH stated that the correct infrastructure is fundamental to the data provision in the Practices. DR commented that for procurement route we need to be open and honest and at this stage it was not appropriate to go to market as we do not have a robust specification. However, we will look at the IT services we receive and benchmark against comparable providers in parallel with preparing specifications. The output of benchmarking will be brought to a future FPCC (2016) to ensure that we have considered all the options. DR advised that until a robust specification is in place and the CCG future intentions with regard to IM&T and the IM&T links with Sefton CCGs are clearly known and understood we will roll over the contract for one year and (in parallel) put in place a process to ensure that the procurement is robust for the future. SB explained that the funding allocation from NHS England has been reduced. This funding was required to bridge the gap between resources available and costs of GPIT services required. MW asked TJ

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how we can agree a recurrent spend if the future funding from NHS England is not known. TJ explained that Liverpool PCT originally contributed £4.5m and LCCG only received back £1.5m. The resources are there, however the responsibilities are being passed back with a significantly reduced budget. (i.e. we are not accountable but responsible for this). TJ suggested that we commit to the maximum £2.2m to be offset by NHSE delegated budgets. TJ queried the payment routes for Virgin Media, Sunquest, etc. DR clarified that these are paid directly by the provider. TJ stated that we need a trajectory up to 2017 and recommended that we approve £2.2m recurrently with a future review. KS queried what we had agreed in the overall investment plan. AO confirmed that this is in the recurrent budget (of £2.4m with an allocation for GPIT of £1.5m from NHSE). KS confirmed that the FPCC cannot approve spend of new money. Discussions ensued with regard to the provision of IT services and the future funding processes and the associated risks. DA wanted confirmation that the service is provided by Virgin Media and not Virgin Health. This was confirmed. DA queried how other CCGs with significant financial constraints are dealing with this as IT systems and IT support is critical in the health environment. NF highlighted the providers both those within and outside the NHS and we will need to work with them to ensure an IT service is provided. The decisions made at Primary Care Clinical Commissioning Committee needs to be made clear and if the decisions that are made at the Finance Procurement and Contracting Committee are different then this need to go back to the Governing Body for final approval. It was agreed that a further discussion is to take place outside of the meeting on the extra £1m funding. It was approved that the recurrent allocation is being underwritten by LCCG, this is a core services that we cannot not approve as the risks are significant. Should the structural changes occur then we

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will need to go back to the Governing Body for approval of additional funding. That Liverpool CCG Finance, Procurement and Contracting Committee:

Noted the contents of the report Approved the non-recurrent funding allocation for 2015/16

from existing budgets. Approved the recurrent funding allocation from 2016/17 Confirmed the procurement route for this proposal

It was noted that NF, TA and SB were not allowed to vote. 4b Rapid Response Falls Service (pilot service) (FPCC52-15b)

Jane Fradley (JF) talked through the report and highlighted non-recurrent funding is required for 2 years and this is part of the Healthy Liverpool Healthy Ageing Programme. The FPCC were asked to:

Approve Investment of £249,719 pa for a 2 year pilot to implement a rapid response falls service.

Note that with regard to future procurement, the options on whether to go to market will be considered during the course of the pilot for presentation (at a future date) to FPCC.

Liverpool Community Health (LCH) currently have a community falls team which will be the of referral pathway for the service users accessing the Rapid Response Falls Service once commissioned, this will ensure that service users have rapid access to a nurse led falls service. However the community falls team is not commissioned by LCCG as a falls service it is part of the current AHP contract, therefore in addition to the Rapid Response Falls Service the community falls team will be redesigned and commissioned (separately from the RRFS) so that the service can respond in a timely manner to the additional service users (estimated to be 4,181) that will come through the Rapid Response Falls Service.

Three (3) providers have shown interest in providing a Falls Pick up Service and are already providing some element of falls pick up service.

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The 3 organisations will be asked to participate in an abridged tender exercise however a full procurement will be undertaken in the longer term (subject to the service delivering the KPI / outcomes envisaged) .

DA commented that reading the Nottingham Falls Service provision this looks an exciting service with excellent outcomes. DA queried who is going to build up a register of patients who are at risk. DA mentioned the social services and fire service and this would be beneficial to link in.

JF stated that the pickup service will maintain the register and refer to the Redesigned/commissioned Community Falls Service. JF reported she has a meeting with Jayne Hulme from the 111 team to incorporate the service into the falls pick up pathway, so that any service users/HCP calling 111 will also be able to access the service if they meet the criteria.

KS raised a procurement query and asked if we are comfortable going out to the current providers – did we know they are the only providers delivering this services. KS highlighted page 78 (Monitoring and Evaluation) and asked if there are targets and will there be an achievement payment in the contract. JF stated that targets will be built in to the service specification and closely monitored. MW commented that the paper was presented well, although appears dated, for example the technology is there to predict falls and that is the direction we should be going in. MW confirmed she was happy to support the route in the interim, however would like there to be some investigation in to the technology that would predict falls (i.e. More Independent). DA commented that this could be built in to the service in the future, but the pilot and predictive information is the correct process. TA gave her full support for the service, however queried that the statistics which show that 59% were over 65, therefore what are we doing about the 41% under 65. MU stated that falls for the 41% (in this age bracket) generally relate to other issues (i.e. alcohol and drug abuse) and could be part of our offer to the vulnerable adult sector and will be addressed in the community model. MU stated that a greater understanding from the piece of work is required and hopes that the learning from the pilot will assist this.

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TJ enquired as to the links with the NWAS and whether it is part of the cost of NWAS service and included in the numbers. ID stated that the release of savings will come from the AED savings and not from the 999 calls. ID reported that the contract baseline was cost and volume basis and could be reduced based on the savings from the conveyancing of clients and KPIs which are monitored.

The Committee approved the investment of £249,719k pa for a 2 year pilot

Noted that with regard to future procurement, the options on whether to go to market will be considered during the course of the pilot and be presented to a future FPC. It was highlighted that the housing associations need to be involved in the development of the service in the future.

Jane Fradley(JF) left the meeting. 4c Dementia Proposal (Proposal to commission integrated

network of care for dementia (Phase 1) with an expansion to psychosocial support (Post Diagnostic) (FPCC52-15C)

MU read through the report and stated that this is phase 1 of the strategy and additional funding requests will be required for the next phases. Phase 1 is to increase equality in the city and invest £285,751k in Mersey Care to deliver a centrally coordinated service (post diagnostic service) for one additional dementia care navigator base in Mersey Care. This will result in 3 places for dementia post diagnostic support to be provided across the city. In addition £11,333 for Liverpool Community Health to continue delivery of specialist exercise classes for people with dementia. Finally, £41,186 Chinese Wellbeing to work with 5 BAME community groups to continue with this work (1 day per week working with the community groups).

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DA highlighted that the difference in what was offered in the North and the South that has existed for many years. The proposal is going in the right direction to ensure an equitable service and is supportive of the project and that this is a growing health issue area, however highlighted that monitoring of outcomes would be difficult. MW commented that she is uncomfortable with the lack of BME Community Development Workers (CDW) health workers not being used and there is a confusion of being a champion and working with the individuals in the community. MW queried why the Chinese Wellbeing group being asked to put on the additional sessions. MU stated that the disparity of the level of service across the city should be addressed with a uniform service provided with the investment. MU outlined the historic position of the Mersey Care provision resulting in an inequitable service and no post diagnostic service offered in the North of the city. NF further explained the history of the service. MU explained that one of the CDW health workers for the BME has been instrumental in setting up the project, coordinating and leading this work and has developed the Dementia role within the five community groups. The Dementia Champions have been trained up in each of the 5 community groups (Chinese, Arabic, Faith, African Elders, Somali). MU explained the issues of accessing the BME groups and the different cultural sensitivities. MU explained that the original tender for the BME CDWs service only included mental health and not Dementia. MU outlined the Chinese Wellbeing work and stated that they had added value to the 4 other smaller community groups. They had progressed much further in their work on dementia and had started to offer post diagnostic support for people who had identified themselves with dementia. The other groups are not at this stage and still working to improve understanding of the condition whilst the Chinese Wellbeing groups have progressed further and are there to assist them in reaching this stage. Chinese Wellbeing will coordinate and manage the work of the Dementia Champions in the other community groups and host the project.

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KS stated that the benefits and outcomes of this proposal have been discussed at Senior Management Team (SMT) and asked how we would ensure that outcomes are part of the contract of the providers. KS also commented that we need to ensure that we are not paying for services twice and ensure the model is correct. TJ suggested that additional work needs to be undertaken on the modelling. The recommendations are not robust enough and there are some pages not signed in the proposal. It therefore lacks clarity on what we want to commission and this needs to be clear. In addition, it is not clear what we could put in to the procurement or what we would put in the contract. TJ highlighted that the KPIs and outcomes are not clear. As senior officers we need to be clear and accurate before a proposal comes to the Committee and ensure we are not paying for a service twice. NF stated he had similar issues with the proposal that MW had raised, but could understand some of the logic of the proposal, but agrees that he too is not clear what the Committee is being asked. NF sought advice from DR and asked DR if it is clear what we are looking to procure. DR stated that he could put outcomes in to the contract and would need to discuss with the providers and this could be undertaken to ensure that the provider understands what is required to the satisfaction of both parties (i.e. LCCG and provider). NF asked DR asked if he was comfortable with Mersey Care to provide the service. DR stated yes but would use the pilot to look at all options and bring back to a future FPCC as to whether it stays with Mersey Care or goes out to market. NF confirmed that the Committee were comfortable accepting MU robust answers to the issues raised. The Committee confirmed they were now reassured.

NF confirmed that the Committee are approving items: £41,186 Chinese Wellbeing £285,751 Merseycare for post diagnostic

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£11333 Liverpool Community Health to continue The future procurement route is to come back to the FPCC

following the pilot. TJ stated caution in relation to business cases coming to the FPCC in the same style, i.e. pilots for 2 years. Discussion ensued with regard to the format of future business cases. It was acknowledged that closeness to the issues could lead to problems in describing business cases. 5 Digital Care and Innovation: Assistive Technology and Person

Held Record (PHR) Investment Case (FPCC53-15) DH talked through the paper and drew attention to the multi-faceted services provided (Telehealth), the sensitivity analysis and the high numbers that may be put in to the service and the risks associated with that. DH stated that monitoring of the service is critical and may result in the business case coming back to the Governing Body and Finance Procurement and Contracting Committee if the patient numbers increase significantly and therefore represent an additional funding requirement. Monitoring will be maintained on the numbers entering the service. The Committee are asked to agree the procurement approach. This investment was included within the Healthy Liverpool Programme investments approved in May 2015 in principle. The detailed business case has already been approved by the Governing Body and Senior Management Team. For 2015/16 funding is available and future funding requirements will be included in financial plans.

DH outlined the Procurement Element (page 162) detailed below; Multiple contracts and services will be procured. The Finance, Procurement and Contracting Committee (FPCC) are requested to note the procurements below and note that where appropriate procurement options papers will be presented to FPCC for the relevant procurements and subsequent FPCC approval. A breakdown of these services and the expected procurement route is provided in the table below:

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Service Description Estimated Value and contract length

Procurement Route Justification

Health Technology – telehealth provision, installation and monitoring/triage of patients.

£5M contract over 3 year period.

Full (OJEU) procurement in the open market.

This is a high value contract and Liverpool is seen as a leader in this area attracting significant attention. Anything less than a full market test would not satisfy legal requirements and the likelihood of challenge would be very high.

Care Technology – telecare service including provision and monitoring of a wide range of equipment.

£800k to £1M over a three year period

Full procurement in the open market as a joint service between LCCG and Liverpool City Council.

A joint procurement would create a much higher value contract. LCC has agreed to lead the procurement of this service.

Person Held Record platform development and maintenance

£150 to £350k annual contract (dependent on level of development required)

Procurement via G-Cloud framework.

Services are available via the government procurement framework providing a faster and more cost effective method of procurement. Annual or at most bi-annual contract preferred to maintain best value for money and most suitable provider.

Community support and engagement – provision of community support services for technology and self-care and skills.

Value will vary depending on market analysis as services may be split across multiple providers. 3 year contract(s) with a maximum single contract value of £750k

Dependent of contract value and length. Multiple contracts with local providers under SFI limits will be selected by a minimum of 3 quotes. A single larger contract will require full market procurement.

Route depends on market analysis.

All other minor contracts Other contracts are expected to be 1-2 years in length and below SFI levels for tendering.

3 quotes (all expected to be below SFI levels for tendering).

All contract procurements to comply with SFI’s.

DA highlighted the risk register and asked for an explanation of how the scoring had been allocated (page 160 item 4). DH stated that this was based on the MI (More Independent) risk register and has been modelled around that process.

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DA queried who owns MI and iLinks. DH stated that MI is a registered trademark and is owned by Liverpool CCG and iLinks is a branding that covers a number of areas and a sharing framework but it is not a company/entity. KS confirmed that proposal has been presented to the Governing Body and the only area that Finance Procurement and Contracting Committee (FPCC) need to consider is highlighted on page 162. KS queried the means testing of Liverpool City Council (LCC) and would it create any difficulties. DH gave assurance that this will not cause an issue as this is in relation to supply and installation of the kit. DH outlined the VAT issue and stated that this is resolved via Liverpool City Council (LCC) as they do not pay VAT and this is not a VAT avoidance scheme and it is a logical agreement and process. MW queried who is undertaking the market analysis DH stated Liverpool CCG have already started the work. DR stated that he supports DH in the proposal and has highlighted the additional support that is needed for the procurement process and this has been discussed with DH/SB. The Committee approved the procurement route.

SB, AO, MU, DR all left the meeting at this point. 6 Health Enterprise Innovation Exchange Proposal for

European Structural Investment Funds (HEIE Investment Funds) (FPCC55-15)

MW outlined the HEIE proposal and that the application has been submitted and has been subject to a lot of external and internal discussion. Should the bid be successful it will be beneficial to the partners, although the funds that go to each of the partners is only small. As the Accountable Body it gives LCCG an element of control and good leverage when it comes to compliance.

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The Committee are asked to endorse the bid on behalf of the CCG. Should the bid be successful then the procurement route will need to follow the usual European Procurement Rules. KS commented that this is an exciting process, and if successful will bring in £1.5m. KS asked if there are any other opportunities for match funding. DH and MW confirmed there are and these are being followed up. The Committee approved the HEIE recommendation to take

lead role as the Accountable Body in a Liverpool City Region (LCR) bid for European funds to support health innovation and it was acknowledge that this is uncertain territory.

7 Digital Health Trainers (HT) Procurement Wavier (FPCC55-15) DH read through the waiver and highlighted that this is an extension of the waiver that had been previously submitted to the Committee. At the time, there was some uncertainty as to LCC’s intentions with regards the overall Health Trainer contract, but our expectation was that they would re-procure the service within this timescale. In fact, they have extended the PSS contract until the end of March 2016. This request is therefore to allow the CCG to extend our PSS contract until 31st March 2016, when we intend to have jointly procured a combined service. However, to cater for the possibility that this re-procurement is delayed, the Committee are asked to approve an option to extend the CCG contract by a further 6 months, if necessary. The current service provider is happy to work with us on this basis. LCCG will collaborate with the council to ensure that our additional requirements are incorporated into their overall contract when it is renewed. As the HLP Digital Care options develop, we want to move to all Health Trainers (HTs) having the skills and knowledge to offer technological support rather than it being a specialist function. No additional budget is required for this extension and all funding is included in current budgets. Should the additional 6 months be required, the funding has been identified will be available within the existing 2016/17 budget.

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The Committee approved the recommendations and the waiver extension until 31 March 2016 with a further 6 months if required.

Dave Horsfield(DH) left the meeting. 8 Interim Provider – Queens Drive Surgery (FPCC56-15) SA read though the paper and highlighted that the previous holder of the contract at The Surgery Queens Drive retired on 31st March 2015, following which a ‘caretaker’ arrangement was put in place to allow time for a longer term interim arrangement to be made. In accordance with the LCCG’s Primary Care Interim Provider Policy, this interim arrangement is to be for no longer than 18 months and all NHS Liverpool Clinical Commissioning Group member practices only were to be invited to submit bids to deliver the interim arrangement. The Primary Care Interim Provider Policy is utilised in situations where LCCG needs to appoint a general practice provider and does not have time to undertake a competitive procurement. The period of the interim arrangement will be used to undertake a competitive procurement and secure a longer term contractual arrangement. MW stated that she is not comfortable with affordability not being included and this should be included in any procurement. KS stated that the funding for the service is already predetermined in line with the LCCG Specification. MW was surprised at the difference in the information and GP website details of the practices. SA explained that a section had been omitted from one of the practices and they had also exceeded the word limit by including the skills of the GP. TA queried whether we are limiting our choice because of this. MW and KS stated that this information will need to be fed back to the practices. SA commented that the Pass/Fail affordability has subsequently been completed and passed.

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NF highlighted that this is the first time we have had to go through the process and that lessons learned should be reflected on internally and key messages highlighted to the practice. The Committee noted that at a rating of 31% we would not be able to appoint Storrsdale. Lessons Learnt will be taken back to the Primary Care Commissioning Committee (PCCC) Action: SA to report the Lessons Learnt to the PCCC.

The Committee agreed the award of an interim contract to

Anfield Group Practice for a period of 17 months from 1st November 2015 to 31st March 2017 at an annual contract value of £315,388.

9/10 Learning Disability Acute Nurse Liaison Service Business Case (FPCC57-15) and Learning Disability Primary Care Facilitator Service (FPCC58-15) Antoinette Egan (AE) read through the report and highlighted the data information of the population with Learning Disabilities and issues in mainstream health care effecting clients with Learning Disabilities (LD). The business cases are about addressing mainstream health care inequalities for LD clients/patients. Primary Care LD - Merseycare had 2 support staff to address health care needs. It was deemed that this was not enough support, and therefore increase the capacity of the service by 2 staff to cover North, Matchworks and 2 x Central localities. Acute Care LD – introduces LD liaison nurses in to the service who would provide advice, training and support and would provide direct case management where appropriate. No outcomes identified as this is a new provision, KS commented that it was agreed at the Governing Body that we would invest in services for those with LD. However, are we missing a trick if

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we are not aligning the outcomes with uptake of health checks. There should be a link with primary care and secondary care and building a provision for the future. Action: AE to consider the suggestions discussed.

MW commented that an option was given to Kerry Harvey and Antoinette Egan to withdraw the papers, however they have chosen to come along for the learning. MW stated that the Governing Body approved an envelope of expenditure with no indication of outcomes. However, we do not know what we are buying and it looks like we are buying posts (i.e. recruitment). This is a statutory responsibility for the Trusts/providers so why are LCCG paying for their legal obligations. What are the Trusts/providers doing to ensure they are meeting their legal obligations. If LCCG fund for 2 years where is the assurance of the funding from the Trust/provider to fund these posts after this time period. The paper was not clear if it was a liaison service or if case loads are being held by the postholders, and where will they receive their information from (i.e. access to Boards/Committee). There is no evidence from the current post holders and it appears anecdotal. The business cases do not appear to have the sufficient robustness that is required. DA queried have we got the ability to ensure that the posts link together. AE stated that the plan is to build a network so they can link with other LD services. KS said there appears to be more work required to be met on the proposals, it needs to be clearer on the investment i.e. target, outcomes (measurements) to show if it makes any difference. Questioned if we are we prepared to put in the monies for the Trust to meet their legal obligations. MW stated that FPCC would only fund it if there was a guarantee that the Trust will fund after the 2 years. AE commented that there has been no agreement with providers to continue with the funding after 2 years.

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TJ commented that this is good case for learning as an organisation, with the Committee and the Senior Management Team need to get involved and providing advice so that the business case answers all the current questions and assists the presenter. SMT needs to work with AE to develop the cases. Action: AE and TJ to meet to discuss the cases and the work

that is required. The LD business cases were not approved by the FPCC. 11 Haemto-Oncology (verbal update) KS updated the Committee on the Governing Body decision of supporting the Clatterbridge investment, however with some of the conditions strengthened. Clatterbridge had a Board meeting on 30 September 2015 and we were required to get back to them before. KS had spoken with NF, MW and TJ regarding how the strength and the conditions that all 3 organisations will be behind the scheme and that they will not request additional funding. In summary

• All 3 organisation have confirmed their support for the scheme with a 2nd letter signed by all 3 Chief Executives;

• KS stated that commissioners are not exposed to addition finance risks. It has been agreed that any stranded costs will be managed between providers;

• The Royal Liverpool agrees that any vacated bed capacity will not be used without the approval of LCCG. In addition, if any other bed capacity were to become available then that will also not be used without the approval and agreement of the CCG.

Action: KS to present a paper to the Governing Body in

October to state that the conditions have been met and the CCG are satisfied with the assurances given.

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12 Finance, Contracts and KPI Update (FPCC59-15) PS provided an update on the Finance, Contracts and KPI and confirmed that the budget is on track and currently some variances which are being monitored. The Committee noted the report.

13 Any Other Business No other business was reported.

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HEALTHY LIVERPOOL PROGRAMME

HOSPITAL BASED SERVICES

COMMITTEE(S) IN COMMON

KNOWSLEY, LIVERPOOL AND SOUTH SEFTON CCGS AND NHSE

WEDNESDAY 7 OCTOBER 2015

PRESENT:

Nadim Fazlani Chair NHS Liverpool CCG Katherine Sheerin Chief Officer NHS Liverpool CCG Tom Jackson Chief Finance Officer NHS Liverpool CCG Fiona Taylor Chief Officer NHS South Sefton CCG Andy Pryce GP / Chair NHS Knowsley CCG Ian Davies Head of Operations & Corporate Performance NHS Liverpool CCG Paul Brickwood Chief Finance Officer NHS Knowsley/St Helens CCG Ian Moncur Councillor Sefton Council Dr Donal O’Donoghue

Secondary Care Doctor/Governing Body Member

NHS Liverpool CCG

APOLOGIES:

Dianne Johnson Chief Officer NHS Knowsley CCG Samih Kalakeche Director of Adult Services and Health Liverpool City Council Dr Fiona Lemmens Governing Body GP NHS Knowsley CCG

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Actions:

1 Welcome, Introductions and apologies: The Chair welcomed all and introductions were made. Apologies were noted as above.

2 Declaration of Interest: None declared specific to the agenda.

3

3.1

Minutes & Actions of the previous meeting: The minutes of the previous meeting, held on 2 September 2015 were agreed as a true and accurate record. Actions: Discharge Process: SRG to scope out different Discharge Process across Aintree/Royal. Joint working across CCGs: • Paper considered at the CCG Network to go to each CCG Governing

Body. • Service Leads meeting together to share plans.

ID AOS

4 Strategic Direction Case (SDC): The Hospitals Chapter of the SDC was shared and discussed. It was explained that the overall SDC has been to the LCCG Governing Body and is being presented to all Trusts and South Sefton and Knowsley CCGs for endorsement. This will then be translated into a public facing document and launched at the next Mayor’s Health Summit on the 16 November 2015.

KS

5 Phase 1 Hospital Services Changes: The following services are likely to be subject to consultation in Phase 1: Cancer: H-O, Upper GI, HPB and Pelvic Urgent Care (including Walk in Centres) Maternity/Neonates Cardiology Services Stroke Services Cardiology was also discussed and there is a clear need to ensure alignment of the pathway across the 3 CCGs.

6 Route to Decision Making: The Committee was reminded that the Healthy Liverpool Programme consists of 5 broad programmes with a significant number of projects. For many of these LCCG can move ahead and for others there will be more structural changes required. It will be the role of the Committees in Common to review options for changes in hospital services in advance of consultation.

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7 Key Next Steps: 1. Confirm list of service which will require formal consultation.

2. Confirm the options for those services.

3. Undertake pre-consultation.

4. After the Mayoral election undertake formal consultation.

FT highlighted that we need to consider work going on in hospitals outside of Liverpool which will have an impact. The Deloitte report on the sustainability of services in Southport and Ormskirk was highlighted, this will report back at the end of December 2015.

Action: ID to liaise directly with Carl regarding the implications of this

Ian Moncur highlighted that Sefton Local Authority has a clear process for agreeing steps required for consultation and that we would need to work in line with those.

Action: FL/DJ to identify leads from Sefton/Knowsley Council to discuss the consultation process and routes.

ID

FL/DJ

8 Provider Discussions: An overview of the discussions between RLBUHT/LWH and RLBUHT/Aintree was given.

9 Date of next meeting: Wednesday,4 November 2015 4 – 5.30 pm following CCG Network (venue same as CCG Network)

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