NHS NENE CCG GOVERNING BODY MEETING IN PUBLIC 19 July … · Improvement Working Group meeting with...

NHS NENE CCG GOVERNING BODY MEETING IN PUBLIC 19 July 2016 13:30 – 16:30

Boardroom, Francis Crick House AGENDA

Welcome and Introductions Decision/Discussion Ratification/ Information Reference Lead

1. Welcome and Introductions

DS

2. Apologies for Absence

DS

3. Declarations of Interest

DS

Standing Items Reference Lead

4. Minutes of the Previous Meeting

Ratification PGB-16-72 DS

5. Action Log

Information PGB-16-73 DS

6. Chair and Accountable Officer’s Report • Armed Forces Community Covenant Video

Information PGB-16-74 DS/JW

7. Quality and Performance Report

Information PGB-16-75 AJ/KM

8. Finance, Contracting, Transformation & Savings Report

Information PGB-16-76 SR/KM

9. Board Assurance Framework Discussion PGB-16-77 SD

Strategy Reference Lead

10. Sustainability & Transformation Plan Update

Discussion Verbal

MD/JM

11. Urgent Care Strategy Information Presentation SK/EC/ JT

12. Organisational Change Policy Ratification PGB-16-78 JW/DS

Governance Reference Lead

13. Board Assurance Framework – Review

Discussion PGB-16-79 All

Items for Information Reference Lead 14. Board of Directors Report

Information PGB-16-80 JW

15. Joint Quality Committee Report

Information PGB-16-81 AJ

16. Finance , QIPP and Contracting Committee Report

Information PGB-16-82 SR

17. Health & Wellbeing Board Minutes Information PGB-16-83 DS

18. Register of Interests Information PGB-16-84 SD

19. Glossary Information PGB-16-85 SD

Any Other Business 20.

Date of next meeting: 20 September 2016 at 1.30pm, followed by AGM

GOVERNING BODY MEETING IN PUBLIC BOARDROOM, FRANCIS CRICK HOUSE

TUESDAY 21 JUNE 2016

Present: Dr Darin Seiger (DS) GP Chair Dr Az Ali (AA) Clinical Executive Director for Acute Trusts (North) Paul Bevan (PBe) Lay Member Governance Dr. Chris Bunch (CB) Secondary Care Doctor Dr. Naomi Caldwell (NC) Clinical Executive Director for Localities & Primary Care Dr. Emma Clancy (EC) Clinical Executive Director for Acute Trusts (South) Dr. Matthew Davies (MD) Clinical Executive Director for Strategy Christina Edwards (CE) Lay Member Quality & Deputy Governing Body Chair Charlotte Fry (CF) Director of Primary Care Transformation Roz Horton (RH) Lay Member – Patient & Public Engagement Alison Jamson (AJ) Interim Director of Quality Alison Kemp (AK) Director of Integrated Commissioning Kathryn Moody (KM) Director of Commissioning Dr Raf Poggi (RaP) Clinical Executive Director for Joint Commissioning & Community Providers Stuart Rees (SR) Chief Finance Officer John Wardell (JW) Accountable Officer Rosemary Yule (RY) Lay Member Governance In attendance: Graham Barter (GB) DocMed Federation (Item 9) Stuart Dalton (SD) Deputy Director of Governance Tony Ferrari (TF) Risk & Business Continuity Manager (Item 7) Pat Haslam (PH) Locality Team Administrator (Item 6) Daniel Kane (DK) GP Alliance Federation (Item 9) James Murray (JM) Interim Director of Planning (Item 11) Marianne Phillips (MP) Corporate Secretary Nicki Price (NP) 3Sixty Care Federation (Item 9) 1. Welcome and Introductions DS welcomed those convened to the Governing Body Meeting in Public. 2. Apologies for Absence Apologies were received from Kevin Thomas, Lay Member Governance and DS informed the meeting that due to their attendance to present at Locality Board Meetings AA, NC and MD

PGB-16-72 Governing Body Meeting in Public 19 July 2016

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would be arriving later. As a result some items would be taken out of order to accommodate their arrival. Due notice of the meeting had been given in line with the Constitution and the meeting was quorate. 3. Declarations of Interest There were no declarations of interest made by those present. Standing Items 4. Minutes of the Previous Meeting PGB-16-50 The Minutes of the meeting held on 19th April 2016 were agreed as an accurate record. 5. Action Log PGB-16-51 Corporate Objectives 16/17 – Metrics – SD confirmed that the metrics would be brought back to the Governing Body in July for agreement. East Midlands Ambulance Service- OD Session – SD confirmed that the session was on the OD Schedule and that this would be circulated to the Governing Body the following day for information. Quality & Performance Report – Primary Care Quality Dashboard - AJ confirmed that the Dashboard had been discussed by the Primary Care Co-Commissioning Joint Committee and amendments had been agreed. The amended dashboard would be taken back to the Committee prior to its presentation to the Governing Body – likely to be the September meeting. It was agreed that this would be scheduled and the action could be marked as complete. The remaining completed actions were noted. 6. Chair & Accountable Officer’s Report PGB-16-52 DS highlighted the events led by the CCG’s Safeguarding Team which had been held up as a national example of good practice; the Antibiotic Guardian Award won by the Medicines Management Team; the focus on the ageing population; and the excellent work undertaken by Pat Haslam championing Veterans and the Armed Forces Community Covenant (a video for which would be shown at the next meeting since technical difficulties had prevented its showing that day). PH cited a patient story of how important it was to identify veterans in distress, the highest numbers being those who served in Northern Ireland. JW noted that the Sustainability and Transformation Plan (STP) was due to be submitted on 30th June 2016 (an update for which would be provided later in the meeting); the planned deep


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dives on Quality Innovation Productivity Prevention (QIPP) by NHS England, which for Nene CCG was scheduled for 6th July 2016; the re-procurement of the Commissioning Support Service (a paper for which would be discussed later in the meeting); the three areas of focus at the recent Health and Wellbeing Board which were: assurance in relation to governance arrangements for the Better Care Fund; Learning Disabilities Transforming Care Plan (an item later on the Agenda); and the STP – which was positively received by the Board. JW also noted that the results of the Stakeholder Survey had been published and would be discussed and triangulated to establish what the results told the CCG and what was needed at a Governing Body OD session prior to presentation at a Governing Body meeting. The Governing Body noted that the NHS England CCG Assurance process was changing in line with the 5 Year Forward View and the STP and would focus on better health; better care; leadership; and sustainability through six clinical priority areas and would be rated in an OFSTED (Office for Standards in Education, Children’s Services and Skills) style scoring system. The next assurance meeting with NHS England was scheduled for July and it was expected that the new system would be utilised. 7. (Item 8 on Agenda) Board Assurance Framework (BAF) PGB-16-54 CF introduced the paper, explaining the process by which the Governing Body had arrived at the three top risks set out. The Governing Body was asked to consider and reflect on the three risks to ensure they were correct and consider how papers on the Agenda addressed those risks. The Governing Body agreed that the process had enabled a clearer framework to link risks to objectives and noted that the document remained a work in progress – especially in light of the STP developments which would re-focus risks across the whole system. PBe noted the importance of ensuring the actions set out were clearly linked back to the risks to show the expected impact. AA joined the meeting. JW noted the need to embed the risks into the committee structure in order to make it business as usual and ensure the process added value. SD explained that two risks were proposed for removal from the Framework: the first related to engagement which would be incorporated into the wider engagement risk; and the second related to the PMS Contract for which the target score had been reached. The risks relating to the PMS Contract review were captured elsewhere and it was confirmed that both risks would be detailed on department risk registers, just not specified individually on the BAF. The Governing Body approved the removal of the two risks from the BAF.


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8. (Item 7 on Agenda) Quality & Performance Report PGB-16-53 KM noted that all contracts had been signed with providers and that the performance reporting would incorporate the requirements of those contracts. The report itself was under review and would be changing in format and content in the coming months in order to better triangulate information around specific providers in terms of quality, performance and finance. For those providers who had signed up to the STF (Sustainability & Transformation Fund) their performance would be measured against an agreed trajectory and not the national standard. Kettering General Hospital (KGH) and Northampton General Hospital (NGH) were minded to sign up to the STF (subject to their Board approval) and would therefore be measured against agreed trajectories. A&E four hour transit times continued to be challenging and against the agreed trajectories both Trusts had met their targets in April and May. In Flow and Out Flow Groups were operating, led by the CCG to manage patients through both Trusts and actions were being monitored through the System Resilience Groups. NC and MD joined the meeting. NGH had an agreed trajectory in place for 62 day cancer waiting times but were continuing to fail to meet the target. A recovery plan was in place and AA confirmed that through the Cancer Improvement Working Group which met every two weeks, performance and actions were being closely monitored. Diagnostics were a specific challenge and in response the Trust was outsourcing routine endoscopies to ensure cancer endoscopies were carried out within the seven day timeframe; an additional CT scanner was expected in mid-August; and an additional MRI at the end of quarter three / early quarter four. Urology was a particularly challenging pathway due to its complex nature and recent staffing issues had been addressed with month on month improvement now being seen. Additional staff were being put in place in head and neck specialty; and inter patient transfers were also being reviewed. The Governing Body discussed the issues, noting that the new equipment would address service resilience issues but that any additional staff needed to run the additional equipment would be for the Trust to consider and plan for. AA confirmed that all cases where delay had occurred were discussed at each Cancer Improvement Working Group meeting with any harm to patients being dealt with through the normal Serious Incident process. The Working Group regularly reviewed the last 10 breaches and had discussed the recommendation by NHS England at the last CCG Assurance meeting to introduce a 45 day


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early warning threshold in order to prevent breaches occurring, but had concluded that the Trust were working to the Manchester Standard which should be a sufficient trigger process. AJ confirmed that members of the Quality Team had been attending the Cancer Board meetings at each Trust to seek assurance that the right decisions and actions were being taken. To date the Team had received the assurance they required. In addition, thematic reviews were regularly discussed at the Cancer Improvement Working Group to share learning and drive improvement. KM went on to issues with 18 week Referral to Treatment (RTT) times at KGH (for which Corby CCG were the Lead Commissioner) where reporting had been suspended due to the identification of significant data issues. The Trust was undertaking a thorough validation exercise and where patients had been identified as waiting over 18 weeks, appropriate and effective treatment was being provided as soon as possible. Both Nene and Corby CCGs had appointed an RTT Programme Director who was working closely with KGH. The validation exercise was due to complete on 27th June 2016. CE reported that representatives from KGH’s Board had been invited to the Joint Quality Committee to account for the actions being taken to address this issue. The session had been beneficial with a presentation and a question and answer session. The Committee had discussed the action plan; the external training procured; the clinical harm process which had been agreed; and the communications with GPs across the County. The Trust was holding fortnightly meetings to gain assurance on the RTT issues and the Joint Quality Committee would continue to monitor the situation closely and would invite KGH back in the future to update on progress. AJ confirmed that an external review commissioned by Nene and Corby CCGs was also underway to provide an additional level of scrutiny. JW confirmed that the Joint Quality Committee had been able to take assurance in relation to the process and plans in place to deal with the RTT issues, but only partial assurance in relation to the totality of the issue since the validation process and reviews were yet to be completed. The Governing Body noted that a press statement had been released by KGH and that no patient concerns had been received to date. Any concerns would be routed through the GP Concerns process as normal. KM confirmed that an update would be contained within the report on a regular basis. RY queried the IAPT (Improving Access to Psychological Therapies) performance in terms of the quality of the data and whether the CCG was placing sufficient focus and emphasis on


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improvement. AK and RaP confirmed that a recovery plan had been enacted as a result of the poor performance but that the impact of the work would be shown in future reports. Work had been undertaken in relation to additional capacity; how resources were utilised; and how the service provision was reflected across the County. AK also confirmed that data compliance had improved but was a work in progress. The importance of IAPT services was related back to the veteran’s patient story from Pat Haslam. Dementia Diagnosis rates were discussed and RaP confirmed that both Nene and Corby CCGs had developed a joint recovery plan to improve diagnosis rates which Corby CCG was starting to see the impact of, but which would take longer to impact for Nene CCG due to its larger size. The success in Corby CCG demonstrated that the Plan was appropriate and would achieve the desired outcome. AJ introduced the Quality section of the report and noted that many of the main quality issues had already been discussed. AJ did however highlight the OFSTED (Office for Standards in Education, Children’s Services and Skills) inspection of Children’s Safeguarding which had been scored as Requires Improvement to Good. The related improvement plan was being developed and due to be completed at the end of the week. JW noted that the Joint Quality Committee had raised concerns as to whether the Local Authority had had any restrictions lifted in relation to Children’s Services as a result of the inspection. The Committee sought assurance that the investment into early years would not be reduced and an action was agreed that the Local authority would present on the issue to the Health & Wellbeing Board which would then be fed back to the Joint Quality Committee and the Governing Body in due course.

ACTION: AJ

The Governing Body noted the strong working relationships being built with the Local Authority by AK and AA at service level and how this would impact positively going forward. The Governing Body noted the Quality & Performance Report. Quality & Primary Care 9. (Item 10 on Agenda) East Midlands Ambulance Service (EMAS) – Care Quality Commission (CQC) Report PGB-16-55 EC introduced the report explaining that the CQC’s inspection had highlighted areas of concern previously raised by the CCG such as staffing and appropriate skill mix. Areas where the service scored well included training, staff knowledge and the level of care.


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Whilst it was noted that Hardwick CCG was the lead commissioner for EMAS, Nene CCG were represented at all meetings. The improvement plan as a result of the inspection was still awaited. The Governing Body discussed the report noting that staffing was of particular concern for the CCG and would be the main focus of an oversight meeting the following week. KM further noted that the current Northamptonshire Locality Manager at EMAS was moving to Lincolnshire and as a result a single Locality Manager would be responsible for two counties. The Governing Body was not assured by this lack of focus on Northamptonshire which was already receiving a poorer service to its neighbouring counties and KM agreed to feed this back to EMAS.

ACTION: KM

MD reported that an audit had been undertaken at the start of the year on delayed conveyances and non-conveyances which were Red 1 or Green calls handled by EMAS. The audit had found no harm to patients as a result of delays in the service. RH noted that members of the public were reporting the transportation of patients in their own vehicles when delays were experienced and requested this be considered when audits were undertaken. The Governing Body discussed the appropriateness of conveyances and noted the benefit of the ECAT (Enhanced Clinical Assessment Team) who were able to assess on scene and change the pathway for a patient to the most appropriate for their condition. RY noted the issues with vehicles for the Service which were reported by the CQC – insufficient numbers of vehicles; unreliability of vehicles; and the significant numbers of calls missed or delayed due to breakdowns. It was noted that the last time EMAS had presented to the Governing Body they had referenced a grant which had been applied for, for emergency vehicles. The Governing Body agreed that it would discuss further at the OD session where options could be tested prior to inviting the CEO of EMAS to the Governing Body to discuss the options being considered. GB, NP and DK joined the meeting. 10. (Item 9 on Agenda) GP Federations NC introduced GB, NP and DK and noted that all GPs in the meeting were members of one of the respective Federations in their role as GPs. They would all remain in the room since there were no decisions to be made.


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GB presented on DocMed; NP on 3Sixty Care; and DK on GP Alliance; providing an overview of their vision, objectives and plans for the future. DS thanked them for attending and presenting and JW noted the extensive work undertaken by the Federations in a relatively short space of time. It was noted that the Federations were critical to the STP and often referred to as the bedrock of the process. The CCG was committed to supporting the Federations in their development and in the collective journey for the whole health system. The outcome of the McKinsey work was discussed and it was noted that a particular statement concerning the numbers of GPs needed should be reframed since whilst the system needed plans which would work with fewer GPs, the aim would be to continue to increase recruitment and retention of GPs in Northamptonshire. The Governing Body noted and supported the need to harness and maintain the current momentum for change within Primary Care and CF confirmed that whilst the national picture in terms of financial flows was still unclear the CCG was currently reviewing how it could provide support ‘in kind’ to the Federations in terms of resources. Whilst the drafting of the Commissioning Intentions for 2017/18 was commencing, it was noted that the MCP (Multi Specialty Community Providers) timelines were still unclear and that it might be necessary to work up a model which could operate in shadow form. NP declared an interest in the provision of Vasectomy Services through her Practice but noted the need to retain as much of the community contracts in Practices as possible to enable GPs to have portfolio careers. Whilst CF understood this, it was noted that the CCG had to comply with Procurement Law and each service would need to be reviewed on a case by case basis in terms of how it could be re-procured. It was noted that the CCG was reviewing its contract timelines to ensure that potentially more holistic approaches to services were not prevented by contract re-procurements. GB, NP and DK confirmed that the Federations were working collaboratively and were clear that they needed to move at a similar pace to maximise potential opportunities. The continuing help and value of the Local Medical Committee was also noted, particularly in ensuring GPs continued to represent their populations and didn’t become overly centralised. JM joined the meeting.


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Strategy 11. Sustainability and Transformation Plan (STP) Update PGB-16-56 JM updated the Governing Body noting that the submission date for the Plan of the 30th June 2016 was now being referred to as a ‘checkpoint’ which highlighted the ongoing work past the deadline date. Since the last Governing Body meeting McKinsey had been assisting in the development of the MCP (Multi Specialty Community Provider) Model; supported the transformation piece; and assisted with Programme Management. The document now had a structure within it and a coherent story was being created. The latest version of the Plan was circulated to all Partners on a weekly basis to ensure all comments and input could be captured. The delivery structure now needed to be agreed and CB confirmed that the Lay Scrutiny Committee had met three times to ensure all Partners had been fully engaged. JW noted that a Checkpoint Session had been attended a month previously which had identified further areas of focus and clarity required; a need to describe how the financial gap would be managed; and more detail on the engagement with Partners. A further update was provided on 17th June where NHS England was content that the system had reached the level required but that the proof would be in the delivery. The high level plan to bridge the financial gap was discussed and a RAG rating would be applied over the next week. The engagement around the Plan was discussed and it was noted that once the Plan was in a suitable shape, it would be taken out to be tested with patient and clinical groups. JM confirmed that the engagement work undertaken to date had been incorporated into the Plan and had played a significant part in setting the tone for the document. JW noted that it was imperative for all Partners to seek assurance on the Plan but also to assure themselves that the Plan reflected their wishes, especially as a result of the tight national timescales within which the Plan had been produced. The Governing Body agreed that it was important that all Partners were fully signed up and accountable equally for the Plan. DS queried the lack of clinical leadership on the governance slide in the paper and MD confirmed that the clinical priorities needed to be worked through to understand what was needed and to garner support for cross organisation clinical working. The meeting adjourned for 10 Minutes at 3.50pm and GB, NP and DK left the meeting.


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The meeting reconvened at 4.00pm. 12. Commissioning Support Service (CSS) Re-procurement & Organisational Changes JW explained that the paper had been brought to indicate the intention to re-procure the CSS as per the national requirement to do so; and the organisational review that would be undertaken as a result. The paper set out the reasons for the re-procurement; the process that would be undertaken; a high level timeline; and the intention for a partnership approach with Corby CCG. The Governing Body discussed the paper, noting that the two CCGs would need to agree the approach to take prior to commencement; that the HR advisors being utilised from Arden Gem CSU would not be involved and therefore would not be conflicted; and that the CCGs would need to be mindful of opportunities across the system despite organisations such as the Local Authority not being involved. The Governing Body discussed and agreed the recommendations set out in the paper. Governance 13. Northamptonshire Learning Disabilities Transforming Care Plan PGB-16-58 AK introduced the paper noting that it was Learning Disability Awareness Week and that the teams were undertaking a number of promotional events in Practices. The Plan (Nene CCG, Corby CCG, Northamptonshire County Council, and Providers) presented brought the extensive local work in line with national guidelines. It was submitted in March and was rated as assured – fully met. The Plan was now being circulated to all Boards for approval prior to publication (it was noted that the Health & Wellbeing Board had already approved it). The Governing Body commended the hard work of the team, particularly in the successful rehoming of vulnerable people which had been monitored by the Joint Quality Committee. The Governing Body approved the Learning Disabilities Transforming Care Plan. 14. Non-Emergency Patient Transport Service – Delegation of Authority PGB-16-59 KM explained that the current contract with NSL ended in June 2017 and that a procurement process therefore needed to be undertaken. NSL did not wish to remain in the market but there were a number of other potential providers and a process had begun for Northamptonshire. Subsequent to that process commencing, Lincolnshire and Leicestershire CCGs had expressed an interest in a joint procurement in order to maximise procurement power which the Nene and Corby CCG Executives had agreed would be beneficial. It was noted however that Northamptonshire would still have a specific contract for the County.


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The Governing Body discussed the proposal, noting that procurement expertise would be received from Arden Gem CSU; that Neil Boughton would be the lead for the CCG; that productivity and efficiency would be the main focus for the procurement as financial savings would be unlikely; that benchmarking for a similar service would be helpful to ensure sensible financial bids; and that the weighting of the scoring would need to be considered carefully. The Governing Body approved the alignment of the procurement with Lincolnshire and Leicestershire CCGs; and approved the delegation of authority for certain decision making to KM; Neil Boughton; and Caron Williams (Corby CCG), accepting the level of risk that this delegation presented. 15. Revised Primary Care Co-Commissioning Joint Committee Terms of Reference PGB-16-60 NC explained that as a result of Corby CCG taking on full delegation from NHS England from 1st April 2016 for Primary Care Commissioning, the Terms of Reference for the Joint Committee of Nene CCG and NHS England had been revised and amended and also brought in line with NHS England Conflicts of Interest guidance. The Governing Body ratified the Terms of Reference. 16. Primary Care Memorandum of Understanding (MOU) & Quality Transition Document PGB-16-61 NC explained that the MOU and the Quality Transition Document in shadow form were presented for ratification and set out the process towards full delegation of Primary Care Commissioning to Nene CCG in nine months’ time; the areas which would delegated; and the ways in which quality information would be shared. The Governing Body ratified the Shadow MOU and Quality Transition Document. 17. Board Assurance Framework (BAF) – Review PGB-16-62 The Governing Body discussed and agreed that the items on the Agenda had addressed the top three risks set out in the BAF and agreed that this focus should continue going forward for Governing Body meetings. Items for Information 18. Finance, Contracting, Transformation & Savings Report PGB-16-63 The report was noted. 19. Board of Directors Report PGB-16-64 The report was noted.


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20. Audit & Risk Committee Report PGB-16-65 The report was noted. 21. Joint Quality Committee Report PGB-16-66 The report was noted. 22. Finance, QIPP & Contracting Committee Report PGB-16-67 The report was noted. 23. Primary Care Co-Commissioning Joint Committee Report PGB-16-68 The report was noted. 24. Health & Wellbeing Board Minutes PGB-16-69 The Minutes were noted. 25. Register of Interests PGB-16-70 The Register was noted. 26. Glossary PGB-16-71 The Glossary was noted. Any Other Business There being no further business the meeting closed at 4.55pm.


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GOVERNING BODY MEETING IN PUBLIC

ACTION LOG RED: CONCERN/INABILITY TO COMPLETE ACTION

AMBER: IN PROGRESS GREEN: ACTION COMPLETE

Date of Meeting

Item / Paper Number Action Lead Due RAG Rating Status

21.06.16 7 Quality & Performance Report Clarity re, LA investment into early years – to be reported to Quality Committee → GB

AJ 20 Sept 16 A

19.04.16 11 Corporate Objectives 2016-19 Link to Right Care be more explicit in performance measures; dates to be added; and number of metrics to be considered

SD 17 May 16 A

06.06.16 Effective rationalised metrics including Right Care and dates are being worked up in conjunction with Matt Spilsbury. 21 06 16 Metrics will be brought to GB in July. 04.07.16 Deferred to September meeting in order to work through at an OD session in August prior to formal presentation.

21.06.16 10 EMAS CQC Report KM to feedback GB’s lack of assurance in relation to lack of focus of Locality Manager at EMAS (covering 2 counties)

KM 19 July 16 G

28.06.16 Formally notified trust Director of Strategy and lead commissioners in Collaborative Commissioning Meeting (22/06).

16.02.16 9 East Midlands Ambulance Service Update

OD session to be scheduled to discuss commissioning Ambulance services

DS/MP 15 March 16 G

21.03.16 OD Session Forward Plan drafted, session timing to be finalised. 06.06.16 SD discussing with DS. 21 06 16 On OD Schedule which will be circulated. Closed.


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MD Matthew Davies

DS Darin Seiger MP Marianne Phillips SD Stuart Dalton AJ Alison Jamson

KM Kathryn Moody

18.08.15 9 Quality & Performance Report Activity, quality and performance rates to be broken down by Locality

MD February 15 G

20.10.15 Quality Dashboard being produced through PCCJC – MD will take forward. Likely to take three months. 28.01 Deferred -Dashboard needs to be discussed by PCCJC prior to presentation at the Governing Body. 21 06 16 will be brought to September GB. Closed.


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GP Chair’s Report

Youth Ambition Awards

The Northamptonshire Mental Health Stigma Programme Participation Group has won the Project or Campaign of the Year Award at the Youth Ambition Awards! The award ceremony took place on 29th June at Wicksteed Pavilion in Kettering. The Youth Ambition Awards are an annual celebration of children and young people across Northamptonshire and are held jointly with Northamptonshire Newspapers’ Education Awards which is delivered by Northamptonshire County Council. The aim is to reward the achievements of special young people and showcase the great things they do in their local community. It could be large or small, but it will have started out with clear objectives and the young people will be able to show how those objectives have been met. They will also have used creative ways and communications channels to tackle any issues. The Project or Campaign of the Year Award demonstrates how the worked together with their peers and other groups to make it a success story and was open to young people aged 11 to 22 years. David Loyd-Hearn, the CCGs Children and Young People Commissioning Manager for Emotional Health and Wellbeing and the East Midlands Network will be presenting the programme as a part of our showcase in July at the regional FIM event. Armed Forces Day Armed Forces Day was held on Saturday 25th June 2016 with celebrations starting during the week leading up to a parade through Northampton organised by the Royal British Legion and a fly past and marching bands ending a spectacular day of events and support for all our Armed Forces Community. With that in mind, I wanted to share with you a short video that demonstrates the support veterans have across the region. The video contains a story of first-hand experience the devastating effects post-traumatic stress disorder can have on a veteran and their family.


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Other:

• Met with CEO Association for Young People with ME following Radio Interview • Introductory meeting with Sylvia Hughes, new Chair of Health & Wellbeing Board • Chaired Health Countywide Chair & CEO STP delivery meeting • Central Midlands Patient Safety and Learning Network Launch Event, Towcester • Countywide Chair & Lay Members/ NEDs meeting


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Accountable Officer’s Report

Sustainability and Transformation Plan (STP)

The Northamptonshire system wide draft STP was submitted for the next checkpoint to NHS England on 30th June 2016. There is then a further checkpoint with NHS England national and regional leaders meeting with the Northamptonshire STP footprint on Monday 18th July 2016 to discuss the STP and start to develop a shared consensus about the subsequent steps required to deliver the plan. Further work will be undertaken over the summer which will culminate in a final version of the STP being completed by October 2016.

NHSE/CCG QIPP Deep Dive Visit

NHS England met with the CCG on 6th July 2016 to discuss in depth the QIPP Schemes. The meeting was attended by the Clinical Executive Directors, Executive Management Team and our programme leads from across the organisation. NHSE was supportive of the CCG’s strategy to QIPP and the development of the Transformation and Innovation Committee (TIC) which will oversee the delivery of the schemes.

CCG Assurance

The CCG met with NHS England for its first assurance meeting using the new format which focussed on the four domains recently published 2016/17 CCG Assurance Framework and clinical priorities accordingly:

• Better Health – looking at how the CCG is contributing towards improving the health and wellbeing of its population, and bending the demand curve

• Better Care – Focuses on care redesign, performance of constitutional standards and outcomes including important clinical areas

• Leadership – assessment of the quality of the CCG’s leadership, its plans and how it works with its partners and its governance arrangements

• Sustainability – reviews how the CCG is remaining in financial balance, and is securing good value for patients and the public from the money it spends

Key areas of clinical focus in our first meeting were cancer, urgent care, maternity /children’s, diabetes and mental health.

Local Digital Road Map

The Local Digital Roadmap was submitted to NHS England on 30th June 2016. As part of the assurance process, review panels are being established across the region to review the submission, ensure that it is aligned to the Northamptonshire STP plans and any associated investments


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Northamptonshire partners have agreed to work collaboratively as a single ‘footprint’ to develop the STP and LDR. The e-share Northants group, which has representatives from partner organisations, through joint working with STP leads and engagement with wider stakeholders, have developed this LDR which is intrinsically linked to support and ensure the success of the STP.

Digital collaborative working within the county is currently at an early stage, however all parties recognise the need for rapid progress towards joined up working.

Our local ambition is to make appropriate electronic patient record data available to any clinician in any care setting in order to better facilitate health and care decisions:

• Providing data from systems other than the system that they use routinely • Joining up as many existing data sources in the county in the short/medium term • Working towards the ultimate connection of all data on a read and write basis • Removing the legacy recording of clinical information onto paper and replace with a

digital solution • Reviewing and rationalising systems across the digital footprint • Improving quality, access and efficiency for the benefits of citizens/patients and services • Aligning with the STP to achieve the key digital capabilities

Recruitment of Registered Nurse Lay Member

The CCG has advertised to recruit to the vacant Registered Nurse Lay Member position of the Governing Body. The closing date for applications is Tuesday 26th July with interviews being held in August.

Other:

The Accountable Officer attended: • The Overview Scrutiny Committee – 20th June 2016 • NHS Corby CCG’s AGM – 7th July 2016 • Invitation to speak at the HSJ Summit on 23rd September at Staverton Park, Daventry. • External panel member for the appointment of a Director of Operations at

Northamptonshire Healthcare NHS Foundation Trust


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Effective • Compassionate Supportive • Safe

This paper is being submitted to the Governing Body for amendment and/or approval as appropriate. It should not be regarded, or published, as CCG Policy until formally agreed at the Governing Body meeting, which the press and public are

entitled to attend.

Governing Body Meeting In Public – 19 July 2016

Report Title Quality & Performance Report July 2016 - Exception update Date 4 July 2016 Number PGB-16-75 Lead

Director Alison Jamson, Interim Director of Quality Kathryn Moody, Director of Commissioning

Author Quality Team and Performance Team

Clinical Director

None

Report Summary This report provides an update by exception on performance and quality issues

based on the most recent data available. The report identifies the following as key performance issues:

• Patients waiting 4 hours or less in A&E at both NGH and KGHFT, • Ambulance response times, • 62 days and 31 days cancer waiting times standard at NGH, • Referral to Treatment (RTT) 18 weeks standard at KGHFT, noting specific

issues with regards to data quality that is also impacting reporting of diagnostics data.

• Improved Access to Psychological Therapies (IAPT) standards, • Dementia diagnosis rates for Nene CCG.

The report also identifies key quality updates:

• Domiciliary care - CQC restrictions on practice • EMAS - CQC inspection • KGHFT - Risks to patient safety subsequent to referral to treatment (RTT)

delays / Dementia CQUIN performance • Children’s Safeguarding - Joint Targeted Area Inspection / Ofsted

Inspection of Children’s Services • Milton Park Campus Mental Health Locked Rehabilitation – CQC report

Purpose ☒ Discussion ☐ Discussion ☐ Ratification ☐ Information Recommendation

The Governing Body is asked to: 1) Review the key performance issues and be assured that the recovery actions

being taken by the respective providers and the wider system to recover performance are appropriate.

2) Take note of the key quality updates and quality section of the report and the action taken.

Corporate or Statutory

This report supports the following Nene CCG objectives:


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Objectives • We will ensure clinically led commissioning of personalised, safe and effective care from high performing providers.

• We will drive the Financial Strategy for the whole Health Economy that efficiently and effectively delivers health services that achieve the constitutional standards, value for money and innovation.

Identified Risks & Mitigation Actions

The following risks on the BAF are linked to this report. BAF020: Key performance targets are not achieved by providers serving our population. BAF021: The ability of CCG-commissioned providers to respond to commissioner requirements. Non delivery of NHS Constitutional standards increases the risk of poor patient experience and potential harm. To mitigate this risk, each area of underperformance is being tracked and managed through contract and executive meetings with the relevant provider(s). System wide meetings are also focussed on improving performance and reducing risk (for example, Urgent Care Working Group, Cancer Improvement Working Groups and North/South System Resilience Groups). With regards to quality, the CCG quality team will follow up each area of underperformance and quality concerns with relevant provider(s) through Clinical Quality Review Meetings to ensure implications for patient experience and potential harm are understood and managed.

Conflicts of Interest or Legal Compliance Mitigation Actions

Nothing above, any conflicts of interests noted in the meeting.

Finance / QIPP / Resource Implications

• Additional provision has been made in the KGHFT 16/17 contract by both Nene CCG and Corby CCG to mitigate the potential of a RTT backlog (patients waiting over 18 weeks) once the data has been finally validated. However until the data is fully validated, the final impact will not be known.

• If A&E performance does not recover in time for winter then additional resource may be required to support flow through and out of hospital. This is being closely managed by the UCWG and the respective SRGs.

• In 2016/17 EMAS will be billing additional cost to the CCG for acute ambulance handovers greater than one hour. However, at the time of writing this report the CCG had no agreement with NGH or KGHFT to implement acute ambulance handover delay penalties. This is due to the perceived issues with the quality of the data involved.

Engagement Not applicable. Quality & Equality Impact Assessment

Not applicable.

Report history This report provides an exception based update for the 21 June 2016. Next Steps Performance and quality issues will be tracked, managed and escalated until

resolution is reached through the relevant meetings as detailed above. Appendices None. Director Approval Alison Jamson, Interim Director of Quality (4 June 2016)

Kathryn Moody, Director of Commissioning (4 June 2016)


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Quality and Performance Exception Report

June 2016 Performance exceptions

Urgent care

Patients waiting 4 hours or less in A&E

NGH did not achieve the 95% standard for April 2016, with performance of 88.5%, but is in line with their recovery trajectory of 88.4%. Unvalidated data for May 2016 shows improvement with performance of 89.2%, which is above the NGH recovery trajectory of 84.0%. Indicative data for June shows that the trust may have reached performance of circa 94%, which would also be above their recovery trajectory which is 85%. KGHFT did not achieve the 95% standard for April 2016, with performance of 85.4%, but is in line with their recovery trajectory of 85.0%. Unvalidated data for May 2016 shows improvement with performance of 86.9%, which is above the KGHFT recovery trajectory of 85.0%. Indicative data for June shows that the trust may have reached performance of circa 90%, which would also be above their recovery trajectory which is 85.0%. The Urgent Care Working Group (UCWG) with oversight from the North System Resilience Group (SRG) and South System Resilience Group (SRG) continue to implement a comprehensive programme of initiatives to improve inflow (managing NEL demand), internal flow (hospital processes) and outflow (discharges). Ambulance response times

EMAS continues to have significant issues with ambulance response times, with the trust not meeting any of the three response time standards in April. Performance against A8 Red 1 calls was 66.3% (75% standard) above recovery trajectory of 65.0%. A8 Red 2 calls performance was 57.3% (75% standard) above recovery trajectory of 51.8%; and 19 minutes performance was 86.7% (95% standard), above recovery trajectory of 86% Following a CQC visit in November, EMAS have been issued with a S29A for immediate improvement in key areas, including Care and Treatment, Recruitment and Sickness absence. EMAS have formulated an improvement plan in response to the CQC visit which is monitored via the QAG. Monthly meetings are being held with commissioners to review progress against improvement plan, the first meeting held on 28 June 2016. Cancer Waiting Times (CWT)

In April, NGH met six of the nine CWT standards. The three standards not met were 31 day first treatment standard (96%) with performance of 93.7%, the 62 day standard (85%) with performance of 71.4% (which is below their recovery trajectory of 75% in April) and the 31 days subsequent surgery standard (94%) with performance of 88.9%. Since publication of the Quality & Performance Report, validated data for May data has become available and shows NGH meeting seven of the nine CWT standards.


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The 31 subsequent surgery standard has recovered with performance of 100%. 62 days shows performance of 76.2% which is below the trajectory of 77.2%. 31 days performance of 93.3% in May which is above the trajectory of 92.3%. NGH recovery trajectory for 62 days shows recovery in September, which will be predominantly by reducing cancer diagnostic waits to seven days in line with best practice. They plan to do this through focussing existing diagnostic capacity on cancer pathways and increasing diagnostic capacity, for example a third CT scanner is expected to be implemented in August. NGH have also provided a recovery trajectory for 31 days first treatment, with recovery by July 2016. To improve 31 day performance the trust is improving patient tracking and has taken immediate action to achieve this, for example a daily divisional manager overview. In April, KGHFT met eight of the nine CWT standards. The standard not met was the 62 day screening standard (90%) with performance of 80%. May validated data shows improved performance of 88.0%, however still not meeting standard. Planned care

Referral To Treatment (RTT) 18 weeks standard

Due to on-going issues regarding the quality of their RTT and diagnostics data, KGHFT have not submitted national data for these two standards from December 2015. The trust is planning to reinstate reporting RTT data from January 2017.

NGH are meeting the 92% incomplete standard overall and across all specialties with the exception of Trauma and Orthopaedics, which was 88.3% in May. A backlog built up during winter due to non-elective pressures. NGH are forecasting recovery by November, which will be delivered and sustained through outsourcing activity from mid-August 2016.

Diagnostics within 6 weeks

As detailed above, from December 2015, KGHFT have suspended diagnostics reporting due to issues with data quality. The trust is planning to reinstate reporting diagnostics data from October 2016. NGH met the diagnostic standard in April and May. Mental Health

Improved Access to Psychological Therapies (IAPT)

Due to issues with local and national data mismatch; commissioners have made request to Health and Social Care Information Centre team to reconcile with Provider. Regular monitoring in place; CQUIN to implement data capture from third sector (as per national review team) although concerns about impact on access rates v recovery rates. Access and recovery rates expected to improve following implementation of self-referral system. Dementia Diagnosis for people aged 65 years +

Nene CCG dementia diagnosis rate in May 2016 at 59.32% which is a reduction from 61.12% in April but remains below the standard 66.7%. Actions to improve performance include audit/screening of patients in Care Homes Project starting in July 2016.


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Quality Exceptions

Domiciliary care - CQC restrictions on practice Care XL domiciliary care provider had an unannounced CQC inspection with restrictions placed on the provider’s capacity (hours of care provided). Clients in receipt of NHS funded care have been migrated to an alternate provider. The final inspection report has yet to be provided although the provider is now addressing the issues identified with respect to recruitment and training processes. East Midlands Ambulance Service (EMAS) - CQC inspection The CQC inspection took place week beginning 16 November 2015 and the inspection report published on 10 May 2015. The inspection report covers the emergency ambulance service, emergency operations centre and patient transport services. Overall, the trust was rated as ‘requires improvement’. Caring and responsive were rated as ‘good’. Effective and well led were rated as ‘requires improvement’ and safety as ‘inadequate’. The CQC have therefore taken enforcement action against the trust in this respect. The CQC action plan oversight meeting was held on 28 June at Horizon Place (EMAS HQ). The meeting, chaired by NHS Hardwick, was attended by commissioners by county, NHS Improvement and NHS England. An action plan has been developed with key actions, timeframe and leads identified and will be monitored through the oversight group and local progress will flow through the local collaborative commissioner meetings. EMAS July public board papers covering the action plan and associated narrative have been published on the trust website. The next oversight meeting Friday 29 July 2016. KGHFT - Risks to patient safety subsequent to referral to treatment (RTT) delays The trust has consistently failed to meet referral to treatment (RTT) targets which presents a potential risk to patients of harm due to delayed access to treatment. The trust has developed an internal process for the review of potential harm. An external clinical harm review process for the CCGs has been agreed. The trust and CCGs have agreed a revision to the clinical harm review process following a tripartite meeting on 24 May 2016 and are meeting monthly to monitor progress. KGHFT - Dementia CQUIN performance The requirements of the Find, Assess, Investigate and Refer (FAIR) test are no longer a CQUIN for 2016/17. However, this remains a national reporting requirement. The CCG has challenged the trust through the CQRM and received a recovery action plan. Progress will be monitored through the CQRM. The sending of care plans to the GPs of patients with a diagnosis of dementia has been expanded in a CQUIN for 2016/17 and will be reported on and monitored through the year. Performance remains challenged. The trust is specifically targeting action on areas with low response rates and have implemented a series of ‘pop up’ booths in lobbies to promote participation. A new head of nursing has been appointed to the medicine CBU and has been specifically tasked with addressing poor performance.


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Children’s Safeguarding Joint Targeted Area Inspection - Northamptonshire multi-agency partners have been given notice that a joint targeted area inspection will take place by the end of August. The areas specifically where health is a major influencing partner are the Multi-Agency Safeguarding Team (MASH) and the Reducing Incidents of Sexual Exploitation (RISE) team. Ofsted Inspection of Children’s Services - The Improvement Board met in June and agreed the response to the recommendations of the recent report. These have been sent to Ofsted for approval. Milton Park Campus Mental Health Locked Rehabilitation – CQC report Following a CQC inspection in August 2015 the report was published in May 2016. The provider received an overall rating of inadequate. This contract is part of a collaborative with NHS Hardwick CCG as the lead commissioner. NHS Nene and Corby CCGs currently monitor 3 patients within this mental health locked rehabilitation contract; none of these patients are funded by Nene or Corby CCGs. Funding CCGs have been notified of the CQC outcome both by Milton Park Campus and NHS Nene and Corby CCGs Mental Health Commissioners and ‘safe and well’ reviews have been planned. NHS Nene and Corby CCGs Individual Package of Care panel (IPC) has placed one patient within this campus but not in the locked rehabilitation area. Monthly monitoring visits have been undertaken by IPC, a further ‘safe and well’ visit has been undertaken on 29 May 2016. No concerns were raised. The provider has provided an update on the work undertaken towards completing their action plan. Further CQC inspection is scheduled for September 2016. A joint quality visit with NHS Bedford CCG is planned for 16 June 2016. No concerns were raised.


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entitled to attend.


Report Title Finance, Contracting, Transformation and Savings Report Date 1st July 2016 Number PGB-16-76 Lead

Director Stuart Rees, Chief Finance Officer Kathryn Moody, Director of Commissioning

Author Andrew Burwell – Deputy CFO Neil Boughton - Head of Non-Clinical Contracting and Procurement Peter Watson - Transformation Programme Manager

Clinical Director

N/A

Report Summary The attached report provides details of the CCG Financial position as at the end of

May 2016. The report also includes details on the individual contracts and the Quality Innovation Productivity and Prevention (QIPP) performance based on activity data from month 1.

Purpose ☐ Decision ☐ Discussion ☐ Ratification ☒ Information Recommendation

1) Note the financial position of the CCG at month 2 and the forecast achievement of the required 1% underspend. 2) Note the performance of the contracts based on month 1 data. 3) Note the delivery of transformation and savings based on month 1 data.

Corporate or Statutory Objectives

Statutory financial duties in 2016/17


Expenditure in certain services could be higher than planned but a series of mitigating actions have been identified to ensure that the CCG remains on track to deliver the 1% surplus at year end.


There is no conflict of interest.


No resource implications

Engagement N/A Quality & Equality Impact Assessment

N/A


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Report history This report was presented to the Finance, QiPP and Contracting Committee on 30th June 2016.

Next Steps The financial position of the CCG will be reported monthly to the Finance, QIPP and Contracting Committee and as appropriate to the Governing Body.

Appendices - Director Approval Stuart Rees – Chief Finance Officer on 4th July 2016


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2016-2017 Finance, Contracting, Transformation and Savings Report

Month 2 Position


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No. Item

Finance

1 Assurance Metrics2 Headlines

2.1 Key Actions & Risks3 Financial Dashboard4 Expenditure Summary

5.1 Revenue Resource Allocation5.2 Key Variances

6 Variance Analysis7 Statement of Financial Position

Contracting

Transformation and Savings

Contents


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Description of Financial duties Outturn RAG RAG Explanation

For Further

Information

refer to

section

1. Maintain expenditure within the revenue resource limit GAs at month 2 the Clinical Commissioning Group (CCG) is underspent by £1.299m which is inline with the

planned underspend for this stage of the year. 4 & 5

2. Maintain expenditure within the allocated cash limit

The CCG is expecting to remain within its maximum cash drawdown limit (MCD) for 2016/17. The CCG

had a cash at bank balance of £2.8m at the end of month 2 and this compares to a target month end

cash at bank balance of £0.713m.

7

3. Ensure running costs are maintained within the Running Cost Allocation

(RCA).Running Costs are currently within the allocation for 2016/17 and are forecast to remain so at year end. 4

4. Ensure a minimum of 0.5% contingency / reserves are maintainedThe contingency reserve is forecast to be spent by year end but is not currently committed at the end of

month 2.4

5. Ensure the target surplus is achieved. (To be carried forward into

2015/16)

The CCG is forecasting that it will deliver the required 1% surplus in 2016/17. Risks are being monitored

against the CCG risk and mitigation plan.2,3 & 4

6. Ensure 1.5% is invested non recurrently to enable carry forward into

2015/ 16.

The 1.5% transformation funding has been ring fenced in 2016/17 and remains uncommited as per

guidance from NHS England. This is expected to be topsliced by NHSE later in the year.4

7. Ensure compliance with the Better Payment Practice Code (BPPC) Based on month 2 data the CCG has achieved the 95% target in all 4 of the required areas. 7

1. Finance Assurance Metrics


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d) Delivery of Transformation and savings plans - There is a risk that some schemes may not achieve the planned levels of savings.

The CCG financial plan was based on delivering a savings target of £21.709m. Plans have been identified to this value and are currently being implemented. There is a risk that slippage may occur on some of the schemes and

therefore some mitigations have been identified. Further mitigations may be required if slippage is greater than anticipated.

The CCG may also experience some additional cost pressures in year on acute activity, Continuing Healthcare (CHC) expenditure and prescribing costs. Current estimates are that these risks could range from between £4m

and £8m. The main risks are described below:

a) Prescribing - awaiting confirmation of the impact of the Category M price reduction noting the anticipation that this is back dated for the full year.

These risks will continue to be monitored throughout the year and mitigations developed and applied as required in order to deliver the target 1% surplus at year end.

The CCG risk and mitigation plan has been approved by the Board of Directors and the Finance, QiPP and Contracting Committee.

Key Headlines

At the end of month 2 the CCG has an underspend of £1.299m. This is inline with the financial plan for month 2. The CCG continues to forecast that it will achieve the required £7.791m underspend at year end. However

achievement of the surplus will be reliant on delivering a series of mitigations designed to offset the shortfall from initial savings plans and the impact of inyear risks from overperformance and service changes within the

Health and social Care economy.

Limited financial information is available at month 2 and so the reported position is based on a combination of draft data from providers and local knowledge.

An analysis of the current expenditure by service area can be seen at sections 3, 4 and 5 of this report.

2. Financial Headlines

b) Acute providers opening additional bed capacity leads to additional costs and overperformance.

c) Continuing Healthcare - growth in packages could be higher than planned


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Plan Actual Variance YTD Plan YTD ActualYTD

VarianceAnnual Plan

£m £m £m £m

Current Month 126.39 125.09 (1.30) NGH 33.79 33.79 0.00 202.87

YTD 126.39 125.09 (1.30) KGH 20.60 20.77 0.17 126.05

Full Year Forecast 778.97 771.18 (7.79) NHFT 18.34 18.34 0.00 110.01

Financial Position (£m)

3. Financial Dashboard

Financial Position (£m)

55,000

57,000

59,000

61,000

63,000

65,000

67,000

69,000

Apr. May Jun. Jul. Aug. Sept. Oct. Nov. Dec. Jan. Feb. Mar.

£'0

00

16/17 Financial Position

Unmitigated 2016/17 Plan

2016/17 Plan

16/17 Actual Expenditure

15/16 Expenditure


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5.1 Revenue Resource Allocation

5.2 Key Variances

Delegated Full Year

Budget (£m)Budget Group M01 M01 + M02 M03 M04 M05 M06 M07 M08 M09 M10 M11 M12 Total

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

778,968 CCG Allocation 126,386 126,386

426,318 Plan 70,371 70,371.0

Actual 70,538 70,538.0

Variance 167 167.0

202,641 Plan 33,774 33,774.0

Actual 34,280 34,280.0

Variance 506 506

6,738 Plan 1,123 1,123.0

Actual 1,122 1,122.0

Variance (1) (1)

4,950 Plan 825 825.0

Actual 858 858.0

Variance 33 33

91,988 Plan 14,902 14,902.0

Actual 14,902 14,902.0

Variance - -

13,747 Plan 2,291 2,291.0

Actual 2,291 2,291.0

Variance - -

17,641 Plan 1,801 1,801.0

Actual 1,096 1,096.0

Variance (705) (705)

7,154 Plan - -

Actual - -

Variance - -

7,791 Surplus / (Deficit) 0 1,299 0 0 0 0 0 0 0 0 0 0 1,299

under or (over) achievement of target 0 0 0 0 0 0 0 0 0 0 0 0

Programme Projects and other Costs

Reserves

5. Income and Expenditure

The delegated budget for 2016/17 is £778.968m. There were no new allocations in months 1 or 2.

Monthly Actual Expenditure (RAG Variance)

Acute

Non-Acute including CHC and BCF

Primary Care

OOH

Prescribing

An explanation of the variances is shown in the contracting section of the report. It should be noted that contracting data is based on month 1 actual activity whereas the finance report also includes an estimate of the month 2 expenditure.

Running Costs


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7.1 Better Payments Practice Code

Invoice Count Invoices Passed % PassedBPPC Amount

£'000

Invoice Amount

(Passed) £'000% Amount Passed

Total Non-NHS 3,428 3,384 98.72% 21,375 21,232 99.33%

Total NHS 749 734 98.00% 85,301 85,271 99.96%

7.2 Cash Limit

7.3 Aged Debt Report

Customer classification Total AR due and AR Current 1-30 Days 31-60 Days 61-90 Days > 90 days

NHS 367,232 - 104,064 - 343 262,826 Non-NHS 247,346 68,893 19,546 95,779 3,386 59,742 NCC 3,373,592 - 41,741 8,136 61,078 3,262,636

3,988,170.31 68,893.19 165,350.85 103,915.00 64,807.27 3,585,204.00

7. Statement of Financial Position (Balance Sheet)

CCGs are required to have a maximum closing cash balance of 1.25% of the cash drawn down for that month. For May, the CCG had a closing bank balance of £2.8m which is above the target of £0.713m.

A large element of the outstanding debt relates to funding disputes with the County Council. Discussions are continuing to try and resolve these outstanding issues.

-

5

M01 M02 M03 M04 M05 M06 M07 M08 M09 M10 M11 M12

Month end cash balances (£millions)

Month End Cash Balances Plan Month End Cash Balances Actual


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2016-2017 Contracting Month 1 Position


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1

Contracting Summary 1. Month 1 Position 1.1. The table below identifies the financial and activity variance from plan for acute service

providers and Northamptonshire Healthcare Foundation Trust, all of which NHS Nene CCG holds a contract with.

Table 1, Contract Activity and Finance Variance to Plan - Month 1

1.2. Reported figures for acute service providers are based on unadjusted SLAM returns and are subject to change during the SLAM/ SUS reconciliation process.

1.3. Month 1 reporting is showing an under performance to plan of £51k. The calculated year end outturn variance as of month 1 is a break even position.

1.4. A summary of the main over performing contracts is as follows: • University Hospital Leicester - month 1 financial over performance £175k, driven by

Elective Care (Hepatobiliary & Pancreatic, Clinical Haematology and Spinal Surgery) at £58k and Adult ICU at £106k (88 bed days over plan).

• Ramsay Horton – month 1 financial over performance £59k, driven by Elective Inpatient Trauma & Orthopaedics at £56k and Trauma & Orthopaedic Day Cases at £12k.

• Ramsay Woodland – month 1 financial over performance £138k, driven by Elective Inpatient activity at £142k of which £57k relates to procedures centred on the knee.

• BMI Three Shires – month 1 financial over performance £170k, driven by Trauma & Orthopaedic Elective Inpatient and Day Case activity (claims totalling £347k and £170k respectively.

1.5. Variations between SLAM figures reported within this Contracting Report and the Financial Ledger reporting contained within the Finance Report will be present due to reporting mechanisms and timeframes used to determine the reported forecast expenditure and adjustments to the financial ledger.


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2

2. Contracting Headlines 2.1. There are a number of issues to which we wish to draw the Governing Bodies attention. These

are outlined below. 2.2. Northampton General Hospital NHS Trust (NGH) • The contract for services was signed by all parties on the 25 April 2016, in line with the national

timetable at a value of £202,873k inclusive of CQUIN’s. NHS Nene and NGH remain engaged in the works required to agree the application of readmissions and MRET funding and the efficacy of existing schemes currently funded by these monies.

• NHS Nene and NGH have agreed to undertake a joint system review of capacity within the south of the county. Through this review the system will look to understand current and projected capacity requirements, current and projected available capacity and issues relating to capacity and mitigating actions required to improve the management and alignment of demand and capacity.

• Month 1 SLAM identifies an under performance of (£286k) or (2%) when compared to plan. The most significant contributing areas to month 1 performance are: Non-Elective - £233k over performed specifically within General Medicine. This relates to a

number of invalid HRG codes, which the Trust has confirmed will be resolved by the freeze date (20 June). Initial analysis of month 2 submitted data would indicate that the Trust has undertaken the required works; although this is in the process of validation by commissioners. The Contracting Team are undertaking a detailed analysis of over-performance in non-elective activity including an assessment of potential increases in ambulatory care conditions.

Outpatient Procedures – over performed by £156k. Ophthalmology £74k above plan with activity 27% above; Vitreous Retinal and Minor Cornea procedures £64k and £51k respectively over the plan. Urology £39k over, intermediate large intestine procedures 19 years & over £38k variance seeing 91 more patients than planned.

Outpatient FA Single Professional Consultant Led – shows an over performance of £100k. There has been a swing back against this POD from the multi-professional consultant led POD (which is currently showing an under performance of (£133k). This appears to be specifically in T&O, non-admitted face to face first attendances (WF01B) with an over performance of £91k.

Excess bed days emergency – under performance of (£209k). General Medicine (£176k) under across numerous HRG’s, Kidney or Urinary Tract Infections, Heart Failure or shock, COPD. The under-performance in this area is unusual and could increase in-year.

Elective – underperforming by (£142k). T&O (£141k) under, Major hip & knee procedures under, but offset by day case activity. Linked to the over-performance in non-elective activity.

Outpatient FA Multi Professional Consultant Led – under performance of (£133k). As detailed above there has been a swing in performance from OPFASPCL. This is also within T&O, multi-professional non-admitted face to face first attendances (WF02B) with an under performance of (£75k).


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3

• The Trust has breached the A&E 95% 4 hour transit time standard, achieving 88.5% in month 1. • The Trust breached four of the nine cancer targets in April 2016 according to un-validated data:

62 days urgent referral to treatment of all cancers at 71.3% (standard 85%) 31 days from diagnosis to first definitive treatment at 94.8 % (standard 96%) 31 days for second or subsequent treatment – surgery at 80% (standard 94%) 31 days for second or subsequent treatment – drugs at 85.7% (standard 98%)

• RTT – whilst the Trust has met the overall ‘Incomplete’ standard in month 1, the Trust did breach one specialty; Trauma & Orthopaedics with 84.2% (standard 92%).

2.3. Kettering General Hospital NHS Foundation Trust (KGH) • NHS Nene and KGH agreed the 2016/17 Contract for services at a value of £126,047k inclusive of

CQUIN’s. As part of this agreement, the following matters were included within the side letter to the contract for services: The contract is inclusive of £2m (NHS Nene share £1.5m) for the delivery of RTT recovery

activity. Payment of RTT recovery monies will be made in line with PbR rules and is therefore subject to delivery of activity.

Commissioners are to undertake a review of the stroke pathway with the aim of reducing the length of stay for patients. Should commissioners not undertake required works by the end of quarter 2, £125k per subsequent quarter will be paid to the Trust for each quarter the works remain incomplete.

By the end of Q2 the Trust and commissioners to review and agree the application of readmissions money within the North Northamptonshire system.

• Month 1 SLAM identifies an under performance of (£158k) or (2%) when compared to the plan. The Governing Body are asked to note that the Trust have highlighted that this data does not include any RTT outsourcing as they are awaiting the information. To support Trust and commissioner planning and forecasting, the NHS Nene and NHS Corby have requested that the Trust provide an evidence based estimate of activity delivered each month. The main areas of contractual performance at month 1 are: Other Adjustments – over performance of £97k when compared to plan. The Trust has

reinvested the entire A&E penalty in April (£63k) and the Readmissions (£98k) which has caused this price variance. The CCG has challenged the Trust citing that any reinvestment is subject to the outcome of the joint review and should not be considered as an automatic adjustment.

Excess Bed Days Emergency – Month 1 over performance of £83k (1,873 days) when compared to plan. Month 1 SLAM shows that the over performance is predominantly within Geriatric Medicine £75k and General Medicine £38k and relates to patients admitted in 2015/16 for Cardiac, Trauma and Cranial treatment.

GP DA Pathology – over performance of £24k when compared to plan and 8% more activity than planned for. This activity is within the Biochemistry specialty showing £17k above the plan and 9% more activity.

Elective – under performance of (£74k) when compared to plan. This POD is currently showing an underperformance however the Governing Body are asked to note that this may be affected by the charging of RTT works as set out above.


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4

Non-Elective – under performance of (£56k) and (2%) less activity than planned for. The Governing Body are asked to note that detailed analysis of submitted activity has identified that this under performance is due to the underperformance of General Medicine COPD offsetting an over performance in Respiratory Medicine and Gastroenterology.

• The Trust delivered a performance of 85.4% against the 95% A&E Transit time standard in April 2016 however, are achieving against their trajectory.

• The Trust achieved 5 out of the 7 (applicable) cancer targets during month 1, failing to achieve the standards for: 62 cancer urgent GP referral, delivery 84.4% v target 85%. Total of 71 patients treated and

11 breaches in month 1 62 day consultant screening, delivery 82.1% v target 90%.

• The Trust Board is aware of significant data quality issues for RTT which have been identified subsequent to an IT system upgrade. Having taken specialist external advice, the Trust Board has agreed the temporary cessation of reporting whilst a remedial action plan is implemented, therefore no submissions have been provided since December. This plan is wide ranging and covers a range of areas including data quality, internal processes, capability development, capacity enhancements and improved management support, this plan has been endorsed by NHSI and IMAS.

2.4. Northamptonshire Healthcare Foundation Trust • NHS Nene and NHFT have agreed a 2016/17 contract for services valued at £110,011k

(countywide value of £122,780k) inclusive of CQUIN and recurrent funding for a Mental Health Crisis Pathway.

• The Executive led collaborative NHS Nene, NHS Corby and NHFT Strategic Contract Review Meeting will assure delivery of the following priority programmes pertinent to the contract: Integrated Transformation Programme (inclusive of capacity review). Learning Disability service redesign. Mental Health Crisis Pathway. Dementia Pathway review. Children’s and Young Peoples services review. In addition to the above, it has been agreed to undertake a collaboratively review access to the Podiatry service following NHFT raising concerns of increased demand on available capacity.

• The NHS Nene and NHS Corby CCG Quality Team have undertaken a review of quality standards at the Berrywood facility. At the time of writing this report formal feedback had not been provided to NHFT. Internal reporting of the visit will be made through the NHS Nene and NHS Corby Quality Committee and contractual action aligned accordingly.

• NHFT are working collaboratively with commissioners and NHS England with regard to potential discrepancies between local and national IAPT recover and access reported performance. At the request of commissioners, NHFT are undertaking a review of local and national reporting mechanisms to support identification of issues/ anomalies and inform a plan going forward.


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5

2.5. Out of County Secondary Care Providers • The Governing Body are asked to note that all 2016/17 Out of County contracts for acute

services are agreed as per the values listed in table 2 below.

Code Provider Name Contract

Type

2016/17 Agreed

Contract Value

RTH Oxford University Hospitals NHS Foundation Trust Associate £17,855,795

RWE University Hospitals of Leicester NHS Trust Associate £7,804,710

RKB University Hospitals Coventry & Warwickshire NHS Trust Associate £7,186,181

RD8 Milton Keynes Hospital NHS Foundation Trust Associate £3,203,268

RC1 Bedford Hospital NHS Trust Associate £1,225,245

RGT Cambridge University Hospitals NHS Foundation Trust Associate £987,959

RXQ Buckinghamshire Healthcare NHS Trust Associate £473,004 RQQ Hinchingbrooke Health Care NHS Trust Associate £572,597 RX1 Nottingham University Hospitals NHS Trust Associate £449,159

RAN Royal National Orthopaedic Hospital NHS Trust Associate £543,646

RJ1 Guy's and St Thomas' NHS Foundation Trust Associate £376,662

RRV University College London Hospitals NHS Foundation Trust Associate £734,060

NVC25 Ramsay Horton Associate £1,906,510

Total £43,318,795

Table 2, Out of County Secondary Care Provider 2016/17 Contract Values

• Month 1 SLAM identifies a total Out of County providers over performance of £75K (2%) when

compared to plan. Month 1 data indicates the following providers have material performances variances: University Hospitals of Leicester – over by £175,050 (Activity 112 over). Ramsay Horton – over by £58,666 (Activity 8 under). Oxford University Hospitals – under by £88,075 (Activity 673 over).

• The YTD over performance at University Hospitals of Leicester is driven by an over performance of £106K in adult ICU (88 bed days over plan) and £58k in Elective Care (Hepatobiliary & Pancreatic; Clinical Haematology; and Spinal Surgery) £58K. Contracting has sought additional supporting information from the Trust to support validation and ensure appropriate charging of activity delivered.

• The YTD over performance at Ramsay Horton of £59K is driven by an over performance in T&O activity with Elective Inpatient being £56k over and Day Cases being £12k over. The Governing Body are asked to note that the over performance of Ramsay Horton is being fed into the deep dive being conducted in relation to the over performance of Private Providers.

• The YTD under performance at the Oxford University Hospitals is driven by a £69k under performance in Elective Inpatients and a £46K under performance in Emergency Inpatients.


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6

2.6. Independent Providers • Ramsay Woodland – NHS Nene and the provider have agreed a 2016/17 contract for services

value of £12,941K. The contract is awaiting commissioner signature. • Month 1 SLAM identifies an over performance of £138K (13%) when compared to plan, driven

by an over performance of £142k in Elective Inpatient activity centred upon T&O (£57k relating to procedures of the knee alone).

• NHS Nene and BMI Three Shires Hospital (now trading as Three Shires Hospital Limited Liability Partnership [3SH LLP]) have agreed and signed a 2016/17 contract for services value of £7,838k inclusive of CQUIN’s.

• Month 1 SLAM identifies an over performance of £170k (26.70%) when compared to plan, driven by over performance within T&O Elective Inpatients and Day Case activity; with expenditure of £347k for 51 attendances and £170k for 82 attendances respectively (£197k relating to Reconstruction Procedures Category, £33k Major Knee Procedures for Non-Trauma, Category 1, without CC, £26k Intermediate Knee Procedures for Non-Trauma, without CC.

• NHS Nene contracting is undertaking a deep dive analysis into the identified month 1 over performance of Private Provider. This deep dive is to triangulate countywide referral and activity data to enable a detailed understanding of activity, identify prevalent issues for resolution and inform the establishment of actions to mitigate 2016/17 over performance where possible.

2.7. East Midlands Ambulance Service (EMAS) • The NHS Nene value of the 2016/17 contract for service between collaborative commissioners

and EMAS is £18,462,944 excluding CQUIN, or £18,924,569 inclusive of CQUIN. The contract has been built with sight of EMAS activity growth assumption, commissioner activity assumptions and may be considered as a “block” contract arrangement (excluding CQUIN). Shadow monitoring of tariffed activity will be undertaken to support the assessment of Value for Money and the informing of future service provision and contracts.

• Commissioner and EMAS have committed for a joint Independent Strategic Demand and Capacity Review to be undertaken in 2016/17, the outcomes of which will be used to inform future service provision and contracts. The review will align to local Sustainability and Transformation Plans, recognising the changing landscape of urgent and emergency care provision.

• Progress against works required following the EMAS CQC report will be monitored and assured through the collaborative Clinical oversight Group. The group is chaired by the NHS Hardwick CCG Chief Nurse and has representation from CCG Directors of Nursing (or nominated deputies). The group will provide a regular briefing for presentation to CCG Governing Bodies and local Quality governance processes.

• The service has failed to deliver the following Trust performance metrics in month 1: CAT A Red 1 8 mins, delivery 66.3% v target of 75%. CAT A Red 2 8 mins, delivery 57.3% v target of 75%. CAT A 19 mins, delivery 86.7% v target of 95%. Ambulance non conveyance all emergencies, delivery 39.2% v target of 42%.


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• The service has failed to deliver the following Northamptonshire performance metrics in month 1: CAT A Red 1 8 mins, delivery 61.02% v target 75% (failed for 9 consecutive months). CAT A Red 2 8 mins, delivery 50.95% v target 75% (failed for 24 consecutive months). CAT A 19 mins, delivery 82.47% v target 95% (failed for 23 consecutive months).

• During the contract negotiation EMAS informed commissioners that it would not achieve National Performance Standards as a Trust in 2016/17. The 2016/17 contract is inclusive of a performance trajectory that demonstrates improvement on 2015/16 performance and an agreement that all penalties are to be reinvested into schemes to improve performance.

2.8. Procurement • Procurement are currently engaged with commissioners in the scoping and planning of the

following works: Residential and Nursing Reprovision Children’s and Young Peoples Services Primary Medical Out of Hours Services Commissioning Support Services

• The re-procurement of Non Scalpel Vasectomy services is currently live to the market and on track for delivery. Commissioners are not aware of any issues at this time.

• Contracting and Procurement have assumed the lead for the re-procurement of Non-Emergency Transport Services. Collaborative works with Lincolnshire CCGs to support the re-procurement continue and are on track to deliver the PQQ go live date.

• The NHS Nene Procurement Policy and associated documents are currently being reviewed to ensure they are reflective of the amendments to the The Public Contract Regulations 2015 The Public Procurement (Amendments, Repeals and Revocations) Regulations 2016 Concession Contracts Regulations 2016

3. Contracting and QIPP 2015/16 – Month 12 • The table below identifies the value of challenges and penalties raised against providers up to

Month 12. The NHS Nene CCG Contracting Team monitors performance against these targets. Where slippage is identified the operational contract meetings look to establish rationale for and mitigate against the impact of such slippage.

• Month 12 Contracting QIPP identifies an over performance of £3,121,656 with an achievement of £5,721,656 verses a target of £2,600,000.

Table 3, Challenges and Penalties Issued to Secondary Care Providers, Months 1-12


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2016/17 Transformation and Savings Plan Report June 2016 Position

Governing Body


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1. 2016/17 Month 1 Performance • Table 1.1 shows the financial plan and Month 1 performance for the Clinical Commissioning Group’s (CCG) Savings and Transformation plan. • Whilst at Month 1 the CCG has delivered £4.07m savings above plan, these are due to £4.39m savings from Finance Budget Reviews and

savings will not continue on this trajectory. • There is currently a forecast under delivery of (£10.59m), please note this is the position at Month 1 and may be subject to change dependent

on future pace of scheme implementation. It is also prior to the CCG risk and mitigation plan implementation. This gap does not include the £3.00m required to invest in recurrent transformation.

3

Table 1.1 2016/17 Plan and Month 1 Performance

Phase One Savings and Transformation Plan2015/16 Financial

Plan (£m)Risk Assessed Value 2015/16

Finance Budget Reviews- Delivered 4.39 0.59 4.39 3.80 4.39

Sub-Total 4.39 0.59 4.39 3.80 4.39Contracting Non Contracted Activity 0.60 0.00 0.00 0.00 0.30

Sub-Total 0.60 0.00 0.00 0.00 0.30Integrated Commissioning Complex Care 2.71 0.01 0.00 (0.01) 1.45Integrated Commissioning Out of Hospital 0.60 0.05 0.00 (0.05) 0.30Integrated Commissioning Transactional 1.02 0.01 0.01 (0.01) 0.48

Sub-Total 4.33 0.07 0.01 (0.07) 2.22Localities Care Homes 0.49 0.00 0.00 0.00 0.34

Sub-Total 0.49 0.00 0.00 0.00 0.34Planned Care Transactional 0.37 0.00 0.00 0.00 0.00

Sub-Total 0.37 0.00 0.00 0.00 0.00Prescribing Prescribing 2.76 0.12 0.45 0.33 AG 2.76

Sub-Total 2.76 0.12 0.45 0.45 2.76Primary Care Additional OOH (Oxford Healthcare) 0.13 0.00 0.00 0.00 0.00

Sub-Total 0.13 0.00 0.00 0.00 0.00Urgent Care Transactional 1.19 0.10 0.00 (0.10) 1.11

Sub-Total 1.19 0.10 0.00 0.00 1.11

Sub- Total Phase One Savings and Transformation Plan 14.25 0.88 4.84 4.18 11.12

Phase Two, BCF and Closed Schemes2015/16 Financial

Plan (£m)Risk Assessed Value 2015/16

Rightcare & Contracting Phase Two Schemes 4.54 0.10 0.00 (0.10) 0.00BCF BCF Schemes Removed 2.76 0.00 0.00 0.00 0.00Transactional Closed Schemes 0.16 0.01 0.00 (0.01) 0.00

Sub-Total Phase Two, BCF and Closed Schemes 7.46 0.11 0.00 (0.11) 0.00

Grand Total 21.71 0.99 4.84 4.07 11.12

10.59

Local Metric RAG

FOT Gross

REMAINING GAP

M1 Year to Date Performance (£m)

M1 Year to Date Performance (£m) RAG Performance

Programme Area Sub-Programme Gross Saving M1 YTD Plan M1 YTD Actual M1 YTD VarianceCritical

Path RAG

M1 YTD VarianceCritical

Path RAGLocal

Metric RAGFOT Gross

RAG Performance

Programme Area Sub-Programme Gross Saving M1 YTD Plan M1 YTD Actual


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2. 2016/17 Programme Summaries

Integrated Care

• Integrated Care is the largest programme in the CCG both in terms of scale of change and target savings, £4.33m in total forming 30% of the phase one savings plan. The programme has been split into sub groups for Complex Care, Transactional Savings and Out of Hospital. Preventable Infections, Review of Community Beds and Collaborative Care Teams (CCTs) are all included in the Better Care Fund (BCF) this totals £2.76m of planned savings that have been removed.

Care Homes

• The CCG recognises that historically there has been significant focus on Care Homes, however this has not been co-ordinated across the

organisation. A new programme will bring together the work done by Quality, Localities, CHC, Contracting and Community Commissioning to ensure schemes are aligned and working together to increase impact and reduce duplication, It will also focus on working with the Local Authority to improve quality and outcomes for Care Homes patients.

Planned Care

• Delivery of the Planned Care Radiology scheme is still pending engagement with GP Federations. There are £0.14m savings planned from this scheme, however it is strategically important from the perspective of developing a test a learn for new commissioning and contracting principles. Planned Care have an engagement plan, however it is recommended that this is closely supported to enable delivery, and to establish working relationships and principles with GP Federations.

Prescribing

• The Prescribing programme has a savings target of £2.76m, this includes a £0.80m stretch target. Whilst Prescribing have well formed plans and a track record of delivery this will but pressure on delivery of the overall Prescribing budget.

Urgent Care

• Transactional schemes for Urgent Care are focussed on the closure of additional capacity in the community that is no longer required. Although these are transactional it is important that processes are in place to track the discharges of the remaining CCG funded patients in those beds. Whilst a finance and contracting tracking process is in place, an Urgent Care team led process of monitoring Estimated Date of Discharge (EDD) is currently being established.

4


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5. Summary, Next Steps and Recommendations

9

Summary

• The CCG’s Phase One savings plan now totals £14.25m, of this current forecast savings are only £11.12m, meaning that there is a current risk of (£10.59m) under delivery. This does not include the need to create a £3.00m transformation fund, and the risk of further slippage on implementation.

• The majority of savings are transactional, this means that if the CCG experiences cost pressures in acute spend these plans will not mitigate this risk.

• Rightcare has been removed from the plan until scheme specific implementation plans and metrics are developed.

• Data Challenges have not been included in the forecast position, until clear demonstration of impact on run rate, versus avoidance of cost.

• The CCG has implemented the Transformation Delivery Group (TDG) and Transformation and Innovation Committee (TaIC) to support development and delivery of plans.

Next Steps and Recommendations

• The CCG will have a QIPP “Deep Dive” meeting with NHS England on the 5th July.

• The TDG and TaIC will continue to meet. Specific focus is required from the TDG on ensuring plans are fit for purpose. It is also recommended that the CCG supports a more Project Management focused approach to management of schemes.

• Scheme specific plans are required for Rightcare urgently to mitigate under delivery of savings in other areas, and mitigate potential acute cost pressures that may arise late in the year.

• Work is required to support development of GP Federations, to support in year delivery and also to ensure that organisationally they can support development and delivery of savings in future years.

• Ongoing budget reviews and management of transactional actions required to deliver savings; aligned to systematic review of discretionary spend and decommissioning/disinvestment opportunities.

• The committee should note that the current level of identified transformational schemes is unacceptable, and failure to impact the run rate in key areas will mean that the CCG is at risk of creating a recurrent deficit, whilst moving into a period of reduced growth funding.


21 of 21



entitled to attend.


Report Title Board Assurance Framework (BAF) and Corporate Risk Register Date 06.07.16 Number PGB-16-77 Lead

Director Charlotte Fry, Deputy Accountable Officer

Author Tony Ferrari, Risk & Business Continuity Manager

Clinical Director

N/A

Report Summary The Business Assurance Framework sets out the risks to the CCG achieving its

corporate objectives. Purpose ☐ Decision ☒ Discussion ☐ Ratification ☒ Information Recommendation

The Governing Body is asked to review the BAF and in particular the top 3 risks to:

• Assure that all key strategic risks have been identified • Satisfy itself that the controls and mitigating actions are robust,

particularly for the top three risks and risk BAF025 (Finances) where the current risk has increased

• To identify if any risks warrant a separate paper or a risk management improvement plan to Governing Body or the lead committee


The BAF represents the risks to achieving all of the CCGs corporate objectives, each risk is matched to a specific objective or objectives.


The Board Assurance Framework and corporate risk register considers all the highest scoring risks faced by the CCG.


None Identified unless highlighted on the register


None, bar where highlighted on the register

Engagement Strategic risks BAF 024, BAF031 and BAF 032 specifically refer to engagement. Quality & Equality Impact Assessment

None, bar where highlighted on the register

Report history The BAF is reported to every Governing Body; The BAF was considered at Audit Committee on 14 July.

Next Steps The BAF will next be reported to the September meeting of the Governing Body Appendices The Board Assurance Framework and Corporate Risk Register are attached as

Appendix 1.


1 of 9

Director Approval John Wardell, Accountable Officer on 11th July 2016.

Executive Summary: The attached Board Assurance Framework (BAF) sets out the high level risks to achieving the CCG’s Corporate Objectives. Given the short period between meetings there have only been relatively minor changes to the Board Assurance Framework since it was last reported to the Governing Body on 21st June 2016. The top three risks identified by the Board of Directors and reported to the Governing Body in June 2016 remain as:

• Not developing a sustainable health economy through the STP Process (BAF 024)

• Inability to lead change and transformation through effective engagement with our key stakeholders including members (BAF 031)

• Nene CCG capacity and capability is insufficient to deliver its Operational and Strategic Plans

(BAF 015) Risks with increased score

BAF 025 - Not fulfilling our statutory financial duties for the year due to financial pressures from activity above planned levels or inability of providers to manage budgets may lead to reduced capacity for patient care, an inability to forward plan and a reduction in financial allocation and lack of investment.

The risk score for BAF 025 has increased from 9 to 12 due to increased activity at our acute providers.

The following new actions have been identified to mitigate the increased risk:

• Review of discretionary expenditure by 31.07.16

• Tighten financial governance by 31.07.16

• Push QIPP delivery and develop further plans by 30.08.16

• Bring forward transformational plans by 30.08.16

• Establish Transformation Committee by 30.09.16

New risks

No new risks are reported at this time.

Risks proposed for removal from the BAF

There are no risks proposed for removal.


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2

3

4

5

NHS Nene CCG - Board Assurance Framework - Summary V3.5

Co

rpo

rate

Ob

ject

ive

Re

fere

nce

Risk Dir

ect

or

Co

mm

itte

e

AP

RIL

MA

Y

JUN

JUL

AU

G

SEP

OC

T

NO

V

DEC

JAN

FEB

MA

RC

H

TAR

GET

TARGET

DATE KEY CHANGES

STRATEGIC RISKS

1BAF

024

Not developing a Sustainable Health Economy for Northamptonshire through the STP process caused by insufficient resources, lack of capacity or

planning at a granular level could lead a non sustainable economy, inequality of services and poor patient experienceJM

FQC

C 4x4

=16

4x3

=12

4x3

=12

4x3

=12

3x3

=931/10/16

• STP submitted on target

• Target date updated

1BAF

021

The ability of CCG commissioned providers to respond to commissioner requirements due to insufficient capability and capacity and lack of

engagement resulting in a failure to meet CCG objectives, potential patient harm and pressure on other providers.KM TC

4x4

=16

4x4

=16

4x4

=16

3x4

=12

3x3

=930/9/16

• Reduction in risk score to 12

• Reduction in target score to 9

• Extension of target date

1,2,3BAF

019

The CCG is unable to discharge its commissioning responsibilities through a lack of high quality and robust information, poor planning and analysis

leading to sub-optimal commissioning decisions and poor patient experienceKM

FQC

C 4x4

=16

4x4

=16

4x4

=16

4x4

=16

3x3

=930/9/16

2BAF

029

The urgent care system is struggling to provide an effective, timely and appropriate level of service to patients as a result of insufficient capacity and

capability, increased DToC numbers and inability to discharge patients effectively resulting in poor service levels, increased pressure on the health

economy, increased costs, poor patient experience and decreased staff morale.

KM

Q&

PC 4x4

=16

4x4

=16

4x4

=16

4x4

=16

3x4

=1230/9/16

3BAF

031

Inability to effectively engage with key stakeholders including members due to poor communication and lack of capacity resulting in potential for

inequalities, poor working relationship and the potential for reputational damage. CF

Bo

D 5x4

=20

5x4

=20

5x4

=20

5x4

=20

2x4

=831/3/17

4BAF

028

The challenge to recruit and retain GPs that may lead to insufficient GP provision to meet patient need, increased pressure on A&E departments and

poor patient experience and patient outcomesCF

Bo

D 5x4

=20

5x4

=20

5x4

=20

5x4

=20

4x4

=1631/12/20

4BAF

015

Nene CCG capacity and capability is insufficient to deliver its Operational and Strategic Plans due to lack of appropriate skills, lack of organisational

memory and need to develop new ways of working leading to strategic objectives not being met, a lack of effective leadership and poor staff morale.CF

Bo

D 2x3

=6

2x3

=6

2x3

=6

2x3

=6

2x3

=631/12/16

5BAF

020

Key performance targets are not achieved by providers serving our population due to insufficient capability and capacity, poor planning and services not

fit for purpose causing service levels below standard, reduced income from Quality Premiums and potentially harmful impacts on patientsKM

Q&

PC 4x4

=16

4x4

=16

4x4

=16

4x4

=16

3x4

=1231.10.16


5BAF

025

Not fulfilling our statutory financial duties for the year due to financial pressures from activity above planned levels or inability of providers to manage

budgets may lead to reduced capacity for patient care, an inability to forward plan and a reduction in financial allocation and lack of investmentSR

FQC

C 3x3

=9

3x3

=9

3x3

=9

4x3

=12

2x3

=631/3/17

• Increase in risk score to 12

5BAF

026

Better Care Fund (BCF) does not support the transformation to deliver improved quality or mitigate financial risk in the system leading to overspend,

breakdown of relationships between organisations.AK

HW

B 4x4

=16

4x4

=16

4x3

=12

4x3

=12

2x3

=631/3/17

RISKS PROPOSED FOR REMOVAL FROM THE BAF

CORPORATE RISKS

4

PCC

CC

014

Inability to appropriately support the Co-Commissioning Agenda due to lack of resource in Primary Care and no funding from NHS England causing an

Inability to progress delegated commissioning status and the need for CCGs to identify additional fundingCF

PC

CC

C

4x4

=16

4x4

=16

4x4

=16

4x4

=16

2x4

=831/3/17

4

PCC

CC

015

Changes to PMS Contract core payments could financially destabilise member practices as payment will be reduced by 20% each year for the next five

years leading to reduced services to patients, reduced patient experience, poor staff morale and potential GP retirementsCF

PC

CC

C

4x4

=16

4x4

=16

4x4

=16

4x4

=16

3x3

=931/3/21

2QT

061KGH failure to meet referral to treatment (RTT) targets due to data anomalies leading to potential risk to patients of harm due to delayed access to

treatment

AJ QC N/A N/A

3x5

=15

3x5

=15

1x5

=5

31/8/16

2QT

068

CQC identified poor practice requiring improvement across NHFT as they have failed to meet regulatory standards as set out in their CQC registration

including staffing and patient experience in mental health services resulting in a risk to patients' care and experience, commissioning inadequate care and

a negative impact on the CCG's reputation.

AJ QC N/A N/A

4x4

=16

4x4

=16

1x4

=5

31/7/16

Jul-16

Communication & Engagement - We will proactively support local people, seldom heard communities, member practices and partners to achieve better health outcomes for everyone in Northamptonshire, through effective collaboration, communication and timely engagement

Workforce and Culture - We will build and support a motivated workforce equipped with the required capabilities, culture and competencies to meet the evolving needs of primary care and commissioning.

Statutory Duties - We will drive the Financial Strategy for the whole Health Economy that efficiently and effectively delivers health services that achieve the constitutional standards, value for money and innovation.

CORPORATE OBJECTIVES

Transformation - We will create the environment to enable the commissioning and delivery of high quality services to reduce health inequalities and improve health outcomes and resilient communities

Clinical Commissioning - We will ensure clinically led commissioning of personalised, safe and effective care from high performing providers

Appendix 1


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5NHS Nene Clinical Commissioning Group Board Assurance Framework Jul-16 Version 3.5

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Clin

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Lead

&

Co

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ob

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Ref

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Risk description Including cause and effect(s) In

itia

l Sco

re

Last

Rep

ort

ed

Key ControlsControls must be realistic measures to mitigate the risk, commentary on current

performance is not a key control Cu

rren

t S

core Assurance for controls

Can include meeting

agendas / minutes, reports,

plans & audits

Future Actions (must include completion date and owner if not

named risk lead)

Progress against Future

Actions Targ

et S

core

Targ

et d

ate

STRATEGIC RISKS

Jam

es M

urr

ay

Fin

ance

, QIP

P &

Co

ntr

acti

ng

Co

mm

itte

e

1BAF

024

Not developing a Sustainable Health

Economy for Northamptonshire through the

STP process caused by insufficient

resources, lack of capacity or planning at a

granular level could lead a non sustainable

economy, inequality of services and poor

patient experience

4x4

=1

6

4x3

=1

2

• Draft Sustainable Transformation Plan (STP) and supporting governance statement

• Health and Social Care Executive Committee

• Weekly Health and Social Care Accountable Officer / Chief Executive Meetings to

discuss issues and align tasks

• Regular review of patient safety data

• North Action Plan

• Urgent Care plans

• FQCC continuous review

• Health and social financial position monitored monthly at FMAG.

• Health & Wellbeing Strategy

4x3

=1

2

• Minutes of Health &

Social Care Executive

Committee

• Minutes of Finance, QIPP

and Contracting

Committee

• STP Agenda items

• Finance reports

• Develop workforce strategy/plan as part of the

overall agenda for Northamptonshire by 30.06.16

• Update of financial model for system by

30.06.16

• Develop a decommissioning plan by 31.07.16

• STP signed off in line with national timelines by

30.09.16

• Implementation of a system wide execution

and delivery plan by 31.07.16

• National STP review on 18.07.16

• STP Granular plans to be converted onto

organisational/operational plans by 30.09.16

• Governance structure set up

and awaiting final approval

• Discussions started continuing

over execution and delivery plan

• STP submitted by deadline

• Workforce strategy/plan

incorporated into STP

3x3

=9

31

/10

/16

Kat

hry

n M

oo

dy

Tran

sfo

rmat

ion

Co

mm

itte

e

1BAF

021

The ability of CCG commissioned providers

to respond to commissioner requirements

due to insufficient capability and capacity

and lack of engagement resulting in a failure

to meet CCG objectives, potential patient

harm and pressure on other providers.

4x4

=1

6

4x4

=1

6

• Contract Monitoring

• Provider Schedule trackers and quality and performance reports

• Healthier Northamptonshire Programme built into the contract framework

• Continuous review of the CCG Objectives

• Health & Social Care Executive Committee

• Healthier Northamptonshire programme refreshed/restated

• Section 75 Agreement

• Contract and Performance Meetings

• Clinical Quality Review Meetings

• Development of Master Plan

• North/County/South System Resilience Groups

• Agreed commissioning framework and timetable that includes review, planning,

agreement and delivery

• Primary Care Strategy

• Development of Commissioning Intentions

• STP submitted within expected timeframe

3x4

=1

2

•Minutes of Health &


Committee


Wellbeing Board

• Minutes of Contract and

Performance meetings

• Minutes of Clinical

Quality Review Meetings

• STP development to ensure system signed up

to one place, to include key deliverables and

ensure commissioner requirements delivered by

30.06.16

• STP implementation plan to be developed

during July 2016

• Review of CCG structures to reflect system

requirements and delivery across STP footprint

by 30.09.16

• STP Development continuing

• Structure development

continuing

3x3

=9

30

/09

/16



CO

RP

OR

ATE

OB

JEC

TIV

ES




2

Appendix 1


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NHS Nene Clinical Commissioning Group Board Assurance Framework Jul-16 Version 3.5

Dir

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Clin

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Lead

&

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Co

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rate

ob

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ive

Ref

eren

ceRisk description

Including cause and effect(s) Init

ial S

core

Last

Rep

ort

ed



rren

t S


Can include meeting


plans & audits


named risk lead)


Actions Targ

et S

core

Targ

et d

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Kat

hry

n M

oo

dy

Fin

ance

, QIP

P &

Co

ntr

acti

ng

Co

mm

itte

e

1,2,3BAF

019

The CCG is unable to discharge its

commissioning responsibilities through a

lack of high quality and robust information,

poor planning and analysis leading to

suboptimal commissioning decisions and

poor patient experience

5x4

=2

0

4x4

=1

6

• Countywide information meetings

• 2015-16 contract negotiation inclusive of revisions to information sharing protocols

• Nene CCG has delivered a step change in information reporting and analysis

• Resolution reached with regard to data sharing across health and social care (BCF)

system

• Closer linkages between information flows and commissioning activities

• Information development plan

• Arden GEM Service Development Group

• Escalation of information issues through Executive where not supplied in a timely

manner

• Capacity and demand planning

• Revised information schedules developed

• KGH recovery phase re: RTT completed

4x4

=1

6

• Minutes of Information

Meetings

• Minutes of Contract

Meetings

• 16-17 Standard Contract

• Review of performance function has been

undertaken which has identified goals and has

recommended strengthening for the future and

changes to interim structure regarding acute

commissioning and performance which will be

implemented by 30.09.16

• Ongoing work to quantify and mitigate KGH's

information issues by 30.06.16

• Make, Share, Buy (MSB) option to develop

more integrated information by 31.08.16

• KGH RTT Recovery Plan continues, reporting to

be re by 31.10.16

• MSB timeline established

• Review of performance

function completed

• KGH Recovery Plan in progress

including external support via

NHS Improvement

3x3

=9

30

/09

/16

Kat

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Qu

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y an

d P

erf

orm

ance

Co

mm

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2BAF

029

The urgent care system is struggling to

provide an effective, timely and appropriate

level of service to patients as a result of

insufficient capacity and capability,

increased DToC numbers and inability to

discharge patients effectively resulting in

poor service levels, increased pressure on

the health economy, increased costs, poor

patient experience and decreased staff

morale.

5x5

=2

5

4x4

=1

6

• Review of performance management of providers

• Joint NHS Nene and Corby CCGs Quality and Performance Committee.

• System Resilience Groups

• A&E - Weekly system wide Urgent Care Working Groups

• Emergency Care Improvement Team at KGH

• Contract performance notices raised with KGH and NGH regarding A&E.

• Discharge to assess home first option in place for CHC, Dementia home based model

awaiting approval

• Updated surge and escalation plan

• Additional pathway plans in place to prevent attendance at A&E

• A&E RAP for NGH

• Action plan in response to ECIP recommendations for KGH

• Revised UCWG and sub group structure in place.

• Bed Bureau in place co-located with urgent care team

• Crisis pathway commissioned via NHFT

4x4

=1

6

• Minutes of Joint NHS

Nene and Corby CCGs

Quality and Performance

Committee.

• Minutes of System

Resilience Groups

• Minutes of Urgent Care

Working Group

• Escalation meetings with

regulators

• Review of CCG structure to strengthen

transformation agenda and reduce reliance on

short term measures by 30.09.16

• Agreed Emergency Care Improvement

Programme (ECIP) support provided until

30.09.16

• ECIP workshop to be organised for system

leaders in June 2016

• Participation in National/Regional

Surge/Escalation exercise by 30.09.16

• Review of on-call arrangements by 31.08.16

• Head of Urgent Care

appointed

• Director of Urgent Care

appointed

• ECIP funding made available

• Project support to Urgent Care

currently out to recruitment

3x4

=1

2

30

/09

/16

3

Appendix 1


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ial S

core

Last

Rep

ort

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rren

t S


Can include meeting


plans & audits


named risk lead)


Actions Targ

et S

core

Targ

et d

ate

Ch

arlo

tte

Fry

Bo

ard

of

Dir

ect

ors

3BAF

031

Inability to effectively engage with key

stakeholders including members due to

poor communication and lack of capacity

resulting in potential for inequalities, poor

working relationship and the potential for

reputational damage.

5x4

=2

0

5x4

=2

0

• Workshops across system to enhance relationship

• Monthly primary care co-commissioning joint committee

• Federation engagement in redesign

• Health Watch attends Joint Primary Care Co-Commissioning Committee

• Patient congress

• Lay Member for Patient & Public Engagement (Roz Horton)

• Use of task and finish group with member participation to decide on reinvestment of

PMS monies into primary care

•Quality contract 2016/2017 developed

• Offer of mini quality contract for 2016/2017 developed in discussion with locality

chairs

5x4

=2

0

• Minutes of primary care

co-commissioning joint

committee

• Primary Care Transformation, Sustainability

and Working at Scale - engagement of members

and Federations to be integral to STP planning by

30.06.16

• Engage on Out of Hospital Care approaches

with member practices and Federations as part

of STP planning by 30.06.16

• Identify capacity to deliver stakeholder

engagement plan via STP comms stream by

31.08.16

• A Comms & Engagement Strategy Group to

oversee and produce a Communications &

Engagement Strategy and related work plans.

Strategy to November GB for approval

• GB OD session on the Ipsos stakeholder survey

booked for 16.08.16

• Development of the quality contract

2017/2018 by 30.03.17

• Restructure of Localities from eight to three by

31.10.16

• Clinical members, federations

and LMC now included in overall

approach

• Communication and

engagement for STP completed

on target

2x4

=8

31

/03

/17

Ch

arlo

tte

Fry

Bo

ard

of

Dir

ect

ors

4BAF

028

The challenge to recruit and retain GPs that

may lead to insufficient GP provision to

meet patient need, increased pressure on

A&E departments and poor patient

experience and patient outcomes

5x4

=2

0

5x4

=2

0

• Working group to be set up: Local Education Training Committee (LETC) as a sub

committee of the Primary Care Co-Commissioning Joint Committee.

• Dedicated leads appointed (Dr Matthew Davies for Nene, Dr Sanjay Gadhia for

Corby)

• GP recruitment added to agenda of the Primary Care Co-Commissioning Committee

as a standing item.

5x4

=2

0

• Minutes of LETC

• Minutes of LETC

Workforce Sub Group

• Develop Primary Care at Scale under the GP

forward view by 31.12.18

• Set up working group for GP Forward view to

address:

(i) Workload pressures on primary care

(ii) Review SWIPE outputs and create workforce

plan as part of STP by

• Scope collaboratively with providers, NHS

England, Health Education East Midlands (HEEM)

and key workforce partners re:

(i) Recruitment and retention

(ii) Development of non clinical roles

(iii) Review of skill mix needed to deliver new

care models

By 30.09.16

4x4

=1

6

31

/12

/20

Ch

arlo

tte

Fry

Bo

ard

of

Dir

ect

ors

4BAF

015

Nene CCG capacity and capability is

insufficient to deliver its Operational and

Strategic Plans due to lack of appropriate

skills, lack of organisational memory and

need to develop new ways of working

leading to strategic objectives not being

met, a lack of effective leadership and poor

staff morale.

4x4

=1

6

2x3

=6

• Joint meetings being held between Clinical Executive Directors and Locality Chairs

• Workforce Committee established

• Weekly Heads of Service meetings set up to discuss priorities/work plan/resources,

led by Directors.

• Planning process in place supported by an interim Director of Planning

• Corporate objectives agreed

• Capacity and capability gaps filled by internal or external support

• Alignment of development of 5 year Strategic Plan completed

• Internal review carried out by external CSU

2x3

=6

• Minutes of Workforce

Committee

• All staff to have mid year appraisal reviews,

objectives and career planning by 31.10.16

• Development of OD Strategy by 30.11.16

• Director of Integrated

Commissioning in post

• Director of Primary Care

Transformation in post

• Deputy Director of

Governance in post

• Corporate Objectives

implemented

• Staff Appraisals in place

2x3

=6

31

/12

/16

4

Appendix 1


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Ref

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ial S

core

Last

Rep

ort

ed



rren

t S


Can include meeting


plans & audits


named risk lead)


Actions Targ

et S

core

Targ

et d

ate

Kat

hry

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oo

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d P

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orm

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Co

mm

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5BAF

020

Key performance targets are not achieved

by providers serving our population due to

insufficient capability and capacity, poor

planning and services not fit for purpose

causing service levels below standard,

reduced income from Quality Premiums and

potentially harmful impacts on patients

5x4

=2

0

4x4

=1

6


• Joint monthly NHS Nene and Corby CCGs Quality and Performance Committee.

• Combined Monthly System Resilience Groups

• A&E - System wide Urgent Care Working Groups .

• Cancer Improvement Working Group (CIWG) -

• RTT & diagnostics (KGH) weekly monitoring of RTT now in place & monthly CCG/KGH

meeting in place focussed on RTT.

• Outsourcing arrangements in place to mitigate RTT issues.

• Involvement of external support (such as cancer IST and UC IST)

Emergency Care Improvement Team in place at NGH

• Recovery Action Plans agreed with NGH regarding cancer waiting times and A&E

performance

• Recovery Action Plan agreed with NHFT regarding IAPT

• Nene CCG working closely with Corby CCG to address KGH issues with data quality

relating to RTT and diagnostics

• Agreed trajectories linking to STP funding to be agreed by tripartite to ensure

delivery of key standards

• KGH data validation stage complete, now moving into recovery phase

4x4

=1

6

• Minutes of Quality and

Performance committee


working Groups


Resilience Groups

• Trust trajectories to be monitored and

discussed contractually on a monthly basis from

June 2016 - ongoing

• Contractual action to be taken regarding sub-

performance by 31.07.16

• Trusts currently renewed position against

sustainable transformation funding (STF) by

20.06.16

• KGH RTT Position, data validation by 30.06.16

• KGH 2nd phase now beginning re: RTT, will

resume reporting by 31.10.16

• NGH Cancer recovery due in September 2016

• Trusts agreed STF by 30.06.16

allowing contractual monitoring

action

• KGH Recovery plan continues

• NGH Cancer recovery remains

a concern, discussions at

contractual and clinical level

taking place w/c 14.07.16

12

- 3

x4

31

.10

.16

Stu

art

Ree

s

Fin

ance

, QIP

P &

Co

ntr

acti

ng

Co

mm

itte

e

5BAF

025

Not fulfilling our statutory financial duties

for the year due to financial pressures from

activity above planned levels or inability of

providers to manage budgets may lead to

reduced capacity for patient care, an

inability to forward plan and a reduction in

financial allocation and lack of investment

4x4

=1

6

3x3

=9

• Financial performance is reviewed monthly at finance committee and Governing

Body

• A list of risk and mitigations have been identified to achieve the financial control

total monitored through contracting arrangements and monthly finance committee.

• Risk share Arrangement in place for non elective activity

• Internal monitor process for CHC including management of CSU contract delivery of

CHC

• Control on discretionary spend

• Granular review of all budgets and contracts

• Monthly FQCC reporting & assurance

• Bi monthly Governing Body reporting & assurance

• Monthly QIPP Reporting & Assurance

• NHS England deep dive

• Early warning on delivery

4x3

=1

2

•FQCC minutes

• Governing Body Minutes

• Review of discretionary expenditure by

31.07.16


• Push QIPP delivery and develop further plans

by 30.08.16

• Bring forward transformational plans by

30.08.16

• Establish Transformation Committee by

30.09.16 2x3

=6

31

/03

/17

Alis

on

Kem

p

Inte

grat

ed

Car

e B

oar

d

5BAF

026

Better Care Fund (BCF) does not support the

transformation to deliver improved quality

or mitigate financial risk in the system

leading to overspend, breakdown of

relationships between organisations.

4x4

=1

6

4x3

=1

2

• Audit of 2015/16 complete, supports refreshed plan: assured with support by NHS

England

• Quarterly Report to Health & Well Being Board (HWB) agreed and signed off

• Performance against the schemes with investment is being monitored and reported.

• Monthly Integrated Care Board (ICB) including providers is established

• ICB Finance Sub Group established

• Mobilising Integrated Transformation Programme (IPT): PIDS developed and agreed

• Programmes/Schemes reported and monitored at ISG

• Independent review undertaken

• Internal Audit Review

• Better Care Fund submission delivered on time with full agreement

4x3

=1

2

• BCF delivery dashboard

•Minutes of Integrated

Care Board


Wellbeing Board

• Minutes of finance sub-

committee

• Minutes of Programme

Executive Committee

• Agreement of Section 75 by 31.07.16

• Detailed ITP project Plans by 30.08.16

• NHS England deep dive into Quarter one by

31.07.16

• Internal and independent

review completed

2x3

=6

31

/03

/17


5

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Ref

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core

Last

Rep

ort

ed



rren

t S


Can include meeting


plans & audits


named risk lead)


Actions Targ

et S

core

Targ

et d

ate

Ch

arlo

tte

Fry

Nao

mi C

ald

wel

l

Bo

ard

of

Dir

ect

ors

3BAF

030

Inability to lead change and transformation

through effective engagement with our

members and key stakeholders which is

clinically led and locality driven resulting in

potential for inequalities, poor working

relationship and the potential for


5x4

=2

0

5x4

=2

0


chairs

• Locality chairs are linked with the Clinical Executive Directors and leads for Urgent

Care, Planned Care and Joint Commissioning

• Monthly LMC meeting with Clinical Executive Director, Primary Care and Localities




5x4

=2

0

• Minutes of LMC

Meetings


2017/2018 by 30.03.17


31.10.16

• Risk incorporated into BAF 031

2x4

=8

31

/03

/17

Ch

arlo

tte

Fry

Pri

mar

y C

are

Co

mm

itte

e

#REF! #REF!

Personal Medical Services (PMS) Review is

not implemented by March 2016 due to NHS

England not having instigated process or

completing reviews, leading to a potential

destabilisation of individual practices and an

inability to move to full delegation.

4x4

=1

6

2x4

=8

• NHS England have now established PMS programme board

• Joint Commissioning Committee to hold Sub Committees / Task and Finish Groups to

account

• Assurance Checkpoints (milestones) in place

•Process started by NHS England in June 2015

• PMS task group established which includes LMC representation

• Executive Clinical leads identified for both CCGs assigned to the task and finish group

• Update Locality Chairs on a regular basis at Locality Chairs meeting

• Reinvestment report drafted for approval by the committee

• Period of engagement with member practices/LMC regarding the reinvestment of

monies carried out throughout February and March 2016

2x4

=8

• Minutes of Primary Care

Co-Commissioning

Committee

• One practice in Nene CCG underwent formal

review completed by 30.04.16

• Review Completed

2x4

=8

30

/04

/16

CORPORATE RISKS

Ch

arlo

tte

Fry

Pri

mar

y C

are

Co

-

Co

mm

issi

on

ing

Co

mm

itte

e

4PCCC

014

Inability to appropriately support the Co-

Commissioning Agenda due to lack of

resource in Primary Care and no funding

from NHS England causing an Inability to

progress delegated commissioning status

and the need for CCGs to identify additional

funding

4x4

=1

6

4x4

=1

6

• Director of Primary Care Transformation in post

• Transition plan in place to allow CCG to move to full delegation by end of April 2017

4x4

=1

6


Co-Commissioning

Committee

• NHS England transitional plan being developed to

assist in move towards full delegation. This will

include the due diligence process to understand the

impact of the risk, to be completed by 30.09.16

2x4

=8

31

/03

/20

17

Ch

arlo

tte

Fry

Pri

mar

y C

are

Co

-

Co

mm

issi

on

ing

Co

mm

itte

e

4

PCCCC

015

Changes to PMS Contract core payments

could financially destabilise member

practices as payment will be reduced by

20% each year for the next five years leading

to reduced services to patients, reduced

patient experience, poor staff morale and

potential GP retirements

5x3

=1

5

5x3

=1

5

• Practices can apply for a Section 96 long term loan.

5x3

=1

5


Co-Commissioning

Committee

• PCCCJC to monitor risk as this will emerge in

stages as transitional arrangement progress -

ongoing

3x3

=9

31

/03

/20

21

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ial S

core

Last

Rep

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rren

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Can include meeting


plans & audits


named risk lead)


Actions Targ

et S

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Targ

et d

ate

Alis

on

Jam

son

Qu

alit

y C

om

mit

tee

2QT

061

KGH failure to meet referral to treatment

(RTT) targets due to data anomalies leading

to potential risk to patients of harm due to

delayed access to treatment

4x3

=1

2

3x5

=1

5

• Trust have developed recovery action plan and have allocated additional resource to

support the plan.

• Potential for harm to patients discussed at the regular clinical quality review meeting.

• Review of complaints and serious incidents by the CCGs quality team.

• The trust have provided communications to GPs within Northamptonshire via the local

press.

• A clinical harm review process has been established and meetings with the trust and

commissioners to review harm are in place. The CCGs have clinical director and quality

team representation at the meetings.

• There are fortnightly executive assurance meetings in place to review progress with the

trust.

• The trust hosted an external assurance workshop on 24 May 2016 to provide an update

on progress to the CCGs/NHS England, NHS Improvement and NHS Interim Management

and Support team.

3x5

=1

5

• Executive assurance

meeting minutes

• A trust assurance group is in place to address

assurance on patient safety, overall management

oversights of the list and to monitor outcomes for

patients.

• Regular meetings with NHSE, NHSI, NHS IMAS, the

CCGs and the trust are in place to review progress.

1x5

=5

31

/08

/20

16

Alis

on

Jam

son

Qu

alit

y C

om

mit

tee

2QT

068

CQC identified poor practice requiring

improvement across NHFT as they have failed

to meet regulatory standards as set out in their

CQC registration including staffing and patient

experience in mental health services resulting

in a risk to patients' care and experience,

commissioning inadequate care and a negative

impact on the CCG's reputation.

4x4

=1

6

4x4

=1

6• NHFT developed action plan and submitted it to CQC and CCG.

• Trust provides updates through public Board papers.

• Trust agreed to supply PB with copies of updates on CQC compliance progress that is

shared with Monitor.

• Continue to monitor and review via the trust board reports and quality schedule, staff

sickness, training, supervision and recruitment

• Monitor and analyse patient experience data

• Review CQUIN achievement quarterly

• Continue to undertake announced and unannounced quality visits• Quality review visits to

be undertaken.

• Recommendations for action by the trust to be monitored through the six weekly CQRM

with the trust:

- To continue to seek assurance that the trust has robust systems in place to identify

potential harm and act upon any trends/learning sharing this with the CCG on a regular

basis.

- To continue to monitor assurance regarding the actions the trust is taking to improve the

experience for patients.

- To continue to gain assurance against the actions the trust is taking to improve staffing

levels.

- To continue to gain assurance against the actions the trust is taking following the CQC

inspection.

- To continue to undertake announced and unannounced quality review visits with a focus

on the leadership and culture within the Berrywood Hospital wards.

- To continue to analyse and review information submitted by the trust using this to

information to monitor the safety, patient experience and quality of service provided by the

trust.

4x4

=1

6

• NHFT Board Reports

• CQRM Minutes

• CQC Reports

• Monitoring plan agreed at CQRM and continues to

be a rolling agenda item. Assurance provided to CCG

that all necessary action complete and that the

Trust are now compliant. Evidence to be presented

at CQRM for discussion and consideration.

• Following a quality review visit of same sex

accommodation commissioners are not assured that

the trust is currently compliant with the Department

of Health Guidance on same sex accommodation.

Report with recommendations supplied to the trust

and a DON to DON meeting to take place. A copy of

the draft NHFT policy as been shared with the CCG.

• CCGs have been informed all improvement actions

are complete. Evidence of completion to be

provided. Quality Committee to be updated on

progress.

1x4

=4

31

/07

/20

16

7

Appendix 1


9 of 9



entitled to attend.


Report Title Organisational Change Policy Date 6 July 2016 Number PGB-16-78 Lead

Director John Wardell, Accountable Officer

Author Judy Macdonald Senior HR Business Partner

Clinical Director

Dr Darin Seiger, GP Chair

Report Summary The Organisational Change policy has been reviewed and updated in order to be in

place and accessible to all users in time for the beginning of the service redesign exercise that is taking place.

Purpose ☐ Decision ☐ Discussion ☒ Ratification ☐ Information Recommendation

Governing Body is asked to ratify the Organisational Change policy.


To fulfil our transformation and workforce corporate objectives. With a restructuring exercise imminent, it is very important that the relevant policies are current and fit for purpose. Therefore, the current policy has been reviewed in line with current legislation and to ensure other information within it is correct. The changes to it were minor.


The risk is related to the change process being fair, legal and consistently applied. The existence of a policy that outlines all of these areas and provides procedures mitigates against this risk.


There is no conflict of interest. The policy is legally compliant, complies with best practice and follows ACAS guidance.


There are no readily identifiable financial issues related to the policy; however, reference is made to matters (redundancy and pay protection) that would have a financial impact.

Engagement As this is an internal matter, engagement has been with staff within the CCG. The policy has been through the standard process of staff consultation (made available to all staff for comment between 1 and 8 July); and for Workforce Committee approval and discussion at Board of Directors.

Quality & Equality Impact Assessment

Equality and diversity implications are always taken into account in the creation and reviewing of HR policies in order that they are equally accessible to all those needing to use them. They will have no detrimental effect on any person due to their protected characteristics. If there are any problems with understanding, the HR team is available for guidance.

Report history The policy was considered at Board of Directors on 21 June 2016 and – given the urgency of the matter – circulated to Workforce Committee members for virtual discussion over one week on 22 June 2016.


1 of 17

Next Steps After ratification, the policy will be publicised within the CCG and placed on the Intranet. HR will monitor its use.

Appendices Organisational Change Policy. Director Approval Charlotte Fry, Deputy Accountable Officer on 6th July 2016

Organisational Change Policy The Organisational Change Policy covers matters of consultation, recruitment, suitable alternative employment, redundancy and redundancy pay and pay protection.

The policy is sent to Governing Body as it is past its review date of January 2016 and having been reviewed, consulted upon and approved by Workforce Committee and the Board of Directors, it is now presented to the Governing Body for ratification.

The changes to the policy are minor, do not change the material content in the previous version and relate mainly to simplification and clarity. These are shown on the attached policy which shows tracked changes.

It explains the principles within which Nene CCG will work and the processes that will be applied to achieve a fair and equitable restructure of the organisation.


2 of 17

Version: 7

Approved, Board of Directors 21/06/2016

Ratified by: Governing Body

Date Ratified:

Name of Originator / Author: Andrew Utley, Senior Solicitor, DAC Beachcroft LLP/ Stephen Wright, Head of HRBPs, Arden&GEM CSU

Name of responsible committee/ individual:

CCG Corporate Services

Date of Issue: [should be close to ratification date]

Review Date: [should be 2 years post ratification]

Target Audience: All Staff

Nene Clinical Commissioning Group

ORGANISATIONAL CHANGE POLICY

Nene CCG: HR17


3 of 17

ORGANISATIONAL CHANGE VERSION CONTROL PAGE July 2016

VERSION CONTROL SHEET

VERSION DATE WHO STATUS COMMENT

1 09/07/13 Stephen Wright Draft 2 14/08/13 Julie Fitzpatrick Draft 3 03/02/14 Julie Fitzpatrick Final Post union consultation and equality review 4 14/06/16 Judy Macdonald Draft For board discussion and comment 5 21/06/16 Judy Macdonald Draft For WFC comment and approval 6 29/06/16 Judy Macdonald Draft For staff consultation 7 13/07/16 Judy Macdonald Final For ratification (Governing Body)

ASSISTANCE WITH THE APPLICATION OF THIS POLICY AND UPDATES

This policy has been prepared so as to reflect the law as at 15 June 2016. The policy will require periodic review to reflect subsequent

changes to the law. Changes to employment law have generally been made on 1 February, 1 April and 1 October in any given year.

For advice and assistance in relation to the application of this policy and to obtain updates please contact:

Your line manager in the first instance or Corporate Services, Nene Clinical Commissioning Group, Francis Crick House, Summerhouse

Road, Moulton Park, Northampton, NN3 6BF


4 of 17

ORGANISATIONAL CHANGE CONTENTS PAGE July 2016

Contents Page

ITEM PAGE

1. Introduction 1

2. Scope 1

3. Definitions 1

4. Principles 1

5. Responsibilities 2

6. Consultation and Engagement 2-5

7. Suitable Alternative Employment 6

8. Pay Protection 7

9. Eligibility for Redundancy Payment 8

10. Appeal Process 9

11. Due Regard 10

12. Equality Statement 10

APPENDICES

1. Recruitment Process

2. Redeployment Procedure


5 of 17

ORGANISATIONAL CHANGE Page 1 of 10 July 2016

Formatted: Tab stops: 8.5 cm,Centered + Not at 8.25 cm

1 INTRODUCTION

1.1 The aim of this Policy is to outline the procedures which will apply to all employees affected by service or organisational change, modernised working methods and any other form of organisational re-structuring.

1.2 The Director concerned shall lead the organisational change.

1.3 In periods of organisational change, we will do our best to keep redundancies to a minimum. The ways in which we will do that are set out in this policy.

1.4 When redundancies are necessary, we will act consistently, fairly and in such a way as to minimise any hardship suffered by those affected by the redundancies.

1.5 This process relates to any restructuring exercise.

1.6 The Human Resources Business Partner (HRBP) should be consulted and brought into the process at the earliest opportunity.

2 SCOPE

2.1 The procedure outlined in this policy applies to all employees of Nene CCG; it does not apply to individuals working on bank contracts or working through agencies or other contractors. The procedure is not contractual.

3 DEFINITIONS • CCG Clinical Commissioning GroupUnit • CSU Commissioning Support Unit • TU Trade union recognised and accredited by the CCG

4 PRINCIPLES

4.1 We will operate this policy to ensure that there is no discrimination on grounds of gender, sexual orientation, marital or civil partner status, gender reassignment, race, colour, nationality, ethnic or national origin, religion or belief, disability, pregnancy/maternity status, age or trade union membership or activity.

4.2 Part-time employees and those working a fixed term contract will be treated in the same way as full-time employees.

4.3 If we have to select employees for redundancy, we will do so on the basis of fair and objective selection criteria.

4.4 The application of this policy needs to balance the requirements of achieving the necessary implementation of organisational change whilst making every effort to minimise disruption to services and anxiety to staff, retain staff commitment and ensure compliance with employment legislation and best practice.


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4.5 Maintaining continuity of employment and stability within the workforce throughout any organisational change will be of primary importance.

4.6 We shall seek to retain the knowledge, skills and experience of staff within the service where practicable and redundancies will be avoided wherever possible. Where redundancy is the only option, we will manage this in the most fair, consistent and sympathetic manner possible.

5 RESPONSIBILITIES

5.1 Employees are responsible for:

• Ensuring that they are aware of familiar with this policy;

• attending all consultation meetings;

• participating actively in the redeployment process.

5.2 Managers are responsible for:

• ensuring employees are made aware of the procedure for organisational change;

• liaising with HR as a source of expertise, guidance and information;

• ensuring the consultation document is promptly completed and disseminated to all affected staff;

• consulting regarding changes to role/delivery of service and undertaking individual or collective consultation as required;

• supporting individuals throughout the process;

• ensuring any staff on long term absence from work sick or maternity leave are kept informed of the potential change.

5.3 The HRBP is responsible for:

• maintaining and updating theis Organisational Change policy in line with organisational or legislative change;

• providing initial training and ongoing support to all managers in dealing with the change management process;

• providing advice and support to ensure that the policy is applied fairly to all employees;

• providing advice and support in the preparation of consultation documents and the consultation period.

6 CONSULTATION AND ENGAGEMENT

6.1 Consultation will provide an opportunity for staff and/or their representatives to consider comprehensive information and to influence decisions and their application.

6.2 All affected staff will be encouraged to involve their union representative


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throughout the consultation and engaging process.

6.3 The CCG’s management will engage directly with staff and/or, full-time officers and local representatives on all proposed changes where these are confined to an individual department/team or part of the organisation, as long as the director concerned is notified. Sub-groups of Executive Board may be set up to deal with specific aspects of this consultation, if appropriate.

6.4 In the co-ordination of organisational restructuring, the following process will be applied:

• a consultation document will be prepared which will outline the proposed changes and the timetable for undertaking consultation with staff all staffthe Staff Partnership Forum will be informed of the proposals;

• consultation document will be shared with regional officers of the recognised trade unions;

• all staff will be informed of the proposals.

• a consultation document will be prepared which will outline the proposed changes and the timetable for undertaking consultation with staff.

6.5 Collective Consultation in the case of Redundancies

6.5.1 Should the possibility of redundancies arise, we will begin a consultation process as required by law.

6.5.2 Where between 20 andto 99 redundancies are contemplated within a 90-day period, we will consult with employee representatives. Consultation will start at least 30 days before the first redundancy.

6.5.3 Where 100 or more redundancies are contemplated within a 90-day period, consultation will start at least 45 days before the first redundancy.

6.5.4 The following information will be provided to the employee representatives as part of the consultation process:

• the reasons for the proposed redundancies;

• the number and description of employees whom it is proposed to make redundant, and the total number of employees of that description who are employed at the establishment;

• the proposed method of selecting employees who may be dismissed by reason of redundancy;

• the proposed method of carrying out the dismissals;

• due regard will be given to any agreed procedures, including the period over which the dismissals are to take effect;

• the proposed method of calculating any redundancy payments;


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• the number of agency workers working temporarily for and under the supervision and direction of the employer; the parts of the employer's undertaking in which those agency workers are working; and the type of work those agency workers are carrying out.

6.5.5 We will consult with the representatives with a view to reaching agreement on ways of avoiding dismissals, reducing the number of job losses and, where redundancies are necessary, reducing any hardship caused by the dismissals.

6.5.6 At the end of the consultation period, if a new structure has been agreed, the manager will write to all affected staff confirming the structure, job description and person specification.

6.5.7 The letter will specify which of the following will be applicable:

• Those posts which will retain the same duties, bands and into which individuals will be confirmed in post. Members of staff who are confirmed in post will not need to make an application for these posts.

• Staff whose previous jobs will technically no longer exist in the new structure but for whom the scope of the duties, band/salary are largely unchanged (i.e. the job title may have changed but at least 50% of the duties are the same as before) are normally also confirmed in post.

• Those staff whose posts within the current structure will disappear or change substantially and will therefore cease to exist within the revised structure may be declared ‘at risk of redundancy’ and given details of new opportunities.

• Where a decision has been made to permanently remove a post, the staff affected should be advised in writing that they are ‘at risk of redundancy’ and are eligible to apply for posts within the defined ring- fence and given details of new opportunities.

6.6 During the consultation process, we will explain the criteria to be used to select for redundancy.

6.7 The selection criteria chosen will be applied in a fair, consistent and non- discriminatory way.

6.8 We may use different criteria for different redundancy exercises but, in each case, the criteria used will be reasonable and, so far as possible, objective. No one will be selected for redundancy on any of the following grounds:

• on grounds of sex, race, religion or belief, marital status, age, disability, sexual orientation, gender reassignment or the fact that you are a fixed term or part time worker;


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• for reasons related to pregnancy, childbirth, maternity, paternity, parental or adoption;

• union-related reasons;

• for standing as, or carrying out the functions of, an employee representative;

• health and safety reasons;

• for asserting a statutory right;

• in connection with the role of a pension scheme trustee;

• for making protected disclosures;

• in connection with a transfer pursuant to the Transfer of Undertakings (Protection of Employment) Regulations 2006;

• reasons connected to the Working Time Regulations 1998.

6.9 Individual consultation

6.9.1 We will let employees know as soon as possible if they have been provisionally selected for redundancy. Since selection at this initial stage is provisional, it may be subject to change.

6.9.2 We will consult with employees on an individual basis and continue to explore other options. Employees will have a chance to respond to the proposal to make them redundant. Employees are encouraged to raise any alternatives that they think might be appropriate.

6.9.3 As part of the individual consultation process, we will discuss the following with employees:

• the reasons for the redundancies;

• an explanation of the pool for selection, if relevant;

• the selection criteria, if relevant;

• why the employees have been selected for redundancy;

• the timescale;

• any redundancy payment;

• any available vacancies for other jobs;

• any suggestions they may have in relation to their redundancy.

6.9.4 Employees will have a chance to respond to the proposal to make them redundant and will be encouraged to raise any alternatives that they consider appropriate.

6.9.5 We will consider any points employees want to make during the consultation process and will then confirm whether or not they are to be made redundant.


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7 Suitable Alternative Employment

7.1 Employees identified as being ‘at risk’ will be informed of any vacancies; including vacancies in other NHS organisations.

7.2 For the purposes of this policy, any suitable alternative employment opportunities shall, so far as reasonably practicable, be brought to the member of staff's attention in writing before the date of termination of contract and with reasonable time for the member of staff to consider it.

7.3 Suitable alternative employment shall be determined by reference to current employment legislation. Factors to be considered will include location, status and pay. In considering whether a post is suitable alternative employment, regard shall be given to the personal circumstances of the member of staff. Staff shall, however, be expected to show some flexibility by adapting their domestic arrangements where possible.

7.4 The organisation will decide whether a post is deemed 'suitable alternative employment' and as such qualifies for pay protection. An individual employee may appeal against this decision by using the Grievance Procedure, without prejudice to their statutory rights if pay protection is to be offered.

7.5 Anyone who unreasonably refuses to apply, pursue or accept an offer of suitable alternative employment may lose their right to contractual redundancy pay.

7.6 Other Conditions of Service Following transfer to a new post all other conditions of service, with the exception of the pay protection arrangements, will be those pertaining to the band of the new post. Other conditions of service will be adjusted at the time the change becomes effective. Any enhancements over and above basic pay will not be protected.

7.7 Trial Period

7.7.1 We will consider offering the employee a four-week trial period in the new role if any terms and conditions of employment differ at all from the corresponding terms of the employee's previous role.

7.7.2 If either party reasonably finds the situation unacceptable during the trial period the redundancy pay may not be jeopardised. If, following the trial period, a member of staff continues in the alternative job within the CCG, the redundancy will no longer apply so there will no longer by any entitlement to redundancy pay. Where a member of staff accepts alternative employment, the trial period provisions as laid down in current employment legislation shall apply.

7.7.3 Where a member of staff wishes to change to a new post that requires retraining, this may be considered.


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8 Pay Protection

8.1 The arrangements outlined below apply to all employees employed on NHS National terms and conditions of employment.

8.2 There will be no entitlement to pay protection under this section where the reduction of band or enhancement is related to:

• The lack of ability or competence of the employee to perform the duties of their existing band;

• The employee being redeployed following ill health;

• The employee voluntarily seeking to be redeployed to a lower band;

• A redundancy payment being made;

• An acting-up or temporary regrading having reached its agreed end, or finished early.

8.3 No payment will be given unless there is an actual reduction in total earnings calculated as an average over a 12-week period prior to the date of change.

8.4 There is unlikely to be pay protection where alternative work is found in another NHS organisation but an individual will not be obliged to accept this offer.

8.5 The procedure does not apply to individuals employed by agencies or other contractors.

8.6 Employees may be offered pay protection when, as a result of organisational change, they move to an alternative post where earnings are lower due to either a change of band affecting basic pay, or a loss of enhanced payments, or both.

8.7 Staff voluntarily moving to a post in a lower band will normally enter the new band on the same pay point, if this is at a point where the pay bands overlap or at the maximum point of the band.

8.8 Pension

If pay is reduced under the circumstances relating to organisational change or a disability as defined by the Equality Act 2010, members of the NHS Pension scheme may have their period of NHS Pension Scheme membership preserved at the higher rate of pay. Contact must be made with the Human Resources Department within one month of pay being reduced to commence this process as this has to be actioned with the Pension Agency within three months of the change.


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9 Eligibility for Redundancy Payment

9.1 Where a member of staff is to be made redundant, and has worked for the CCG for at least two years, or has accrued at least two years’ continuous service with a recognised NHS organisation, they will be entitled to a redundancy payment.

9.2 Statutory redundancy payment

9.2.1 A statutory redundancy payment is based on an employee’s:

• age;

• length of continuous employment after reaching the age of 18 – up to a maximum of 20 years;

• their weekly pay, up to a statutory limit (which the Government increases each year).

9.2.2 A redundancy payment is calculated as follows:

AGE ENTITLEMENT FOR EACH YEAR

Under 22 Half a week's pay

Between 22 and 41 One week's pay

Over 41 One and a half week's pay

9.2.3 If a member of staff is entitled to a statutory redundancy payment, we will give them a statement explaining how it has been calculated.

9.3 Contractual redundancy payment

9.3.1 Qualifying conditions. To qualify for a contractual redundancy payment the member of staff must have at least 2 years’ continuous NHS service.

9.3.2 Continuous employment refers to full- or part-time employment within the NHS. If an individual has been employed by more than one NHS employer, there must not have been a break of more than a week (measured Sunday to Saturday) between employments for the service to be counted as continuous.

9.3.3 Reckonable service, for the purposes of a contractual redundancy payment, is calculated on service up to the date of termination of employment. It is the same as above but with the following additions:

• where there has been a break in service of up to 12 months, the period of employment prior to the break will count as reckonable service;

• periods of employment as a trainee with a general medical practitioner, in accordance with the provisions of the Trainee


13 of 17



Practitioner Scheme, will count as reckonable service;

• any period or periods of employment with employers outside the NHS, where these are judged to be relevant to NHS employment, can be included, at the CCG’s discretion, in reckonable service.

9.3.4 The following employment will not count as reckonable service:

• employment that has been taken into account for the purposes of a previous redundancy, or loss of office payment by an NHS employer;

• any service that has been taken into account for a member of staff being given pension benefits.

9.3.5 The redundancy payment will take the form of a lump sum, dependent on the member of staff’s reckonable service at the date of the termination of their employment. The lump sum will be calculated on the basis of one month’s pay for each complete year of reckonable service, subject to a minimum of two years’ (104 weeks’) continuous service and a maximum of 24 years’ reckonable service being counted.

9.3.59.3.6 A month’s pay, subject to a total annual earnings floor of £23,000 and cap of £80,000, will be either an amount equal to 1/12th of the annual salary at the date of termination or 4.35 times a week’s pay whichever is more beneficial to the employee.

9.3.69.3.7 The contractual redundancy payment will include the statutory redundancy payment.

9.4 NHS Pension & Retirement

9.4.1 Members of the NHS Pension Scheme, who are made redundant and meet the conditions for a contractual redundancy payment as set out above, may choose to retire early without reduction in the value of pension benefits, as an alternative to receiving the full lump sum benefit.

9.4.2 To qualify for early retirement the member of staff must:

• have reached the minimum pension age.

• be a member of the NHS Pension Scheme;

• have at least two years’ continuous service and two years’ qualifying membership;

9.4.3 Those who wish to exercise this option should refer to the NHS Pensions website for further details and/or speak to a member of the HR Business Partner Team.

Formatted: Font: Not Bold,Superscript


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10 Appeal Process

10.1 Where a member of staff feels he/she has been unfairly dismissed, he/she will have the right of appeal. The redundancy notice shall not be suspended during the appeal process, but shall be revoked if the appeal is successful.

11 Due Regard This policy has been reviewed in relation to having due regard to the Public Sector Equality Duty (PSED) of the Equality Act 2010 to eliminate discrimination, harassment, victimisation; to advance equality of opportunity; and foster good relations.

12 Equality Statement Nene Clinical Commissioning Group (CCG) aims to design and implement policy documents that meet the diverse needs of our services, population and workforce, ensuring that none are placed at a disadvantage over others. It takes into account current UK legislative requirements, including the Equality Action 2010 and the Human Rights Act 1998, and promotes equal opportunities for all. This document has been designed to ensure that no-one receives less favourable treatment due to their reassignment, sexual orientation, marriage and civil partnership, race, religion or belief, pregnancy and maternity. Appropriate consideration has also been given to gender identity, socio-economic status, immigration status and the principles of the Human Rights Act.

In carrying out its functions, Nene CCG must have due regard to the Public Sector Equality Duty (PSED). This applies to all the activities for which Nene CCG is responsible, including policy development, review and implementation.


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Recruitment Process Page i July 2016

RECRUITMENT PROCESS

1 DEFINITIONS

• Slotting In means the process by which staff are confirmed into a post in a new staffing or management structure which is similar to their current post and where that individual is the only contender for that post. Slotting in may occur where a post is in the same band as the individual’s current post and where it remains substantially the same (usually defined as 66% the same) with regard to job content, responsibility, grade, status and requirements for skills, knowledge, experience and location.

• Ring fencing means the process by which staff will be considered for a post in a new staffing or management structure which is similar to their current post and where there is more than one contender for that post.

2 There will be three stages in the process for filling posts in the new structure:

2.1 Stage One takes place amongst the staff that are affected by the change. Posts in the new structure are filled either by Slotting In or by Ring fencing.

2.1.1 Staff who are offered posts during Stage One will be deemed to have been offered suitable alternative employment by the CCG. This will be confirmed in writing by the manager. [This is on the basis that, if staff are Slotted In or offered Ring-fenced posts, it will be assumed that the posts offered are suitable alternative employment and hence the consequences of refusing to accept these posts will be as per refusing suitable alternative employment.]

2.1.2 Employees shall have the right to appeal during Stage One against the decision to be chosen to slot/not to slot in to a post or for selection or non-selection to a ring-fenced pool. Employees shall have 5 working days from the date of the letter to submit an appeal in writing to the manager. The appeal shall be considered by an independent manager equal to or above the change manager and shall be responded to within 5 working days from receipt of the letter.

2.2 Stage Two is where any posts that remain vacant in the new structure following Stage 1 will be opened up to access by any staff on the CCG at risk register for whom the post is considered suitable alternative employment. This may include posts at a lower pay band, in which case pay protection might apply). Priority will be given to employees who are in a redundancy notice period over employees who are on the register for other reasons e.g. pay protection.

2.3 Stage 3 is where vacancies are advertised internally and/or externally, in line with the normal recruitment process.

Employees should only be turned down for posts where they fail to meet the essential criteria or where others in the at risk pool are considered to meet the requirements better (the fact that there may be better candidates in the external labour market is not a reason for non-selection). Any member of staff who is not appointed to a post in the new structure will be offered post-interview feedback, coaching or training where appropriate and has the right to appeal via local grievance procedures.

Appendix One


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Redeployment Procedure Page i July 2016

REDEPLOYMENT PROCEDURE IN CASES OF REDUNDANCY

1. Once confirmed that the employee is to be made redundant and redeployment has been identified as the most appropriate course of action, this procedure will be followed:

1.1 A meeting will be held with the employee and their line manager. The redeployment procedure will be explained in full to the employee concerned, including any potential outcome and the employee’s obligations. The notes of the meeting will be confirmed to the individual in writing.

1.1.1 At this meeting the start date of the redeployment period will be agreed (this is usually from the date of the meeting where redeployment has been discussed) and the relevant pro formas will be completed.

1.2 HR will provide employees with details of all vacancies within the CCG and, where appropriate, make employees aware of any vacancies within local NHS organisations.

1.2.1 Where employees express an interest in any appropriate vacancies, management will meet with the employee concerned to discuss the person specification for the post together with the employee’s relevant skills and experience. Any reasonable additional training that could be of benefit to enable the employee to meet the essential criteria on the person specification will also be discussed. A record of this meeting will be held by the manager concerned.

1.2.2 Where a vacancy is agreed to be suitable, management will arrange for a meeting with the employee concerned and the manager (or their representative) of the vacancy to discuss the employee’s suitability for the post. Additional information may also be sought from Occupational Health.

1.3 Where all parties agree to a 4-week trial period, a start date for this will also be agreed.

1.4 During the trial period, management will arrange regular reviews with the employee concerned and the line manager of the vacant post.

1.5 If the trial period is completed successfully, and all parties are in agreement, the employee will be confirmed in the new post and a new contract of employment issued.

1.5.1 The employee will no longer be at risk and therefore redundancy will no longer apply and no redundancy payment will be made.

1.6 If the trial period is unsuccessful, the remainder of the redeployment period will continue from the date the trial period ends and the manager, in consultation with HR will endeavour to identify other suitable redeployment opportunities.

1.6.1 During this period, the employee will still be at risk of redundancy and a redundancy payment will still be applicable.

1.7 In cases of redeployment due to redundancy, Pay Protection as referred to in the Organisational Change Policy would be applied.

Appendix Two


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PGB-16-79

Board Assurance Framework - Review


1 of 8

1

2

3

4

5

NHS Nene CCG - Board Assurance Framework - Summary V3.5

Co

rpo

rate

Ob

ject

ive

Re

fere

nce

Risk Dir

ect

or

Co

mm

itte

e

AP

RIL

MA

Y

JUN

JUL

AU

G

SEP

OC

T

NO

V

DEC

JAN

FEB

MA

RC

H

TAR

GET

TARGET

DATE KEY CHANGES

STRATEGIC RISKS

1BAF

024

Not developing a Sustainable Health Economy for Northamptonshire through the STP process caused by insufficient resources, lack of capacity or

planning at a granular level could lead a non sustainable economy, inequality of services and poor patient experienceJM

FQC

C 4x4

=16

4x3

=12

4x3

=12

4x3

=12

3x3

=931/10/16

• STP submitted on target

• Target date updated

1BAF

021

The ability of CCG commissioned providers to respond to commissioner requirements due to insufficient capability and capacity and lack of

engagement resulting in a failure to meet CCG objectives, potential patient harm and pressure on other providers.KM TC

4x4

=16

4x4

=16

4x4

=16

3x4

=12

3x3

=930/9/16

• Reduction in risk score to 12

• Reduction in target score to 9


1,2,3BAF

019

The CCG is unable to discharge its commissioning responsibilities through a lack of high quality and robust information, poor planning and analysis

leading to sub-optimal commissioning decisions and poor patient experienceKM

FQC

C 4x4

=16

4x4

=16

4x4

=16

4x4

=16

3x3

=930/9/16

2BAF

029

The urgent care system is struggling to provide an effective, timely and appropriate level of service to patients as a result of insufficient capacity and

capability, increased DToC numbers and inability to discharge patients effectively resulting in poor service levels, increased pressure on the health

economy, increased costs, poor patient experience and decreased staff morale.

KM

Q&

PC 4x4

=16

4x4

=16

4x4

=16

4x4

=16

3x4

=1230/9/16

3BAF

031

Inability to effectively engage with key stakeholders including members due to poor communication and lack of capacity resulting in potential for

inequalities, poor working relationship and the potential for reputational damage. CF

Bo

D 5x4

=20

5x4

=20

5x4

=20

5x4

=20

2x4

=831/3/17

4BAF

028

The challenge to recruit and retain GPs that may lead to insufficient GP provision to meet patient need, increased pressure on A&E departments and

poor patient experience and patient outcomesCF

Bo

D 5x4

=20

5x4

=20

5x4

=20

5x4

=20

4x4

=1631/12/20

4BAF

015

Nene CCG capacity and capability is insufficient to deliver its Operational and Strategic Plans due to lack of appropriate skills, lack of organisational

memory and need to develop new ways of working leading to strategic objectives not being met, a lack of effective leadership and poor staff morale.CF

Bo

D 2x3

=6

2x3

=6

2x3

=6

2x3

=6

2x3

=631/12/16

5BAF

020

Key performance targets are not achieved by providers serving our population due to insufficient capability and capacity, poor planning and services not

fit for purpose causing service levels below standard, reduced income from Quality Premiums and potentially harmful impacts on patientsKM

Q&

PC 4x4

=16

4x4

=16

4x4

=16

4x4

=16

3x4

=1231.10.16


5BAF

025

Not fulfilling our statutory financial duties for the year due to financial pressures from activity above planned levels or inability of providers to manage

budgets may lead to reduced capacity for patient care, an inability to forward plan and a reduction in financial allocation and lack of investmentSR

FQC

C 3x3

=9

3x3

=9

3x3

=9

4x3

=12

2x3

=631/3/17

• Increase in risk score to 12

5BAF

026

Better Care Fund (BCF) does not support the transformation to deliver improved quality or mitigate financial risk in the system leading to overspend,

breakdown of relationships between organisations.AK

HW

B 4x4

=16

4x4

=16

4x3

=12

4x3

=12

2x3

=631/3/17


CORPORATE RISKS

4

PCC

CC

014

Inability to appropriately support the Co-Commissioning Agenda due to lack of resource in Primary Care and no funding from NHS England causing an

Inability to progress delegated commissioning status and the need for CCGs to identify additional fundingCF

PC

CC

C

4x4

=16

4x4

=16

4x4

=16

4x4

=16

2x4

=831/3/17

4

PCC

CC

015

Changes to PMS Contract core payments could financially destabilise member practices as payment will be reduced by 20% each year for the next five

years leading to reduced services to patients, reduced patient experience, poor staff morale and potential GP retirementsCF

PC

CC

C

4x4

=16

4x4

=16

4x4

=16

4x4

=16

3x3

=931/3/21

2QT

061KGH failure to meet referral to treatment (RTT) targets due to data anomalies leading to potential risk to patients of harm due to delayed access to

treatment

AJ QC N/A N/A

3x5

=15

3x5

=15

1x5

=5

31/8/16

2QT

068

CQC identified poor practice requiring improvement across NHFT as they have failed to meet regulatory standards as set out in their CQC registration

including staffing and patient experience in mental health services resulting in a risk to patients' care and experience, commissioning inadequate care and

a negative impact on the CCG's reputation.

AJ QC N/A N/A

4x4

=16

4x4

=16

1x4

=5

31/7/16

Jul-16




CORPORATE OBJECTIVES




2 of 8

1

2

3

4

5NHS Nene Clinical Commissioning Group Board Assurance Framework Jul-16 Version 3.5

Dir

ecto

r,

Clin

ical

Lead

&

Co

mm

itte

e

Co

rpo

rate

ob

ject

ive

Ref

eren

ce

Risk description Including cause and effect(s) In

itia

l Sco

re

Last

Rep

ort

ed



rren

t S


Can include meeting


plans & audits


named risk lead)


Actions Targ

et S

core

Targ

et d

ate

STRATEGIC RISKS

Jam

es M

urr

ay

Fin

ance

, QIP

P &

Co

ntr

acti

ng

Co

mm

itte

e

1BAF

024

Not developing a Sustainable Health

Economy for Northamptonshire through the

STP process caused by insufficient

resources, lack of capacity or planning at a

granular level could lead a non sustainable

economy, inequality of services and poor

patient experience

4x4

=1

6

4x3

=1

2

• Draft Sustainable Transformation Plan (STP) and supporting governance statement

• Health and Social Care Executive Committee

• Weekly Health and Social Care Accountable Officer / Chief Executive Meetings to

discuss issues and align tasks

• Regular review of patient safety data

• North Action Plan

• Urgent Care plans

• FQCC continuous review

• Health and social financial position monitored monthly at FMAG.

• Health & Wellbeing Strategy

4x3

=1

2



Committee

• Minutes of Finance, QIPP

and Contracting

Committee

• STP Agenda items

• Finance reports

• Develop workforce strategy/plan as part of the

overall agenda for Northamptonshire by 30.06.16

• Update of financial model for system by

30.06.16

• Develop a decommissioning plan by 31.07.16

• STP signed off in line with national timelines by

30.09.16

• Implementation of a system wide execution

and delivery plan by 31.07.16

• National STP review on 18.07.16

• STP Granular plans to be converted onto

organisational/operational plans by 30.09.16

• Governance structure set up

and awaiting final approval

• Discussions started continuing

over execution and delivery plan

• STP submitted by deadline

• Workforce strategy/plan

incorporated into STP

3x3

=9

31

/10

/16

Kat

hry

n M

oo

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Tran

sfo

rmat

ion

Co

mm

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e

1BAF

021

The ability of CCG commissioned providers

to respond to commissioner requirements

due to insufficient capability and capacity

and lack of engagement resulting in a failure

to meet CCG objectives, potential patient

harm and pressure on other providers.

4x4

=1

6

4x4

=1

6

• Contract Monitoring

• Provider Schedule trackers and quality and performance reports

• Healthier Northamptonshire Programme built into the contract framework

• Continuous review of the CCG Objectives

• Health & Social Care Executive Committee

• Healthier Northamptonshire programme refreshed/restated

• Section 75 Agreement

• Contract and Performance Meetings

• Clinical Quality Review Meetings

• Development of Master Plan

• North/County/South System Resilience Groups

• Agreed commissioning framework and timetable that includes review, planning,

agreement and delivery

• Primary Care Strategy

• Development of Commissioning Intentions

• STP submitted within expected timeframe

3x4

=1

2

•Minutes of Health &


Committee


Wellbeing Board

• Minutes of Contract and

Performance meetings

• Minutes of Clinical

Quality Review Meetings

• STP development to ensure system signed up

to one place, to include key deliverables and

ensure commissioner requirements delivered by

30.06.16

• STP implementation plan to be developed

during July 2016

• Review of CCG structures to reflect system

requirements and delivery across STP footprint

by 30.09.16

• STP Development continuing

• Structure development

continuing

3x3

=9

30

/09

/16



CO

RP

OR

ATE

OB

JEC

TIV

ES




2PGB-16-79 Governing Body Meeting in Public 19 July 2016

3 of 8


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ial S

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rren

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Can include meeting


plans & audits


named risk lead)


Actions Targ

et S

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Targ

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oo

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Fin

ance

, QIP

P &

Co

ntr

acti

ng

Co

mm

itte

e

1,2,3BAF

019

The CCG is unable to discharge its

commissioning responsibilities through a

lack of high quality and robust information,

poor planning and analysis leading to

suboptimal commissioning decisions and

poor patient experience

5x4

=2

0

4x4

=1

6

• Countywide information meetings

• 2015-16 contract negotiation inclusive of revisions to information sharing protocols

• Nene CCG has delivered a step change in information reporting and analysis

• Resolution reached with regard to data sharing across health and social care (BCF)

system

• Closer linkages between information flows and commissioning activities

• Information development plan

• Arden GEM Service Development Group

• Escalation of information issues through Executive where not supplied in a timely

manner

• Capacity and demand planning

• Revised information schedules developed

• KGH recovery phase re: RTT completed

4x4

=1

6

• Minutes of Information

Meetings

• Minutes of Contract

Meetings

• 16-17 Standard Contract

• Review of performance function has been

undertaken which has identified goals and has

recommended strengthening for the future and

changes to interim structure regarding acute

commissioning and performance which will be

implemented by 30.09.16

• Ongoing work to quantify and mitigate KGH's

information issues by 30.06.16

• Make, Share, Buy (MSB) option to develop

more integrated information by 31.08.16

• KGH RTT Recovery Plan continues, reporting to

be re by 31.10.16

• MSB timeline established

• Review of performance

function completed

• KGH Recovery Plan in progress

including external support via

NHS Improvement

3x3

=9

30

/09

/16

Kat

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erf

orm

ance

Co

mm

itte

e.

2BAF

029

The urgent care system is struggling to

provide an effective, timely and appropriate

level of service to patients as a result of

insufficient capacity and capability,

increased DToC numbers and inability to

discharge patients effectively resulting in

poor service levels, increased pressure on

the health economy, increased costs, poor

patient experience and decreased staff

morale.

5x5

=2

5

4x4

=1

6


• Joint NHS Nene and Corby CCGs Quality and Performance Committee.

• System Resilience Groups

• A&E - Weekly system wide Urgent Care Working Groups

• Emergency Care Improvement Team at KGH

• Contract performance notices raised with KGH and NGH regarding A&E.

• Discharge to assess home first option in place for CHC, Dementia home based model

awaiting approval

• Updated surge and escalation plan

• Additional pathway plans in place to prevent attendance at A&E

• A&E RAP for NGH

• Action plan in response to ECIP recommendations for KGH

• Revised UCWG and sub group structure in place.

• Bed Bureau in place co-located with urgent care team

• Crisis pathway commissioned via NHFT

4x4

=1

6

• Minutes of Joint NHS

Nene and Corby CCGs

Quality and Performance

Committee.


Resilience Groups


Working Group

• Escalation meetings with

regulators

• Review of CCG structure to strengthen

transformation agenda and reduce reliance on

short term measures by 30.09.16

• Agreed Emergency Care Improvement

Programme (ECIP) support provided until

30.09.16

• ECIP workshop to be organised for system

leaders in June 2016

• Participation in National/Regional

Surge/Escalation exercise by 30.09.16

• Review of on-call arrangements by 31.08.16

• Head of Urgent Care

appointed

• Director of Urgent Care

appointed

• ECIP funding made available

• Project support to Urgent Care

currently out to recruitment

3x4

=1

2

30

/09

/16


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core

Last

Rep

ort

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t S


Can include meeting


plans & audits


named risk lead)


Actions Targ

et S

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Targ

et d

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Ch

arlo

tte

Fry

Bo

ard

of

Dir

ect

ors

3BAF

031

Inability to effectively engage with key

stakeholders including members due to

poor communication and lack of capacity

resulting in potential for inequalities, poor

working relationship and the potential for


5x4

=2

0

5x4

=2

0

• Workshops across system to enhance relationship

• Monthly primary care co-commissioning joint committee

• Federation engagement in redesign

• Health Watch attends Joint Primary Care Co-Commissioning Committee

• Patient congress

• Lay Member for Patient & Public Engagement (Roz Horton)





chairs

5x4

=2

0

• Minutes of primary care

co-commissioning joint

committee

• Primary Care Transformation, Sustainability

and Working at Scale - engagement of members

and Federations to be integral to STP planning by

30.06.16

• Engage on Out of Hospital Care approaches

with member practices and Federations as part

of STP planning by 30.06.16

• Identify capacity to deliver stakeholder

engagement plan via STP comms stream by

31.08.16

• A Comms & Engagement Strategy Group to

oversee and produce a Communications &

Engagement Strategy and related work plans.

Strategy to November GB for approval

• GB OD session on the Ipsos stakeholder survey

booked for 16.08.16


2017/2018 by 30.03.17


31.10.16

• Clinical members, federations

and LMC now included in overall

approach

• Communication and

engagement for STP completed

on target

2x4

=8

31

/03

/17

Ch

arlo

tte

Fry

Bo

ard

of

Dir

ect

ors

4BAF

028

The challenge to recruit and retain GPs that

may lead to insufficient GP provision to

meet patient need, increased pressure on

A&E departments and poor patient

experience and patient outcomes

5x4

=2

0

5x4

=2

0

• Working group to be set up: Local Education Training Committee (LETC) as a sub

committee of the Primary Care Co-Commissioning Joint Committee.

• Dedicated leads appointed (Dr Matthew Davies for Nene, Dr Sanjay Gadhia for

Corby)

• GP recruitment added to agenda of the Primary Care Co-Commissioning Committee

as a standing item.

5x4

=2

0

• Minutes of LETC

• Minutes of LETC

Workforce Sub Group

• Develop Primary Care at Scale under the GP

forward view by 31.12.18

• Set up working group for GP Forward view to

address:

(i) Workload pressures on primary care

(ii) Review SWIPE outputs and create workforce

plan as part of STP by

• Scope collaboratively with providers, NHS

England, Health Education East Midlands (HEEM)

and key workforce partners re:

(i) Recruitment and retention

(ii) Development of non clinical roles

(iii) Review of skill mix needed to deliver new

care models

By 30.09.16

4x4

=1

6

31

/12

/20

Ch

arlo

tte

Fry

Bo

ard

of

Dir

ect

ors

4BAF

015

Nene CCG capacity and capability is

insufficient to deliver its Operational and

Strategic Plans due to lack of appropriate

skills, lack of organisational memory and

need to develop new ways of working

leading to strategic objectives not being

met, a lack of effective leadership and poor

staff morale.

4x4

=1

6

2x3

=6

• Joint meetings being held between Clinical Executive Directors and Locality Chairs

• Workforce Committee established

• Weekly Heads of Service meetings set up to discuss priorities/work plan/resources,

led by Directors.

• Planning process in place supported by an interim Director of Planning

• Corporate objectives agreed

• Capacity and capability gaps filled by internal or external support

• Alignment of development of 5 year Strategic Plan completed

• Internal review carried out by external CSU

2x3

=6

• Minutes of Workforce

Committee

• All staff to have mid year appraisal reviews,

objectives and career planning by 31.10.16

• Development of OD Strategy by 30.11.16

• Director of Integrated

Commissioning in post

• Director of Primary Care

Transformation in post

• Deputy Director of

Governance in post

• Corporate Objectives

implemented

• Staff Appraisals in place

2x3

=6

31

/12

/16


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Ref

eren

ceRisk description


ial S

core

Last

Rep

ort

ed



rren

t S


Can include meeting


plans & audits


named risk lead)


Actions Targ

et S

core

Targ

et d

ate

Kat

hry

n M

oo

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alit

y an

d P

erf

orm

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Co

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5BAF

020

Key performance targets are not achieved

by providers serving our population due to

insufficient capability and capacity, poor

planning and services not fit for purpose

causing service levels below standard,

reduced income from Quality Premiums and

potentially harmful impacts on patients

5x4

=2

0

4x4

=1

6


• Joint monthly NHS Nene and Corby CCGs Quality and Performance Committee.

• Combined Monthly System Resilience Groups

• A&E - System wide Urgent Care Working Groups .

• Cancer Improvement Working Group (CIWG) -

• RTT & diagnostics (KGH) weekly monitoring of RTT now in place & monthly CCG/KGH

meeting in place focussed on RTT.

• Outsourcing arrangements in place to mitigate RTT issues.

• Involvement of external support (such as cancer IST and UC IST)

Emergency Care Improvement Team in place at NGH

• Recovery Action Plans agreed with NGH regarding cancer waiting times and A&E

performance

• Recovery Action Plan agreed with NHFT regarding IAPT

• Nene CCG working closely with Corby CCG to address KGH issues with data quality

relating to RTT and diagnostics

• Agreed trajectories linking to STP funding to be agreed by tripartite to ensure

delivery of key standards

• KGH data validation stage complete, now moving into recovery phase

4x4

=1

6

• Minutes of Quality and

Performance committee


working Groups


Resilience Groups

• Trust trajectories to be monitored and

discussed contractually on a monthly basis from

June 2016 - ongoing

• Contractual action to be taken regarding sub-

performance by 31.07.16

• Trusts currently renewed position against

sustainable transformation funding (STF) by

20.06.16

• KGH RTT Position, data validation by 30.06.16

• KGH 2nd phase now beginning re: RTT, will

resume reporting by 31.10.16

• NGH Cancer recovery due in September 2016

• Trusts agreed STF by 30.06.16

allowing contractual monitoring

action

• KGH Recovery plan continues

• NGH Cancer recovery remains

a concern, discussions at

contractual and clinical level

taking place w/c 14.07.16

12

- 3

x4

31

.10

.16

Stu

art

Ree

s

Fin

ance

, QIP

P &

Co

ntr

acti

ng

Co

mm

itte

e

5BAF

025

Not fulfilling our statutory financial duties

for the year due to financial pressures from

activity above planned levels or inability of

providers to manage budgets may lead to

reduced capacity for patient care, an

inability to forward plan and a reduction in

financial allocation and lack of investment

4x4

=1

6

3x3

=9

• Financial performance is reviewed monthly at finance committee and Governing

Body

• A list of risk and mitigations have been identified to achieve the financial control

total monitored through contracting arrangements and monthly finance committee.

• Risk share Arrangement in place for non elective activity

• Internal monitor process for CHC including management of CSU contract delivery of

CHC

• Control on discretionary spend

• Granular review of all budgets and contracts

• Monthly FQCC reporting & assurance

• Bi monthly Governing Body reporting & assurance

• Monthly QIPP Reporting & Assurance

• NHS England deep dive

• Early warning on delivery

4x3

=1

2

•FQCC minutes

• Governing Body Minutes

• Review of discretionary expenditure by

31.07.16


• Push QIPP delivery and develop further plans

by 30.08.16

• Bring forward transformational plans by

30.08.16

• Establish Transformation Committee by

30.09.16 2x3

=6

31

/03

/17

Alis

on

Kem

p

Inte

grat

ed

Car

e B

oar

d

5BAF

026

Better Care Fund (BCF) does not support the

transformation to deliver improved quality

or mitigate financial risk in the system

leading to overspend, breakdown of

relationships between organisations.

4x4

=1

6

4x3

=1

2

• Audit of 2015/16 complete, supports refreshed plan: assured with support by NHS

England

• Quarterly Report to Health & Well Being Board (HWB) agreed and signed off

• Performance against the schemes with investment is being monitored and reported.

• Monthly Integrated Care Board (ICB) including providers is established

• ICB Finance Sub Group established

• Mobilising Integrated Transformation Programme (IPT): PIDS developed and agreed

• Programmes/Schemes reported and monitored at ISG

• Independent review undertaken

• Internal Audit Review

• Better Care Fund submission delivered on time with full agreement

4x3

=1

2

• BCF delivery dashboard

•Minutes of Integrated

Care Board


Wellbeing Board

• Minutes of finance sub-

committee

• Minutes of Programme

Executive Committee

• Agreement of Section 75 by 31.07.16

• Detailed ITP project Plans by 30.08.16

• NHS England deep dive into Quarter one by

31.07.16

• Internal and independent

review completed

2x3

=6

31

/03

/17



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ial S

core

Last

Rep

ort

ed



rren

t S


Can include meeting


plans & audits


named risk lead)


Actions Targ

et S

core

Targ

et d

ate

Ch

arlo

tte

Fry

Nao

mi C

ald

wel

l

Bo

ard

of

Dir

ect

ors

3BAF

030

Inability to lead change and transformation

through effective engagement with our

members and key stakeholders which is

clinically led and locality driven resulting in

potential for inequalities, poor working

relationship and the potential for


5x4

=2

0

5x4

=2

0


chairs

• Locality chairs are linked with the Clinical Executive Directors and leads for Urgent

Care, Planned Care and Joint Commissioning

• Monthly LMC meeting with Clinical Executive Director, Primary Care and Localities




5x4

=2

0

• Minutes of LMC

Meetings


2017/2018 by 30.03.17


31.10.16

• Risk incorporated into BAF 031

2x4

=8

31

/03

/17

Ch

arlo

tte

Fry

Pri

mar

y C

are

Co

mm

itte

e

#REF! #REF!

Personal Medical Services (PMS) Review is

not implemented by March 2016 due to NHS

England not having instigated process or

completing reviews, leading to a potential

destabilisation of individual practices and an

inability to move to full delegation.

4x4

=1

6

2x4

=8

• NHS England have now established PMS programme board

• Joint Commissioning Committee to hold Sub Committees / Task and Finish Groups to

account

• Assurance Checkpoints (milestones) in place

•Process started by NHS England in June 2015

• PMS task group established which includes LMC representation

• Executive Clinical leads identified for both CCGs assigned to the task and finish group

• Update Locality Chairs on a regular basis at Locality Chairs meeting

• Reinvestment report drafted for approval by the committee

• Period of engagement with member practices/LMC regarding the reinvestment of

monies carried out throughout February and March 2016

2x4

=8


Co-Commissioning

Committee

• One practice in Nene CCG underwent formal

review completed by 30.04.16

• Review Completed

2x4

=8

30

/04

/16

CORPORATE RISKS

Ch

arlo

tte

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Pri

mar

y C

are

Co

-

Co

mm

issi

on

ing

Co

mm

itte

e

4PCCC

014

Inability to appropriately support the Co-

Commissioning Agenda due to lack of

resource in Primary Care and no funding

from NHS England causing an Inability to

progress delegated commissioning status

and the need for CCGs to identify additional

funding

4x4

=1

6

4x4

=1

6

• Director of Primary Care Transformation in post

• Transition plan in place to allow CCG to move to full delegation by end of April 2017

4x4

=1

6


Co-Commissioning

Committee

• NHS England transitional plan being developed to

assist in move towards full delegation. This will

include the due diligence process to understand the

impact of the risk, to be completed by 30.09.16

2x4

=8

31

/03

/20

17

Ch

arlo

tte

Fry

Pri

mar

y C

are

Co

-

Co

mm

issi

on

ing

Co

mm

itte

e

4

PCCCC

015

Changes to PMS Contract core payments

could financially destabilise member

practices as payment will be reduced by

20% each year for the next five years leading

to reduced services to patients, reduced

patient experience, poor staff morale and

potential GP retirements

5x3

=1

5

5x3

=1

5

• Practices can apply for a Section 96 long term loan.

5x3

=1

5


Co-Commissioning

Committee

• PCCCJC to monitor risk as this will emerge in

stages as transitional arrangement progress -

ongoing

3x3

=9

31

/03

/20

21


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rren

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Can include meeting


plans & audits


named risk lead)


Actions Targ

et S

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Targ

et d

ate

Alis

on

Jam

son

Qu

alit

y C

om

mit

tee

2QT

061

KGH failure to meet referral to treatment

(RTT) targets due to data anomalies leading

to potential risk to patients of harm due to

delayed access to treatment

4x3

=1

2

3x5

=1

5

• Trust have developed recovery action plan and have allocated additional resource to

support the plan.

• Potential for harm to patients discussed at the regular clinical quality review meeting.

• Review of complaints and serious incidents by the CCGs quality team.

• The trust have provided communications to GPs within Northamptonshire via the local

press.

• A clinical harm review process has been established and meetings with the trust and

commissioners to review harm are in place. The CCGs have clinical director and quality

team representation at the meetings.

• There are fortnightly executive assurance meetings in place to review progress with the

trust.

• The trust hosted an external assurance workshop on 24 May 2016 to provide an update

on progress to the CCGs/NHS England, NHS Improvement and NHS Interim Management

and Support team.

3x5

=1

5

• Executive assurance

meeting minutes

• A trust assurance group is in place to address

assurance on patient safety, overall management

oversights of the list and to monitor outcomes for

patients.

• Regular meetings with NHSE, NHSI, NHS IMAS, the

CCGs and the trust are in place to review progress.

1x5

=5

31

/08

/20

16

Alis

on

Jam

son

Qu

alit

y C

om

mit

tee

2QT

068

CQC identified poor practice requiring

improvement across NHFT as they have failed

to meet regulatory standards as set out in their

CQC registration including staffing and patient

experience in mental health services resulting

in a risk to patients' care and experience,

commissioning inadequate care and a negative

impact on the CCG's reputation.

4x4

=1

6

4x4

=1

6• NHFT developed action plan and submitted it to CQC and CCG.

• Trust provides updates through public Board papers.

• Trust agreed to supply PB with copies of updates on CQC compliance progress that is

shared with Monitor.

• Continue to monitor and review via the trust board reports and quality schedule, staff

sickness, training, supervision and recruitment

• Monitor and analyse patient experience data

• Review CQUIN achievement quarterly

• Continue to undertake announced and unannounced quality visits• Quality review visits to

be undertaken.

• Recommendations for action by the trust to be monitored through the six weekly CQRM

with the trust:

- To continue to seek assurance that the trust has robust systems in place to identify

potential harm and act upon any trends/learning sharing this with the CCG on a regular

basis.

- To continue to monitor assurance regarding the actions the trust is taking to improve the

experience for patients.

- To continue to gain assurance against the actions the trust is taking to improve staffing

levels.

- To continue to gain assurance against the actions the trust is taking following the CQC

inspection.

- To continue to undertake announced and unannounced quality review visits with a focus

on the leadership and culture within the Berrywood Hospital wards.

- To continue to analyse and review information submitted by the trust using this to

information to monitor the safety, patient experience and quality of service provided by the

trust.

4x4

=1

6

• NHFT Board Reports

• CQRM Minutes

• CQC Reports

• Monitoring plan agreed at CQRM and continues to

be a rolling agenda item. Assurance provided to CCG

that all necessary action complete and that the

Trust are now compliant. Evidence to be presented

at CQRM for discussion and consideration.

• Following a quality review visit of same sex

accommodation commissioners are not assured that

the trust is currently compliant with the Department

of Health Guidance on same sex accommodation.

Report with recommendations supplied to the trust

and a DON to DON meeting to take place. A copy of

the draft NHFT policy as been shared with the CCG.

• CCGs have been informed all improvement actions

are complete. Evidence of completion to be

provided. Quality Committee to be updated on

progress.

1x4

=4

31

/07

/20

16


8 of 8

Effective • Compassionate

Supportive • Safe

Summary of Key Actions / Discussions / Decisions

The Board Of Directors met on 24th May and 7th June 2016 and a summary of the discussions is set out below. Where appropriate conflicts of interest were declared, noted and managed in line with the CCG’s Conflicts of Interest Policy. In County/ Out of County Comparison The Board of Directors discussed elective activity covered by both the NHS and other providers. This followed a request from the Board of Directors in April for further detail regarding a comparison of out of county providers and in county providers. The Board of Directors reviewed, in detail, the key areas of growth in 2015/16 identified as issues for some in and out of county providers. The clinical leads questioned whether the issue related to coding and counting. The Board of Directors agreed that the data required looking at in more detail and a deeper understanding of how the procedures are defined was needed. Planned Care QIPP A progress update on the Planned Care QIPP was delivered to the Board, informing a number of areas previously highlighted as ‘green’ may not be achieved. It was agreed that the Senior Management Team & Heads of Service would in order to gain a broader understanding of the financial position. Annual Report 2015/16 The Board of Directors noted a significant improvement and approved the reports submission to the Audit & Risk Committee. Board Assurance Framework (BAF) The BAF had been revised and incorporated the changes agreed at the Governing Body OD session in May 2016. A number of risks were highlighted as overarching and could be l8inked. The target dates were reviewed to ensure that they were realistic and achievable.

This paper is being submitted to the Governing Body for amendment and/or approval as appropriate. It should not be regarded, or published, as CCG Policy until formally agreed at the

Governing Body meeting, which the press and public are entitled to attend.

Governing Body Meeting in Public – 19 July 2016

Title:

Board of Directors Meeting Summary

Author: Sarah-Jane Barfoot, Assistant Corporate Secretary

Number: PGB-16-80 Executive Director:

John Wardell, Accountable Officer


1 of 2

Estates Priorities for Primary Care Estates & Technology Fund The deadline for Estates and Technology Transformation Programme (ETTP) bids to be uploaded onto the portal had been revised to the 30th June 2016, following the publication of the General Practice Forward View in April 2016. The CCG would be working with the emerging federations to gain understanding of their priorities and these would be included in the business cases being developed by the McKinsey work stream. Further updates would be provided to the Board at the next meeting. STP Plan It was reported that the first draft of the STP document was complete and that a number of key areas would be developed in the forthcoming week. The organisation was in a reasonably strong position, with the Senior Responsible Officer’s group adding real value to the development of the plan. Local engagement plans as part of the STP process had not been as robust as hoped for. However areas would continue to be built on existing engagement through Health and Wellbeing Boards and other existing local arrangements such as Locality Boards, where relevant. It was agreed that members of the Board would attend upcoming Locality Boards, line with their availability, to address questions around the development and implementation of the STP. The Board of Directors noted the importance of systematic working and ensuring each partner is taking accountability. The Finance Bridge would be presented to NHS England on Friday 17th June 2016. The Board of Directors discussed how the delivery and implementation of the plan would be monitored. It was agreed that the expectation from the centre was not clear post July 2016. This would be discussed at the next Management Team meeting and a solution would be brought back to the Board of Directors for agreement.


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Supportive • Safe


The Quality Committee met on 14 June 2016 and a summary of the agreed key points to be highlighted to the Governing Body are set out below: Referral to Treatment (RTT) concerns at Kettering General Hospital NHS Foundation Trust Dr Andrew Chilton (AC) Medical Director and Rebecca Brown (RB) Chief Operating Officer from Kettering General Hospital NHS Foundation Trust (KGH) attended the Quality Committee to provide assurance regarding the referral to treatment issues being experienced by KGH and the potential impact on patients. RB and AC gave a detailed presentation to inform the Committee of the RTT position at KGH, outlining the background, ongoing work being undertaken and recovery action plan in relation to the RTT issue which had been ongoing since concerns around the backlog of data had been identified by KGH approximately 12 months ago. The following progress to date was noted: • An action plan was in place with four key work streams (data and information, operational

delivery, clinical harm and training and communication); endorsed by all external reviewers, including the Clinical Commissioning Groups (CCGs), NHS England and NHS Improvement.

• An externally led training programme had been implemented. • A clinical harm process had been agreed with the CCGs and implemented. • Standard Operating Procedures (SOPs) had been written and/or amended to support the

administrative process through the organisation. • Operational improvements had been made to documentation, pathway management and

patient tracking meetings had been implemented. • Changes had been identified and implemented to the Medway system. • The Patient Access Policy had been re-written and approved by the CCGs and recruitment

had commenced for an Access Manager to maintain RTT expertise internally. • KGH has sent two communications to GPs updating them on this issue. The Trust has a GP

Liaison Officer who has been dealing with issues as soon as they were raised and it was noted that there had been very few.




Title:

NHS Nene and NHS Corby Clinical Commissioning Groups Joint Quality Committee Summary

Author: Helen Sutton, Committee Secretary


Alison Jamson, Interim Director of Quality


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• Additional capacity was in place and was focussed on appropriate priorities. • Approximately 32,000 records had already been validated and where patients were

identified as experiencing a long wait they had been placed in the clinical harm process. • Validation was progressing well and the backlog was being managed while waiting lists

were reducing. It was noted that the trajectory of completing the initial cohort of 47,000 patient records had slipped by 10 days to 27 June 2016.

The Committee felt more assured around the significant amount of information and processes that were in place to deal with this difficult situation. Whilst we could not be assured there was no harm at this time, processes were in place to work through the data and identify this. The trust proposed that all future queries be made via the existing fortnightly meeting in place with the trust. This was felt to be appropriate by the quality committee at the present time. East Midlands Ambulance Service NHS Trust (EMAS) Care Quality Commission (CQC) Inspection Report The Committee were provided with an overview of the May 2016 CQC inspection report. It was noted that the Trust had received an overall rating of ‘requires improvement’ with safety rated as ‘inadequate’. The Trust had been issued with a Section 29A (health and Social Care Act) warning notice requiring that they improve in eight key areas. Six of these areas relate to staffing issues and “insufficient numbers of suitably qualified, skilled and experienced persons”; with the two remaining requirements relating to handover times at Acute Trust emergency departments and serious incidents in which serious harm of death has been identified. It was also noted that staffing issues are most acute in Northamptonshire. The Trust had challenged the serious incident element of the warning notice, and was awaiting a response from the CQC. The quality team had been in close contact with NHS Hardwick CCG as co-ordinating commissioners and requested that the CCGs receive a copy of the Trust recovery action plan in anticipation of the EMAS wide oversight group meeting at the end of June 2016; however this was yet to be received. The committee requested that this be followed up with the co-ordinating commissioner, and an emphasis placed on the urgency and importance of timely receipt of the information to enable an update to be provided to the CCGs’ governing bodies. Outcome of the Ofsted inspection of Northamptonshire County Council – services for children in need of help and protection, children looked after and care leavers; and Review of the effectiveness of the Local Safeguarding Children Board. Following a five week inspection by Ofsted of the local authority’s services for children in need of help and protection, children looked after and care leavers; and a review of the local safeguarding children’s board, Ofsted had published their Inspection Report on the 27 April 2016. The outcome of ‘Children’s services in Northamptonshire require improvement to be good’; confirmed improvement across all areas since the previous inspection in 2013. In all 17 recommendations had been identified and they would form the basis of the next phase of the improvement plan. Clarity would be sought via the Health and Wellbeing Board regarding future levels of funding of children’s services, proposals around recruiting additional social workers in place of the current agency staff (over 40%) and confirmation regarding the proposal to transfer children’s services to a Children’s Trust.


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Willingness of trusts to share data and information with other providers for the benefit of learning The Committee noted the significant progress made and the emerging willingness for providers to share information and be transparent with commissioners about what had gone wrong and lessons learnt. This was already happening in the Countywide Patient Safety Forum and there were plans to expand this to other forums across the health economy.


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Supportive • Safe


The Finance QIPP and Contracting Committee met on 30th June 2016. A summary of the discussion is set out below: FQCC Report Finance The financial report reflecting month 2 financial position of the CCG was presented to the Committee. The report showed an underspend against budget of £1.299m which was in line with the projected forecast for this period. The transformation and savings target remains at £21.7m for which NCCG has plans to recover £14.3m through specific saving schemes. There is a risk that these plans will not deliver in full and current forecasts indicate that we will only deliver £11.19m. This creates a financial gap of £10.52m which will require additional mitigation if the CCG is to deliver the required 1% surplus at year end. An overview of the key actions identified to mitigate the shortfall was presented together with proposals to mitigate the risks. These mitigations will deliver the required surplus at year end if there is no further slippage on the savings and transformation schemes and cost pressures are maintained at current levels. Meetings are planned over the next few weeks to finalise plans which will impact on the run rate at the start of Q4. Contracting The Performance figures presented for Acute Services were based on Service Level Agreement Monitoring (SLAM) data and are subject to change following routine reconciliation of data. The report identified an under performance to plan of £51k at NGH and KGH and over performance to plan at University Hospitals Leicester, Ramsay Horton, Ramsay Woodlands and Three Shires. The Key highlights are as follows:

• Provider performance against the A&E 4 hour transit time and cancer standards was reviewed. The CCG are awaiting approval from NHSE with regard to activity trajectories for




Title:

Finance QIPP and Contracting Committee Report

Author: Kashmir Sangha, Minute Taker


Stuart Rees, Chief Finance Officer


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these standards to enable contract performance management processes to be confirmed.

• Work is currently underway in collaboration with the provider and NHSE to validate performance reporting relating to Access to Psychological Therapy (IAPT).

• The CCG is also working in Collaboration with Lincolnshire and Corby CCGs relating to the

procurement of Non-Emergency Patient Transport Service. Progress is on track for this service to be offered to the market in July.

QIPP The CCG has delivered £4.07m of savings in month 1. However despite this achievement there is still a financial gap of £10.52m. Mitigations have been identified to this value. The Committee’s attention was drawn to the importance of implementing Right Care and this will be monitored along with other schemes through the newly formed ‘Transformation and Innovation’ Committee which meets monthly with a sub-group meeting fortnightly. The group is being set-up to focus specifically on the transformational processes and delivery. A ‘Deep Dive meeting with NHSE subsequently took place on 5th July which reviewed 28 QIPP schemes. The Committee will seek an update on progression of Right Care at the July FQCC meeting. Debt Recovery Process A paper on the CCGs debt recovery process was presented to the Committee. The Committee noted the procedure was outsourced and confirmed this was adequate. Care Homes The CCG have a strategic programme for care homes which is in development. A ‘Care Homes Steering Group’ has been established to design appropriate model of care and contracting solution for delivery from October 2016. A paper was presented detailing the current care home service. It was noted that there were issues with data quality and further clarity was necessary. The current data was refreshed using postcode mapping which resulted in significant movement in activity numbers. Going forward the data will be collated using Residential Institute (RI) codes supplied by NHSE which is more reliable and takes away the process for reporting by post codes. A revised paper was requested at the September meeting reflecting an update around correct data. The Committee also asked for an update in September on meetings held to review data to understand the number of care home beds vs admissions and attendances to identify if the scheme is having the desired impact.


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Sustainable Transformation Plan (STP) The submission was made by the due date and a plan is in place to address specific questions. Strategically, there is still a need for some further work to roll out the plan and identify the work streams. Commissioning Public Health Services Meeting held with Northampton County Council (NCC) and partners. Attendees were unable to finalise a deal but all parties are a lot clearer on each other’s position. Further meetings planned to re-present proposals and look at risks. Further update will be provided to the Committee at the July meeting. GP Out of Hours Services Paper to present the proposal to bring together the following services will be presented at the July meeting:

• North and South Northants Out of Hour Services • Corby Urgent Care Centre • Same Day Care Hubs


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PGB-16-83

Health & Wellbeing Board Minutes


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Minutes of the Health and Wellbeing Board Meeting held at 9.30 am on Thursday 2nd June 2016

Room 15, County Hall, Northampton

Present: Cllr. Robin Brown - Chair (RB) Cabinet Member for Finance, Northamptonshire County Council

Professor Nick Petford (NP) Vice Chancellor, University of Northampton Vice Chair

Cllr Chris Millar - (CM) Leader, Daventry District Council Vice Chair Professor Akeem Ali (AA) Director of Public Health and Wellbeing Northamptonshire County Council

Carole Dehghani (CD) Chief Commissioning Officer, NHS Corby Clinical Commissioning Group

Graham Foster (GF) Chair, Kettering General Hospital Paul Bertin (PB) Chair, Northamptonshire Healthcare Foundation

Trust Dr Jonathan Ireland (JI) Chair, LMC

Trish Thompson (TT) Director of Operations and Delivery, NHS England, Local Area Team

John Wardell JW) Chief Commissioning Officer, NHS Nene Clinical Commissioning Group

Dr Carolyn Kus (CK) Managing Director, Olympus Adult Social Care Services Jane Carr (JC) Chief Executive, Voluntary Impact

Northamptonshire Angela Hillery (AH) Chief Executive, Northamptonshire Healthcare

Foundation Trust Cllr Heather Smith (HS) Leader, Northamptonshire County Council Norman Stronach (NS) Chief Executive, Corby Borough Council Dr Sonia Swart (SS) Chief Executive, Northampton General Hospital David Sissling (DSi) Chief Executive, Kettering General Hospital Dr Jo Watt (JWt) Chair, NHS Corby Clinical Commissioning Group Cllr Matthew Golby (MG) Cabinet Member for Childrens, Northamptonshire County Council Simon Edens (SE) Chief Constable, Northamptonshire Police Catherine Mitchell (CMi) Local Chief Officer, Greater Peterborough Local Substitute Commissioning Group Susan Hills (SH) Healthwatch

Substitute

In Attendance as observers:

Peter Lynch (PL) Health and Wellbeing Board Business Manager Northamptonshire County Council Catherine O’Rouke (CoR) Deputy to Director for Integrated Commissioning,

NHS Nene Clinical Commissioning Group Cllr Bill Parker (BP) Cabinet Member Adult Social Care,

Northamptonshire County Council Dr Paul Blantern (PB) Chief Executive, Northamptonshire County Council


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Janet Doran (JD) Managing Director, First for Wellbeing Anna Earnshaw (AS) Strategic Director for Adult Commissioning and

Transformation, Northamptonshire County Council

Minute Taker: Cheryl Bird (CB) PA, Northamptonshire County Council

Apologies:

Dr Gary Howsam (GH) Chair, Borderline Local Commissioning Group Paul Farenden (PF) Chair, Northampton General Hospital Cllr Sylvia Hughes (SH) Public Health and Wellbeing, Northamptonshire

County Council Professor Will Pope, (WP), Chairman, Healthwatch

Dr Darin Seiger - (DS) Chair, NHS Nene Clinical Commissioning Group Vice Chair

A1. Declaration of interest RB formally requested if any member of the board has any declaration of interest. None was declared.

A2. Chairman’s Announcements RB announced as a result HS becoming Leader of the Council, there have been a number of changes to portfolios. Cllr Bill Parker will replace Cllr Suresh Patel as Cabinet Member for Adults Social Care

and be a deputy to the Board for HS SH will replace RB as the Cabinet Member for Public Health and Wellbeing, and Chair

all future meetings RB will become the Cabinet Member for Finance and no longer be a member of the

Board Tony Ciaburro, Corporate Director for Place Commissioning will be invited to become

a permanent member of the Board. CM will become a Vice Chair to the Board.

A3. Minutes from the previous meetings of the 10th March and 21st April The minutes from the previous meetings of the 10th March and 21st April were agreed as an accurate record.

B1. Governance Update B1.1 JW gave the Board a brief overview of the proposed governance structure for the Northamptonshire Integrated Care Board (NICB). The joint arrangements for monitoring the BCF and S75 arrangements have been agreed with providers and commissioners, although a bigger piece of work is still to be completed around the Sustainable Delivery Plan. The first meeting was held on the 16th May and attended by all Chief Executives across the county, where the terms of reference and schedule of these meetings were agreed. AA will be the Chair of the NICB, Alison Kemp will be the vice chair and Chief Executives or nominated deputy are expected to be in attendance. The NICB would have an oversight role in relation to the changes that will need to take place within the BCF, along with the development of the programme for next year. Reporting arrangements will first be to the respective organisations, then to the Health and Wellbeing Board which has an oversight on delivery of the BCF. CMi asked for the governance structure diagram showing the responsibility for signing of the BCF to include Cambridgeshire and Peterborough Clinical Commissioning Groups, JW agreed.


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B1.2 RB proposed to move the frequency of the Health and Wellbeing Board meetings to bi-monthly, to begin after the meeting on the 17th September. The Board agreed

B2. STP Programme B2.1 JW gave the board a brief overview of the work being completed around the Sustainable Transformation Plan (STP). By the end of July sustainable governance arrangements need to be in place to focus on the delivery of the STP, with the aim to provide services for health and social care in a more integrated way. There are three gaps within the plan that need to be addressed going forward: How will we address the health and wellbeing gap, How will we drive the transformation to close the care and quality gap, How will we close the finance the efficiency gap

This plan must be population health focused, with the footprint as Northamptonshire. The main elements of transformational work taking place are: Hospital transformation, to have a acute function within the county which can be

delivered in a sustainable and systematic way MCP transforming primary care, linking in with mental health services, community

health health service and adult social care service Urgent care, working with primary care around improving same day access and

working through the challenges of delivering domically care and increased integrated care.

Complex care and long term conditions, to have a sustainable plan that will have risk stratification approach to look at the 20% of the population which account for 80% of cost in the system.

Prevention and wellbeing need to emphasis primary and secondary prevention, by using public engagement to articulate the prevention agenda and encourage patient participation.

AA is leading on how to articulate the health and quality challenges currently being faced and the issues to be addressed, which include mental health, children, maternity, and premature deaths.

B2.2 The plan is currently being modified/improved and reviewed on a weekly basis by the NICB and the final submission will be ready for submission by the end of June. A checkpoint session was held with NHS England and external bodies, the feedback from the session was positive in relation to governance and engagement. But more work is needed around the bridging analysis and hospital modernisation programme and a workshop is being held with providers to explore opportunities to address these areas. There will be a meeting with regulators two weeks before the submission and in July Simon Stevens and Jim Mackie, will visit the site to feedback on the submission. B2.3 The Board discussed the plan and the following comments were made: AH - there is a need to focus on implementation of the plan, to ensure it is not organisationally bound, and use the collective resources across the health and social care system. JC – Voluntary Impact and Healthwatch are completing a piece of work assessing the work that communities and Patient VOICE are already completing, to encourage more engagement and for more processes and people to become integrated. There is also concern about the lack of services being offered to sufferers of low level mental health and there is a need to ensure mental health features strongly in the prevention agenda. Due to Voluntary Impact liaising with the Specialist Public Health Team regarding the public health indictors, discussions can be made about identifying the root causes behind health problems and what needs to be completed with regards to prevention to stop issues escalating into health problems. Without investment in the prevention budget, the pressure on acutes and social care services will not change. JI - there are currently considerable pressures across the country within general practice and JI asked all to read the GP Forward View report which highlights the pressures currently being faced. CB to circulate the link with the minutes.


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Action:CB JW - national guidance has been circulated about how funding for STP should be allocated and the two finance directors from the CCG are working through this to ensure all requirements across the system is met. The focus at this stage is to have a credible plan for STP footprint which is deliverable. JW will send the methodically framework for bridging the financial gap to the Board.

Action:JW SE – as the main focus of the STP is health and social care, there could be a risk of losing the emphasis on issues that are closely related and causing poor outcomes such as housing and education. JW - has regular meetings with other STP’s to partake in shared learning as well as liaising with NHS England and networks across other systems. The national teams are also providing evidence of best practice. NP - the University of Northampton (UoN) are the biggest provider of nurses and midwives within the county and the links with other universities across the region, and UoN are keen to be involved in workforce planning. AH asked if a development session could be held on the MCP model as a topic, RB agreed. PBl – there is a huge demand for non eligible social care within the community that need to be focused collectively. DSi - there is a need to start to focus on delivery, the key indicators are currently in the wrong place as more demand is being seen in the acute sector, along with poor patient flow through the acutes, and a dashboard is needed so this Board can see in numerical terms how schemes are progressing. JW - noted there is a need to focus on shared responsibility for delivery, more work is needed on what the metrics will be as a system, the NICB membership and planning process to be reviewed. B2.4 SS advised there is a major workforce issue across the whole health and social care system. In the acutes there are serious staff shortages in some areas and a demoralised workforce who need a lot of support for the future with a need to create new roles to support the clinical workforce and these new roles will require training preferably within the county. SS has been asked to set a Workforce Advisory Board (WAB) which will be jointly chaired by a Provider CEO and Health Education England and will have members from social care, medical, public health and education to support this process. Several programmes of work have been agreed and a workforce strategy will be produced and will report through the STP process. CK noted that she is the national lead for ADAS, ADAS has recognised that the workforce are a priority and CK chairs the national workforce group and will bring feedback on this to future board meetings. CK and SS to discuss this further outside the meeting.

Action: CK/SS BP commented the biggest staffing cost for NCC is agency workers, and asked if the board can work together through UoN to look at ways of reducing this cost. PBl added models like the Children’s Social Work Academy set up across the county would be beneficial, with the possibility of combining academies. NP added the STP will be a part of the implementation of the health and wellbeing strategy and there is a need to ensure universities across the region are involved in tackling the workforce issues and workforce retention by offering training and research facilities. .

B2.5 CoR gave the Board a brief overview of the Transforming Care Plan, which has already been approved by NHS England. This plan is about collaborative working to achieve working pathways of care and achieving accountable for pathways of care. But significant work is needed over the next few months to describe the key deliverables and key milestones to be implemented as part of the three year delivery plan. There are four key objectives: To reduce the need for hospital beds, To keep people of out of hospital through a range of flexible community services, Improve access to early intervention services, Working with individuals and families at an earlier opportunity.


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The implementation plan will be locally monitored through the Learning Disability Transformation Board and there will also be regular reporting to NHS England over the progress of this plan and implementation. NHS England will fund £30k to help with the programme management delivery costs, but there will be no other new money coming into the project so existing resources will be used. The key risks are the decommissioning and recommissioning of services to ensure changes don’t adversely impact on individuals and all changes to services will be subject to Equality impact Assessments. There will be a mini roads taking place across the county to raise awareness and the profile of the plan, whilst helping to engage with organisations and the public. CoR asked for this plan to be on individual organisations websites by July 2016 and for approval of the plan and for key partners commitment to deliver the plan. The Board agreed. AH added NHFT supports this plan, but was disappointed not to be receiving funds from the NHS England Transformation Fund due to Northamptonshire having a good community based services and not bed based services. TT noted this and would feedback. CM commented currently 125 children are attending special schools outside the county and a new school is being built in Daventry to address this and asked for this to be included within the report. JWt would like to see more joined up services to ensure patients do not fall through gaps and asked for the confusion over terminology and ensure all CCGS are noted in the paper are addressed before the paper is agreed. MG will send details of the proposal to build three special needs schools within the county to CoR to be included in the plan.

B2.6 CMi gave the Board an update on the Cambridgeshire and Peterborough STP. There are six workstreams in place across within the governance structure: Sustainable General Practice, Proactive Care and Prevention which includes dementia and this workstream will need

investment to deliver longer term savings, Urgent and Emergency Care which includes Vanguard status Elective Care – picked four areas to work on cardiology ENT orthopaedics

dermatology, Maternity and Neonatal at an early stage, Children and Young People.

Each workstream is chaired by a Chief Executive from a respective organisation and feeds into Health and Care Executive Board. There is also a Clinical Advisory Group which looks at the long and short term options and national best practice before the options go to Executive Board for sign of for implementation. CMi asked JW if the interdependencies from both STP plans can be checked for the impact on areas across the region. JW agreed.

C1 Update Report – Board Member Organisations RB advised the Health and Wellbeing Foras across the county continue to meet on a regular basis and RB meets with the Chairs of the Foras on a regular basis. F3. Date of the Next Meeting The date of the next Health and Wellbeing Board meeting will be on the 15th September at 9.30 am in Sunley Management Centre. Signed…………………………………….. Dated……………………………………….


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REGISTER OF INTERESTS

NAME

POSITION

DETAILS OF INTEREST AND NATURE OF BUSINESS

Dr Azhar Ali Nene Clinical Executive for Acute Trusts North Planned Care Clinical Lead

GP Partner at Abbey Medical Practice

Dr Azhar Ali Nene Clinical Executive for Acute Trusts North Planned Care Clinical Lead

Member of 360 Care (GP Federation)

Paul Bevan Lay Member, Governance Director, Owenbeg Ltd

Mary Bevan , wife - Director, Owenbeg Ltd

Alison Jamson Interim Director of Quality None to declare

Dr Christopher Bunch Secondary Care Doctor, Governing Body Consultant Physician and Caldicott Guardian, Oxford University Hospitals Trust

Dr Naomi Caldwell Nene Clinical Executive Director for Primary Care & Localities

GP Partner, Langham Place Surgery

Macmillan GP


Langham Place Surgery is a member of GP Alliance Federation.

Langham Place Surgery Practice Manager (Mrs Joanne England) is Chair of GP Alliance Federation.


Langham Place Surgery is research ready & involved in research projects.


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Nene CCG Register of Interests Updated May 2016 Page 2 of 4


GP Colleague / Partner is advisor for NHS England – Dr Sarah Greening

Dr Emma Clancy Clinical Executive Director for Acute Trusts (South)

GP Salaried with a view to Partnership, St Lukes, Duston


Clinical Director Bupa UK until 14.04.16


Husband owns Four Shires Home Improvements – no known affiliation to Health

Dr Matthew Davies Clinical Executive Director for Strategy GP Partner, Abbey House Medical Practice

Dr Matthew Davies Clinical Executive Director for Strategy Wife GP, Abbey House Medical Practice

Dr Matthew Davies Clinical Executive Director for Strategy Shareholder Abbey House Pharmacy; Wife also Shareholder Abbey House Pharmacy

Dr Matthew Davies Clinical Executive Director for Strategy Practice is part of Doc Med, part of PML

Dr Mathew Davies Clinical Executive Director for Strategy AQP Provider Community Skin Cancer Services

Dr Matthew Davies Clinical Executive Director for Strategy Wife Trustee Time to Talk Youth Counselling Charity Daventry

Christina E Edwards Deputy Chairman Vice Chairman Sue Ryder

Christina E Edwards Deputy Chairman Trustee Cavell Nursing Trust


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Charlotte Fry Deputy AO & Director of Primary Care Transformation

None to declare

Roz Horton Lay Member with Lead Role in Patient & Public Engagement

Public Member of KGHFT (i.e. their equivalent of public engagement forum)

Mother is Public Member of KGHFT

Alison Kemp Director of Integrated Commissioning None to declare

Sylvia Kennedy Interim Director of System Resilience & Urgent & Emergency Care

Director of Performance, NEL Commissioning Support Unit

Kathryn Moody Director of Contracting and Procurement Husband is Chief Executive of Northamptonshire County Local Councils

James Murray Interim Director of Planning Director of Murray Partnership Limited

Dr Raf Poggi Clinical Director Community Providers & Joint Commissioning

GP Partner – Weavers Medical, Kettering

Weavers (Practice) is member of 360 Care Federation.

Practice (Weavers) occasionally involved in research with HEEM.

Stuart Rees Chief Finance Officer None to declare

Dr Darin Seiger GP Chair GP Partner – Moulton Surgery

Moulton Surgery Member of PML Federation

Dr Darin Seiger GP Chair Non-Paid Special Advisor – Ockham Healthcare


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Dr Darin Seiger GP Chair Vice-Chair Northamptonshire Health & Wellbeing Board

Dr Darin Seiger GP Chair Spoke once at Cardiology Symposium funded by Bayer Healthcare – received costs only time in preparation and attending the event equivalent to GP normal rates of pay

Kevin Thomas Lay Member of Governance

Chair of Audit & Risk Governance

Director and owner of Kevin Thomas Consulting Ltd which currently has no NHS clients and is not seeking to obtain any.


Chair of Audit & Risk Governance

Trustee of Child Migrants Trust Charity


Chair of Audit & Risk Committee

Wife operates as self-employed accountant for GP Practices in Birmingham and Solihull

John Wardell Accountable Officer None to declare

Rosemary Yule Lay Member – Governance Chair of FQCC / Vice Chair Audit & Risk Committee

Ex-Husband Partner at RSM – Nene CCG’s Internal Auditors


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Acronym MeaningA

A&E Accident & Emergency

AQP Any Qualified Provider

B

BAF Board Assurance Framework

BCF Better Care Fund

BCM Business Continutiny Management

BCP Business Continuity Planning

BMA British Medical Association

BNF British National Formulary

C

CAMHS Child & Adolescent Mental Health Services

CCG Clinical Commissioning Group

CHC Continuing Healthcare

COI Conflicts of Interest

COPD Chronic Obstructive Pulmonary Disease

CQC Care Quality Commission

CQN Contract Query Notice

CQUIN Commissioning for Quality & Innovation

CSU Commissioning Support Unit

D

DES Directed Enhanced Service

DH Department of Health

DNR Do not resuscitate

DTOC Delayed Transfers of Care

E

ED Emergency Department

EMAS East Midlands Ambulance Service

EOL End of Life

EPRR Emergency Preparedness, Resilience & Response

EQIA Equality Impact Assessment

F

FT Foundation Trust

G

GMS General Medical Services

GP General Practitioner

H

HEEM Health Education East Midlands

HRWG Health Resilience Working Group

HSCIC Health & Social Care Information Centre

I

IA Internal Audit

ICO Information Commissioner's Office

IAPT Improving Access to Psychological Therapies


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IG Information Governance

K

KGH Kettering General Hospital

KPI Key Performance Indicator

L

LA Local Authority

LHRP Local Health Resilience Partnership

LMC Local Medical Committee

LRF Local Resilience Forum

LRI Leicester Royal Infirmary

M

MASH Multi Agency Safeguarding Hub

MCP Multi Speciality Community Providers

MDT Multi Disciplinary Team

N

NCC Northamptonshire County Council

NELs Non Elective Admissions

NGH Northampton General Hospital

NHFT Northamptonshire Healthcare Foundation Trust

NICE National Institute for Health & Care Excellence

O

OD Organisational Development

OFSTED Office for Standards in Education, Children's Services and Skills

OH Occupational Health

OoH Out of Hours

P

PACs Primary & Acute Care Systems

PAS Patient Administration System

PBC Practice Based Commissioning

PCCJC Primary Care Co-Commissioning Joint Committee

PH Public Health

PLT Protected Learning Time

PMS Primary Medical Services

PPE Patient & Public Engagement

PPI Patient & Public Involvement

PPG Patient Participation Group

Q

QIPP Quality Innovation Productivity Prevention

QOF Quality Outcomes Framework

R

RAG Red, Amber, Green

RTT Referral to Treatment

S

SBS Shared Business Services

SCG Strategic Co-ordinating Group

SI Serious Incident

SIRI Serious Incident Requiring Investigation

SPA Single Point of Access

SRG System Resilience Group

STP Sustainability & Transformation Plan


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T

TCG Tactical Co-ordinating Group

TDA NHS Trust Development Agency

U

UCC Urgent Care Centre

V

VFM Value for Money


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