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Meeting Title

East Leicestershire and Rutland Clinical Commissioning Group – Governing Body meeting

Date Tuesday 12 December 2017

Meeting no. 44. Time 9:30am – 11:15am

Chair Dr Richard Palin (Chairman)

Venue / Location

Council Chambers, County Hall, Glenfield, Leicester, LE3 8TB.

AGENDA ITEM ACTION PRESENTER PAPER TIMING

B/17/209 Welcome and Introductions Dr Richard

Palin 9:30am

B/17/210 Apologies for Absences:

To receive

Dr Richard Palin verbal 9:30am

B/17/211 Notification of Any Other Business To receive


B/17/212 Declarations of Interest on Agenda Topics To receive All verbal 9:35am

B/17/213 Minutes of the meeting held on 14 November 2017

To approve

Dr Richard Palin

A 9:35am

B/17/214 Matters Arising: Update on actions from the meeting held on 14 November 2017

To receive

Dr Richard Palin

B

9:40am

B/17/215 To receive questions from the Public in relation to items on the agenda only

To receive


REPORTS

B/17/216 Chairman’s Report To receive

Dr Richard Palin C 9:55am

B/17/217 Accountable Officer’s Corporate Report To receive

Karen English D 10:00am

ITEMS FOR DECISION, ACTION AND ESCALATION

B/17/218 Finance Report: Month 7 update To receive Donna Enoux E 10:05am

B/17/219 Corporate Performance Assurance Report To receive Paul Gibara F 10:20am

B/17/220 LLR Alliance Community Paediatrics Service To receive

Sarah Shuttlewood G 10:35am

B/17/221

Locality Chairs’ Report: Oadby and Wigston Melton, Rutland and Harborough Blaby and Lutterworth

To receive Locality Chairs H 10:45am

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AGENDA ITEM ACTION PRESENTER PAPER TIMING

ITEMS FOR INFORMATION

B/17/222 Summary Report from the Provider Performance Assurance Group (November 2017)

To receive

Warwick Kendrick I

11:00am

B/17/223 Summary report from the Audit Committee meeting in November 2017 and approved minutes from October 2017

To receive

Warwick Kendrick J

B/17/224 A verbal summary report from the Primary Care Commissioning Committee meeting in December 2017

To receive Clive Wood verbal

B/17/225 A verbal summary report from the Integrated Governance Committee meeting in December 2017

To receive

Dr Tabitha Randell verbal

B/17/226 A verbal Summary Report from the Financial Turnaround Committee November 2017

To receive Alan Smith verbal

B/17/227 System Leadership team meeting approved minutes October 2017

To receive Karen English K

DATE OF NEXT MEETING

B/17/228

The next meeting of the East Leicestershire and Rutland CCG Governing Body will take place on Tuesday 13 February 2018, meeting room to be confirmed.

To receive

11:15am

Blank Page

Paper A East Leicestershire and Rutland CCG Governing Body Meeting

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EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP

Minutes of the Governing Body Meeting held on Tuesday 14 November 2017 at

9:30am in the Council Chambers, County Hall, Leicester LE3 8TB

Present: Dr Richard Palin Chairman Mrs Karen English Managing Director Mr Clive Wood Deputy Chair / Independent Lay Member Dr Andy Ker Clinical Vice Chair Mr Tim Sacks Chief Operating Officer Ms Donna Enoux Chief Finance Officer Mr Paul Gibara Chief Commissioning and Performance Officer Dr Girish Purohit GP Locality Lead, Melton, Rutland and Harborough Dr Hilary Fox GP Locality Lead, Melton, Rutland and Harborough Dr Graham Johnson GP Locality Lead, Blaby and Lutterworth Dr Vivek Varakantam GP Locality Lead, Oadby and Wigston Dr Nick Glover GP Locality Lead, Blaby and Lutterworth Dr Tabitha Randell Secondary Care Clinician Mr Alan Smith Independent Lay Member Mrs Carmel O’Brien Chief Nurse and Quality Officer Mr Warwick Kendrick Independent Lay Member Mr Colin Thompson Public Health Consultant

In Attendance: Mrs Daljit K. Bains Head of Corporate Governance and Legal Affairs Mrs Emma Casteleijn Head of Communications Mr Jim Bosworth Associate Director Contracting Mrs Jennifer Fenelon Healthwatch Rutland Ms Nicky Topham Reconfiguration Programme Director (for item B/17/195 only) Mr Tim Pearce Major projects finance lead, UHL (for item B/17/195 only) Mr Paul Traynor Chief Financial Officer, UHL (for item B/17/195 only) Ms Sue Nattrass Senior Project Manager, UHL (for item B/17/195 only) Mr Nigel Bond Head of Capital Projects, UHL (for item B/17/195 only) Mr Rakesh Vaja Head of Service, UHL (for item B/17/195 only) Mrs Natasha Parekh Corporate Affairs Support Officer (minutes) Members of the public: 1 member of the public seated in the public gallery.

ITEM DISCUSSION LEAD RESPONSIBLE

B/17/184 Welcome and Introductions Dr Richard Palin welcomed members of the Governing Body and members of the public to the November 2017 meeting of the East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) Governing Body.

B/17/185 Apologies for Absence: Apologies for absence were received from:

Mrs Sue Staples, Healthwatch Leicestershire.


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B/17/186 Notification of Any Other Business The Chairman had not received notification of any additional items of business.

B/17/187 Declarations of Interest on Agenda Topics All GP members declared an interest in items relating to primary care where a potential conflict may arise and also where there are any items concerning the Leicester, Leicestershire and Rutland Provider Arm where GP members’ are minor shareholders. Dr Palin informed that there may be conflicts of interests for GPs in relation to Paper M - Healthwatch Leicestershire Quick Poll Survey. It was noted that the Register of Interests is published on the CCG website for further details. It was RESOLVED to:

RECEIVE and NOTE the declarations made.

B/17/188 Minutes of the Meeting Held on Tuesday 10 October 2017 (Paper A) The minutes of the Governing Body meeting held on 10 October 2017 were accepted as an accurate record, subject to the following amendments being incorporated.

Page 11, first paragraph - first part of the sentence to be deleted, the second half starting with “Dr Vivek Varakantam…” to remain.

Page 14, penultimate paragraph - Mrs Carmel O’Brien stated that she would provide an amended form of words to replace the first sentence as this did not capture fully the point she had raised.

Page 14, last paragraph – Dr Girish Purohit advised that the second half of the sentence, “not having this machine should not determine any change in the level of service,” to be replaced with “… not having this machine should not determine any change in the management of the service.”

Page 20, item B/17/180, Summary Report from the Integrated Governance Committee (IGC) (October 2017) – first sentence, Dr Tabitha Randell’s surname to be inserted.

It was RESOLVED to:

APPROVE the minutes of the last meeting, subject to the amendments made.

Carmel O’Brien


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B/17/189 Matters Arising: Update on Actions from the Meeting held on 10 October 2017 (Paper B) An update on the following action was received:

B/17/178 – Summary Report from the Provider Performance Assurance (PPAG) Group meeting – to write to WL CCG raising concerns in relation to EMAS performance - Dr Palin mentioned this action is currently outstanding and will be completed ahead of the next meeting.

It was RESOLVED to:

RECEIVE and NOTE the update on the action.

B/17/190 To Receive Questions from the Public in relation to items on the agenda Dr Palin invited questions from the members of the public relating to items on the agenda. There were no questions raised on agenda items. It was RESOLVED to:

NOTE that no questions were raised on agenda items from the public.

B/17/191 Chairman’s Report (Paper C) Dr Palin presented this report, which provided an overview and update on some of the key constitutional and strategic areas that affect the Governing Body, including meetings attended by Dr Palin since his last report in October 2017. It was RESOLVED to:

RECEIVE the Chairman’s report.

B/17/192 Accountable Officer’s Corporate Report (Paper D) Mrs Karen English highlighted some of the key activities the Executive Management Team (EMT) has been involved in since the last meeting of the Governing Body in October 2017. Mrs English drew attention to the following 2 key items:

Consultation on draft Leicester, Leicestershire and Rutland (LLR) Carers’ Strategy – the Governing Body was asked to


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approve to jointly consult on the draft LLR Carers Strategy 2018–2021. Mrs English informed that the draft Strategy sets out the draft strategic priorities relating to unpaid carers of all ages, and is intended as a joint Strategy including all local authorities and CCGs across LLR. The partners to the Strategy are: Leicestershire County Council, Leicester City Council, Rutland County Council, Leicester City CCG, West Leicestershire CCG and ELR CCG on the priorities. Significant carer and stakeholder engagement has been undertaken during the summer of 2017, and the draft Strategy has been co-produced alongside carers. Amendments may be required to the draft Strategy after formal consultation responses are received. Timeline for the consultation was stipulated within the report compiled by local authority colleagues. Mrs English although a web link to the draft Strategy has been provided, a copy will be circulated for ease of reference.

Equality and Inclusion Strategy 2017 - 2020 - Mrs English informed that this strategy was currently being refreshed. The Governing Body is asked to note that the draft version will be circulated to the Governing Body members for comments in November / December 2017 with an aim for it to be approved at the December or January 2018 meeting. The principles in the current Strategy remain current and the equality objectives are still valid, however before the Governing Body receive the final version for approval input from the Governing Body would be welcomed.

Ms Jennifer Fenelon added that carers in Rutland have informed that they are happy with the level of engagement carried out in respect of the draft Carers’ Strategy. It was RESOLVED to:

RECEIVE the Accountable Officer’s Corporate Report;

APPROVE to jointly consult on the draft LLR Carers’ Strategy 2018–2021.

Daljit Bains Daljit Bains

B/17/193 Finance Report: Month 6 update Report (Paper E) Ms Donna Enoux highlighted that the report provides details of the financial position for ELR CCG as at month 6 of 2017/18, including the latest iteration of the revised requirements for reporting financial, Quality Innovation Performance Prevention (QIPP) and contractual information to NHS England. The overall revenue allocation for ELR CCG at month 6 stands at £420,445k an increase of £59k for LD Transformation funding. The


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CCG has no approved capital funding for 2017/18 and the allocation is detailed in Appendix A. The year to date position is a surplus of £0.310m compared to a year to date plan of £3.854m and therefore the CCG is £3.544m over plan at month 6. As reported at the last meeting, the CCG has faced a number of financial pressures relating to the finalisation of certain debtor and creditor balances from 2016/17. These have generated a £4.65m pressure at month 6. This value is a reduction of approximately £200k from month 5, as although it now includes confirmed pressures from Independent Sector Acute providers totalling £349k. This has been offset by the removal of £63k of anticipated recharges and the recognition of £500k of estimated primary care rates rebates, as part of a national review programme being commissioned by NHS England. The £500k rates value is believed to be a conservative estimate ahead of receiving a formal schedule from the company engaged by NHS England to deliver the review.

In addition, the CCG is reflecting a net £0.85m of QIPP slippage at month 6. This is a reduction from the value of £1.3m shown at month 5 as a result of revising the forecast investment in planned care QIPP schemes this year. Other budgetary variances analysed total approximately £1.2m, making a total year to date pressure of approximately £6.7m.

The CCG has released its £2.1m contingency in its entirety to support this pressure along with approximately £1m of uncommitted Commissioning reserve but this only serves to reduce the net variance to the £3.544m.

Taking account of anticipated QIPP delivery the CCG continues to forecast the achievement of the required surplus of £7.708m by year end but the updated CCG QIPP programme at month 6 now includes a requirement to identify further schemes to deliver £2.205m of savings. Dr Graham Johnson raised a query in relation to paragraph 22 on primary care commissioning, and paragraph 23 covering prescribing. Dr Johnson highlighted that paragraph 22 makes reference to “a decrease of £238k following realignment of GP Federation and GP prescribing recharge budgets” and asked what this meant. In relation to paragraph 23, Dr Johnson asked for clarification on what was being referred to as, “A level of risk remains against this forecast as the price of certain items is being affected by reported stock shortages. (No Cheaper Stock Obtainable) …”

Ms Enoux explained that in relation to paragraph 22, this referred to funding, from the £3 per head funding, that the CCG paid to support the GP Federation. It was noted that a discussion had taken place at


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the Primary Care Commissioning Committee (PCCC) to agree this. With regards to the remainder of the budget, more reference is made in paragraph 22. Ms Enoux informed that she was not sure what this relates to and would seek clarification and to advise accordingly. Dr Johnson expressed concerns that as a GP, he is not always aware which drug is more expensive than others. He suggested that information could be circulated to practices to raise awareness. Mr Tim Sacks to liaise with Mr John Nicholls (Head of Prescribing) to ensure communication is circulated to practices as soon as possible.

It was RESOLVED to:

RECEIVE the report.

Donna Enoux Tim Sacks

B/18/194 Performance Assurance Report (Paper F) Mr Paul Gibara highlighted that the report provides an overview of performance for the ELR CCG and LLR where data is available and it sets out the key performance indicators that the CCG are held to account for. Following feedback from the last meeting, where possible, performance trend lines have been included within the report. Mr Gibara drew attention to three key areas: Referral to Treatment (RTT) targets has now been taken LLR wide for further discussions and work to be completed on specialities; IAPT performance continues to be challenging and formal contract performance routes are being explored with the provider; and the Emergency Department (ED) continues to be a challenge. It was noted that national directive to classify the urgent care activities of the urgent care centres as category 3 activity would potentially result in the UHL only ED performance improving by 0.5%. Dr Randell informed that a discussion in relation to this and its impact was raised at the Integrated Governance Committee meeting in the previous week, and the Committee was concerned that the CCG appeared to have no choice but to except this, and that this would potentially improve UHL’s performance figures without any action taken to actually improve performance. Governing Body members suggested that the CCG strongly resist the change as this does not help patients and simply makes targets appear better. The priority is to focus on patient care. It was concluded that UHL currently have no influence on the activity of urgent care centres. Concerns were raised about a potential risk of retrospective costs if the activity was categorised differently.


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Mr Sacks noted the comments raised however confirmed this was a national directive. Ms Enoux added that the CCG are already paying the patient tariff and assurance is required on this area to avoid any further cost pressures. Mr Gibara stated that there are plans to do an analysis and potentially seek legal advice if needed. Governing Body members urged that the CCG’s concerns and opinions be registered and to write to NHS England to ensure the overall feelings are known. Mrs English responded that she in agreement with the concerns raised and is happy to support the clinicians for this to go ahead and a letter be written to NHS England. Dr Palin concluded that Mr Gibara to compile a letter in his name addressed to NHS England highlighting the CCG’s concerns and implications of the categorisation. Mr Kendrick added that the letter should also include financial details on how the CCG do not want to face any financial risks. Dr Nick Glover expressed his gratitude towards Mrs English and the CCG for the support and taking forward the views of the clinicians. Furthermore, Mrs English added that the issue was raised at both the Provider Performance Assurance Group (PPAG) and the Managing Directors’ (MDs’) meetings. It was noted that Mrs Tamsin Hooton was to contact NHS England in relation to the matter concerning the category 3 matter. The CCGs will be seeking legal advice and Mrs Tamsin Hooton and Mr Tim Sacks are working closely on this matter. Mrs English advised that this currently happens elsewhere across the country and LLR were simply being aligned to systems across the country. Mrs Fenelon referred to page 14 of the report and highlighted the red RAG rated EMAS figures and asked what is being done to improve on this area. In response it was noted that EMAS performance had been reviewed in detail across a number of meetings and the Provider Performance Assurance Group would be undertaking a deep dive at its November 2017 meeting. Dr Palin requested for a summary of the key issues following the EMAS deep dive to be forwarded to him. It was RESOLVED to:

RECEIVE the report.

Paul Gibara

Paul Gibara

B/17/197 Integrated Governance Committee (IGC) Terms of Reference (Paper I) Dr Palin suggested moving ahead to Paper I on the agenda as the meeting was running ahead of schedule and members from UHL had not yet arrived for the agenda item.


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Dr Randell presented the report and highlighted that the Terms of Reference (ToR) for the IGC have been reviewed by the Committee in October 2017 and minor amendments were made and proposed for the Governing Body to approve. In addition, the Committee considered whether approval of s75 agreements should fall within the remit of the Committee as opposed to the Governing Body and therefore include within the terms of reference. This would assist the Governing Body in that the detail of the agreements would then be reviewed and approved at Committee level. It was noted that the s75 agreement is an agreement made under section 75 of National Health Services Act 2006 between a local authority and an NHS body in England. Section 75 agreements can include arrangements for pooling resources and delegating certain NHS and local authority health-related functions to the other partners, if it would lead to an improvement in the way those functions are exercised. It can be a technical document containing a lot of detail which the Governing Body may not have the time to explore in detail. The IGC members agreed with this as a proposal for the Governing Body to consider. Dr Palin asked Mrs Bains whether the paper is now okay to be approved or whether it needs to go back to the IGC to debate. Mrs Bains responded that at present the authority to approve a s75 is a matter reserved to the Governing Body, and the proposal from the IGC is for the Governing Body to consider delegating this to the IGC for approval of all s75 agreements, or the Governing Body may choose to continue to reserve the right and ask that the IGC review s75 agreements and present a recommendation to the Governing Body. A query was raised whether the IGC should have delegated authority given the inclusion of financial risk sharing contained within these agreements. Mrs Bains informed that the relevant plans associated with the s75 agreements would have to be agreed via the appropriate governance forum, usually the Governing Body. Mrs Bains referred to the example provided within the report relating to the s75 agreement currently in place for the Better Care Fund with Leicestershire County Council and West Leicestershire CCG. The Governing Body approved the Better Care Fund plan, including the finances, and the governance arrangements are then laid out within the s75 agreement. Mrs Fenelon asked about consultation and assurance that consultation would be carried out. Mrs Bains informed that the s75 agreement was a legal document and patient and stakeholder consultation on this document would not normally be the case. Mrs Bains informed that schemes that the s75 supports, as in the


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example quoted earlier under the Better Care Fund would be consulted on. Mrs Fenelon reiterated the question as suggested that assurance in relation to consultation should be provided. It was noted that where public consultation is required this will be carried out. Governing Body members suggested that the preference would be to continue to reserve the right to approve s75 agreements at Governing Body level, however for the Integrated Governance Committee to review and make a recommendation to the Governing Body. Dr Vivek Varakantam referred to the quorum section within the terms of reference. It was noted that the Committee could transact business with only 1 GP present; and suggested that this may need to be strengthen. Mrs Bains informed that the Governing Body members will recall when the terms of reference were last reviewed, the Committee put forward a proposal to reduce the quorum from 2 GP members to 1 as a result of constraints upon GP capacity and vacant GP position. The Governing Body had approved the amendments to the terms of reference and agreed to reduce the quorum to include 1 GP. Dr Randell added that this was a pragmatic solution at the time and could be reviewed at some point in the future to increase this to have 2 members of GPs being present. Dr Girish Purohit added that it was practical at the time of the decision and would suggest a review in approximately 6 months. It was RESOLVED to:

APPROVE the updated terms of reference for the Integrated Governance Committee with the matter relating to the approval of the s75 agreements to reside with the Governing Body, and for the Integrated Governance Committee to review s75 agreements and make recommendations to the Governing Body.

B/17/195 University of Leicester NHS Trust (UHL) Clinical Strategy (Phase 2) – Interim ICU Outline Business Case (Paper G) Dr Palin welcomed 6 colleagues from UHL to present Paper G: Ms Nicky Topham (Reconfiguration Programmes Director); Mr Tim Pearce (Major Projects Finance Lead); Mr Paul Traynor (Chief Financial Officer); Ms Sue Nattrass (Senior Project Manager); Mr Nigel Bond (Head of Capital Projects) and Mr Rakesh Vaja (Head of Service). Ms Nicky Topham introduced the report and stated that this case is being presented to the meetings in public of the LLR CCGs’ Governing Bodies in order to secure approval from UHL’s local


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commissioners to proceed with the development of the Full Business Case (FBC). The report explains that this case is fully aligned to the STP and forms the next key stage in the delivery of UHL’s two acute site model. It was noted that the project has been split into 4 components: the expansion of Intensive Care Unit (ICU) at Glenfield Hospital (GH) by 11 bed spaces; the refurbishment of space at GH for the development of interventional radiology facilities; the development of new wards at GH to support the transfer of Hepatobiliary (HPB) and Renal Transplant services from Leicester General Hospitals (LGH); and lastly the refurbishment of ward space at Leicester Royal Infirmary (LRI) to support the transfer of colorectal and emergency general surgery services from LGH. The need to move Level 3 ICU away from Leicester General Hospital (LGH) was first identified in 2014 owing to the increasing risk to clinical sustainability of the service. Mr Paul Traynor informed that at this stage, the project is split into discrete business cases, which were approved internally by the Trust in 2015. This case was approved with a capital cost of £16.47m, an acknowledged interim operating cost pressure of £2.25m; £2.05m was non-recurrent whilst acute services remain at the LGH; with an additional £640k of capital charges. Owing to the national lack of capital for NHS developments, external capital for this project has not been available to date. The only component of this development that has been undertaken is the expansion of 6 ICU beds at the LRI into the Theatre Recovery area. This was funded through the Trust’s internal Capital Resources Limit (CRL) in 2015. UHL was successful in its bid for funds for the move of Level 3 ICU off the LGH from the 2017 Spring Budget. The total cost of this bid was £30.8m. The capital ask has increased as the GH wards (previously assumed to be within retained estate) are now new build wards, since the original assumptions (based on left shift) which vacated wards at the GH have not come to fruition.

Discussions with NHS Improvement (NHSI) and NHS England have concluded that in order to access the capital, UHL needs to submit a new Outline Business Case (OBC) and Full Business Case (FBC) for the whole £30.8m value of the scheme. This case needs approval by the UHL Trust Board and the LLR CCGs’ Governing Bodies before it is considered by the NHSI local and Regional Teams. It was noted that the STP partners were supportive of the bid. This case was subject to approval at the UHL Trust Board on 2 November 2017 and was supported.


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It was noted that ‘support in principle’ had been received from NHS England commissioners and gaining CCG support was the last stage of approval with a plan for the full business case to be out in February 2018. Representatives from UHL advised that the “do nothing” option of retaining Level 3 ICU at LGH has been assessed against the option to relocate it to LRI and GH. The “Do Nothing” option assesses the impact of UHL losing the activity that is dependent on level 3 ICU at the LGH in the event that the ICU becomes unsustainable. For each of the 4 schemes within the project option appraisal on the design solutions have been undertaken to identify the preferred solutions. 2 of the schemes relate to the refurbishment of retained estate which creates derogation to national recommendations. The 2 new build options have derogation due to space constraints principally: Bed spaces; ICU bed spaces of 20m P

2P to 23m P

2 Pas opposed

to 25m P

2 Precommended bed spaces; Percentages of single rooms are

30% as opposed to 50% recommendation. Members of the Governing Body agreed with the direction of travel however questioned some of the recommendations of the options, particularly in relation to bed space and room size. In response representatives from UHL explained that the derogations are supported by the Chief Nurse and the clinical teams, and were discussed with the NHSI quality team at a meeting on the 31 October. Ms Topham also stated that the guidance was followed when reviewing the bed sizes and spaces in relation to the infrastructure of the walls. Once detailed design is completed a full list of derogations from HBNs and HTMs will be included in the FBC. Having reviewed the financial information, Dr Johnson added that it would be difficult to agree with the £2.4m annual cost and £5m reserve as the CCG does not have the funds to support. Mr Paul Traynor responded that he understands the CCG does not have the funds to support this and that the CCG is not currently being asked to financially support the business case as UHL is looking to absorb the costs. The maternity department was discussed where Dr Randell noted the timeline within the reports relating to the closure of general beds and asked how this would affect the maternity department. It was highlighted that the department was due for consultation already and now this new activity could add further change. Mr Rakesh Vaja responded that discussions have already been had on this subject and UHL are confident that the level of service will continue to be provided. Mr Kendrick added that the clinical case is clear and detailed,


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however questioned on whether the case will prove that it is value for money. Mrs Fenelon added to Mr Kendrick’s point and made a statement that the papers within the report are all impressive. However, noted the comment in relation to closing LGH site and stated that this decision cannot be made today as consultation would be required and due process would need to be followed. Mr Traynor responded that this business case does not relate to closure of LGH, and that this business case is a stand-alone case although part of a wider reconfiguration subject to capital being available. Mr Traynor assured the Governing Body that consultation and due process would need to be adhered to, however the report is not asking for approval to close LGH. Mrs Fenelon responded that despite the comment, due process must be followed before consultation. Dr Johnson raised a final point from section 1.6: financial case and questioned the financial position of this OBC where it shows there will be an additional cost of £3.15 million per annum recurrently until the Trust reconfigures on to two sites, when the additional cost reduces to £1.2 million. The recurrent additional cost will be offset by savings from reconfiguration when the reconfiguration of LGH concludes and its associated infrastructure costs are removed. Mr Traynor added that the case can come to a stop after this initial stage and it is still under consultation. The Governing Body concluded to receive the OBC for Interim ICU, Relocation of Level 3 ICU from LGH and provide its approval, recognising that there is no planned increase in activity associated with this case or financial implications outside of normal commissioning arrangements. UHL representatives agreed to check for their own assurance processes as to whether the report has been presented to the Health Overview and Scrutiny Committee for Rutland as part of their engagement process, given the query raised by Mrs Fenelon. It was noted that the report had been presented to the Health Overview and Scrutiny Committee in Leicestershire and Leicester. Mr Traynor thanked the Governing Body for their support and mentioned that UHL are due back for an update after reconfiguration. It was RESOLVED to:

RECEIVE the Outline Business Case for “Interim ICU – Relocation of Level 3 ICU from LGH” and provide its APPROVAL, recognising that there is no planned increase in activity associated with this case or financial implications


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outside of normal commissioning arrangements.

B/17/196 Board Assurance Framework 2017/18 (Paper H) Ms Enoux explained purpose of the report is to provide the Governing Body with assurance in respect of the systems and processes in place across the organisation to identify, evaluate, manage and monitor strategic risks through the Board Assurance Framework. The report provides an overview of the work undertaken in the review the format of the Board Assurance Framework in line with the actions approved by the Audit Committee following the Governing Body development session on risk management held in January 2017. It was noted that the Audit Committee had agreed to make a recommendation to the Governing Body to approve the version of the Board Assurance Framework as appended to this report given that the format and content have been improved; and to note that the revised format continues to provide assurance of an effective risk management process to monitor and review corporate risks. The report is to be taken as read and the next steps include the review and approval of the Risk Management Strategy and Policy and review of the format of the directorate level risk registers. Governing Body members positively commented on the Board Assurance Framework, and noted that the format is better and overall was well received. Dr Nick Glover noted that BAF 3 - Quality - Primary Care and questioned how this liaises with what Care Quality Commissioning (CQC) feeds in. Mrs Carmel O’Brien responded that the GP five year forward view is covered across the 3 CCGs and is happy to pick up on this query further outside of the meeting if required. It was mentioned that residual risk score in relation to the risk relating to EMAS needs to be reviewed given the performance issues highlighted earlier within the Corporate Performance Report. BAF 1 also needed reviewing as all providers were covered within this risk. Mr Kendrick mentioned that the Audit committee meeting is due tomorrow and this item is on the agenda for discussion and will as always be reviewed thoroughly. Dr Palin noted that the Audit Committee meeting is tomorrow where further discussions will take place. He noted that the Governing Body members were in agreement that the updated Board Assurance Framework 2017/18 be approved and approved that the authority be delegated to the Audit Committee for the approval of the Risk Management Strategy and Policy.

Carmel O’Brien


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It was RESOLVED to:

APPROVE the updated Board Assurance Framework 2017/18.

DELEGATE authority for the approval of the Risk Management Strategy and Policy to the Audit Committee, and the scheme of reservation and delegation be updated accordingly to reflect this.

B/17/198 Commissioning Collaborative Committee (CCB) governance arrangements (Paper J) Mrs English presented informed that in August 2017 the three LLR CCGs reached agreement that there was a strong appetite for greater collaboration, and that an essential enabler for this collaboration was to establish a governance mechanism to support joint decision making; it was agreed that consideration should be given to establishing CCB as a formal joint committee of the three LLR CCG Governing Bodies. This proposal was given further consideration and support at a subsequent meeting of the Chairs, Clinical Vice Chairs and MDs of LLR.

This paper sets out the proposal that CCB be re-constituted as a joint committee of the three CCGs, with specific areas of responsibility for collaborative activities delegated to it by the respective governing bodies of the CCGs. Once agreed this change will require all three CCGs to update their constitutions and schemes of reservation and delegation. In relation to the point referred to on page 5, paragraph 23, Dr Glover asked if the Governing Body had the power to vito a decision, Mrs English informed this was possible. Dr Purohit referenced page 5, paragraph 18: “Where the CCB does take a decision on behalf of its member organisations, members will be expected to have routed issues and decisions through their own organisation’s governance mechanisms as required and ensured visibility of the matters to be considered by CCB,” and asked where internally would these decisions be discussed. Mrs English informed there are a number of internal routes, for instance via the internal committee structure. However acknowledged that there must be sufficient time allocated to allow for scrutiny of papers for consideration through internal governance processes. It was noted that that there will be a minority of clinical


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representatives on the joint committee, and it was confirmed that a Chief Nurse will also be in attendance as a functional representative. Discussions continued in relation to the importance of sufficient time for scrutiny of papers and to ensure the committee members are given sufficient timescales to observe the content of reports and the decisions being asked of them. Dr Palin highlighted that the agenda items need to be circulated in advance for scrutiny and to tighten the process for papers being sent and circulated ahead of the meeting. When required papers will be presented to the CCG’s internal committee meetings and / or the Governing Body ahead of CCB to ensure a CCG view can be formed. In response to a query from Mr Clive Wood, Mrs Bains confirmed that the conflicts of interest panel will review the papers in advance of the meeting and advise on matters to be declared by members of the committee and where there are likely to be any conflicts of interest and how these should be managed. It was noted that the conflicts of interest guardians, who are lay members within each CCG appointed to this role, usually the Audit Committee chairs, will also support the conflicts of interest screening panel. Dr Palin put the item to a vote, advising that the options under consideration were: a) That the report and appendices are not approved unless there is a

process appended to the paper highlighting the process / timescales for reports making their way to CCB and Governing Body; or

b) That the report and the appendices as they stand are approved, subject to the comments highlighted by the Governing Body members, in particular ensuring that papers are prepared well in advance for consideration within the CCG first and timescales to be drafted.

The majority of the voting members voted for option b) above with one member voting against. Dr Palin summarised that Governing Body approved to constitute the CCB as a formal joint committee of the ELR CCG Governing Body, with the proviso that a detailed update be provided at the next meeting with paper submission timescales and also to note that a summary report from CCB will be expected to the Governing Body. It was RESOLVED to:

AGREE that the Commissioning Collaborative Board be constituted as a formal joint Committee of the ELR CCG Governing Body, subject to the comments raised and agreed.


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APROVE the draft terms of reference and scheme of reservation and delegation

AGREE to make the necessary changes to the constitution of the CCG to reflect the formal status of the CCB and the authority delegated to it.

B/17/199 Locality Chairs’ Report (Paper K) The chair stated the report is to be taken as read and each section to be headed by Individual locality leads; Melton Rutland and Harborough (MRH) Locality: Dr Purohit thanked Mr Sacks for his work on the GP five year forward view and drew attention to the report and stated that there are 3 key areas presented in the report;

General Practice Five Year Forward View: Funding - MRH locality members discussed accessing 5 Year Forward View and/ or Transformation monies. They reiterated that clarity is needed on how to access funding and the process for evaluating a business case. This is needed prior to Sub Localities in November to facilitate productive discussions. In addition the members wanted assurance that the practices and or groups of practices would have enough time to apply for any funds available this financial year.

Child and Adolescent Mental Health Services (CAMHS) Crisis Team: update on Service - MRH locality members received an update from the CAMHS Crisis Team on the service pathway, now that the team was fully staffed. Members noted the referral route into the service, the hours of operation and the crisis input available from the service. It was clarified that the service was available to all 0-18yrs patients registered with an LLR GP including those residing out of area. The CCG was asked to clarify if the service information was on PRISM and it was noted that a communication programme was under development to confirm who can refer to the service.

Information Technology - The membership, particularly the more rural practices in Rutland raised an issue regarding poor internet connectivity at their branch surgeries and how this impacts upon GP/nurse consultations. The membership wanted assurance that everything that can be done to address this important issue has been explored and that practices will be supported by the CCG to resolve the issues. Dr Purohit requested for the IT issue to be taken forward for a


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resolution to be found. Dr Palin requested for Mr Sacks to identify a resolution regarding the IT issues in rural practices in Rutland.

Oadby and Wigston: Dr Vivek Varakantam drew attention to details in the report and highlighted the following key areas:

Transferring Care Safely - The locality were updated on the transferring care safely work. GPs were advised that this was being piloted currently with two practices within the CCG and that ELR CCG would be the first CCG roll out from Nov. This joint initiative which is being developed across LLR will look at improving handover issues, left shift work and new reporting pathways to raise issues safely. GPs were concerned about the level of reporting that they would need to undertake but were receptive to this new initiative.

Urgent Care - Paula Vaughan attended to the locality to further progress discussions around plans for urgent care. The current model was outlined and consistency with opening hours was highlighted. GPs were keen to explore options for providing services by the sub areas during in hours but as a whole locality for out of hours. The locality was enthusiastic about the prospect of urgent care, and a number of discussions had already taken place prior to the locality meeting. Some concerns were raised around the demand for particular GPs but all were in agreement that further information was needed to aid discussion and the locality were keen to have federation involvement. The Federation felt that the locality was in an advanced stage compared to other areas with regards to joint working. Further information was requested from the CCG to help with the discussions.

Blaby and Lutterworth: Dr Glover drew attention to page 5 of the report highlighting the following key areas for the Blaby and Lutterworth Locality.

Community Paediatrics – During a meeting on 1 November Sue Sutton, the LLR Alliance manager gave a verbal update on the issues of the service; the City and County had two different models of working which had created pressures mainly in Lutterworth but also to a lesser degree in Rutland and Harborough. They had started to work closely with LPT and the Children’s and Family Team to review demand and capacity, review if other Health Care Professionals could take on certain roles and align the City and County model. The members felt the current contract processes were

Tim Sacks


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unsatisfactory as there were no levers when the service fell short of its requirements. The membership would like to understand why a community service, is under the UHL (acute) pillar of the alliance contract? Dr Randell added that discussions on community paediatrics have been occurring year on year and it seems nothing is progressing from these conversations. Dr Johnson added that although this is a community service, the UHL pillar does not service this which does not seem to make sense. Discussions were had that community services should not sit under the UHL pillar and more under alliance management. Mrs O’Brien added that this is a contract issue which sits in the LC CCG hosted contacts team. The frustrations and concerns have been noted and will be addressed with the LC contracts team. It was concluded than a plan can be expected at the next Governing Body meeting.

Dr Palin concluded that an email to be sent to the LC CCG contracts team and to invite appropriate lead for an update at the next meeting. It was RESOLVED to:

RECEIVE the report.

Carmel O’Brien

B/17/200 Integrated Patient Experience and Engagement Report: Q2 2017/18 (Paper L) Mrs O’Brien presented the report and stated that it summarises ELR CCG’s patient experience and engagement activities and demonstrates how feedback is, and will be used to influence service development and changes and to identify trends, learning, and actions needed and planned improvements.

Attention was drawn to the following sections: patient engagement, patient feedback, Annual General Meeting (AGM), GP patient surveys, Freedom of Information Requests and listening booths activity. It was RESOLVED to:

RECEIVE the report.

B/17/201 Healthwatch Leicestershire Quick Poll Survey (Paper M) In the absence of Mrs Sue Staples, Dr Palin presented the report and


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highlighted that the content of the paper is extremely useful and future such surveys are to be brought to the Governing Body. Further questions were invited on the paper. Dr Glover noticed an error on page 3 regarding the number of listed practices in the ELR CCG. The report currently suggests 33. Mr Sacks responded that formally there are 33 practices listed as under ELR, this includes the Assist Practice and the Violent Patients’ Service, however these two practices are not part of the CCG formal membership. Mr Smith observed that if only 19 practices out of 63 in total responded to the survey, then LC CCG is under represented throughout the survey. Mrs Sue Staples was thanked for the hard work that has gone into the report. It was RESOLVED to:

RECEIVE the report.

B/17/202 Summary report from the Audit Committee meeting in 10 October 2017 and approved minutes from August 2017 (Paper N) Mr Kendrick has taken the papers as read and invited any questions. No questions were raised. It was RESOLVED to:

RECEIVE the report.

B/17/203 Summary Report from the Provider Performance Assurance Group (PPAG) (October 2017) (Paper O) Mr Kendrick has taken the papers as read and invited any questions. No questions were raised and it was highlighted that the poor performance figures from IAPT, EMAS and 62 day waits for cancer patients are to be addressed from a corporate perspective. It was RESOLVED to:

RECEIVE the report.

B/17/204 A verbal summary report from the Primary Care Commissioning Committee (PCCC) meeting in November 2017 and approved minutes from October 2017 (Paper P) Mr Wood gave a verbal summary and highlighted that the Committee received feedback on the Sustainable Transformation Partnership


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(STP) from NHS England. Mrs Sacks added that the report was comprehensive and it was RAG rated Green across the board which is very positive so far. Dr Andy Ker expressed appreciation for the hard work and the reported the green rating across the board and formally thanked all parties involved. It was RESOLVED to:

RECEIVE the report

B/17/205 A verbal summary report from the Integrated Governance Committee meeting in November 2017 with approved minutes from October 2017 (Paper Q) Dr Tabitha Randell provided a verbal update following the IGC in November and highlighted that primary care performance dashboard would be presented to the committee and may be incorporated into the corporate performance report. The committee approved the following papers: PREVENT strategy, Modern Slavery Statement, Care Home delivery plan, Patient Group Direction Policy and 6 separate PGDs were also approved. The following papers were received by the Committee: hosted safeguarding report Q2, Special Educational Needs and/or Disability (SEND) assurance return and Q2 update, Patient safety report, National Diabetes Prevention Programme and lastly primary care Urinary Tract Infections supporting material for care home service users. It was RESOLVED to:

RECEIVE the report

B/17/206 Summary Report from the Financial Turnaround Committee (October 2017) Mr Wood mentioned that he chaired the meeting in Mr Smith’s absence and that there was nothing more to add following Ms Enoux’s finance update earlier on in the agenda and reiterated that the CCG is in a difficult and tight financial position which is reflected within the report. It was RESOLVED to:

RECEIVE the report


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B/17/207 System Leadership team meeting approved minutes September 2017 (Paper R) Dr Palin noted the report as read and invited any further questions. Dr Johnson questioned how the subject of urgent care can take place in a meeting where there are no relevant people with the background to add to the discussion. Mrs English responded that Sue Locke had attended the meeting who leads on ED. It was RESOLVED to:

RECEIVE the report

B/17/208 Date of next meeting Dr Palin thanked the members of public for their attendance. The next meeting of the Governing Body of the East Leicestershire and Rutland CCG Governing Body will be take place on Tuesday 12 December 2017, Council Chambers, County Hall, Glenfield, Leicester. Meeting concluded at 12:00pm

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Paper B ELR CCG Governing Body Meeting

12 December 2017

1

NHS EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP

ACTION NOTES

Minute No. Meeting Item Responsible Officer

Action Required To be completed

by

Progress as at December 2017

Status

B/17/178 October 2017

Summary Report from the Provider Performance Assurance Group PPAG (September 2017)

Dr Richard Palin / Karen

English

Write to WL CCG raising concerns in relation to EMAS performance particularly across ELR CCG.

November 2017

December

2017

Action superseded by action further down on the action log relating to letter to NHS England. ACTION CLOSED

GREEN

B/17/188 November 2017

Minutes of the previous meeting

Carmel O’Brien

To provide amendments to penultimate paragraph on page 14 of the October 2017 minutes.

November 2017

Amendments provided. ACTION COMPLETE

GREEN


Accountable Officer’s Corporate Report

Daljit K. Bains

Consultation on draft Leicester, Leicestershire and Rutland (LLR) Carers’ Strategy

immediate Email containing draft Strategy circulated to Governing Body 15 November 2017. ACTION COMPLETE

GREEN



Daljit K. Bains

Draft Equality and Inclusion Strategy 2017 - 2020 to be circulated to Governing Body for comments.

End Nov / early Dec

2017

To be circulated week commencing 4 December 2017.

AMBER


Finance Report: Month 6 update Report - Prescribing

Donna Enoux

Paragraph 22 details the remainder of the budget. Clarification required on the level of risk remaining against the forecast.

November 2017

Donna Enoux emailed Dr Graham Johnson with an explanation. ACTION COMPLETE

GREEN

Outstanding On-going Completed

Key


12 December 2017

2



by


Status


Finance Report: Month 6 update Report - Prescribing

Tim Sacks

To liaise with John Nicholls (Head of Prescribing) to ensure communication is circulated to GP practices as soon as possible in relation to high and low cost drugs.

November 2017

Verbal update to be provided at the meeting.

AMBER


Performance Assurance Report: Emergency Department Performance figures

Paul Gibara

Mr Gibara to compile a letter to NHS England from Dr Palin highlighting the CCG’s concerns in respect of categorising activity of urgent care centres as category 3 and the implications of this.

December 2017

Letter compiled in draft for agreement by the Chairman. ACTION COMPLETE

GREEN


Performance Assurance Report: EMAS Deep Dive

Paul Gibara

To provide Dr Palin with a summary of the key issues from the EMAS deep dive following PPAG meeting.

End November

2017

ACTION COMPLETE GREEN


Board Assurance Framework 2017/18

Carmel O’Brien

To review content and residual risk scores for BAF 1, BAF 2 and BAF 3.

December 2017


AMBER


Locality Chairs report: Melton Rutland and Harborough (MRH)

Tim Sacks To identify a resolution regarding the IT issues at rural practices in Rutland.

December 2017


AMBER


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3



by


Status


Locality Chairs report: Blaby and Lutterworth)

Carmel O’Brien

Email to be sent to the LC CCG contracts team and to request an update on Community Paediatrics for the next meeting.

December 2017

ACTION COMPLETE GREEN

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Paper C East Leicestershire and Rutland CCG Governing Body meeting

12 December 2017

1 Dr Richard Palin Chairman

EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING

12 December 2017

Chairman’s Report Introduction 1. The purpose of this report is to provide an overview and update of some of the key

constitutional or strategic updates that affect the Governing Body and meetings that I have attended since my last report in November 2017.

GP Locality Lead appointment to the Governing Body

2. I am pleased to welcome Dr Anuj Chahal, the newly appointed GP Locality Lead

for the Market Harborough sub-locality.

3. Dr Chahal brings a wealth of experience to the Governing Body as a clinician and also having held previous positions in the ELR GP Federation and LLR Provider Company Ltd.

Meetings attended

4. Over the last month I have attended a number of key meetings including:

• System Leadership Team meeting;

• The Commissioning Collaborative Board meeting;

• Senior Leaders’ Collaborative meeting which was a facilitated event. This event followed on from the meeting held in August where the 3 Leicester, Leicestershire and Rutland (LLR) CCG Chairs, clinical vice chairs and Managing Directors met to agree a way forward in respect of further collaborative working across LLR;

• Joint NHS Board Meeting held at the end of November 2017 to identify next

steps in relation to the Sustainable Transformation Partnership plan. An update will be presented to the Governing Body in due course; and

• A meeting with the NHS England’s regional team to discuss the financial

challenges across the LLR system. This meeting was attended by all three LLR CCG Chairs, Managing Directors and clinical vice chairs.

Recommendations The East Leicestershire and Rutland CCG Governing Body is requested to: RECEIVE the contents of the report.

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Paper D East Leicestershire and Rutland CCG Governing Body meeting

12 December 2017

Karen English 1 Accountable Officer

NHS EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP

GOVERNING BODY MEETING 12 December 2017


Introduction 1. This report sets out to the Governing Body some of the key activities the

Executive Management Team (EMT) and I have been involved in since the last meeting of the Governing Body in November 2017.

East Midlands Congenital Heart Centre 2. We are pleased to hear, that at the end of November 2017, NHS England

confirmed that it will continue to commission heart services at the East Midlands Congenital Heart Centre (EMCHC) based at the Glenfield Hospital, Leicester. This means that the centre will continue to provide lifesaving surgery for children and adults in the region.

3. The decision made by the NHS England puts an end to years of uncertainty. This is a testament to the professionalism and determination of all the EMCHC staff, of stakeholders and partner organisations that have fought to ensure the service continues to be located in the region to deliver a high quality of health care.

Collaborative Commissioning Board 4. Further to the discussion at the last meeting, the Governing Body agreed to

establish the Commissioning Collaborative Board as a joint committee of the CCG, following agreement by the membership. Agreement from the membership on changes to the Constitution will be sought in the New Year, and then submitted to NHS England for formal approval. In the meantime, the CCG will work in conjunction with Leicester City CCG and West Leicestershire CCG to ensure the new Commissioning Collaborative Board joint committee is established in shadow form from January 2018.

Annual Practice Nurse and HCA Conference 5. Over 150 Practice Nurses and Healthcare Assistants (HCAs) from across

Leicester, Leicestershire and Rutland came together for their annual conference on Wednesday 29 November 2017.

6. The conference, which was organised by the General Practice Training Team based at ELR CCG, is an opportunity for practice nurses and HCAs to learn more about specific areas of healthcare and receive an update on some of the latest developments that affect patients.

7. Nurses and HCAs also heard from Chief Operating Officer, Mr Tim Sacks about

some of the changes proposed under the Sustainability and Transformation

Paper D East Leicestershire and Rutland CCG Governing Body meeting

12 December 2017

Karen English 2 Accountable Officer

Partnership plan, and some of the plans to address workforce challenges across Leicester, Leicestershire and Rutland.

PUBLICATIONS 8. Publications and updates published by NHS England via its fortnightly newsletter

Bulletin for CCGs can be found at the following http://www.england.nhs.uk/publications/bulletins/bulletin-for-ccgs/. The Executive Management Team undertakes a regular review of the content of the Bulletin and ensure actions are taken accordingly. Assurances and updates are reported through to the Governing Body as evident on the agenda and through updates in the Accountable Officer’s report.

Recommendation The East Leicestershire and Rutland CCG Governing Body is requested to: RECEIVE the contents of the report.

http://www.england.nhs.uk/publications/bulletins/bulletin-for-ccgs/

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Paper E East Leicestershire and Rutland Governing Body Meeting

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1


GOVERNING BODY MEETING

Front Sheet

REPORT TITLE: Finance Report – October 2017 (month 7)

MEETING DATE: 12th December 2017

REPORT BY: Colin Groom, Deputy Chief Finance Officer

SPONSORED BY: Donna Enoux, Chief Finance Officer

PRESENTER: Donna Enoux, Chief Finance Officer

EXECUTIVE SUMMARY: This report and attached appendices contain the financial position for 2017/18 for East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) at month 7. The first page of this report contains an executive summary.

RECOMMENDATIONS:

The ELR CCG Governing Body is requested to: Receive for information the contents of the report and the appendices attached Note the financial position at month 7 and the risks to the achievement of the year end control total surplus. Note the latest iteration of the NHSE Metric Return.

REPORT SUPPORTS THE FOLLOWING STRATEGIC AIM(S) 2017 – 2018: Transform services and enhance quality of life for people with long-term conditions

Improve integration of local services between health and social care; and between acute and primary/community care.

Improve the quality of care – clinical effectiveness, safety and patient experience

Listening to our patients and public – acting on what patients and the public tell us.

Reduce inequalities in access to healthcare

Living within our means using public money effectively

Implementing key enablers to support the strategic aims (e.g. constitutional and governance arrangements, communications and patient engagement).

EQUALITY ANALYSIS

An Equality Analysis and due regard to the positive general duties of the Equality Act 2010 has not been undertaken in the development of this report as it is judged that it is not proportionate on the basis that the financial reporting underpins the commissioning strategy and priorities of the CCG. The commissioning strategy and priorities have and continue to be equality impact assessed as the strategy is reviewed and refreshed and this includes the financial plans. This completes the due regard required.


12 December 2017

2


12 December 2017

Finance Report Executive Summary Financial Position 1. The detailed report confirms the CCG is £7.307m away from plan at month 7. The

CCG has been in discussion with NHSE local and regional teams over the level of financial pressures being experienced in 2017/18. These can be broadly grouped into three main categories;

a. finalisation of accruals entered to 2016/17 accounts b. in year QIPP delivery risk/slippage c. other in year variances

2. Risks remaining in the year end forecast include further pressures from 2016/17

accruals, QIPP delivery and other operational cost pressures.

3. The overall financial summary position shared with NHS England is as follows

Year to Date

£m

Forecast before

Financial Recovery Actions

£m

Worst Case before


£m

Best Case before


£m Pressures from 2016/17 5.919 5.919 7.508 5.919 QIPP slippage 1.897 4.614 4.864 4.614 In year operational variances 3.854 5.705 6.456 4.886 Release of contingency reserve (2.066) (2.066) (2.066) (2.066) Replacement/extended QIPP schemes

(2.297) (6.028) (5.276) (6.408)

Year to date variance month 7 7.307 8.144 11.486 6.945

Other Financial Metrics 4. Cash flow – Cash target met for the month. Cumulative cash drawings are £1.8m

ahead of a straight line as a result of settling creditors from 2016/17. Review ongoing to ensure CCG can operate within it’s annual cash targets due to the pressures in the overall financial position.

5. Better Payment Practice Code – continued strong performance in month. All cumulative metrics in excess of 99.3% compliance

6. Capital – no operational CCG capital expenditure anticipated. GPIT capital purchases progressing.

7. CSU Performance – All CCG tasks completed to timetables and KPIs achieved.


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3


GOVERNING BODY MEETING 12 December 2017

Detailed Finance Report

Introduction 1. This report and attached appendices provide details of the financial position for East

Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) at month 7 of 2017/18, the pressures contained within that position and the risks to the delivery of the CCG’s financial targets for the year.

2017/18 Allocations 2. The overall revenue allocation for ELR CCG at month 7 stands at £420,497 an

increase of £52k including a further £50k for LD Transformation funding.

3. The CCG has no approved capital funding for 2017/18.

4. The allocation is detailed in Appendix A. Financial Performance 5. The budget statement in Appendix B details the ledger position for 2017/18 as at

month 7. The year to date position is a deficit of £2.810m compared to a year to date planned surplus of £4.496m and therefore the CCG is £7.307m over plan at month 7.

6. This is a material movement from the variance of £3.544m quoted at month 6. As previously reported, the CCG has faced a number of financial pressures relating to the finalisation of certain debtor and creditor balances from 2016/17. Further items finalised in the month have increased this pressure from £4.65m at month 6 to £5.919m at month 7. The remainder of the movement in the overall monthly position is a result of corrections to previous month’s reporting totalling £2.47m. These corrections followed a detailed review by the CCG and NHS England as part of an ongoing process to firm up the risks to delivery of the control total for 2017/18.

7. The main components of the year to date variance from plan are shown below;

£m Pressures from 2016/17 5.919 QIPP slippage 1.897 In year operational variances 3.854 Release of contingency reserve (2.066) Replacement/extended QIPP schemes (2.297) Year to date variance month 7 7.307

8. With the agreement of NHS England, the CCG continues to forecast the

achievement of the required surplus of £7.708m by year end but is in discussion over the level of risk contained within this position. At the time of writing the CCG has


12 December 2017

4

identified to NHSE that the likely outturn is a £6.9m-£8.9m variance from plan and is due to meet with Regional NHSE colleagues as part of a formal escalation over these risks.

9. Further updates following this escalation meeting will be provided to the Governing Body.

Acute Commissioning 10. Acute budgets for the year total £193.254m, an increase of £0.511m following the

realignment of Out of Hours and Visiting Services budgets.

11. Acute budgets include £137.344m for UHL, £7.348m in respect of the Alliance, £27.667m in respect of NHS providers outside Leicestershire and Rutland and £8.499m in respect of East Midlands Ambulance Service.

12. In addition, approximately £0.7m is held centrally in reserves relating to 0.5% CQUIN for UHL and a number of out of county providers that is required to be held uncommitted at this stage to support the system risk reserve but may be made available to the providers later in the year if the CCG is instructed to do so by NHSE.

13. Month 6 activity information has been received for all Acute Contracts and has been

used as the basis for the position reported at month 7. This data is subject to a series of reconciliation processes, as a result of which a number of challenges and queries have been raised to providers over the accuracy of the reported position.

14. As a result of overperformance across a range of services, particularly outpatients,

the UHL contract is reported as £0.989m overspent at Month 7. Taking account of QIPP to be delivered later in the year the position is forecast to increase slightly to an overspend of £1.136m by year end. This is an increase over the forecast of £0.391m at month 6, largely due to corrections in the value of QIPP that is now assumed to be deliverable by the year end.

15. The Alliance position at month 7 is an underspend of £0.384m (Month 6 £0.415m)

and the forecast is for an underspend of £0.633m. This underspend is across most PODs but is slowing as a result of aborbing a level of activity from Nuffield who have given notice on Ophtalmology and Gynaecology day cases during 2017-18.

16. In aggregate, the Out Of County Contracts are £0.551m overspent at month 7

(month 6 £0.26m). These include a continuing material under spend at United Lincolnshire Hospitals and a material overspend at North West Anglia Foundation Trust. These variances are believed to be partially offsetting as a result of the Grantham Hospital A&E overnight closure due to staffing shortfalls.

17. The Independent Sector contracts are currently reporting a £0.279m overspend at

month 7 (month 6 £0.126m), predicted to rise to £0.528m by year end. The Newmedica, Woodland Hospital and Spire contracts account for the majority of the overspend.


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5

Non-Acute Commissioning

18. Overall Non-Acute Commissioning budgets stand at £109.621m an increase of £2.375m due to restating the Better Care Fund budget. This budget had been understated in the original plan for 2017/18 and has been provided from central reserves.

19. The annual budget for Leicestershire Partnership Trust (LPT) is £55.1m including an

allowance for memory clinic drugs. The forecast position for this contract is an overspend of £0.566m, a worsening of £0.346m from the position quoted at month 6, largely due to further QIPP slippage.

20. The aggregate of Continuing Healthcare and similar Personalised Commissioning

and individually commissioned services is a budget of £23.885m. The combined forecast against these budgets is for an overspend of £1.369m, an increase of £0.54m over that reported at month 6 as a result of updated information on the cost of Discharge to Assess placements and additional growth in package numbers and cost over the budgeted allowance.

Primary Care Commissioning and Other

21. Overall Primary Care budgets stand at £97.794m, a decrease of £0.511m following

the realignment of Visiting Services budgets into the Out of Ours contract line. Prescribing 22. Prescribing budgets total £48.729m. The year to date and forecast values are based

on extrapolations of April to August prescribing data. The year to date position for GP prescribing is a £30k overspend but allowing for the anticipated benefit of material savings from the Pregabalin price reduction and over delivery of QIPP in the second half of the year is forecast to switch to a £520k underspend by year end. A level of risk remains against this forecast as the price of certain items is being affected by reported stock shortages (No Cheaper Stock Obtainable) and the continued growth in Direct Oral Anticoagulant (DOAC) prescribing.

23. In addition to the GP prescribing position, Central prescribing and High Cost Drugs budgets are forecast to contribute a further £82k and £57k underspend respectively.

Delegated Primary Care budgets 24. Delegated Primary Care (Co-Commissioning) budgets total £41.57m. A net budget of

£40.57m is modelled in Appendix B, as the delegated budget of £1.0m for the Oadby Walk In Centre is recorded within the Minor Injury Unit budget.

25. Overspends are being projected against in year premises costs, locum sickness and indemnity insurance budgets, contributing to a forecast overspend of £0.263m by year end.


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Other Primary Care Budgets 26. Budgets totalling £8.492m have been allocated for Other Primary Care Services

including Walk in Centres, GP enhanced services and other local initiatives. These budgets include a level of investment to support practice transformation in accordance with national guidelines.

27. At month 7, these budgets are £0.113m underspent, forecast to rise to £0.124m by year end. This is predominantly as a result of the recognition of recharges to neighbouring CCGs for their patients’ attendance at the Oadby Urgent Care Centre.

Running Costs 28. Running costs are forecast to breakeven against the £6.381m budget. A series of

vacancies have supported the delivery of savings to date and detailed discussions are continuing with budget holders to ensure this delivery can be maintained.

Miscellaneous including Reserves 29. The annual budget of £5.740m is a reduction of £2.325m to provide the required

funding to correct the Better Care Fund Budget. The position shown on Appendix B comprises the following;

Annual Budget (£000)

Forecast Expenditure

(£000) Variance

(£000)

Transformation Reserve 1,824 1,824 0 Contingency Reserve 2,066 0 (2,066) Corporate Support Costs 1,793 1,754 (38) Commissioning Reserve 1,183 1,183 0 Other Reserves (1,126) 0 1,126 Impact of Prior year accruals 0 5,919 5,919 Other mitigations 0 (8,144) (8,144) Total Miscellaneous including Reserves 5,740 2,536 (3,203)

30. The CCG is required to create a 1% transformation reserve at the start of the year.

Elements of this reserve can be committed to non-recurrent items in year but the CCG is required to hold the equivalent of 0.5% of its recurrent programme allocation uncommitted as a system risk reserve. The value of £1.824m in the table above reflects this uncommitted value.

31. The CCG 0.5% Contingency of £2.066m, created to cover any cost pressures that may arise, had been released in full by month 4 and therefore the CCG has no further contingency to guard against any additional pressures that may arise later in the year.


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32. Corporate functions to directly support clinical services such as CSU support to Personalised Commissioning and the support to the Better Care Together (BCT) programme total £1.793m. These functions are forecast to underspend by £0.038m by year end.

33. Commissioning Reserves – The budget and forecast expenditure in this reserve is

made up of the following elements;

• £0.729m relating to 0.5% CQUIN values retained from the baseline of UHL, Derby, Kettering and United Lincolnshire Hospitals. These values are retained by the CCG to support the system risk reserve. The CCG will receive instructions later in the year for the treatment of these values.

• £0.454m to cover the anticipated allocation reduction relating to overseas visitors funding

34. Other Reserves – In month 6, this reserve held approximately £1.3m of uncommitted

funds to support general cost pressures. As reported above, subsequent to month 6 reporting it was recognised that the contribution to the Better Care Fund was underfunded by £2.4m. This value has been transferred from the other reserves line resulting in the negative budget of £1.126m in the table above. This value effectively representing an unidentified planning gap at the start of the year.

35. As reported earlier, the impact of finalising prior year accruals, including the impact of mediation has resulted in a cost pressure of £5.919m

36. Other mitigations – as agreed with NHS England, this represents the value of additional mitigations being sought to support the planned requirement of delivering a surplus of £7.708m. This remains the subject of the escalation review meeting referenced above.

Capital 37. The CCG has not been allocated any capital in it’s base plan for 2017-18. Bids are

still being pursued to support the development of learning disability facilities to support the transforming care agenda and it is possible that if slippage is encountered by those CCGs within the region that have received capital funding, further bids may be accepted in year.

38. Appendix F confirms the level of GPIT capital being processed by the CCG on behalf of NHS England. Assets purchased using these funds will remain on the asset register of NHSE.

Better Payment Practice Code (BPPC)

39. The BPPC performance for the CCG as at month 7 is shown in Appendix C and

confirms another strong performance in month taking the cumulative performance to the following levels;

• NHS creditors (number) – 99.36% • NHS creditors (value) – 99.95% • Non NHS creditors (number) – 99.98% • Non NHS creditors (value) – 99.96%


12 December 2017

8

CSU Performance 40. The ‘Month End Summary CFO Report’ for month 7 confirmed that all required tasks

supporting the CCG were completed to deadline and all KPIs achieved. All payroll payovers were made by the deadlines and all control accounts were reconciled and the full reconciliation pack distributed.

41. The following control codes have been flagged as amber

• Manual payments as it contains balances from month 2 and month 4 that are anticipated to be cleared in month 8.

• Employee overpayments includes a balance from month 6 which requires recharging to a neighbouring CCG. The invoice has been raised in month 8.

• All other codes are rated green.

42. As shown in the Statement of Financial Position and Cash Flow Statement, the CCG closing cash book balance for month 7 was £64k and the closing bank balance was £180k. Since its authorisation, the CCG has monitored itself against the initial NHSE requirement to hold no more than 1.25% of their monthly draw down at month end. Confirmation has been received that this target is no longer actively monitored by NHSE but the CCG is continuing to operate this approach as it is considered best practice. For October, this target was £359k and therefore the CCG has comfortably achieved against its ambition.

Statement of Financial Position and Cash Flow Statement 43. Appendix D outlines the Statement of Financial Position for ELR CCG as at the end

of March 17 and the most recent three months of the current year.

44. Current assets have reduced by approximately £0.6m following the cancellation of ICS recharge invoices to local providers. Current liabilities have increased by approximately £5m due to the payment profile of Co-Commissioning, BCF and other local authority agreements.

45. Appendix E outlines the Cash Flow Statement for ELR CCG for Month 7. This shows that, by the end of October, the CCG cash drawings are approximately £1.8m higher than might be assumed in a straight 1/12ths profile. This has reduced significantly following the payment of creditors from 2016/17 earlier in the year.

46. The CCG is reviewing cash forecasts alongside the review of risks to the control total

to ensure it is able to operate within the nationally identified Maximum Cash Drawdown (MCD).

NHSE Reporting 47. As previously reported, the CCG is required to submit to NHS England a combined

finance, activity, contracting and QIPP report (Metric Return). Within this return, a range of activity areas are reported against the latest NHSE approved annual plan.


12 December 2017

9

48. Variances highlighted via these returns are discussed between the CCG and NHSE at monthly operational meetings and at formal quarterly assurance meetings. Outpatients, GP and other referrals, Non elective admissions and A&E are over plan and detailed actions are in place to address these.

Risks 49. As stated above, at the time of writing the CCG is in dialogue with NHS England over

a likely variance from plan of £6.9m-£8.9m by year end prior to the production of a formal Financial Recovery Plan (FRP). A number of additional risks remain that have the potential to further adversely affect the CCG’s financial position for 2017/18. These are highlighted below;

• Non achievement of QIPP schemes. At month 7, £0.25m of QIPP schemes are RAG rated as red meaning they do not have sufficiently developed plans to provide assurance of delivery. A further £3.01m of schemes are rated Amber and therefore also pose a level of risk

• In year cost pressures relating to support to GP practices. • Any further risk linked to the finalisation of remaining accruals for 2016-17

against values provided in the accounts. • Resolution of a number of ongoing contract discussion areas including;

o Impact of independent sector providers giving notice on certain specialties with relevant activity to be transferred to Alliance subject to capacity.

o Out Of County and Independent Sector provider over performance due to capacity constraints at UHL

• Running Cost allocation overspend • Variable elements of the LPT Mental Health contract beyond the values

included in the forecast position. Summary 50. The financial position of ELR CCG is reporting a year to date deficit of £2.810m, a

variance of £7.307m against the plan of £4.496m. The financial forecast is a surplus of £7,708k in accordance with the requirement to reflect the cumulative surplus from 31 March 2017 in the CCG ledger, however the CCG is in discussions with NHSE over the pressures within this forecast that are indicating a likely variance, before FRP of £6.9m-£8.9m.

Recommendations: The East Leicestershire and Rutland CCG Governing Body is requested to: Receive for information the contents of the report and the appendices attached. Note the financial position at month 7, the reported forecast achievement of the year end control total surplus and the associated risks and mitigations and the ongoing discussion with NHSE over these pressures. Note the submission of the latest metric return to NHSE.

ELR CCG Allocation 2017/18 Appendix A

M1 M2 M3 M4 M5 M6 M7

Movement

from M1

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

Recurrent allocation (programme)

Recurrent baseline 364,802 364,802 364,802 364,802 364,802 364,802 364,802 0

Primary Care Co-Commissioning 41,720 41,720 41,720 41,720 41,720 41,720 41,720 0

NUH Pacemakers 7 7 7 7 7 7 7 0

Co-Commissioning Allocation adjustment (127) (127) (127) (127) (127) (127) (127) 0

Renal Repatriation 13 13 13 13 13 13 13 0

Bone Morphogenetic Protein (3) (3) (3) (3) (3) (3) (3) 0

Diabetic Eye Screening Programme (67) (67) (67) (67) (67) (67) (67) 0

Wheelchair funding 33 33 33 33 33 33

Total recurrent allocation (programme) 406,345 406,345 406,378 406,378 406,378 406,378 406,378 33

Non recurrent allocation (programme)

IR Changes (Specialised Services) (1,362) (1,362) (1,362) (1,362) (1,362) (1,362) (1,362) 0

HRG4+ changes (158) (158) (158) (158) (158) (158) (158) 0

Return of previous year surplus adjusted for in year draw up 7,674 7,674 7,674 7,674 7,674 7,674 7,674

Reception and clerical training - (Training Care Navigators and Medical Assistants) 56 56 56 56 56 56

NHS WiFi 142 142 142 142 142 142

Market rents adjustment 509 509 509 509 509 509

Paramedic Rebanding Additional Funding 2017-18 85 85 85 85 85 85

HSCN - GP funding 100 100 100 100 100 100

Surplus/Deficit Carry Forward - 1617 Final Outturn 2 2 2 2 2 2

Sterile Products and Suspended Doctors Transfer (76) (76) (76) (76) (76)

EMAS Resilience Funding 2017/18 86 86 86 86 86

LD transformation funding for TCP 60 60 60 60 60

NHS Diabetes Prevention Programme 14 14 14 14

Additional month 5 IR Changes - (Specialised Services) (45) (45) (45) (45)

Q2 LD transformation funding for TCP 59 59 59

Armed Forces Out of Hours GP Funding 14 14

LD transformation funding for TCP - Accelerated Discharge 50 50

IR Changes (Specialised Services) (12) (12)

0

Total non recurrent allocation (programme) (1,520) 6,154 7,048 7,118 7,087 7,146 7,198 8,718

Total allocations (programme) 404,825 412,499 413,426 413,496 413,465 413,524 413,576 8,751

Recurrent allocation (running costs)

Recurrent baseline 6,921 6,921 6,921 6,921 6,921 6,921 6,921 0

Non recurrent allocation (running costs)

Total allocations (running costs) 6,921 6,921 6,921 6,921 6,921 6,921 6,921 0

TOTAL ALLOCATIONS 411,746 419,420 420,347 420,417 420,386 420,445 420,497 8,751

Capital Funding Approved by NHSE 0 0 0 0 0 0 0 0

Allocations formally received 0 0 0 0 0 0 0 0

East Leicestershire & Rutland CCG Summary - 2017/18 Month 7 Appendix B

Budget (£000)Expenditure

(£000)

Variance

(£000)Budget (£000)

Expenditure

(£000)

Variance

(£000)

Total allocation 246,061 246,061 0 420,497 420,497 0

Acute Commissioning 113,651 115,532 1,881 193,254 195,325 2,070

Non-acute Commissioning 63,988 65,337 1,348 109,621 111,256 1,636

Practice Prescribing 28,607 28,565 (41) 48,729 48,088 (641)

GP Commissioning 23,667 23,984 317 40,572 40,835 263

Primary Care Services 4,954 4,841 (113) 8,492 8,368 (124)

Miscellaneous (inc reserves) 2,978 6,911 3,933 5,740 2,536 (3,203)

Total Programme Expenditure 237,844 245,169 7,325 406,408 406,408 0

Total Running Costs 3,721 3,703 (18) 6,381 6,381 (0)

Total Expenditure 241,565 248,871 7,307 412,789 412,789 0

Surplus

Programme control total 4,180 -3,145 (7,325) 7,168 7,168 0

Running Costs control total 317 335 18 540 540 0

Total control total 4,496 -2,810 (7,307) 7,708 7,708 0

Year to Date Full Year Forecast

Appendix C

A B C D E F A B C D E F

No of Bills

Paid Within

Period

No of Bills

Paid Within

Target

% of Bills

Paid Within

Target

Value of Bills

Paid Within

Period

Value of Bills

Paid Within

Target

% Value of

Bills Paid

Within

Target

No of Bills

Paid Within

Period

No of Bills

Paid Within

Target

% of Bills

Paid Within

Target

Value of Bills

Paid Within

Period

Value of Bills

Paid Within

Target

% Value of

Bills Paid

Within

TargetNo. No. % £'000 £'000 % No. No. % £'000 £'000 %

April 319 318 99.69 20,533 20,531 99.99 539 539 100.00 5,636 5,636 100.00May 200 196 98.00 20,434 20,360 99.64 768 767 99.87 5,657 5,646 99.81June 314 314 100.00 21,094 21,094 100.00 814 814 100.00 6,239 6,239 100.00July 277 277 100.00 23,265 23,265 100.00 543 543 100.00 2,620 2,620 100.00Aug 358 355 99.16 19,874 19,874 100.00 774 774 100.00 3,523 3,523 100.00September 189 189 100.00 19,772 19,772 100.00 679 679 100.00 3,353 3,353 100.00October 230 226 98.26 20,636 20,634 99.99 869 869 100.00 3,639 3,639 100.00NovemberDecemberJanuaryFebruaryMarch

Totals 1,887 1,875 99.36 145,608 145,530 99.95 4,986 4,985 99.98 30,667 30,656 99.96

East Leicestershire & Rutland CCG

Better Payment Practice Code October 2017

NHS Creditors Non NHS Creditors

Appendix D

Balance as at

31 March 2017

Balance as at

31 August 2017

Balance as at

30th September

2017

Balance as at

31st October

2017

£'000s £'000s £'000s £'000s

Non Current Assets:

Premises, Plant, Fixtures & Fittings 1,686 1,558 1,532 1,507

IM&T 95 84 81 79

Other 0 0 0 0

Long-term Receivables 0 0 0 0

TOTAL Non Current Assets 1,780 1,641 1,614 1,586 Sub Analysis 31 October 2017

Current Assets:

Inventories 0 0 0 0

Trade Receivables 2,269 1,395 1,325 758 Trade Receivables Volume

UHL Maternity Prepayment 1,483 1,483 1,483 1,483 Not yet due 3 0

Prepayments – In Month 152 1,110 785 832 1-30 days 22 7

Accrued Income 1,843 273 408 516 31-60 days 11 136

Includes £127k to recharge ICS bed risk share contributions to West

Leicestershire and Leicester City CCGs

VAT and CHC Risk Pool 367 64 78 49 61-90 days 8 121

Includes £55k for Capital Charge - Alliance Capital Depreciation, £24k

Recharge of post acute reablement at Peaker Park Care Home

2016/17.

Cash and Cash Equivalents 161 13 205 64 91+ days 107 495

Other Receivables 7 7 151 758

TOTAL Current Assets 6,275 4,338 4,291 3,709

TOTAL ASSETS 8,055 5,979 5,905 5,295Value

(£'000)

Trade Payables (2,282) (884) (763) (1,989) Trade Payables Volume

Prescribing Accruals (7,163) (7,949) (7,814) (7,653) Not yet due 251 1,761

Aged creditor report Includes £22.163m of payables that are not due by

31st October, these all been adjusted out of the payables values.e.g

UHL, LPT and Leicestershire County Council

Other Accruals (7,332) (4,012) (5,856) (9,922) 1-30 days 70 176

Payroll Creditors (182) (189) (178) (187) 31-60 days 32 -132Includes £180k of credit notes with local acute providers relating to

underperformance adjustments.

Provisions (199) (205) (205) (205) 61-90 days 19 -1

Borrowings 0 0 0 0 91+ days 39 185Includes £148k balance on hold with Arden and GEM CSU re CHC

disputed balance.

Total Current Liabilities (17,158) (13,239) (14,816) (19,956) 411 1,989

TOTAL LIABILITIES (17,158) (13,239) (14,816) (19,956)

ASSETS LESS LIABILITIES (Total Assets Employed) (9,103) (7,260) (8,911) (14,661)

TAXPAYERS EQUITY

General Fund (Opening Balance, Fixed) (14,502) (9,112) (9,112) (9,112)

Income & Expenditure (year to date) (403,434) (176,389) (210,655) (248,871)

Parliamentary Funding (year to date) 408,830 178,238 210,853 243,319

Co Commissioning (year to date) 0 0 0 0

Other Reserves 3 3 3 3

Total (9,103) (7,260) (8,911) (14,661)

Statement of Financial Position

Value

(£'000)

Includes £311k recharges to Leicester City CCG re attendances at

Oadby and Wigston Urgent care centre. £47k oustanding with Central

Nottighamshire Clinical Services. £31k recharges to West Leicestershire

CCG re staff recharges.£15k oustanding with Oakham Medical Practice.

Appendix E

East Leics and Rutland

03W

April May June July August September October

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

Receipts

Balance b/fwd 172 274 241 181 273 147 319

NCB-Drawdown 30,950 31,430 34,550 32,450 31,400 28,880 28,700

Other (including VAT) 1,041 163 470 675 279 438 638

Total Receipts 32,163 31,867 35,261 33,306 31,952 29,465 29,657

Payments

Creditors NHS 20,611 20,588 21,248 23,372 20,008 19,881 20,667

Creditors BACS/CHAPS 7,116 6,367 8,394 6,162 7,490 5,187 4,821

Salary BACS/CHAPS 218 224 222 228 246 236 240

Pensions (Including GP pensions) 458 369 325 394 359 410 427

Tax & NI 110 101 105 105 108 117 107

Standing Orders /Direct Debits 0 0 0 0 0 0

PCS Payments 3,376 3,977 4,786 2,772 3,594 3,315 3,215

Total - Expenditure 31,889 31,626 35,080 33,033 31,805 29,146 29,477

Balance c/fwd 274 241 181 273 147 319 180

April May June July August September October

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

Cumulative Cash Drawn 30,950 62,380 96,930 129,380 160,780 189,660 218,360

Assumed Drawdown in equal 1/12ths 30,936 61,868 92,802 123,736 154,670 185,605 216,539

Cumulative Variance to equal 1/12ths

profile 14 512 4,128 5,644 6,110 4,056 1,821

Cashflow reporting

Month 7 2017/18

Year to date

ELR CCG Capital Additions Plan 2017/18 Appendix F

Month 7

Capital Scheme

Asset

Type Scheme Description

Financial PlanYear to date

Expenditure

Forecast

Expenditure

Forecast

Variance from

Plan

Comments

£ £ £ £

CCG IT IT 0 0 0 0

CCG Capital Subtotal 0 0 0 0

CCG Assets - TOTAL 0 0 0 0

GP IT - NHSE assets IT Practice Data Migration 210,000 210,000

GP IT - NHSE assets IT Technology Refresh 400,000 400,000

GP IT Total 610,000 610,000

Not applicable to CCG Plan as

these are NHSE assets

Blank Page

Paper F ELR CCG Governing Body meeting

12 December 2017


Front Sheet

REPORT TITLE: Performance Report 2017/18

MEETING DATE: 12th December 2017

REPORT BY: Alison Buteux, Performance Manager, (MLCSU)

SPONSORED BY: Karen English - Managing Director, (ELR CCG)

PRESENTER: Paul Gibara – Chief Commissioning and Performance Officer, (ELR CCG)

EXECUTIVE SUMMARY: This report provides an overview of performance for East Leicestershire & Rutland CCG and LLR where data is available for June/July 2017. It sets out the key performance indicators that the CCG are held to account for. These are detailed in the CCG Improvement & Assessment Framework for 2017/18.

Part of the Framework includes a:

• Better Health Dashboard relating to preventative measures and: • Better Care Dashboard which links with six national clinical priorities; mental

health; dementia; learning disabilities; cancer; diabetes and maternity and the NHS Constitution.

The Key Organisational Measures demonstrate the following:

The position is worsening. 5 out of the 8 cancer targets were achieved in September. The following were not achieved:-

• 62 day waits; patients receiving first definitive treatment for cancer within 62 days of GP referral for suspected cancer and patients receiving first definitive treatment for cancer within 62 days of referral from an NHS Cancer Screening Service; and

• 31 day wait; patients receiving subsequent treatment for cancer within 31 days where that treatment is surgery.

ED continues to be a challenge. The ELR position for all providers is 0.6% worse than the UHL only position. The out of county (OOC) provider’s performance impacts on the A&E four hour wait target. It was agreed at the A&E Delivery Board (AEDB) that UHL would start reporting type 3 activity (Urgent Care Centres) within their ED daily reports. Type 3 data has been provided within this report.

RTT 18 week incompletes target was not achieved in October for ELR CCG by 0.54%. There are zero 52 week breaches a good positon for ELR CCG to be in.

IAPT performance continues to be challenging and formal contract performance routes are now underway with the provider for ELR.


12 December 2017

Dementia diagnosis rate achieved target in October at 66.8%. This will fluctuate throughout the year.

Quality Premium

2016/17 - If the assurance process runs smoothly and any appeals are resolved swiftly, we would expect that the first payment would be completed by the end of December. The second payment would be expected to appear by the end of February. Due to the late publication of Cancer data, this is a two stage payment this year.

2017/18 - Constitutional indicators are currently being reported, data is not available for the some KPIs. Performance will be monitored on a monthly basis and soon as data is published it will be reported.

RECOMMENDATIONS: The East Leicestershire and Rutland CCG Governing Body is requested to: RECEIVE the contents of the report REPORT SUPPORTS THE FOLLOWING STRATEGIC AIM(S) 2016 – 2017: Transform services and enhance quality of life for people with long-term conditions







EQUALITY ANALYSIS An Equality Analysis and due regard to the positive general duties of the Equality Act 2010 has not been undertaken in the development of this report as it is judged that it is not proportionate on the basis that the Performance Assurance reporting underpins the commissioning strategy and priorities of the CCG. This completes the due regard required.

RISK ANALYSIS AND LINK TO BOARD ASSURANCE FRAMEWORK: The content of the report identifies action(s) to be taken / are being taken to mitigate the following corporate risk(s) as identified in the Board Assurance Framework:

BAF 1: ACUTE – The quality of care provided by acute providers does not match commissioner’s expectation with respect to quality and safety. BAF 2: QUALITY – The quality of care provided by non-acute providers does not match commissioner’s expectation with respect to quality and safety. BAF 8: URGENT CARE – Increased pressure on the Emergency Department which could results in sub-optimal care due to ability to access urgent care services.


12 December 2017

1 | P a g e

This report focuses on the CCG’s Improvement & Assessment Framework (IAF) 2016/17 which contains a number of service indicators relating to Better Health and Better Care. NHS England uses these indicators to hold the CCG to account on performance, and associated delivery actions are reported where there are high risks. The report contains:

• Key Organisational Indicators (NHSE Priority Measures) • Better Health Indicators • Better Care Indicators • Better Care/ Better Health Annual Indicators • Benchmarking Report • CCG Quality Premium 2016/17 and 2017/18 • Appendix A – Cancer Breaches 104+ and Appendix B – A&E Type 3 Data

Key Messages

The Key Organisational Measures demonstrate the following:

This position is worsening. 5 out of 8 cancer targets were achieved in September. The 3 cancer targets that did not achieve were both the 62 day waits; patients receiving first definitive treatment for cancer within 62 days of GP referral for suspected cancer (16 breaches due from 1 capacity, 7 complexity, 1 patient cancelled, 1 patient choice, 2 delay and 4 other. Patients receiving first definitive treatment for cancer within 62 days of referral from an NHS Cancer Screening Service (2 breaches due to complexity and patient unfit). 31 day wait; patients receiving subsequent treatment for cancer within 31 days where that treatment is surgery (4 breaches due to 2 patients unfit, 1 complexity and 1 capacity).

ED continues to be a challenge. The ELR position for all providers has been presented and is 0.6% worse than the UHL only position. The Out Of County (OCC) providers impacts on the A&E four hour waits. It was agreed at the A&E Delivery Board (AEDB) that UHL would start reporting their daily activity on their ED daily reports. An extract from the daily reports has been provided and will continue to be provided.

RTT 18 week incompletes target was not achieved in October for ELR CCG by 0.54%. There are zero 52 week breaches.

IAPT performance continues to be challenging and formal contract performance routes are now underway with the provider for ELR.

Dementia diagnosis rate achieved target in October at 66.8%, ongoing work continues for this measure. This measure is likely to fluctuate during the financial year.

East Leicestershire & Rutland CCG CCG Improvement & Assessment Framework

Sept/Oct 2017

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The Benchmarking Report for August and Q1 shows:

• UHL benchmarked nationally and against its peer providers for A&E 4 Hour Wait; 12 Hour Trolley Wait; RTT 18 Weeks; Cancer 2 Week Wait; Cancer 62 Day Wait; and Cancelled Operations.

The Quality Premium for:

• 2016/17 – If the assurance process runs smoothly and any appeals are resolved swiftly, we would expect that the first payment would be completed by the end of December. The second payment would be expected to appear by the end of February. Due to the late publication of Cancer data, this is a two stage payment this year.

• 2017/18 - This is being monitored on a monthly basis and as soon as data is published it will be reported. This is a two year Quality Premium scheme. The QP paid to CCGs in 2018/19 and 2019/20 reflects the quality of the health services commissioned by them in 2017/18 and 2018/19. The QP award will be based on measures that cover a combination of national and local priorities, and on delivery of the gateway tests.

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Cancer Indicators 62 day waits % of patients receiving first definitive treatment for cancer within 62 days of an urgent GP referral for suspected cancer (Quality Premium KPI)

Q1 Q2 Q3 Q4 YTD Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

% of patients receiving first definitive treatment for cancer within 62 days of referral from an NHS Cancer Screening Service

2 Week Waits % of patients seen within two weeks of an urgent GP referral for suspected cancer

Five cancer measures for September 2017 achieved. Three failed to achieve target these are:- 62 day waits; patients receiving first definitive treatment for cancer within 62 days of GP referral for suspected cancer (16 breaches due from 1 capacity, 7 complexity, 1 patient cancelled, 1 patient choice, 2 delay and 4 other. Patients receiving first definitive treatment for cancer within 62 days of referral from an NHS Cancer Screening Service (2 breaches due to complexity and patient unfit). 31 day wait; patients receiving subsequent treatment for cancer within 31 days where that treatment is surgery (4 breaches due to 2 patients unfit, 1 complexity and 1 capacity.

Key Organisational Targets

4 | P a g e

% of patients seen within two weeks of an urgent referral for breast symptoms

31 Day Waits


% of patients receiving first definitive treatment within 31 days of a cancer diagnosis

% of patients receiving subsequent treatment for cancer within 31 days where that treatment is surgery

% of patients receiving subsequent treatment for cancer within 31 days where that treatment is an anti- cancer drug regimen

% of patients receiving subsequent treatment for cancer within 31 days where that treatment is radiotherapy treatment course

62 Day Waits- The 62 day wait for first definitive treatment has fluctuated and remains volatile. The 62 day wait for first definitive treatment following NHS cancer screening was last compliant in August. 31 Day Waits - Continued emergency and theatre pressures have resulted in a deteriorating performance position. Although Cancelled operations has improved it continues to affect the ability to maintain performance against standard A UHL action plan is in place which is reviewed, monitored and challenged at the RTT/Cancer Board. A clinical representative attends this meeting on behalf of the CCG. Harm reports for patients waiting 104+ days continue to be received and reviewed by the Contracting Quality Team and discussed at Clinical Quality Review Group.

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Urgent Care Emergency admissions for urgent care sensitive conditions (per 100,000 population) ELR CCG

Target 2015/16 2016/17 Q2

2016/17 Q3

Below Baseline

2188 2191 2170

A&E 4 Hour Wait - ELR Patient for all providers (Quality Premium KPI)


A&E 4 Hour Wait – ELR Patients at Leicester Hospitals of Leicester NHS Trust (UHL)

A&E 4 Hour Wait - ELR Patients at Kettering General Hospital NHS Foundation Trust (KGH)

A&E 4 Hour Wait for OOC Providers for October 2017 North West Anglia NHS Foundation Trust 76.88% United Lincolnshire Hospitals NHS Trust 76.62% University Hospitals of Coventry and Warwickshire NHS Trust 78.48%

ELR CCG 4 Hour Performance-ELR CCG A&E performance for all providers remains static. The LLR system continues to be subject to scrutiny from NHSE/NHSI with regards to ongoing system wide performance issues. Throughout September and into October, ELR CCG (and LLR position) has not hit the agreed performance improvement standards against the A&E 4 hour wait trajectories. As a part of the wider strategic improvement plans, ED flow actions and issues are managed through the High Impact Action plan, which is presented to the A&E delivery board (AEDB) monthly. ELR CCGs are represented on the system-wide AEDB, which is overseeing the implementation of the High Impact Actions Plan to recover ED 4 hour performance. CCGs are leading on the specific actions to minimise presentations at the LRI campus.

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UHL Only for all Patients Q1 Q2 Q3 Q4 YTD Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

12 hour Trolley Waits - UHL


Ambulance Handovers > 30 Mins (UHL)

Target 2016/17 Aug 17 Sept 17 Zero

Tolerance 16.10% 6% 4%

Ambulance Handovers > 60 Mins (UHL)

Target 2016/17 Aug 17 Sept 17

Zero Tolerance

8.70% 1.4% 0.4%

Achievement of milestones in the delivery of an integrated urgent care service

Target Aug 16 Jan 17 Above

Baseline 4 of the 8 key elements of

Integrated Urgent Care were being delivered

7 of the 8 key elements of Integrated Urgent Care were being

delivered

UHL Ambulance Handovers- There has been an improvement since February 2017. The performance in July, August and September has been the best for several years. A Contract Performance Notice was issued to UHL on 10 December 2015. The actions above form part of the system-wide recovery plan, accepted in fulfilment of this. The Remedial Action Plan is updated and monitored fortnightly at the AEDB. EMAS’ performance has continued to improve for Pre-Handover delays at LRI, however, there was an increase in the number of pre-handover delays at Leicester General Hospital in September. The number of patients handed-over to LRI within 15 minutes has continued to improve – an increase of 20% since April, and 92% of patients were handed-over within 30 minutes in September.

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Elective Access RTT - 18 Weeks Incompletes – For All Providers (Quality Premium KPI)


RTT – 18 Weeks Incompletes at Specialty Level For All Providers (Function Level) – October 2017

RTT-18 Weeks- ELR CCG RTT for performance improved in October 17, although this has still not achieved target. (18,578 patients were seen within 18 weeks, with 1,734 over 18 weeks for all providers). Specialty Level Each specialty has developed an action plan to achieve 92% performance, which is subject to operational and financial viability. Demand Management has been included in the Planned Care programme with a much higher profile. Detailed datasets in respect of outpatient activity are a regular item to be reviewed at the Planned Care Delivery Group which meets weekly apart from the first week of each month when the programme board meets. Initiatives such as Advice & Guidance and use of PRISIM are having an impact.

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No of 52 Week Waiters (No of ELR Patients that are waiting at period end for incomplete pathways) Q1 Q2 Q3 Q4 YTD Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Diagnostic Test Waiting Time - % of patients waiting 6 weeks or more for a diagnostic test

Cancelled Operations not re-admitted within in 28 days (UHL Only)

Target 2016/17 Aug 17 Sept 17 UHL Only

Zero Tolerance

14.2% 223

Patients

11% 14

patients

18% 27

patients

RTT performance is monitored regularly at: Joint Cancer/RTT Board (includes GP clinical representation, NHSE, NHSI, Healthwatch), Contract Performance Meeting (CPM) and Contract Technical Meeting. No of 52 Week Waiters- There has been an improvement for ELR patients waiting 52 weeks. No breaches occurred in October 2017 for ELR CCG. Cancelled Operations Not Re-admitted in 28 Days- The majority of cancellations were due to lack of theatre time, equipment and theatre list overruns or lack of beds (ward, ITU and HDU). A significant number of patients are also cancelled on the day due to admission of a high priority (i.e. ED) patient and a there were more cancellations in August related to lack of theatre time due to closures at Glenfield for maintenance. The UHL Theatre Programme board is being reviewed with a view to have three working groups, one of which will look at operationally reducing cancellations on the day.

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Mental Health

IAPT Access– Entering Treatment Target 2015/16 Apr 17 May 17 Jun 17 Jul 17 Aug 17 Sept 17 15% 14% 11.10% 10.9% 12.83% 12.39% 9.13% 11.18% Data National National Local Local

Local data – review with caution IAPT Recovery Rate

Target 2015/16 Apr 17 May 17 Jun 17 Jul 17 Aug 17 Sept 17 50% 54% 56% 62% 57% 63% 66% 63% Data National National Local Local

IAPT Access Talking Therapies – 6 Weeks Wait

Target 2015/16 Apr 17 May 17 Jun 17 Jul 17 Aug 17 Sep 17 75% 52% 74% 69% 67% 60% 59% 55% Data National National Local Local

IAPT Access Talking Therapies – 18 Weeks Wait

Target 2015/16 Apr 17 May 17 Jun 17 Jul 17 Aug 17 Sep 17 75% 97% 100% 97% 96% 99% 99% 99% Data National National Local Local

The percentage of people experiencing a first episode of psychosis with a NICE approved care package within two weeks of referral. The access and waiting time standard requires that more than 50% of people do so within two weeks of referral.


IAPT Access- Patients entering treatment continues to underperform against the trajectory. The reasons are due to vacancies/staffing issues and low number of referrals. Actions being taken to improve performance:- . Engaging with further education colleges to offer IAPT for post-16's, first meeting held on 15th November 2017 . CCG developing a detailed communications plan - mental health awareness days will be used to promote IAPT, the first will take place on Monday 15th January for 'Blue Monday'. . Promoting the service via the Voluntary Sector – Presented at Health and Wellbeing Forum on 21st November 2017 . Staff recruitment ongoing . High Intensity staff will be used to assess patients during December and January to offset staff shortages. 6 Week Wait - Continues to underperform against the trajectory. The reasons are due to

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Care Programme Approach (CPA) - % of patients under adult mental illness on CPA who were followed up within 7 days of discharge from psychiatric in-patient care

% of Routine Cases For Children & Young People’s Eating Disorder Referrals waiting within 4 weeks

Target 2016/17 Q1 Q2 100% 50% 80%

(10 patients seen / 8 completed within 4

weeks)

100% (7 patients seen and completed within 4

weeks) % of Urgent Cases For Children & Young People’s Eating Disorder Referrals waiting within 1 week

Target 2016/17 Q1 Q2 100% 44% 100%

(1 Patient) 100%

(1 Patient) The metric for patients completed within 4 weeks/1 week in the table above is calculated for both complete and incomplete care pathways but is only applicable to the complete care pathway patients.

. Waiting times are recorded upon discharge from the service, therefore long waiting times as a result of staffing issues observed in February and March are now being seen . Actions that are being put in place to improve waiting times will not been seen in the data for 3-4 months. . Staffing capacity is an ongoing issue Actions being taken to improve performance:- . 7 Psychological Well-being Practitioner (PCP) workers have now been recruited, start dates during December . High intensity workers are being used to see step 2 patients to reduce the waiting list and will be used to assess patients during December and January to offset staff shortages. . Stress control groups are being piloted in the service to enable multiple patients to be treated at one time. This will be a rolling programme. This programme is compliant with NICE guidelines. . The provider has agreed to use a gateway model which will enable staff to transfer through bands 5-

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6-7 with the aim to retaining staff - this is now with their HR department to formalise the process . Director level meeting held on the 3rd November. Notts Health has agreed to produce a recovery trajectory which is due at the end of November. The action plan will be provided by Notts Health at the end of November 2017. Commissioners will review this once it has been received in order to identify any risks or concerns.

Dementia

Dementia Diagnosis Rates Target 2016/17 Apr

17 May 17

Jun 17

Jul 17

Aug 17

Sept 17

Oct 17

66.7% 64% 65.9% 66.3% 66.9% 66.6% 66.9% 66.3% 66.8%

Dementia Diagnosis - The estimated diagnosis rate for people has achieved at 66.8% NHSE’s change in approach to the predicted dementia population size will result in monthly fluctuations on performance (which are likely to impact delivery of the target by 0.01-0.05%).

Key: Status U – Unpublished data Status P – Published data

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Additional indicators have been added to the report to show an overall performance for the better health indicators. Indicators currently not achieving are e-referral service, inequality in unplanned hospitalisation for chronic ambulatory care sensitive conditions and appropriate prescribing of broad spectrum antibiotics in primary care.

Maternal Smoking at Delivery - % Women smoking at time of delivery (SATOD)

Target 2017/18 2017/18 Below 8.6%

Q1 6.8%

Q2 9.3%

Local Data

Injuries from falls in people aged 65 and over (per 100,000 population)

Target 2017/18

2016/17 Q2

2016/17 Q3

Reduction on

baseline

1536 1500

No change from last month.

Utilisation of NHS E-referral service to enable choice at first routine elective referral

Target 2017/18

2016/17 Jul 17

Aug 17

Sept 17

80% 72% 73% 73% 72%

The CCG is actively working with provider partners NHS Digital, and member practices to increase and improve the overall quality of the service for patients

• ERS continues to be promoted through discussion at locality meetings and through the monthly practice newsletters..

• UHL continue to report performance of ASIs to the LLR e-comms project board monthly and continue to work closely with the CCGs to help achieve the ASI target of 4%.

• The use of eRS is promoted through the CCGs demand management plan in line with promoting PRISM usage and advice and guidance and forms part of the demand management specification.

• ELR CCG will work closely with UHL to scope and implement the paper switch off project which will strengthen and promote ERS usage.

Better Health Indicators

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Personal Health Budgets No. of personal health budgets per 100,000 population

Target 2016/17 Q3

2016/17 Q4

Increase to

50-100k by 2020

17.9 18.6


Deaths which take place in hospital % of deaths which take place in hospital

Target 2015/16 Q4 - 2016/17 Q3

Q1 16/17 - Q4 16/17

45.2% Below

baseline

43.9% 43.4%

Rolling annual data


Health Inequalities – linked to deprivation Inequality in unplanned hospitalisation for chronic ambulatory care sensitive conditions:

Target Q4

2016/17 Q2

2016/17 Q3

811 Reduction in

gradient

797 905

Inequality in avoidable emergency admissions: Target

Q4 2016/17

Q2 2016/17

Q3

1659 Reduction in

gradient

1514 1644

(Gradient of inequality)

The ELR CCG gradient indicates it is amongst the CCGs with the least inequality. No change from last month.

Anti-microbial resistance: Appropriate prescribing of broad spectrum antibiotics in primary care

Appropriate prescribing of antibiotics in primary care (Star PU)

Target 2017/18

Mar 17 Jul 17 Aug 17

Below 1.161

1.025 1.022 1.022

Appropriate prescribing of broad spectrum antibiotics in primary care (Antibiotic Co-amoxiclav, Cephalosporins & Quinolones)

Target 2016/17

Mar 17 Jul 17 Aug 17

Below 10%

10.8% 10.8% 10.8%

The Medicines Management Team are implementing a tool for the GPs clinical system to help the decision making process for prescribing. The toolkit has been approved and is going to be rolled out to the GPs imminently. The GPs will undertake an audit, as part of the GP Service Improvement Plan (SIP) which will identify over prescribing of antibiotics. The results are due by the end of the financial year. No change from last month.

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Urgent & Emergency Care – Ambulance Response Times (EMAS) Category 1 – Calls from people with life-threatening illnesses or injuries (eg; cardiac arrest or serious allergic reaction)

Category 2 – Emergency calls (eg; burns, epilepsy or stroke)

Category 3 – Urgent calls (eg; late labour, non-severe burns or diabetes – may be seen in own home)

Category 4 – Less urgent calls (eg; diarrhoea & vomiting or urinary infections – may be referred to GP or called back)

Ambulance Response Calls The new standards may not be consistently achieved until new ways of working are in place. Therefore, commissioners would be expected to monitor and discuss the performance against the new measures; not to be formally judged until 1st April 2018. Performance percentiles against the national Category 1 - 4 standards from 19th July 2017 to date. EMAS performed well for the region overall for Category 1 in September, however, did not meet the national standards for LLR in all four Categories. The percentiles are only available at regional and divisional level at the moment. The PMIT team are working on making these available at a CCG level. There has been a spike in activity in September; EMAS have reported the spike being as a result in higher acuity and in particular a higher number of patients with respiratory issues. EMAS also advised that they are experiencing difficulties accessing the respiratory pathway at Glenfield and the lack of alternatives pathways in the community. This information has been shared with the urgent care clinical lead for further investigation. Category C1T C1T is not part of the national indicators, however C1T is a subset of C1. C1T are C1 calls that are resolved with a conveyance (and therefore the difference between C1 and C1T will be C1 calls resolved via See&Treat). The national performance standard for C1 includes the response times for all calls coded as C1, and therefore the response times for C1T will be captured within the C1 times.

Better Care Indicators (excluding key organisational targets)

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Crew Clear (Post-handover) Delays of > 30 Minutes (LRI)

Target

Aug 17

Sept 17

Oct 17

Zero Tolerance

3.3% 3.6% 4.1%

Crew Clear Delays (Post-handover of > 1 hour (LRI)

Target Aug 17 Sept 17

Oct 17

Zero Tolerance

0.2% 0.2% 0.2%

DTOC Leicestershire Local Authority Level

Target 2016/17 Aug 17

Sep 17

Reduction On

Baseline

63 Average per day

52 48

Rutland Local Authority Level

Target 2016/17 Aug 17

Sep 17

Reduction On

Baseline

3 Average per day

1 2

DTOC - NHS England are replacing the measure in some of the publication documents with a DTOC beds figure, which is the delayed days figure divided by the number of days in the month, which should be more representative. The data is shown at Leicestershire and Rutland level.

Children & Young People’s Transformation Baseline Oct 16 2016/17

Q4 100% 5 Q’s

Fully Compliant

35% 3 Q’s

Partially compliant

35% 1 Q non-

compliant

Crisis Care & Liaison MH Baseline Oct 16 2016/17

Q4 100% 5 Q’s

Fully Compliant

35% 3 Q’s

Partially compliant

47.5% 2 Qs partially

compliant 3 Non-

compliant Out of area placements for acute mental health inpatient care - transformation

Baseline Oct 16 2016/17 Q4

100% 5 Q’s

Fully Compliant

75% Mostly meeting

expectations

100% Meeting

expectations

The Quarter 4 submission was the final submission for this collection. The collection was designed to capture data for three transformation indicators for mental health which were included within the Improvement Assessment Framework 2016/17. Children & Young People – In 2017/17 there was an SDIP in place to move towards Core 24 services which ended with the end of the Vanguard. Plan is to bid for wave 2 funding in 17/18. This will become part of the Core 24 plans if funding successful. Liaison & Crisis Resolution – There is not an agreed and funded SDIP in place to ensure the CRT is operating effectively. Alternatively the STP has agreed that the LPT acute care transformation plan will cover redesign of CRT services and so it is included in the transformation draft SDIP. No change from last month.

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Learning Disabilities Specialist In-Patient Care – LLR Reliance on specialist inpatient care for people with a learning disability and/or autism - (per 1m pop)

Target 2017/18

Q1 2017/18

57.64 (50 patients)

Q2 2017/18

55.33 (48 patients)

LLR

56.49 (49

patients)

55.33 (48

Patients) ELR 7 Patients 10 Patients

Primary Medical Care Management of Long term Conditions (Unplanned hospitalisation for chronic ambulatory care sensitive conditions per 100,00 population)

Target 2015/16 Q4

2016/17 Q2

2016/17 Q3

Below 2015/16 Position

791 787 779

Overall Patient Experience of G.P Services Target Jul-Sept 15 &

Jan-Mar 16 84.5%

Jan - Mar 2017

Equal to or above

84%

84.8% 84.5%

Primary Care Access - General Practice provision of pre-bookable appointments during extended hours on weekdays and weekends

Target 17/18

Oct 16 Mar 17

100% by April

2019

90% (28 out of 31 practices) - partial

provision for extended access 10% (3 out of 31

practices) - no provision for

extended access

87.5% (28 out of 32 practices) -

partial provision for extended

access 12.5% (4 out of 32 practices) -

no provision for extended access

Primary Care Workforce - Number of GPs and Practice Nurses (full-time equivalent) per 1,000 weighted patients by CCG

Target 17/18

Sept 15 Mar 16

Above Baseline

1.19 1.23


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Continuing Health Care No. of people eligible for standard NHS Continuing Healthcare per 50,000 population

Target 2015/16 Q4

2016/17 Q2

2016/17 Q3

Above Baseline

44.4 56.4 54.2


Additional Indicators - Infection Control MRSA

Clostridium difficile

MRSA – One MRSA case has been currently assigned to the CCG in July. The case was in arbitration and has been assigned to a 3rd party. CDIFF - The infection control team closely monitor CDIFF, with the three CCGs working together focusing on high risk areas and patient safety issues.

NHS 111 Calls answered within 30 seconds

Target 2016/17

Aug 17

Sept 17

<2.9% 2.1% 1.8% 3.5%

Calls answered within 60 seconds Target 2016/

17 Aug 17

Sept 17

>95% 90.4% 92% 84%

NHS 111 - NHS111 performance improved in August, however there was a reduction of 1,974 calls (9%) in the number of calls received this month. There was a 0.6% increase in the number of calls answered within 60 seconds, with a 2second reduction in the average answer time though this is still in amber; however, there was a slight increase of 0.3% in the number of calls abandoned after 30 seconds. There was a further increase of 0.6% in recommended Emergency Ambulance dispatch as a final disposition from the previous month, exceeding the contractual threshold, and commissioners will be asking for this to be audited. The service remains on target for recommended to attend A&E and primary care. It is noted that the performance in August for disposition to attend A&E was better for LLR (5.6%) than the regional average (7.3%).

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Children Waiting Less than 18 Weeks for a Wheelchair Percentage of children waiting less than 18 weeks for a wheelchair

2017-18 Q1 Q2 YTD Apr May Jun Jul Aug Sep

RAG R G R

Status P P -

Actual 88.235% 95.238% 91.398%

Target 92.00% 92.00% 92.00%

The number of children whose episode of care was closed within the reporting period, where equipment was delivered in 18 weeks or less of being referred to the service. The 18 week pathway begins when it is identified a service user requires a wheelchair. The clock stops when the service user receives their wheelchair.

The contracts team receive monthly data from the wheelchair provider (Blatchford) and assess their performance at LLR level. There are several issues driving the RTT performance; administrative issues, increase in patient numbers and available appointments adjustments to equipment/subsequent equipment requirements. Blatchford’s has improved communication with its approved repair contractor (provide delivery, collection, repair and reconditioning) and is ensuring that the delivery of equipment is communicated and therefore a patients RTT clock is stopped. The LLR Contracts Team is reviewing this with Blatchford’s to ensure this is sustained in future months. Training has been provided to staff to ensure the correct referral is selected to start the 18 week clock, and checks and balance are in place to identify any errors. There are issues for the paediatric service with equipment handover and service users requiring subsequent equipment before the pathway can be completed and then unavailability of service users to attend the available appointments. The LLR Contracts Team will review this to clarify the issues affecting equipment handover and ensure that an appropriate range of appointments are available for service users to book onto.

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Better Health

Childhood Obesity % Children aged 10-11 classified as overweight or obese

Target 2014/15 2015/16 2015/16

Above Baseline

28.9% CCG 30% Leics

31.3% Leicestershire

LA 34.2%

England

CCG Data Not

Available

Last published February 2016.

Diabetes % of people with good blood pressure control

Target 2014/15 2015/16 Above

baseline 41.9% 41.9%

% People who attend an education course

Target 2013

2014

Above baseline

2.4% 3.4%

Last published July 2017.

Long Term Condition People with long term condition feeling supported to manage their condition(s)

Target Jan-Mar 2017

Above 65.7%

(2015/16 Outturn)

65%

GP Patient Survey published July 2017.

Quality of life for carers

Target

Jul 14- Mar 15

Jul-15- Mar 16

Above 2014/15 Baseline

0.83 0.82

This indicator is derived from the GP Patient Survey. A question evaluates what best describes a carers own health state. Respondents who identify themselves as carer’s forms part of one of the questions. The CCG position from July 2015 to March 2016 is reported at 0.82; therefore this indicator is not achieving the standard target reported below the national average of 0.83.

Better Health / Better Care Annual Indicators

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Better Care

Cancer Waits Cancers diagnosed at early stage - % of cancers diagnosed at stage 1 & 2 (Quality Premium KPI)

Target

2014 2015

Above 2014 position

52.5% 52.1%

Cancer Patient Experience

Target 2015 2016 Above

Baseline 8.6

8.6

One year survival for all cancer

Target 2013 2014

2015

Above Baseline

70.2% 71.0

Due March 2018

Last published July 2017.

Learning Disabilities Health Checks

2015/16 2016/17 Q3

34% 23%

Health Checks – It is evident that data shared nationally is not accurate. Data is being shared locally with Primary Care Liaison Nurse Meetings, and data issues have been identified. Work is ongoing to rectify, and new templates are being installed on local systems.

Maternity Neonatal mortality & still births per 1,000 pop

2014 2015 6.7 5.8

Women’s Experience of Maternity Services

2015 2015 79.7

(England) 79.2

(CCG)

2016 data due May 2018

A multi-agency strategy & action plan lead by Public Health has been agreed and signed off by the Health & Wellbeing Board. It covers maternal and infant factors, and the wider health issues which are significant for Leicester. Plans include; the development of new GROW protocol; tailored scanning to identify at risk mothers & babies; new awareness training on reduce foetal movements; promotion of early booking and safe sleep, with additional training for midwives, and targeted work and parenting support.

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Friends and Family Patient Experience Friends and Family Test scores for A&E (UHL)

Friends and Family Test inpatients (UHL)

Friends and Family Test scores for Maternity

The target for the 3 UHL indicators is 97%. As at August 2017 Inpatients was on target at 97%. A&E was on target for the month of August with an improvement to 98% (The highest score in over 12 months) with year to date performance remaining at 95%. Maternity showed a drop in monthly performance to 93% with year to date remaining at 95%. Provider Actions The Friends and Family Test recommender’s rate has been below the national average for some months. The Patient experience team undertook some analysis in 16/17 Quarter 4 to determine which wards and areas had the lowest FFT recommender and response FFT rate. These wards will be supported by the Patient Experience and Engagement Committee to improve.

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Benchmarking for NHS Constitution indicators

Provider Benchmarking report (UHL v Peers)- July/Aug 2017 Data

Indicator Target Date of data England UHL Mid Yorkshire

NHS Trust

Nottingham University Hospitals

Leeds Teaching Hospitals NHS

Trust

Heart of England NHS Foundation

Trust

University Hospitals of North Midlands NHS trust (Previously North

Staffs)

A&E 4 hour wait 95% Sep 2017 (Month) 90.3%82.7%(Rank

138/153)

86.0%(Rank

123/153)

85.3%(Rank

130/153)

90.4%(Rank

77/153)

78.3%(Rank

147/153)

78.4%(146/153)

12 Hour Trolley Wait breaches Zero Sep 2017 (Month) 0.36 Average 0 0 0 0 0 0

RTT 18 weeks Incompletes 92% Sep 2017 (Month) 91.7% Average91.4%(Rank

108/185)

82.3%(Rank

171/185)

97.14%(Rank 31/185)

88.%(Rank

137/185)

92.0%(Rank 82/185)

79.1%(Rank

182/185)

Cancer 2WW 93% Q2 17/18 95.2%95.64%(Rank

67/146)

95.53%(Rank

72/146)

93.87%(Rank

104/146)

95.59%(Rank

69/146)

93.9%(Rank

106/146)

98.21%(Rank 18/146)

Cancer 62 Day 85% Q2 17/18 81.25%68.63%(Rank

131/142)

83.77%(Rank

57/142)

76.26%(Rank

105/142)

77.19%(Rank

100/142)

85.71%(Rank 42/142)

78.85%(Rank 89/142)

Cancelled ops Number of last minute elective operations cancelled for non clinical reasons

Zero Q2 17/18128.73

Average

336(Rank

158/163)

85(Rank

81/163)

163(Rank

123/163)

504(Rank

162/163)

282(Rank

152/163)

441(Rank

161/163)

Number of patients not treated within 28 days of last minute elective cancellation

Zero Q2 17/1810.10

Average

58(Rank

170/171)

0(Rank 1/171)

5(Rank

110/171)

57(Rank

169/171)

0(Rank 1/171)

25(Rank

154/171)

UHL Peers Group

Benchmarking

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Quality Premium for 2016/17

In summary, taking into account for 2016/17 guidance and new data published the predicted Quality Premium delivery is £26,706. Quality Premium 2017/18

This is monitored on a monthly basis and soon as data is published it will be reported (see appendix A for the QP report).

Quality Premium

Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 YTD

LC CCG Patients 10 19 13 13 18 15

WL CCG Patients 20 27 24 19 23 17

EL&R CCG Patients 11 16 23 17 20 20Total 41 62 60 49 61 52

All CCGs 37 59 57 46 56 54

LC CCG 10 19 13 13 18 15

WL CCG 13 25 19 16 19 14

EL&R CCG 8 14 22 13 14 18

As at 28th

April 17

As at 26th

May 17

As at 25th

June 17

As at 30th

July 17

As at 6th

Aug 17

As at 8th

Sept 17

As at 6th

Oct 17

As at 5th

Nov 17

As at xx

Dec 17

As at xx

Jan 18

As at xx

Feb 18

As at xx

Mar 18

50 72 59 65 58 72 64 70

UHL All CCGs (Adjusted Position - excludes tertiary referrals post day 38 of pathway) 46 70 49 55 49 58 59 61

63 54 38 38 34 37 40 36

9 16 12 12 9 11 18 27

64 No Data 77 67 55 27 54 49

21 39 21 19 15 19 9 12

75 68 69 46 47 55 55 31

26 19 28 28 33 38 38 38

73 86 69 67 60 72 72 58

37 59 61 50 37 56 61 47

Outcomes / Learning themes for over 62 day breaches

United Lincolnshire Hospitals NHS Trust (ULHT)

Nottingham University Hospitals NHS Trust (NUH)

UHL

Please see the tab '62 day themes' for the details of the September 2017 62 day breaches.

This information is routinely provided as part of the monthly UHL Trust Board Report and Joint Cancer/RTT Board.

62 day breaches are reviewed quarterly by UHL. Any thematic findings are shared on a quarterly basis and where appropriate new actions are added to the Remedial Action Plan.

There is a triangulation exercise which looks at the Thematic Findings, NHSE/NHSI Review, Exeter Data (Trust level) and the RAP.

The local Clinical Quality Review Group and Quality Assurance Group are sighted on any quality and patient safety/experience concerns. The contracting Quality Lead is also a member of the Cancer/RTT Working Group and associated Board.

Escalation is via the Cancer/RTT Board and Contract Performance meeting.

The regional Quality Surveillance Group also receives any quality and patient safety/experiences concerns.

Out of County Providers

LLR Cancer Waits Report (+62 day breaches)

UHL All CCGs (Unadjusted Position)

Derby Teaching Hospital NHS Foundation Trust

George Eliot Hospital Trust

Current backlog of patients waiting over 62 days

Number of treated patients that waited over 62 days

All providers

UHL Only

UHCW

Burton Hospital Trust

North West Anglia NHS Foundation Trust (NWAFT)

Kettering General Hospital NHS Foundation Trust (KGH)

17/11/2017

City CCG

Target 85% Open Exeter report reference 8.4

Amber82%-84.9%

Red <82%


Average

monthly

performa

nce YTD

17/18

3 month

rolling

average

Forecast

year end

position

Monthly

breach

tolerance

47 57 50 53 56 66 329 55 58 658

10 19 11 13 14 13 80 13 13 160

78.7% 66.7% 78.0% 75.5% 75.0% 80.3% 75.7% 75.7% 77.1% 75.7%

East CCG


Amber82%-84.9%

Red <82%


Average

monthly

performa

nce YTD

17/18

3 month

rolling

average

Forecast

year end

position

Monthly

breach

tolerance

72 77 81 78 84 74 466 78 79 932

7 12 21 9 14 14 77 13 12 154

90.3% 84.4% 74.1% 88.5% 83.3% 81.1% 83.5% 83.5% 84.3% 83.5%

West CCG


Amber82%-84.9%

Red <82%


Average

monthly

performa

nce YTD

17/18

3 month

rolling

average

Forecast

year end

position

Monthly

breach

tolerance

72 95.5 88 72 83 67 477.5 80 74 955

11 23.5 18 14 17 12 95.5 16 14 191

84.7% 75.4% 79.5% 80.6% 79.5% 82.1% 80.0% 80.0% 80.6% 80.0%

*Note: Breach reasons are not available by CCG as the standard is measured and monitored at Trust level

PHQ03: Percentage of patients receiving first definitive treatment for cancer within 62-days of an urgent GP referral for suspected cancer

Total patients seen

8.0Breaches

Achievement


Total patients seen

10.5Breaches

Achievement


Total patients seen

3.1Breaches

Achievement

Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 YTD LC CCG Patients 2 3 1 6 3 3

WL CCG Patients 3 3 7 3 5 2

EL&R CCG Patients 5 2 2 3 4 2Total 10 8 10 12 12 7

All CCGs 10 8 10 11 13 11

LC CCG 2 3 1 6 3 3

WL CCG 2 3 6 2 5 0

EL&R CCG 4 1 2 1 3 2

As at 28th

April 17

As at 26th

May 17

As at 25th

June 17

As at 30th

July 17

As at 6th

Aug 17

As at 8th

Sept 17

As at 6th

Oct 17

As at 5th

Nov 17

As at xx

Dec 17

As at xx

Jan 18

As at xx

Feb 18

As at xx

Mar 18

6 5 12 12 16 8 8 16

16 17 17 17 12 4 7 6

4 4 4 6 7 1 8 16

2 19 19 12 14 0 6 15

11 7 7 2 2 5 5 0

17 23 15 16 10 6 6 8

2 5 3 3 5 5 5 9

18 19 26 7 8 9 9 11

17 10 20 19 22 18 20 13

Outcomes / Learning from RCA and harm reviews for over 104 day breaches

Plan / trajectory to clear +104 day breaches

LLR Cancer Waits Report (+104 day breaches)

UHL

Please see the tab '>104 day themes' for the details of the September 2017 >104 day breaches.

This information is routinely provided as part of the monthly UHL Trust Board Report and Joint Cancer/RTT Board.

Harm reviews are carried out by UHL for confirmed cancer patients who have waited >104 days once treated.

The local Clinical Quality Review Group and Quality Assurance Group are sighted on any quality and patient safety/experience concerns. The contracting Quality Lead is also a member of the Cancer/RTT Working

Group and associated Board. Escalation is via the Cancer/RTT Board and Contract Performance meeting.

The regional Quality Surveillance Group also receives any quality and patient safety/experiences concerns.


UHL


Number of treated patients that waited over 104 days

All providers

Current backlog of patients waiting over 104 days

UHL All CCGs

Derby Teaching Hospital NHS Foundation Trust

George Eliot Hospital Trust

UHCW

UHL Only

Burton Hospital Trust

North West Anglia NHS Foundation Trust (NWAFT)

Kettering General Hospital NHS Foundation Trust (KGH)

United Lincolnshire Hospitals NHS Trust (ULHT)

Nottingham University Hospitals NHS Trust (NUH)

September Cancer Report Key themes identified in backlog (13th October)

Note – This report includes all patients (including those waiting 104 days+)

Summary of delays Numbers of patientsSummary

Clinically Appropriate Pathway Delays 8

In Urology (x7) – patients where the initial TRUS biopsy is reported as either

benign/non-diagnostic but in correlation with clinical review, an MRI is required for

further investigation a clinically appropriate 6 week delay is required between biopsy

and MRI to allow for healing and to avoid a haematoma on MRI.

In Gynae (x1) – where a failed hysteroscopy resulting in an airway injury during the

procedure required recovery prior to a repeat attempt

September Cancer Report

Summary of delays Numbers of patientsSummary

Complex Patients/Complex Diagnostic Pathways 11

Across 6 tumour sites, – these are patients undergoing multiple tests, MDTs, complex

pathology reporting and diagnostics. This includes patients referred between

multiple tumour sites with unknown primaries and patients with complex pathology

to inform diagnosis. This also includes patients previously on a long term follow up

pathway in Lung (x2).

Capacity Delays – OPD & Surgical 9

In 4 tumour sites, a combination of surgical treatment/diagnostic capacity, high risk

anaesthetic capacity and Oncology outpatient capacity affecting the patients

pathway. This also includes where (x2) patients were cancelled for more clinically

urgent cancer patients delaying their TCI dates resulting in a breach.

UHL Pathway Delays (Next Steps compliance) 10

Across 3 tumour sites – where more than 1 delay has occurred within the pathway

and lack of compliance with Next Steps is evident. This includes where diagnostic

tests have been incorrectly requested as non 2WW and subsequently escalated,

cancelled diagnostic procedures due to poor bowel prep where re-booking hasn’t

taken place within 7 days, delayed clinical decision making pending additional

diagnostics and x1 case where missing notes delayed the diagnostic biopsy.

Patient Delays (Choice, Engagement, Thinking Time) 13

Across 5 tumour sites – a significant proportion of the backlog where patients have

DNA’d on multiple occasions , required thinking time re decision making for

treatment planning , work commitments, patient holidays, family events and religious

festivals in addition to delays to diagnostics with patients only available for weekend

Endoscopy lists at specific sites.

Patients Unfit 10

Across 6 tumour sites, patients who are unavailable for treatment due to other

ongoing health issues of a higher clinical priority, where high blood pressure and

uncontrolled diabetes result in a delay to the patient be anaesthetically fit for

treatment

Late Tertiary Referrals 5Across 5 tumour sites, where tertiaries are received after Day 38.

Key themes identified in backlog (13th October)Note – This report includes all patients (including those waiting 104 days+)


Tumour Site

Total

Number of

patients

Pt No Current

Wait

(Days)

Confirmed

Cancer Y/N

Treatment

Date

Y/N

Summary Delay Reasons

LOGI 2

52

53

120

110

Y

Y

N

N

Patient undergone CT Colon, OGD, colonoscopy, CT Thorax, EMR and US Guided Liver Biopsy. Multiple MDT discussions required across LOGI, Lung and HPB for diagnosis and treatment plan. Fitness for surgery required assessment and consultation re chemotherapy options and if patient for chemo. Delays to diagnostics due to bridging plans and further re-staging. Oncology OPD 6.10.17 queries whether patient may be for observation only and no systemic treatment, patient thinking time given for review in 1 months time. Cancer Centre querying wait time, CNS engagement and plan from clinical team.

Originally referred on the UPGI pathway and went straight to test for OGD which was reported as NAD but for CT Colon due to weight loss and iron deficiency ? Patient referred on wrong pathway by GP. Delay to CT Colon due referral issues of 11 days -report flagged patient for colorectal MDT discussion. Patient transferred to LOGI on Day 31. MDT recommendation for MRI Liver, CPET and outpatient discussion. OPD outcome for colonoscopy and biopsies - TCI dates cancelled by hospital as patient unfit, ? the risk of surgery outweighs the benefits due to patient fitness. Referred to Oncology for discussion re palliative chemo. Capacity issues within Oncology delayed Onc OPD by 39 days. Brought forward to 13.10.17 - await outcome

Backlog Review for patients waiting >104 days @ 13/10/17

The following details all patients declared in the 104 Day Backlog for week ending 13/10/17. Note the patient reference number has been added to trackpatients each month as requested by the CCG. Last months report showed 7 patients in the 104 Day backlog, 5 of which have now been treated. Thereare currently 12 patients in the backlog at the time of reporting, 6 of which have treatment TCI dates agreed/planned.

NOTE: where patients who have a treatment date confirmed but with no diagnosis of Cancer confirmed, on review of histology, should that confirm acancer diagnosis then this would class as treatment in those cases.

September Cancer Report Backlog Review for patients waiting >104 days @ 13/10/17

Tumour Site

Total

Number of

patients

Pt No Current

Wait

(Days)

Confirmed

Cancer Y/N

Treatment

Date

Y/N


Urology 7

47

48

54

156

150

125

N

Y

N

Y

Y

N

Patient originally referred on a Gynae 2WW pathway 8/5/17, following investigation discharged from Gynae 2WW and followed up routinely. Subsequent USS identified ? Tumour in kidney, referred to Urology for MDT discussion. CT chest and CT Angiogram requested, patient now listed for surgery awaiting a TCI date. CT showed oblique lying horseshoe kidney with left moeity lying within the pelvis from which a 5.4cm mass arises - complex diagnosis. Required repeat CT angiogram of the abdomen and pelvis to allow renal arterial reconstructive images in preparation for open excision of the renal tumour. Added to waiting list 13.9.17 - complex joint surgical case, specific surgeon for mass and horseshoe kidney. TCI confirmed as 25/10/17

Day 106 referral from Lincoln, received 23/8/17. Patient contacted for outpatient consultation in Leicester, advised on holiday during September - wished to be seen following return 21/9/17. Awaiting return from holiday for listing for surgery and agreeing a TCI date. Patient could have had surgery on 18/09/17 - pause applied. Preassessment 13/10/17. TCI confirmed as 16/10/17 - patient treated 16.10.17

Diagnostic cystoscopy performed at Day 8, bone scan planned for Day 17 which was cancelled by the patient as unwell and not fit for bone scan until 13.7.17 (Day 37) and MRI 18.7.17. Follow up arranged for Day 43 which the patient cancelled, requesting a one month delay to think about things. CNS engagement evidences issues in gaining contact with the patient with no response. Patient brought to outpatients on the 12.8.17 (Day 67), for repeat CT ? for surveillance only.. CT reported and further follow up with patient recommends US Guided Biopsy. Delay to USGBx date due to complex protocolling, TCI 5.10.17. Currently awaiting pathology and follow up 17.10.17

Tumour Site

Total

Number of

patients

Pt No Current

Wait

(Days)

Confirmed

Cancer Y/N

Treatment

Date

Y/N


Urology 7

55

56

57

58

125

122

110

105

Y

Y

Y

N

N

Y

Y

N

KGH referral Day 84, seen in Urology Outpatients Day 90 and added to the waiting list for treatment. Service currently looking for additional theatre lists to provide a TCI in early November

Referred 9.6.17, diagnosed 29.6.17 following TRUS biopsy. Outpatient follow up 7.7.17, patient not keen on surgery, would like to discuss radiation. For MRI and referred to discuss PACE trial. MRI 10.7.17, MDT discussion 20.7.17 - still awaiting Oncology OPD due to capacity. MDT outcome - for repeat MRI 6 weeks post TRUS. ONC OPD 4.8.17 and complex surgical clinic discussion 9.8.17. Patient undecided on treatment option, for further follow up in Oncology 4.9.17 - outcome patient still undecided - considering PACE trial CNS involvement and further ONC OPA 27.9.17 where patient consented to PACE trial. Treatment start date 30.10.17

Patient originally referred via Lung, transferred to Urology following diagnostics on Day 13. Urology OPD 13.7.17 (Day 23). CT for MDT discussion ? HPB synchronous renal surgery. Patient required high risk anaesthetic assessment prior to surgical TCI. HRA 26.7.17, patient not suitable for surgical treatment, referred to Oncology. Delay to Oncology outpatient due to capacity. OPD 24.8.17 - patient requires renal biopsy pending chemo treatment and repeat CT. CT 13.9.17 (pt declined 30.8.17 date), biopsy 18.9.17. Patient to commence treatment 11.10.17 - await confirmation

Delayed diagnostics due to patient having urgent surgical TCI 31.8.17 requiring recovery from surgery before arranging a template biopsy. Template biopsy delayed by 6 weeks as a result. TCI 17.10.17, await pathology.



Tumour Site

Total

Number of

patients

Pt No Current

Wait

(Days)

Confirmed

Cancer Y/N

Treatment

Date

Y/N


Urology 7

55

56

57

58

125

122

110

105

Y

Y

Y

N

N

Y

Y

N

KGH referral Day 84, seen in Urology Outpatients Day 90 and added to the waiting list for treatment. Service currently looking for additional theatre lists to provide a TCI in early November

Referred 9.6.17, diagnosed 29.6.17 following TRUS biopsy. Outpatient follow up 7.7.17, patient not keen on surgery, would like to discuss radiation. For MRI and referred to discuss PACE trial. MRI 10.7.17, MDT discussion 20.7.17 - still awaiting Oncology OPD due to capacity. MDT outcome - for repeat MRI 6 weeks post TRUS. ONC OPD 4.8.17 and complex surgical clinic discussion 9.8.17. Patient undecided on treatment option, for further follow up in Oncology 4.9.17 - outcome patient still undecided - considering PACE trial CNS involvement and further ONC OPA 27.9.17 where patient consented to PACE trial. Treatment start date 30.10.17

Patient originally referred via Lung, transferred to Urology following diagnostics on Day 13. Urology OPD 13.7.17 (Day 23). CT for MDT discussion ? HPB synchronous renal surgery. Patient required high risk anaesthetic assessment prior to surgical TCI. HRA 26.7.17, patient not suitable for surgical treatment, referred to Oncology. Delay to Oncology outpatient due to capacity. OPD 24.8.17 - patient requires renal biopsy pending chemo treatment and repeat CT. CT 13.9.17 (pt declined 30.8.17 date), biopsy 18.9.17. Patient to commence treatment 11.10.17 - await confirmation

Delayed diagnostics due to patient having urgent surgical TCI 31.8.17 requiring recovery from surgery before arranging a template biopsy. Template biopsy delayed by 6 weeks as a result. TCI 17.10.17, await pathology.



September Cancer Report Backlog Review for patients waiting >104 days @ 13/10/17

Tumour Site

Total

Number of

patients

Pt No Current

Wait

(Days)

Confirmed

Cancer Y/N

Treatment

Date

Y/N


Lung 3

59

60

61

571

116

109

N

N

Y

N

Y

Y

Patient was on Long Term Follow up and excluded from the backlog until the 26.9.17 following repeat surveillance CT 10.9.17 which flagged for MDT discussion. Following MDT discussion, patient for CT Guided Biopsy which took place on the 10/10/17. Await pathology and follow up.

At first MDT discussion post CT, ?thymoma/lymphoma. Biopsy 1/8/17 pathology showed normal lymph node - decision for VATs biopsy. Admitted 21.8.17, MDT follow up with final histology recommended EBUS pending final pathology report. EBUS 19.9.17, review by ENT recommended by MDT - delayed review due to capacity. Seen in ENT 11.10.17, for anaesthetic assessment and joint surgical procedure with Lung/ENT. TCI 26.10.17

Patient originally referred via ENT, transferred to Lung Day 30 following MDT discussion. Bronch 26.7.17, MDT 28.7.17 recommended PET scan to assess if disease localised to inform treatment planning. PET 4.8.17 and MDT review 11.8.17. For surgical consideration - surgical review 16.8.17. For VATs biopsy, TCI 23.8.17. Histology reviewed 1.9.17 at MDT, non diagnostic biopsy due to position of mass. For clinical oncology ? radiotherapy. ONC OPD 19.9.17. Radical radiotherapy planned, provisional start date 16.10.17

Risk Summary

Issue Action being taken Category

1 Next steps not consistently implemented in all areas.

Resulting in unnecessary delay for patients.

Next steps programme board established.

Additional central funding for next steps programme secured.

Recruitment for additional staff for next steps in progress.

Internal factors impacting on delivery

2 Continued increase in demand for screening and urgent

cancer services. Additional 31 day and 62 day treatments

compared to prior years.

Cancer 2020 group delivering alternative pathways (e.g. FIT testing).

Annual planning cycle to review all elements of cancer pathway.

Further central funding requested for increased BI support.

Internal and External factors impacting

on delivery

3 Access to constrained resources within UHL Resources continued to be prioritised for Cancer but this involves

significant re-work to cancel routine patients.

Capital for equipment is severely limited so is currently directed to

safety concerns. Further central support has been requested.

Staffing plans for theatres are requested on the RAP.

Organisations of care programmes focused on Theatres and Beds.

Plans and capital agreed for LRI and GH ITU expansion.

External factors impacting on delivery

4 Access to Oncology and Specialist workforce. Oncology recruitment in line with business case.

Oncology WLI being sought.

H&N staff being identified prior to qualifying.

Internal factors impacting on delivery

7 Patients arriving after day 40 on complex pathways from

other providers

Weekly feedback to tertiary providers.

Specialty level feedback.

NHS I co-ordinating ‘Manchester’ style agreement.

External factors impacting on delivery

Summary of high risks The following remain the high risk issues affecting the delivery of the cancer standards and have been categorised as agreed by the joint working group

Appendix B

UHL Emergency Floor and LLR UCC Performance - Last 7 Days

Emergency Floor, Emergency CCU UCC attendances (VoCare) & Eye Casualty

Extract taken from UHL daily situaiton reports received 29th November.

The total % All UHL and UCC also includes Loughborough UCC activity.

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Paper G ELR CCG Governing Body meeting

12 December 2017

1


Front Sheet

REPORT TITLE: LLR Alliance Community Paediatric Service

MEETING DATE: 12 December 2017

REPORT BY: S Little, S Sutton, G Barker

SPONSORED BY: Carmel O’Brien, Chief Nurse and Quality Officer

PRESENTER: Sarah Shuttlewood, Associate Director of Contracts and Provider Performance

EXECUTIVE SUMMARY: Concerns were raised in relation to county community paediatric service waiting times and differing delivery processes compared to the city. At that point the county service was not achieving the 18 week RTT standard of 92% and the city service was achieving the standard. This report provides a summary of the services provided by LPT and the UHL Alliance pillar, performance information and how this differs by service and by site within each service. A recovery programme has been implemented to improve the RTT performance for the Alliance community paediatrics service improvements have been made to performance with an expected trajectory of June 2018 for achievement of the RTT standard. RECOMMENDATIONS: The East Leicestershire and Rutland CCG Governing Body is requested to: note the contents of the paper


X Improve integration of local services between health and social care; and between acute and primary/community care.


X Listening to our patients and public – acting on what patients and the public tell us.

Reduce inequalities in access to healthcare Living within our means using public money effectively

X



12 December 2017

2

EQUALITY ANALYSIS An Equality Analysis and due regard to the positive general duties of the Equality Act 2010 has not been undertaken in the development of this report as it is judged that it is not proportionate on the basis that the report is for information only.


BAF BAF


12 December 2017

3


LLR Alliance Community Paediatric Service

12 December 2017 Alliance Community Paediatrics Service 1. Concerns were raised by the county community paediatricians in March 2017 in relation to waiting

times and differing delivery processes compared to the city. At that point the county service was not achieving the 18 week RTT standard of 92% and the city service was achieving the standard. It was felt that the city and county received an inequitable service in terms of waiting times.

2. This report provides a summary of the services provided by LPT and the UHL Alliance pillar, performance information and how this differs by service and by site within each service. It then goes on to outline the recovery programme that has been implemented to improve the RTT performance for the Alliance community paediatrics service and the improvements made to performance. It sets out next steps to ensure the service meets the required standard within an agreed timeline.

The Service

1. The Community Paediatrics service sees children registered with a GP in Leicester, Leicestershire and Rutland up to the age of 16 (19 if in a Special Needs school). The service provides the following:

• Investigation of children who present with global developmental delay or significant delay in specific developmental areas.

• Medical assessment for moderate/severe learning difficulties • Medical input for assessment of preschool/primary school age children presenting with

challenging behaviour with suspicion of underlying neurodevelopmental conditions like Autism, ADHD and management as appropriate

• Management of children with certain genetic/medical conditions (e.g. Down’s syndrome, Tuberous Sclerosis, Neurofibromatosis) that need ongoing neurodevelopmental surveillance and management as appropriate

• Management of children with neuro-disability (e.g. Cerebral Palsy), complex health needs and certain life limiting conditions

• Assessment of children with coordination Difficulties (e.g. Developmental Coordination Disorder/Dyspraxia)

• Specialist medical input and management for children with continence issues • Specialist medical input for looked after children, children undergoing adoption and

fostering • Safeguarding medical assessment of children with suspected physical abuse and

neglect through referral from social services • Specialist medical advice for children with significant Special Educational Needs (e.g.

children undergoing Educational Health Care Plan)

2. These services are currently commissioned through two separate contracts:


12 December 2017

4

• Leicestershire Partnership Trust for City patients • LLR Alliance (UHL Pillar) for County patients

3. Both contracts have national monitoring arrangements in line with the 18 week RTT and

quality performance requirements. City performance is monitored by ELRCCG at the LPT Children’s Sub Group and any concerns are raised to CMT and FP&T. County performance is monitored by the hosted LC CCG Acute Contracts team and reviewed at the monthly Alliance contract review meetings.

4. The LPT contract includes a service specification with additional key performance indicators that link to other strategic priorities such as Special Educational Need and Disability and Looked After Children. This information is important for local area inspections. There is no service specification in the Alliance contract as the paediatric medical provision was procured as an element of the planned care provision which was not separately identified within the contractual arrangements.

5. The LPT contract is funded through the LPT block contract arrangement and the Alliance contract is funded through Payment by Results tariff.

6. LPT directly employ the staff providing the city service. The Alliance has a Service Level Agreement in place with LPT for LPT staff to attend community locations on a sessional basis to provide the county service. This SLA is managed and monitored by the Alliance and funded through the tariff payment received for the service from commissioners.

LPT Service

1. The service pathway is as follows, which has been in place for a number of years: • All referrals are received through an LPT electronic system. They are then triaged and

screened through a robust, clinically-lead Single Point of Access (SPA) process. • Some referrals are put on hold where additional information is required from school,

referrer or carers. These are put back on the workflow when the information is received.

• Some referrals are forwarded to a more appropriate service, e.g. Therapy or Child and Adolescent Mental Health Services (CAMHS) or to University Hospitals of Leicester NHS Trust (UHL) specialist services. If a referral is rejected, a letter is sent back to the referrer explaining why and offering advice on other support available.

• Clinic appointments are made through an automated electronic clinic system. Parents receive a letter offering an appointment and once this is accepted, they will receive a text reminder unless parents opt out of their appointment, although this is rare.

2. The service delivers 228 clinics per year, 180 run by consultants and 48 by advance practitioners or nurse specialists in ASD/ ADHD, who are effectively carrying out a significant proportion of the follow-ups. There were 12315 contacts in 2016/17 at a cost of £ 2.8M. This equates to £227 per contact and is extrapolated from the LPT block contract value.

3. The locations of clinics and numbers of clinics per week:


12 December 2017

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LLR Alliance Service

1. The service pathway is as follows, which has been in place for a number of years: • All referrals are received through eRS for appointments to be generated. They are then

triaged through a robust, clinically-lead Single Point of Access (SPA) process; this triage system has been in place since June 2017 and was implemented as part of the recovery plan to improve wait times.

• Some referrals are put on hold where additional information is required from school, referrer or carers. These are put back on the workflow when the information is received.

• Some referrals are forwarded to a more appropriate service, e.g. Therapy or CAMHS or to UHL specialist services. If a referral is rejected, a letter is sent back to the referrer explaining why and offering advice on other support available.

• Clinic appointments are made via eRS. Parents receive a letter outlining when and where their appointment will be and they receive a telephone call reminder service two weeks prior to the appointment.

2. The service delivers 228 clinics per year with 4226 contacts in 2016/17 at a cost of £750K (national tariff payment), which equates to approximately £177 per contact.

3. The locations of clinics and numbers of clinics per week:

Performance

1. The LPT service is currently achieving the 18 week RTT standard of 92%

2. The waiting times did not flag as an under performance for the Alliance service, however on investigation it was found that there was incorrect coding of activity to the correct speciality

City Location Number of Clinics per week Beaumont Leys 2.5 Braunstone 3 Bushloe End 3 Eyres Monsell 2 New Parks 0.5 St Mathews 4 Total 15

County Location Number of Clinics per week Loughborough 5 Melton 2 Oakham 1 (plus trainee) Market Harborough 2 Lutterworth 1 (plus trainee) Hinckley 4 Coalville 4 Total 19


12 December 2017

6

between community paediatrics and paediatric medicine. This has been addressed and the activity has been assigned to the correct speciality.

3. The Alliance is current not achieving the 18 week standard. At 16th November the performance was 86.6% with a total of 404 patients, of which 350 had been seen in 18 weeks or under and 54 were waiting longer than 18 weeks

4. The longest waiting time for a new Outpatient was 42 weeks in June and this had reduced to 25 weeks in October 2017.

5. Number of Service Users over 18 weeks by site for Alliance service at October 2017:

6. It should also be noted that the DNA rate for the LPT service is approximately 10% and for the

Alliance service this is approximately 25%

Referrals into the Alliance Service

1. There has been an increase in referrals into the Alliance service as demonstrated below:

County Location Number of Service User >18 weeks Loughborough 1 Melton 0 Oakham 13 Market Harborough 3 Lutterworth 30 Hinckley 9 Coalville 2 Total 58


12 December 2017

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Action Plan for Recovery

1. The concerns over long waits in the county were flagged at the end of 2016/17 and a review of the reasons for the increase in waiting times highlighted:

• The SLA between LPT and the Alliance has not been regularly reviewed and contains no service specification

• Changing demand to the county services had not been matched to capacity • The city and county models did not have the same model of triage and in the county

this was provided on a local basis by individual consultants • A high DNA rate limiting clinic capacity • The city and county models are managed to different local access policies (LPT and

UHL policies) • No consistent clinic template for the county service • A reduction in capacity from LPT to deliver county sessions during 2016/17

2. A monthly joint task group between the Alliance and LPT was set up in May 2017 to review the

referral pathway and manage the backlog. This group also monitors and updates the remedial action plan (Appendix 1). The key actions were to reduce the long waiting times and implement a triage pathway to ensure the same service is provided across LLR.

3. The following actions have been completed: • SLA between LPT and Alliance has been reviewed • Triage of all referrals to the same model as LPT has been in place fully since June

2017 and referrals are managed centrally for all sites (required additional sessions from LPT to deliver this, both clinical and administrative)

• A clinic template has been introduced to the county service for consistency • Telephone call reminder service implemented to reduce DNA rate (reduced from 25%

to 18%) • On-going close monitoring of waiting times across all community sites with longest

waiters offered slots on alternative sites • On-going work with LPT to increase capacity, this has been introduced on 2 sites with

longest waits: Market Harborough 1 additional session per week until March 2018 and Lutterworth 2-3 additional sessions per month until December 2017

• Referrals are registered to the Community Paediatrics speciality rather than across multiple specialities (i.e. paediatric medicine) to ensure correct RTT reporting

• The current position and the capacity of the SLA to deliver the activity required is including on the Alliance risk register and reviewed monthly and continually scores 16.

• Review of patients already on waiting list without an appointment and where appropriate patients were seen by other professionals, e.g. behavioural psychologists. The service is confident that patients remaining on the waiting list require an appointment with a consultant.

4. These actions have led to a reduction in the longest waiting time from 42 weeks to 29 weeks in four months and a reduction in the backlog for follow ups. The triage service is showing some deflection to other professionals and improved co-ordination of services.


12 December 2017

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5. The maximum waiting times by site as of 23rd November (please note not all patients will be waiting this number of weeks):

6. The trajectory for achievement of the RTT standard is shown below, i.e. expected to achieve

by June 2018 with the caveat of no reduction in the current provision through the LPT SLA. Continued improvements in SPA triage, DNA reduction and increased sessions from LPT through the SLA would reduce this timeframe further; however LPT clinical capacity is currently static.

7. The additional sessions provided by LPT to the Alliance have been at a waiting list initiative rate which impacts on the Income & Expenditure position of the Alliance, and therefore is likely to contribute to a deficit position to the risk share that CCGs are party to. It should be noted that additional capacity is limited in week hours and is being provided at weekends.

8. The performance is regularly monitored by the Acute Contracts team and updates to the action plan reviewed and challenged at the monthly contract review meetings. A revised trajectory showing when performance will be recovered has been requested; this will show the best and worst case scenarios for recovery. It will also consider the financial impact of recovery. The Alliance are modelling the continuation of additional sessions at Lutterworth past December to understand the impact on performance and also the financial implications of on the I&E position as mentioned previously.

9. The action plan will be reviewed by the Contract team and the Alliance and include further issues:

• Differing access policies between the two organisations and the potential for a LLR wide access policy

County Location Maximum waiting time in weeks Loughborough 16 Melton 25 Oakham 26 Market Harborough 22 Lutterworth 29 Hinckley 20 Coalville 13


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• Use of different IT systems by the two organisations that are not linked meaning that records cannot easily be shared should Service Users move between services and delays in communication between Health and Social Care professions cause delays in patient pathways

• No text reminder service for the county as the Alliance uses UHL IT systems and this causes constraints in capacity to develop/improve IT solution

• Pool of available paediatricians to service the county demand • No service specification for the county, which would need to be aligned with the city • Placement of the service in the UHL pillar of the Alliance as the LPT pillar is not yet set

up • Pathways into each service for patients that on the boundary between city and county,

e.g. Lutterworth

10. The further actions for recovery are long term actions and will require strong partnership working to resolve. There will also be potential cost implications as it is felt from the work carried out to date that there is a fundamental mismatch of capacity and demand which requires a pathway review of both services. This will need to provide a recommendation for a sustainable and equitable service provision going forward.

Recommendation: The East Leicestershire and Rutland CCG Governing Body is requested to note the progress with the service.

Paper G ELR CCG Governing Body Meeting

12 December 2017

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Appendix 1: Action Plan Action Note Date Action Lead By When Progress Update

RAG Status

1. 27/03/17

Identify current SLA provision DS 31/03/17 Complete

2 22/03/17 Sept 2017

Meet with Julia Bolton to review service issues

• Agree future meetings to review actions & Progress every 2/52

• Monthly Meeting onwards from September

SS 31/03/17 Complete 22/03/17 • All in Diary 2/52

• All meetings set

3. 22/03/17

Establish Triage process in the Alliance • DW Dr Felix

• Identify sessions and Admin required

JB Review 05/04/17

Complete June 2017

4. 22/03/17

Consider Triage of all current referrals in the system

• Identify Numbers on Waiting list New referrals – who need triage

• Patient details needs cross referencing with City Triage hub to reduce duplication.

AR

PD

June 2017 Complete All referrals now going through Triage since July 2017

5. 22/03/17

Review clinic templates in line with city • To ensure consistency

AR / JB July 2017 Complete

6. 22/03/17

Start Partial Booking across Alliance for all clinics

AR Complete Additional work to telephone reminder

Paper G ELR CCG Governing Body Meeting

12 December 2017

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Action Note Date Action Lead By When Progress Update

RAG Status

• News

• FU

in place started May 2017

7. 22/03/17

Review letters on System 1 for Alliance use- explore possibilities with HISS

JB Letters – not able to change due to HISS

8. 22/03/17 JB to share BPP policy for DNA & RTT

JB Complete Note LPT RTT Policy is not in use as activity is in UHL Pillar and policies are different.

9. 22/03/17

Explore use of System 1 in the Alliance via LHIS

SS Email sent to Alliance Customer support – await response – cost implication

10. 22/03/17

Send Data to Sam Little for commissioning paper

SS Information sent 27/03/17

11. June 2017

Source additional sessions via SLA / Locums to reduce waiting times

JB / SS July 2017 Complete – Locum completing extra sessions WLI paid through LPT

12. August 2017

Source additional session’s appointments in City for children in nearby postcodes.

GB/ JB /SL

September 2017

Awaiting final response – on contract meeting for Nov

Name Sam Little SL Sue Sutton SS Julia Bolton JB Angharad Rastrick AR Alison Tyers AT Paul Bale PB Gemma Barker GB

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Paper H ELR CCG Governing Body Meeting

12 December 2017

1


Front Sheet

REPORT TITLE: ELR CCG GP Locality Meeting Themes – November 2017

MEETING DATE: Tuesday 12 December 2017

REPORT BY: Becky Hunt, Operations Support Officer

SPONSORED BY: Jamie Barrett, Head of Primary Care

PRESENTER: Dr G Purohit, Melton, Rutland and Harborough Dr Nick Glover, GP Locality Lead, Blaby & Lutterworth Dr Andy Ker, Clinical Vice Chair, ELR CCG

EXECUTIVE SUMMARY: The purpose of this report is to provide an overview of the monthly GP Locality meetings held across Blaby and Lutterworth, Oadby and Wigston and Melton, Rutland and Harborough. These meetings are key to the CCG development and allow member practices an opportunity to debate current general practice and highlight themes they wish to inform the Board.

RECOMMENDATIONS: The East Leicestershire and Rutland CCG Governing Body is requested to: RECEIVE the report.


Y Improve integration of local services between health and social care; and between acute and primary/community care.

Y


Y Listening to our patients and public – acting on what patients and the public tell us.

Y

Reduce inequalities in access to healthcare Y Living within our means using public money effectively

Y


Y

EQUALITY ANALYSIS An Equality Analysis and due regard to the positive general duties of the Equality Act 2010 has not been undertaken in the development of this report as it is judged that it is not proportionate on the basis that on the basis that this purely an information summary of discussions which has occurred.

This completes the due regard required.


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BAF 6 BAF 10


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GOVERNING BODY MEETING

GP Locality Meetings – November 2017

12th December 2017

INTRODUCTION

1. The 31 GP practices across the CCG are split into 3 geographical localities, Blaby and Lutterworth, Oadby and Wigston and Melton, Rutland and Harborough. The purpose of the locality structure is to provide a forum for member practices to feed into the CCG, feedback to their practices and discuss key issues and concerns. In addition the locality structure provides:

• Meetings held monthly, 12 times a year • A promotion of two-way discussion on all business and a mechanism for

GPs to be updated on CCG matters to inform commissioning and planning processes.

• Share learning from adverse events e.g. safeguarding issues etc. • Opportunities for clinical discussion and education • Monitoring of performance and quality through the sharing of

benchmarked data and information. LOCALITY MEETING CONTENT These meetings are represented by each practice across the CCG. The themes for the November 2017 meetings can be split up as the following: Dementia Practice Visit Report (BL only) Medicines Quality Update (BL only) Working together (All localities) PoPs Assessing unwell paediatric patients (OW only) COPD template (OW only) Hustings (OW only) Rutland In Reach Beds (Rutland only) Primary Care Home (Rutland only) Vitrucare (Rutland only) St Georges Discussion (Rutland only) Clinical Topics Other Agenda Items Governing Body Update (available for some but not all meetings) Performance report (discussed at BL and OW) AOB


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LOCALITY THEMES The sections below represent the key themes from the Localities for the month of November 2017. 3. MELTON RUTLAND AND HARBOROUGH LOCALITY Clinical Chair: SLAM- Dr Girish Purohit, Rutland- Dr Hilary Fox, Harborough Chris Lyon (non-clinical) November 2017 In November the meetings were held in sub localities so there were three meetings. HARBOROUGH 3.1.1 Working Together – Membership met to discuss working together and how they could work together to access Transformation funds. The group were concerned the money would not be recurrent and therefore some of the projects could not be taken forward. The members agreed that there was potential to pool resources such as the DSN, Community Matron and COPD nurses and other specialist nurses. Transformation money can be used as a two pronged tool, to reduce costs and improve quality, however it was noted that there is sometimes a disparity between the two. 3.1.2 The members discussed working in smaller sub locality and were receptive to this, they also wanted to continue to meet as MRH locality. RUTLAND 3.2.1 Focus on working together Primary Care Home- The members discussed in considerable detail throughout the meeting how the Rutland practices could work together, building upon the Primary Care Home project and discussions which had taken place during the ELRCCG Protected Learning Time session. The membership were in agreement that they could work together and use the foundations build with Rutland Primary Care Home as a vehicle for transformation. The members discussed examples of how working together could benefit practices in helping them with capacity issue, clinical and staff and benefits to patients. The group recognised that amongst Rutland practices, there is a lot of good work being undertaken in individual practices and that sharing this work could make a big difference to all. 3.2.2 Developing a Transformation Bid- The members discussed how they could work together to bid against the Primary Care Transformation fund; the members discussed freeing up clinical time to meet again to identifying GPs and managers to meet together. All members agreed to meet before Christmas and use the PLT scheduled for January to meet to agree what the bid should cover. The members felt assured that there is no defined assessment criteria for awarding the transformation money; the application template has a series of questions that must be answered


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and if practices use this they can apply for funding. It was also reiterated that to drive any change forward all the clinicians need to understand what the vision is, agree this vision and ensure what will make a the biggest impact and define a clear delivery programme and a plan of actions. 3.2.3 Vitrucare- Mr Ian Razzell Practice Director Oakham Medical Practice presented Vitrucare to the membership. This is an online service for patients with Long Term Conditions who can take their own blood pressure readings , diabetes readings etc. and record them online, negating the need for multiple appointments. The service is designed to decrease footfall into the GP practice, signpost to the most appropriate clinician and act as a reporting mechanism for patients for routine readings. It has proved very successful for stable patients with Long term conditions. It also provides condition specific information to educate patients on managing their condition. The patient is empowered to manage their own condition. The web based service is being supported by Rutland County Council who are keen to progress with Vitrucare as it offers proactive care and patients can allow access to information as they choose, be it, health or social care providers.. The members agreed to test the system with a small cohort of patients across 4 practices to see first-hand how it will benefit patients and practices. SLAM 3.3.1 Outputs from Practice PLT- A substantial element of the meeting concentrated on the outputs from the PLT, practice views on their vision/mission statements and resilience. The members indicated they were willing to take steps towards working more closely together but wanted flexibility to work outside of the group where opportunities arose. A question was posed about how the transformation funding could be accessed if there are possible alternative/different structures alongside geographical practices groupings? 3.3.2 Federation work - An update was given on the work of the Federation in relation to business planning and it was noted that the Federation would be willing to work up the plan for SLAM and they would begin to write the outline based on outputs from the meeting. Practices are to confirm within their own organisations if they want the Federation to write the plan for SLAM and acknowledged that there may be Federation costs resulting from additional work. 3.3.3 Areas with scope for working together - Practices discussed a range of areas where they saw scope for working more closely and aligned to each other and which would potentially meet the criteria for Transformation funding. Emphasis was placed on particular areas to be considered in more detail:

• Active signposting/Care navigation • Correspondence management • Internal PLT – 17th January


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• Demand Management • Dementia MDT

Members agreed that they would continue to value a full MRH meeting within any new structures and for SLAM meetings, to include local authority and LPT as appropriate. 3.3.4 UHL paper/electronic records - Practices asked that the paper/electronic discharge letter programme of work be escalated as it was of considerable concern. Duplicate electronic and paper records create more work for practices however the bigger issue is the clinical risk of no communication being received at all. 4. BLABY AND LUTTERWORTH – Chair Dr Nick Glover November 2017 4.1 Radiology – The locality had been trying to resolve issues with the service since June of this year: • ANP’s not able to request X-Rays on ICE • Test results not sent back to referring GP which can and have led to results not being accessible when GPs are on holiday or left the practice. After a long delay in responding to request to meet a meeting was set up with senior managers of the Radiology service to resolve issues highlighted by the practices. Frustratingly, the meeting was cancel by the service managers less than 24hours prior to the meeting. 4.2 Electronic Letters – All practices in the locality had problems with discharge letters, and some practices more than others if they had to use locums for cover. Part of the problem at the moment was that practices were receiving duplicate letters; electronically and paper copies, which caused extra practice work. However it has been identified that there was no discharge letters for some patients which was dangerous for patient safety and care. 4.3 Second Blood collections – Several practices raised concerns over the capacity needed in practice to take bloods in the allotted time prior to their daily blood collections. The service had been approached over a year ago to develop second blood collections for all practices but apart from a pilot the service has remained the same. 4.4 Dementia Prevalence – Dementia prevalence and diagnosis was thoroughly discussed in many elements of the meeting including very useful sharing of procedures and successes. 4.5 Blaby and Lutterworth Hub Discussions – The members split into two groups; North Blaby and South Blaby and Lutterworth practices. The two groups had very successful discussions with a cross sharing of ideas in the plenary at the end. The two groups agreed that Hub access to the Transformation Funding was needed as soon as possible.


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4.6 Prescribing – Shazia Patel presented the new UTI template for care homes, which was well received by the members as a sensible use of prescribing antibiotics. Shazia informed the group that at the December meeting the draft Prescribing Incentive scheme based on a fair budget methodology. 5. OADBY AND WIGSTON – Chair Dr Andy Ker November 2017 5.1 Locality hustings – The two candidates running for election to become the next elected Oadby and Wigston GP Board Member successfully delivered their presentations to the locality. The candidates were both given allotted time for their presentations and meeting attendees were given the opportunity to raise questions directly with the candidates. GPs were reminded that the voting opens on Friday 24th Nov until Fri 8th December. 5.2 PoPs: - The locality received a presentation relating to PoPs (paediatric Observation and Priority score) tool. Predominantly developed for acute use the team would like to give GPs the opportunity to pilot within general practice. Discussion took place around some user experience and how this scoring matrix could help. Attendees were very keen to learn more and all practices were willing to undertake a pilot. 5.3 Joint Working: - The locality continued discussions commenced at the last locality meeting and PLT session. A draft business plan prepared by the federation was shared by James Watkins and Paula Vaughan gave further clarity around plans for urgent care. Practices were encouraged to seek their practices views for not only providing services by the sub areas during in hours but as a whole locality for out of hours. There are still some concerns around the demand and it was agreed that further information regarding activity was needed to aid further discussions. GPs also raised commissioning / contract questions around medical legal responsibility, and felt that clarity on this would greatly help the practice discussions. Recommendation: The East Leicestershire and Rutland CCG Governing Body is requested to: RECEIVE the report

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Paper I East Leicestershire and Rutland CCG Governing Body meeting

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Page 1 of 6


Front Sheet

REPORT TITLE: Assurance Report from the Provider Performance

Assurance Group (PPAG) – November 2017

MEETING DATE: 12 December 2017

REPORT BY: Jayshree Raval, Commissioning Collaborative Support Officer

SPONSORED BY: Karen English, Managing Director

PRESENTER: Warwick Kendrick, Independent Lay Member and Chair of PPAG

PURPOSE OF THE REPORT: This report is from the Provider Performance Assurance Group (PPAG); a meeting held in common of the 3 Leicester, Leicestershire and Rutland CCGs. This report provides the Governing Body with assurance about the arrangements in place to collaboratively monitor the contracts and performance of our key providers.

RECOMMENDATIONS: The East Leicestershire and Rutland CCG Governing Body is requested to:

• RECEIVE the assurance report from PPAG.


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EAST LEICESTERSHIRE AND RULAND CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING

12 December 2017

Assurance Report from the Provider Performance Assurance Group (PPAG) – November 2017

Introduction 1. The purpose of this report is for the Provider Performance Assurance Group

(PPAG) to provide the Governing Body with a summary of the assurance received from the Contract Leads in relation to performance across the collaborative contracts, and the respective providers’ performance.

2. In addition, the report provides a summary of the items for escalation from PPAG during November 2017 for consideration by the Governing Body, and to ensure that the Governing Body is alerted to emerging risks or issues.

3. PPAG is a meeting held in common consisting of members from across each of the

3 Leicester, Leicestershire and Rutland CCGs. PPAG’s role is to:

• Receive assurance and hold to account the Contract Leads; • Advise, make suggestions and recommend actions on provider performance

as appropriate; and • Provide onward assurance to the respective Governing Bodies.

Provider review and areas of concern

4. At the meeting in November 2017, PPAG received a report from each of the

Contract Leads from across the 3 CCGs. The main focus of the meeting was on the following two contracts managed by West Leicestershire Clinical Commissioning Group (WL CCG).

a. Thames Ambulance Service Limited (TASL) b. East Midlands Ambulance Service (EMAS)

5. PPAG would like to draw the Governing Body’s attention to the areas of

performance highlighted below.

Detailed Report: West Leicestershire CCG: Non-Acute Contracts

6. Thames Ambulance Service Limited (TASL): It was noted that the contract with Arriva ended on 30 September 2017 and non-emergency patient transport service commenced with the new provider TASL from 1 October 2017.

7. It was highlighted that the first set of data that was received indicated that TASL performed poorly during the month of October 2017 against the Key Performance Indicators (KPIs) for the arrivals and collection after appointments. This has impacted on:

a. Treatment times due to delays for renal journeys.


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b. Failed discharges have also led to readmissions into University Hospitals of Leicester (UHL) and Leicestershire Partnership Trust (LPT).

c. The poor planning and discharge mechanisms.

8. Following last month’s update on issues around staffing, this has now in the main been resolved and TASL staffing level is at planned level as part of their recovery plan.

9. The main issues that are affecting TASL’s performance are: a. The inflexibility of online booking system b. The high demand on telephone lines c. Planning and despatch processes

10. PPAG were informed that further actions have been put in place, which included: a. Review of the functionality for the online booking to provide access to wider

team, however training is awaited for some of the staff; b. The local call centre in LLR went live on 13 November 2017 for discharge

and outpatients only; and c. Discharge Co-ordinators are working closely with UHL’s operational team.

11. As it is too early to assess the impact of the actions taken above, the contracts

team are monitoring the daily situation reports for improvement and are refreshing the action plan accordingly.

12. It was noted that a meeting was held with the TASL executive board to discuss poor performance and concerns in other areas.

13. East Midlands Ambulance Service (EMAS): EMAS’s performance on handover times have shown continuous improvement in the past months, however deterioration in the performance against the Ambulance Response Programme (ARP) standards was noted for the month of October 2017. It was noted that EMAS performed well for LLR for Category 1 and Category 4 in October 2017, however did not meet the standards for Category 2 and Category 3, and did not meet Category 1T. Currently the percentiles are only available at regional and divisional level however the team are working on making these available at a CCG level.

14. It was highlighted that the staff consultation was underway to change the resource

mix from First Responder Vehicles (FRV) to more Double Crew Ambulance (DCA) is well underway. EMAS have reported that they have received little resistance to the changes required. Consultation is due to end on the 23 December 2017 with the changes being formally implemented from the 1 April 2018.

15. PPAG were informed that NHS England have written to the CCG advising that all

ambulance trusts will need the remainder of the financial year to enable the revised standards to embed. Therefore, although the CCGs are expected to monitor


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performance against the new standards, they will not have the ability to make a considered decision until April 2018.

16. PPAG expressed concerns with regards to the following two elements:

a. The standards for Categories 1T and 2 are not being met and therefore what assurances are provided that no harm has come to patients due to the response times not met.

b. As commissioners, CCGs are unable to hold EMAS to account for not meeting the standards until April 2018.

17. PPAG were informed that a review of Serious Incidents (SIs) at regional level is in the process of being established to review if any harm has been identified. PPAG’s view was that it would be appropriate to take steps in the immediate future rather than looking to carry out review after the incident/s have occurred.

18. It was noted that the jointly commissioned demand and capacity report undertaken

in May 2017 highlighted that EMAS required additional whole-time equivalent (wte) staff in order to deliver on the ARP standards. Since then a revised report in August 2017 highlighted double the number of the additional staff required to deliver on the ARP standards. EMAS are now requesting an additional £9.1m investment in order to meet the new ARP standards.

University Hospitals of Leicester (UHL) NHS Trust

19. Consultant Connect: PPAG were informed that a proposal for the successor solution is awaited and until then UHL will continue to provide this service.

20. Finance: It was noted that the overall position at month 6 is £6m over the revised Price and Activity Matrix (PAM) YTD. It was noted that if it is assumed that challenges of £4.8m and QIPP of £2.6m are delivered, then forecast outturn will be £5.6m over plan.

21. Radiology: At the end of October 2017, UHL reported on high numbers of unreported plain film images. The report detailed the backlog by referrer and time waiting for reports.

22. In addition, it was highlighted that UHL have stopped using the EMRAD system and advised that their decision to withdraw from the EMRAD system was based upon patient safety. UHL stated that they frequently experienced crashing and/or system unavailable during clinic times which resulted in patients having to re-attend clinics.


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23. Prevent Training: Following the agreement with UHL to ensure that 85% of relevant staff have received WRAP training by June 2018. The CCG Safeguarding Team developed 3 trajectory options to enable monitoring of progress.

24. Ophthalmology: It was reported that the continuing pressures in demand experienced by the Ophthalmology service has resulted in a continued backlog of patients waiting for follow up. UHL have advised on the shortfall of clinic appointments per annum of which some are now being sub-contracted to the independent provider. It is noted that the recruitment of 5 additional consultants from 1 November 2017 has been identified to close the gap further.

25. Cancer Standards: PPAG were informed that UHL did not deliver the 62 day standard in the recent month and other cancer standards were also missed. The actions taken to remedy performance were detailed in the report.

26. Alliance Community Paediatrics Service Deep Dive: PPAG were informed that concerns were raised by the county community paediatricians in relation to waiting times and differing delivery processes compared to the city. It was noted that the county service is not been achieving the 18 week RTT standard of 92% and therefore a deep-dive was carried out into the service as requested by East Leicestershire and Rutland CCG. This service is commissioned through two separate contracts: Leicestershire Partnership Trust (LPT) and LLR Alliance (UHL Pillar) for County patients. The Alliance is currently not achieving the 18 week standard. Action plan for recovery has been put in place.

Exception Report: East Leicestershire and Rutland CCG:

Leicestershire Partnership Trust (LPT) 27. Children’s Adolescence Mental Health Service (CAMHS): It was highlighted that

Care Quality Commission (CQC) re-inspected the service recently. CQC report is expected to be published early 2018.

28. Delayed Transfers of Care (DToC): the September data indicated that the length of stay (LOS) has reduced in reported DToC bed days, which was positive. The average length of stay is being monitored by the Delayed Transfer of Care System Group.

29. Following concerns highlighted in the CQC report around Community staffing, a

joint review of Community nursing service staffing is in progress with CCG and LPT with the support from NHS Improvement (NHSI).


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Improving Access to Psychological Therapies (IAPT) Service (Nottinghamshire Healthcare NHS Foundation Trust)

30. Improving Access to Psychological Therapies (IAPT): PPAG were informed

that for County contract, progress has been made to agree a recovery trajectory to address the performance issues following escalation to the Executive Director within Nottinghamshire Healthcare FT. A recovery trajectory is due to be received at the end of November 2017. A Service Development Improvement Plan (SDIP) has been agreed for the City contract.

Continuing Health Care (CHC) 31. PPAG were informed that the Contract Team met with Midlands and Lancashire

Commissioning Support Unit (MLCSU) and there is a clear understanding of the CCG’s expectations and clarification of the KPI requirements. The next step will be to agree a trajectory to ensure full compliance.

RECOMMENDATIONS

East Leicestershire and Rutland CCG Governing Body is requested to:

• RECEIVE the assurance report from the Provider Performance Assurance

Group.

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Paper J East Leicestershire and Rutland CCG Governing Body meeting

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NHS EAST LEICESTERSHIRE AND RUTLAND CCG GOVERNING BODY MEETING

Front Sheet

Title of the report: Summary Report from the Audit Committee (15 November 2017 meeting)

Report to: Governing Body meeting

Date of the meeting:

12 December 2017

Report by:

Daljit K. Bains, Head of Corporate Governance and Legal Affairs

Presented by:

Warwick Kendrick, Chair of the Audit Committee

PURPOSE OF THE REPORT:

This report provides a summary of the key areas of discussion and outcomes from the Audit Committee meeting held on 15 November 2017. The report provides assurance to the Governing Body in respect of the effectiveness of risk management systems and processes across the CCG; and also items for escalation for consideration by the Governing Body ensuring that the Governing Body is alerted to emerging risks or issues.

RECOMMENDATIONS:

The East Leicestershire and Rutland CCG Governing Body is requested to: RECEIVE the report.

REPORT SUPPORTS THE FOLLOWING STRATEGIC AIM(S) 2017 – 2018:

Transform services and enhance quality of life for people with long-term conditions







EQUALITY ANALYSIS

An Equality Analysis and due regard to the positive general duties of the Equality Act 2010 has not been undertaken in respect of this report. The Audit Committee, through its review of effectiveness in risk management systems and processes, also seeks assurances in respect of compliance with statutory requirements, including compliance with the Equality Act. The equality analysis can be found within each document, for example, within the policy documents referred to within the Board Assurance Framework.


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RISK ANALYSIS AND LINK TO BOARD ASSURANCE FRAMEWORK:

The Audit Committee has the remit to seek assurance in respect of the implementation and maintenance of an effective risk management system and process underpinning all strategic aims through seeking assurance in respect of the regular review of the corporate risks captured within the Board Assurance Framework.


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NHS EAST LEICESTERSHIRE AND RUTLAND CCG GOVERNING BODY MEETING

12 December 2017

Summary report from the Chair of the CCG Audit Committee Summary and outcome of meeting 1. The CCG Audit Committee met on 15 November 2017. The minutes for the

October 2017 meeting were approved and are available at Appendix 1.

Keys areas of discussion from November 2017 meeting:

a) Audit and Risk Committee Progress Report and Emerging Issues and Developments for ELR CCG: the External Auditors, Grant Thornton, provided an overview of work in progress to date, which was noted to be in the early stages.

b) Counter Fraud, Bribery and Corruption Progress Report: the counter fraud specialist highlighted the work undertaken to date including supporting the CCG with ensuring compliance against the self-assessment review standards. It was noted that November was counter fraud awareness month and various awareness raising campaigns were being carried out.

c) Internal Audit Progress Report: the Internal Auditors had highlighted their concern in relation to progress made to date to commence internal audit reviews that had been agreed to be carried out collaboratively across the 3 CCGs. The Audit Committee members requested that the matter be escalated to the Managing Directors of the 3 CCGs to ask for their support in gaining some momentum to these reviews ensuring they were completed by end March 2018.

d) Follow-up of audit recommendations (the management’s report): this report by the management team was received and read in conjunction with the Internal Auditors’ update. The Committee members noticed that work continues to ensure the actions following internal audit reviews are completed in a timely manner.

e) Conflicts of Interest Policy: the Committee received an updated version of the CCG’s Conflicts of Interest Policy to review and approve following the meeting. It was noted that the CCG Policy had been reviewed to reflect the recent updated guidance published by NHS England.

f) Update on the review of the Board Assurance Framework and Risk

Registers – the Committee noted that the Governing Body had approved the updated Board Assurance Framework at its meeting in November 2017 and that a further review was underway to update the content in light of the


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discussions at the Governing Body. Furthermore, the Governing Body had delegated authority to the Committee to approve the updated Risk Management Strategy and Policy. It was noted that the updated draft Risk Management Strategy and Policy was to be presented in January 2018; however an initial discussion in relation to risk appetite took place to help inform the refreshed Strategy. The Committee requested that the Executive Management Team review and provide a proposal for consideration in relation to whether the current, subjective, view of risk appetite needs to continue to be applied to individual risks, which means that risk appetite scores will vary across the same category of risk; or whether risk appetite scores should be aligned to categories of risk e.g. clinical risks to have the same risk appetite, as would finance risks etc.

g) Waiver of Standing Orders: the Committee received the updated report on

waivers of standing orders and noted the contents.

h) Losses and Special Payments: it was noted that no losses and special payments were approved during the period reported.

RECOMMENDATIONS The East Leicestershire and Rutland CCG Governing Body is requested to: RECEIVE the report.


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Appendix 1 EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP

Minutes of the Audit Committee held on Tuesday 10 October 2017 at 3:30pm in

Council Chambers, ELR CCG, Pen Lloyd Building, County Hall, Glenfield, Leicester, LE3 8TB

Present: Mr Warwick Kendrick Independent Lay Member (ELR CCG) (Chair) Dr Tabitha Randell Secondary Care Clinician (ELR CCG) Mr Alan Smith Independent Lay Member In Attendance:

Ms Donna Enoux Chief Finance Officer (ELR CCG) Mrs Daljit K. Bains Head of Corporate Governance and Legal Affairs (ELR CCG) Mrs Mandeep Thandi Corporate Affairs Project Officer (ELR CCG) (minutes)

ITEM DISCUSSION LEAD

RESPONSIBLE AC/17/67 Apologies for absence were received from:

Mr John Gregory, Grant Thornton

Mrs Carmel O’Brien, Chief Nurse and Quality Officer (ELR CCG)

Mr Kevin Watkins, Client Manager, 360 Assurance

Mr Warwick Kendrick welcomed all members to the Audit Committee meeting, which had been deferred from September 2017, and thanked all for attending.

AC/17/68 Declarations of Interest on Agenda Topics There were no declarations of interest made.

AC/17/69 Minutes of the Previous Meeting of ELR CCG Audit Committee held on Wednesday 2 August 2017 (Paper A) The minutes of the Audit Committee meeting held in August 2017 were approved as an accurate record of the meeting. It was RESOLVED to:

APPROVE the minutes of the meeting.

AC/17/70 Matters Arising: Update on Actions (Paper B) The matters arising following the Audit Committee meeting held in August 2017 were received and the majority noted as ‘complete,’ with the following updates:

AC/17/45 Losses and Special Payments Report relating to AGEM CSU - Ms Enoux advised there is still an ongoing dispute with Arden and Greater East Midlands Commissioning


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Support Unit (AGEM CSU) and that AGEM CSU was looking into the matter. Ms Enoux informed that she and Mrs English will be meeting with AGEM CSU with an aim to reach a resolution.

It was RESOLVED to:

RECEIVE the matters arising and progress to date.

AC/17/71 Head of Internal Audit Work Programme: Stage 1 Memo (Paper C) Mrs Daljit Bains advised that this report would normally have been presented by the Internal Auditors; and advised that it was important to present the report today as opposed to waiting until the next regular meeting as findings related to risk management arrangements, which would be helpful to note given that the Board Assurance Framework is being reviewed today. Mrs Bains informed that the Head of Internal Audit Review is being completed on a phased approach similar to the previous year. The report detailed the findings and recommendations following the first phase of the review. Findings and recommendations on page 4 and page 5 were referred to. It was noted that the Internal Auditors would be happy to assist with any queries relating to the report. Committee members received the report and noted the findings and recommendations. It was RESOLVED to:

RECEIVE the report.

AC/17/72 To RECEIVE and APPROVE Follow up of Audit Recommendations (management report) (Paper D) Mrs Bains provided an overview of the report and drew the Committee’s attention to Appendix 1 which shows the current position and progress in implementing the outstanding Internal Audit recommendations for 2016-17. Mrs Bains drew the Committee’s attention to the recommendations on Cyber Security which were still outstanding. It was noted that Mrs Bains had sought agreed from the Executive Management Team to fund the work required on the CCG website to enable it to be compliant with the auditor’s recommendations. It was noted that work was in progress to implement the actions, although it had taken longer than anticipated due to the complexities of the work required on the CCG website.


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In respect of the actions relating to the conflicts of interest audit, Mrs Bains advised that the updated Conflicts of Interest Policy will be presented at the next meeting for approval. Table 1 provided an overview of the audits planned for 2017/18 and progress in compiling the terms of reference. Under the Information Management and Technology section of the audit plan, the Committee had agreed for a collaborative audit review to be focused on Information Sharing Protocols. Mrs Bains asked for the Committee’s agreement to allocate this time to undertaking a review in preparation for the General Data Protection Regulations (GDPR) which will be coming into force in May 2018. The GDPR audit review would be helpful to provide a baseline and risk assessment, and enable gaps to be highlighted so that focused effort can be taken ahead of the regulations coming into force. It was noted that the Information Sharing Protocols are being reviewed by the Corporate Affairs Team and present less of a risk in comparison to GDPR compliance, although if there is sufficient time within the audit plan in Q4 should the information sharing protocols review need to be considered then. It was noted that both WL CCG and LC CCG were in agreement with amending the audit plan as proposed and were also seeking agreement from their respective Audit Committees. It was RESOLVED to:

RECEIVE the report and note progress made in implementing the audit recommendations and the audit plan.

APPROVE an amendment to the audit plan: the time allocated to information sharing protocols to be allocated to undertake a baseline review in preparation for GDPR.

AC/17/73 To RECEIVE and APPROVE the updated Board Assurance Framework 2017 – 2018 and Directorate Risk Registers (Paper E) Mrs Bains informed she was please to be able to present the revised Board Assurance Framework (BAF) in its new format. Dr Randell highlighted the report is much more readable and clear. Mrs Bains thanked Committee members for their support with the review of the BAF and pointed out she had taken on board feedback received from the Committee members as well as the Governing Body members during the Board Development Session. Mrs Bains went through the format of the new BAF format using risk BAF 1 as an example and describing the detail covered for each risk.


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The text in red indicates where the Executive Management Team has updated the report since the previous report. Mrs Bains highlighted that the report provides a clear picture of what actions are required to mitigate a risk and advised that the content will continue to evolve as colleagues become familiar with the new format. Mr Kendrick thanked Mrs Bains for the hard work involved in ensuring the BAF is much clearer and agreed it was much easier to follow, highlighting the summary was helpful and the graph is a useful visual aid. Individual risks were then reviewed in more detail, with specific questions and queries highlighted:

BAF 1 – Committee members still felt this risk should be separated into its component parts, however Mrs Bains advised that EMT suggested it was left as a single risk for now.

BAF 2(a), 5(b), 8, 9 and 11 were all approved.

BAF 3 – Quality – Primary Care. Mr Smith questioned whether the report considered Care Quality Commission (CQC) recommendations. Mrs Bains clarified that CQC recommendations are considered at the Primary Care Commissioning Committee in relation to GP Member Practices.

BAF 5(a) – QIPP. Mr Kendrick highlighted this is to be reviewed. Ms Enoux recommended the BAF for the QIPP programme should be maintained by Mr Paul Gibara and not by herself. Although she noted she had previously at EMT advised that she should remain the lead.

BAF 6(a) – Out of Hospital – Primary Care and BAF 6(b) – Out of Hospital – Primary Care. Mr Kendrick pointed out there are no changes highlighted across these risks. Mrs Bains advised that Mr Sacks was still to review the BAF in details.

BAF 6(c) – Out of Hospital – Primary Care: Risk in relation to Out of Hospital Services. Mr Smith stated that there is no capital or transformation money in Primary Care to improve surgeries. Ms Enoux pointed out they do have ETTF funding but there is prioritisation over who can receive this. Ms Enoux agreed with Mr Smith that there are not enough funds.

BAF 7 – Out of Hospital – Community Services. Mrs Bains advised that Mr Sacks will include a note on deescalating this

Daljit Bains


12 December 2017

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risk.

BAF 10 – Finance. Ms Enoux reported that the CCG is off target, greater than what they had initially identified. CCG has always been under funded. Ms Enoux felt inclined to change the risk score to 25.

BAF 12 – Commissioning Support. Ms Enoux advised the current risk score is low but felt the issue of high costs with AGEM should be included.

Mr Smith asked about the review of the risk appetite and the rationale for the scores. Mr Smith would welcome a discussion on this at the next meeting. Mrs Bains advised that she is aiming to present the draft version of the refreshed Risk Management Strategy which will cover the review of the risk appetite. In relation to the BAF, EMT members have agreed risk appetite scores and they are in line with our current Risk Management Strategy. Mrs Bains clarified that there needs to be a shared understanding and it is helpful if all members understand the risk appetite. The landscape has changed and the tolerance is not the same. Mrs Bains indicated if the risk appetite has changed it will need documenting. Mrs Bains detailed the collaborative risks are outlined on page 38 of the report. Ms Enoux highlighted that ML CSU are mentioned in the risk of continuing healthcare. Mrs Bains to remove ML CSU from page 38 of the BAF report. Mr Kendrick advised all he will chase Mr Sacks to ensure he updates his risks in the BAF on a regular basis. Mr Smith suggested a larger font size and format of the directorate level risk registers. Mrs Bains acknowledged this issue and informed that the next task is to review the format of the directorate level risk registers to ensure they are refreshed.. Mrs Bains talked through page 5 of the main report, ‘Table 1: Progress against the actions from the Governing Body Development session held 31 January 2017,’ and explained it has been updated using the BAF. She indicated that all actions from the Board Development Session were complete with the exception of action 10, which related to separating BAF risk 1 into its component parts and as discussed earlier in the meeting this was not considered appropriate at present. Mrs Bains asked Mr Kendrick if this action

Daljit Bains

Warwick Kendrick


12 December 2017

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could therefore be closed. Mr Kendrick agreed this action could be closed and Mrs Bains confirmed this meant that all actions following the Board Development Session have now been completed. Mr Kendrick thanked Mrs Bains once again for the hard work in the review of the BAF. It was RESOLVED to:

RECEIVE the update and NOTE work in progress.

CONFIRMED that actions following the Board Development Session had been completed and AGREED for the action plan to be noted as complete.

AC/17/74 To RECEIVE Waiver of Standing Orders (Paper F) Ms Enoux presented Paper F and highlighted they managed to bring down the cost of the review into public consultation undertaken by KPMG to £14,950. Ms Enoux identified the item Ref 03W18 requested by Mrs English for facilitation fees and team development, was incorrectly approved by Mrs English, in that Mrs English cannot request and also approve the request. Ms Enoux would ensure that the Chairman countersigns this request. Dr Randell queried whether the employer should be paying for course fees and mentioned in her profession, junior doctors are expected to pay for their own exams if they wish to undertake continuing professional development. Committee members suggested that facilitation for EMT development sessions and coaching sessions should be capped and would not expect to see them on a waiver of standing orders report as they should follow the Standing Orders. Ms Enoux would mention this to Mrs Karen English. Ms Enoux highlighted the second item Ref 03W19 was not requested by herself and it was requested by Mrs O’Brien so she would ensure this is amended. It was RESOLVED to:

RECEIVE the report.

Donna Enoux Donna Enoux Donna Enoux

AC/17/75 To RECEIVE Losses and Special Payments Report (Paper G)

Mr Kendrick noted there are no new losses or special payments to add to the report.


12 December 2017

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It was RESOLVED to:

RECEIVE the report.

AC/17/76 Any other business Mr Kendrick noted there was no other business to discuss and thanked all for attending.

AC/17/77 Date of next meeting: Wednesday 15 November 2017 Private meeting between the Audit Committee members and the Internal and External Auditors 9:30am – 10:00am Audit Committee meeting: 10:00am – 12:30pm ELR CCG, Board Room, County Hall, Leicester.

Blank Page

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System Leadership Team

Chair: Toby Sanders Date: 19th October 2017

Time: 9.00 -10.50 Venue: 8th Floor Conference Room, St Johns House, East Street, Leicester, LE1 6NB

Present: Toby Sanders (TS) LLR STP Lead, Managing Director, West Leicestershire CCG

John Adler (JA) Chief Executive, University Hospitals of Leicester NHS Trust

Karen English (KE) Managing Director, East Leicestershire and Rutland CCG

Azhar Farooqi (Afa) Clinical Chair, Leicester City Clinical Commissioning Group

Steven Forbes (SF) Strategic Director for Adult Social Care, Leicester City Council

Spencer Gay (SG) Chief Financial Officer, West Leicestershire CCG

Mark Gregory (MG) Leicester, Leicestershire & Rutland General Manager, East Midlands Ambulance Service NHS Trust

Satheesh Kumar (SK) Medical Director, Leicestershire Partnership NHS Trust, Co-Chair, Clinical Leadership Group

Mayur Lakhani (ML) Chair, West Leicestershire Clinical Commissioning Group, GP, Sileby Co- Chair, Clinical Leadership Group

Sue Lock (SL) Managing Director, Leicester City CCG

Peter Miller (PM) Chief Executive, Leicestershire Partnership NHS Trust

Tim O’Neill (TO’N) Deputy Chief Executive, Rutland County Council

Richard Palin (RP) Chair, East Leicestershire and Rutland CCG

Sarah Prema (SP) Director of Strategy & Implementation, Leicester City Clinical Commissioning Group

Evan Rees (ER) Chair, BCT PPI Group

John Sinnott (JS) Chief Executive, Leicestershire County Council

Apologies Helen Briggs (HB) Chief Executive, Rutland County Council

Niki Bridge (NB) Finance Director and Deputy Programme Director, BCT

Andrew Furlong (AF) Medical Director, University Hospitals of Leicester NHS Trust

Richard Henderson (RH) Deputy Chief Executive, East Midlands Ambulance Service NHS Trust

In Attendance Stuart Baird Communications and Engagement, BCT Charles Walker Communications and Engagement, BCT Shelpa Chauhan Office Manager, BCT

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Janice Richardson Project and Admin support, BCT(Minutes)

1. Apologies and introduction Apologies received from Andrew Furlong. TS noted that the partners will be aware changes are being made to strengthen the Communications and Engagement support, in terms of external stakeholders management for the STP. A number of changes have been made within the programme, including the SRO for Communications and Engagement strand being taken up by Richard Morris in place of Mark Wightman, to ensure this role was held and managed within the CCG network. TS expressed thanks to Mark Wightman for his valued support over the last few years. TS explained in the interim Stuart Baird and Charles Walker will assist Richard Morris, and are in attendance at this SLT meeting to then be able to prepare a newsletter for external stakeholders and the public summarising the current position of the programme, to address matters around consultation, and give an update on the financial position.

2. Conflicts of interest handling The Conflicts of Interest Screening Panel had reviewed the agenda and papers for potential conflicts of interest. This indicated that there were no specific comments in relation to conflicts of interest other than regular conflicts to be declared / noted for this part of the agenda. The panel noted that there were a number of verbal updates and recommended moving away from verbal updates to assist the screening panel identify any potential conflicts of interest.

3. Minutes of last meeting, 21st September 2017 Minutes of the meeting were accepted pending the following changes: Karen English’s role to be amended. Item 2 –Conflicts of interest JS said that the minutes did not adequately reflect the point he was making about the conflict of interest handling at the September meeting and that it was still not clear enough what the purpose of this section of the agenda was or how it was being managed. TS noted that he had not been present at the last meeting but explained that given the status of the SLT as a formal joint committee of the three CCGs, it was important in terms of good governance for any potential conflicts of interest, particularly between NHS commissioner and provider organisations, to be identified and noted. This function is currently being performed informally by the corporate affairs leads of the NHS organisations, along the lines of the 'CoI screening panel' used in some partner organisations. The main purpose is to identify potential competition/procurement/commercial interests which could be perceived as inappropriately influencing the work of SLT. The intention was not to restrict or limit discussion or debate, or to imply that the views of parts of the system were not valid or legitimate. JS noted this response and suggested that it would be helpful to keep the operation of this aspect of the meeting under review through subsequent meetings.

4. Review of Action log 170817/1 - Review the contracting and finance elements and options at Septembers SLT meeting – Next steps discussed within agenda item 5. 170817/3 - To present the detailed plan to September SLT meeting prior to

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NHS E end of September deadline – TS noted that this will be discussed at Collaborative Commissioning Board. 170817/4 - An additional meeting to be held involving UHL and Leicester City CCG to present a proposal to SLT to progress further changes to the CDU model - SP confirmed that the MDs approved the risk share and investment at meeting on 27 September is progressing. It was decided for a report to be provided to SLT in November following a further meeting scheduled for 23 October to discuss the implementation of the in-year plan, workforce provision and contract variation to enact the risk share. 170817/6 - Toby Sanders to email to the group proposals to progress with filling the immediate gaps in the PMO – To be discussed within agenda item 5. 170817/7 - Accountable Officers/SRO’s to review the STP work stream capacity analysis summary and STP capacity analysis by Individual work streams -to be discussed within agenda item 5. 170921/1 - Winter plan to be provided to SLT to note. – Completed. SL noted that an issue that was highlighted at the A& E Delivery Board in terms of an update with TASL around patient transport, and a discussion was held as to whether a contingency plan needed to be considered. JA has been in contact with Caroline Trevithick confirming senior level activity to improve management of the contract whilst recognising that a formal contingency plan may be required. It was proposed that this is reported into the A& E Delivery Board and would be coordinated through Caroline Trevithick.

Louise Young

5. STP leads updates ACS next steps for NHS organisations

TS confirmed that a joint NHS board’s session has been arranged on Tuesday 28 November held at the Leicester Racecourse. Discussions will include financial arrangements, mechanisms for next year and the progress on the final draft STP. TS noted that NHSE is likely to be interested in active local arrangements, particularly CCG arrangements and how they relate to the STP work which may lead to further guidance, support or clarity from NHSE. In preparation of the NHS joint Boards on the 28th November: - NHS organisations to share useful information that could be fed into proposals for an Accountable Care System (ACS), the next steps ahead of the joint NHS Board meeting. - ASC next steps document feedback from the Boards to be taken on board an incorporated into an updated discussion paper for November SLT meeting. Local authority discussions re: STP/ACS TS said that following from the letter received from the three Health and Wellbeing Board Chairs a joint discussion on how NHS organisations and Local Authorities work together on the STP and ACS has been provisionally arranged for 31st October. JS noted that NHS/Local Authority relationship was broadening beyond the STP into Delayed Transfer of Care (DTOC) and TS suggested that this topic should be included in the discussion. Feedback from national events on 26th September PM attended the STP leads event, ML and Caroline Trevithick attended the STP Clinical Leads event.

NHS organisations TS

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PM provided an overview of the STP Leads event. The key speakers included Jim Mackey, Simon Stevens, David Pearson and Bruce Keogh, they focused on current delivery and not necessarily the five year plan. Topics that were discussed included the following:

• Winter plan • flu vaccination • DTOC • Demand management • Flow, GP streaming • Extended access • Ambulances

PM said that the key message was that ‘nothing was more important than the now’. Mental Health, Cancer and Primary Care were identified as three key priorities to maintain services this winter. Jim Mackey discussed finance, workforce challenges from an operational perspective, and breakout sessions were held around how the STP can support 2017 winter plans and emphasised that STP is a partnership not a plan. To support with the delivery, CQC system wide reviews will be completed, highlighting that the reviews are not inspections and ought to be viewed as means of providing recommendations for improvements. David Pearson focussed on the Accountable Care Systems (ACS). It was announced that new capital will be allocated after the November Autumn Statement, and it will not be limited to higher scoring STPs. The most important criteria are transformation, demand management, returns on investment and financial sustainability, a clear STP estates narrative will be essential. In the clinical engagement session, Bruce Keogh asked the delegates to consider whether they are playing for ‘club or county’ namely if they were representing the whole system wide STP or their own individual organisation. ML reported that this was the first meeting for the STP Clinical Leads and was well attended. The STP clinical leads were asked to consider what the best clinical model to provide clinical support to the STPs. Simon Stevens had focussed their discussion on the winter planning and the national challenges and how nationally we might be supporting with these issues. The event was told that tensions between Local Authorities and NHS partners are being picked up nationally, appearing to be a generic issue about culture and decision making. NHSE see a greater role for clinical leads in the STP and see the STPs led by clinical leads in the future. TS noted, in the CCG checkpoint meeting with NHSE there had been discussions about STPs appointing Medical Directors into their structures to provide medical oversight around quality and safety regulations. Discussions are to be held to review Andrew Furlong capacity as the role of the STP Clinical lead and to consider clinical network support. SK noted that as there won’t be a national directional support, a clinical network may need to be considered by the Clinical Leadership Group (CLG), TS replied that this will link in with the direction of travel in identifying ASC roles. PMO arrangements

JA, Andrew Furlong, ML and SK

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TS said that the PMO team are in the process of TUPE transfer from LPT to WLCCG to ensure consistency and alignment with TS’s role as STP Lead. Recruitment for PMO Programme Director and other capacity roles within the team is currently on hold and the PMO structure will be reviewed once there is a clearer position across the three CCGs on their joint working arrangements, and how this fit in with STP work. TS confirmed that areas where there is an immediate requirement in particular with Communications and Engagement. JA suggested that a timeline would be useful for the PMO discussions and questioned if there will be any proposals ready for the joint NHS boards session. TS advised that ongoing conversations are being held with the CCG’s around collaborative working that will involve Paul Watson from NHSE before being progressed further and this meeting is likely to be by the end of November. PPI engagement ER reported that the BCT PPI group have been increasingly concerned about engagement since moving from BCT into STP framework and the re-organisation of the work streams. ER raised the following points:

• Requirement of public facing information about progress of the STP; • Requirement of engagement within many of the work streams; • Need to discuss with PPI on the overarching topics such as ACS; • STP work stream capacity analysis shows Communications and Engagement as

green which is viewed it from one perspective as the PPI group would query this rating;

• ER had decided that it was currently not appropriate to share the SLT confidential papers to the PPI group following the recent information released on social media since this was initially agreed in principle by TS and ER

ER felt that assurances of producing a public newsletter will be beneficial. ER will be working with BCT Communications and Engagement to provide an evaluation report at November SLT meeting following meetings with SRO’s regarding PPI engagement in clinical work streams. TS attended the last PPI group meeting and the feedback received was that whilst some members said that their work stream engagement was good, other PPI members said that engagement within their own work stream was variable. TS proposed that ER follow up with the Chief Officers by email after his meetings with the SROs. JA pointed out that there had been previous discussions about engagement that included holding regular engagement meetings. TS advised that early December would be an appropriate time to hold a quarterly engagement forum for stakeholders, and will be scheduled.

ER and BCT Communications and Engagement

6. Clinical Leadership Group (CLG) feedback from maternity clinical model review TS mentioned that following from the consultation timelines one of the key processes that needed to be completed in sequence is CLG reviewing the maternity clinical model. This peer review took place a couple of weeks ago. ML said the process of having an internal review of the plans worked well and CLG had met with the team that were leading the maternity plans alongside an external peer support from Rebecca McConville from the East Midlands Clinical Senate There are approximately ten thousand births annually in LLR and the idea is to concentrate those births at a proposed women’s hospital, having various options within the single site. Women would essentially have the choice of consultant-led, standalone midwifery unit with shared care, with options for the location of this service, and finally

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home delivery. CLG had explored the several key lines of enquiry:

• Single site approach • Workforce; national standards require giving women continuity of care. A three

point plan was presented. • Sustainability of estates • Electronic patient records

ML also pointed out the dependency on the STP plan, as this is part of the move from three to two sites. JA questioned if there were any collective views on locating the stand alone midwifery led unit on the Leicester General Hospital site. ML confirmed that it was one of the key lines of enquiry. RP felt that it was important to help the public understand that the risk for a stand-alone unit delivery is the same as a home birth. A stand-alone unit requires a certain number of births to be sustainable. AFa asked for more clarity on this matter for consultation, noting there is proposed 12 month pilot within the existing estate at the Leicester General Hospital site to establish whether this a viable option. SL pointed out that there had been a lot of patient and public engagement to get to this point and further engagement plans will be arranged leading up to consultation ML added that there was a strong clinical case for a single site in terms of infant mortality in Leicester City, with national evidence for continuity and workforce, which continues to respect women’s’ needs and wants in relation to pregnancy in terms of choice. SP confirmed that she received an amendment from UHL on the maternity section based on the clinical review, and has updated the narrative in the STP draft plan. ML reported that CLG were content that the plans for maternity were good, incorporating quality and choice and confirmed that the proposed model is consistent with the current national guidance. RP noted that Rebecca McConville was very supportive of the model and provided some suggestions on the presentation and did not propose any significant modifications to the content of plan. TS expressed thanks to CLG for their support in reviewing the maternity clinical model review.

7. Delayed transfers of care position update TS said that the delay transfers of care (DTOC) has been included at SLT to understand the positions from the Local Authorities and the CCG’s and to receive assurance that plans are in place to address the current matters regarding DTOC. TO’N noted Rutland’s performance as good from a local perspective, confirming that the members have signed up to the proposed target while acknowledging the challenge in terms of timescales. The underlying concerns of elected members is that nationally the NHS is trying to performance manage local authorities. Equally there is frustration that LAs performing well are being penalised by NHS regulators. TO’N highlighted the following key matters;

• As a system there is a good understanding of working together to meet targets, which is not helped by this nationally driven process;

• There is an urgent need to bring together the experts together to work through how to record and report on DTOC. Currently it is very difficult to explain this narrative to the elected members;

• Need to spend time with data experts and owners of the targets to clarify the system messaging about the DTOC performance. Underlying issue of Health

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and Social Care DTOC, Rutland do not make that distinction locally but are aware that there other authorities do distinguish and there needs to be a consistent system wide approach and narrative developed.

SF pointed out that Rutland’s performance was in fact exceptional, and described Leicester City’s social care performance as good. The system appears to be penalising this significant effort, and elected members are struggling to understand why Leicester City is one of 16 authorities nationally who are being penalised for what feels like exceptional performance in this area. There are concerns at continued pressure to hold them accountable for something that Leicester City and other Local Authorities do not immediately or directly influence for themselves. Similarly, City also feel that NHSE are trying to performance manage the Authority. A fundamental concern that there is a risk to the local system/base level social services if CCGs are directed by NHSE not to transfer funds via the BCF. It undermines local work that is being done, driving a wedge between the two parts of the system. Cheryl Davenport (CD) explained that Leicestershire are in a similar position, they have a good understanding of the breakdown of the current performance in terms of the rate that needs to be achieved. They understand how the 3.5% national rate translates into the local rate and how their trajectory is expressed. The issue has been escalated with their cabinet and they have changed their corporate risk register so it now shows as red RAG status. A potential outcome of the risk escalation is a CQC review; using the CQC methodology Leicestershire are conducting a self-assessment. In LPT the adult social care team have been updating and corporate management team on all the positive work going on. LPT are working on a data driven solution to give clarity on DTOC performance, as currently there is no way of forecasting when they will reach the target, which is a risk issue for the whole system. JS expressed shared frustration at the situation, empathising with CCG colleagues’ position. Push back from MPs is already being seen nationally. JS also pointed out the risk should be seen in context of how the local NHS and Local Authorities currently work together. He was unable to see how the partners can continue to deliver current performance if financial problems arose for the Local Authorities. TS summarised risks in terms of operational performance, system performance and financial risks. From an NHS perspective views continue to be expressed locally, regionally and nationally through different channels and groups. The possibility of future escalation around delivery was highlighted, leading TS to reflect on the following;

• What is our plan and what are we doing about the residual areas where we have issues. How are the issues raised at both A&E Delivery Board or BCF groups linked up?

• Data reporting and understanding both locally and nationally needs to be addressed.

• The distinction between health and social care DTOCs, and how is that going to be captured.

CD confirmed that the LLR action plan sits with the Discharge Working Group, who report into the A&E Delivery Board. Direction needs to be given in particular for the LPT DTOC forecast. Work is currently underway following direction from Tamsin Hooton. Consideration is needed on how to report partner performance in a consistent manner. JA confirmed that A&E Delivery Board review an operational update monthly. PM pointed out that further work on data is required for consistency in LPT, the data in Mental Health is better than for Community services. TS proposed the Delayed Transfers of Care position update to be included in November’s SLT, to consider current plans, data and reporting and the direction of travel

All partners

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for future health and social care shared performance.

8. BCT Work stream capacity Martin Pope (MP) joined the meeting and presented Paper C which maps the managerial capacity to support work streams. MP explained that the original analysis has been revisited and verified. General themes of where gaps were identified were around IM&T strategic support and organisational development, specifically around change management, additionally a number of work streams that have gaps around implementation leads and project management. MP advised that further analysis of IM&T would have been beneficial in terms of the underpinning work stream and the technology element of the clinical work streams. PM advised that he is working with Tim Sacks and Ian Wakeford on IM&T solutions to establish the right capacity to deliver the required solutions. The aim is to get all work streams to understand their IM&T needs, feed back into the IM&T work stream, and produce a revised version of the digital road map. In terms of the Shared Services work stream there is resource in place to create a plan; additional support is required for delivery and implementation. JA noted that there are bilateral discussions takin place between UHL and LPT as well as between the CCGs, that at some point could be brought together, rather than trying to find an additional resource. In terms of Planned Care, SL recognised and acknowledged that there is more that could be done in the work stream, though a different approach is needed and further consideration given to establish the full potential of what is achievable. ML identified Clinical Leadership as an enabling work stream with a lot of ambition that he felt that it does not have enough support in the system. ML asking how it was represented in this analysis. MP advised that through the work on interdependencies there had been discussions on whether CLG focus could change to provide input into the individual work streams. JS said that in terms of ambition he was unsure how the level of innovation and mechanisms for change, including new ways of working, can be tested. ML said that it was key that this was understood. TS replied that as the group were work streams sponsors; each member of the SLT needed to consider how confident they are that their plans are sufficiently innovative. Primary Care and Estates were highlighted as under resourced. KE stated that there is no Estates resource; she is alone in reviewing paperwork. While KE has explored different opportunities, none have been forthcoming. AFa observed that with limited resources it felt like silo working. MP advised that the interdependencies work will help to address this. There was also the suggestion of potential consolidation across the work streams and a possibility that some roles could work across a group of work streams. SL cited Cancer work stream as an area where silo working has seen increasing input from the East Midlands Cancer Alliance and funding coming down into local communities, reconfiguration of local networks is also being discussed and local resource is still needed for implementation. TO’N suggested that partners should give consideration to data and understanding outcomes as LLR are moving towards a phase in the programme where discussions will be around delivery impact. MP advised that work is in progress on an outcomes framework. TS presented opportunities that SLT could consider how to strengthen resources. TS is expecting written confirmation of NHSE’s reconfiguration of staff in clinical network to support STPs. TS said that NHSE have identified a technical resource to redeploy to

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support STP areas and Midlands & Lancashire CSU offer to potentially provide support. In terms of the BCT work stream capacity it was proposed:

- To discuss at November’s SLT meeting the IM&T, primary care, OD and Estates work streams that require further support.

- Martin Pope to hold conversations with Karen English regarding the NHSE offer

to deploy STP resources to support with the Estates and primary care areas.

Relevant Chief Officers work stream sponsors KE and MP

9. Business Intelligence strategy CD presented Paper D on Business Intelligence (BI) asking SLT to approve the development of an LLR business intelligence strategy as a priority and as an enabler. The paper provides LLR’s current position in the use of Business Intelligence tools and analytics across LLR. CD said that there was good progress in our local area but there is not much awareness around all of the partners. The report provided a stock take on the type of tools currently used and looked at how data is brought across from multiple sources and use tools that can integrate across health and care. There is a huge reliance on good quality linked analysis, understanding LLR’s current position and measuring the impact of the changes that are taking place. The work streams would look to have this in terms of integrated dashboards, integrated data and tools that can be used for this purpose even allowing for national IG rules. There are existing BI strategies for some organisations within LLR which could be used as a starting point. CD proposed that a system wide BI strategy would need to be ambitious to enable delivery. A useful operational exercise would be to do a stock take against the current overview of LLR’s position on BI tools. PM drew attention to the fact that some of the BI tools across the system are coming up for re-procurement, which he has already discussed with CD and Mark Pierce. A system wide strategy would be useful in terms of procurement. PM asked the partners to consider what we collectively required across the system and understand a shared single version of the truth around BI. PM expressed support for an LLR Business Intelligence strategy from an IM&T perspective. Acknowledging challenges from an Information Governance (IG) perspective, SK asked for an IG specialist to be involved from the start in the development of the BI strategy. SL suggested including CD in a meeting with the National IG lead on undertaking IG concerns on research. TS put the recommendations to the partners supporting the strategy as a priority enabler and linking the strategy through the IM&T board in terms of the information element. TS proposed PM and CD to discuss resourcing, looking at how to get capacity through IM&T work stream in general. TS suggested that the recommendation on standard operating procedures (SOP) is seen as secondary piece of work. This would allow other pieces of work such as IG to be worked through first. Decisions around BI tools should be seen within the context of this piece of work which would entail time constraints given and a Draft Business Intelligence strategy to be brought back to January’s SLT meeting.

PM and CD

10. Date, time and venue of next meeting 9.00 – 12.00, Thursday 16th November 2017 8th Floor Conference Room, St Johns House, East Street, Leicester, LE1 6NB

REPORTS - Home - East Leicestershire and Rutland CCG · Blank Page : Paper A ... Ms Sue Nattrass...

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Transcript of REPORTS - Home - East Leicestershire and Rutland CCG · Blank Page : Paper A ... Ms Sue Nattrass...