AGENDA - haltonccg.nhs.uk Body Meeting... · approach to support all communication and media...

NHS HALTON CCG AND NHS WARRINGTON CCG

JOINT PUBLIC MEETING OF THE GOVERNING BODY TO BE HELD ON WEDNESDAY 8TH JULY 2020 AT 2.00pm

VIRTUALLY VIA MICROSOFT TEAMS

AGENDA

Agenda Item No

Timings (approx.)

A

Apologies for Absence:

All

B Declarations of Interest in Agenda Items A conflict of interest is defined as “a set of circumstances by which a reasonable person would consider that an individual’s ability to apply judgement or act, in the context of delivering, commissioning or assuring taxpayer funded health and care services is, or could be, impaired or influenced by another interest they hold”

All

C Chair's Remarks and Questions from the Public Nick Atkin

Warrington CCG Deputy Chair

Verbal

D Minutes of the Joint HCCG and WCCG Governing Body Meeting held on 10th June 2020 (for approval)

Enclosure

E Action Log and Matters Arising

Verbal

F Clinical Chief Officer Report (to note and endorse)

Dr Andy Davies Clinical Chief Officer

Enclosure

Quality & Patient Experience: 049/20 Chief Nurse Report

(to receive assurance)

Michelle Creed Chief Nurse

Enclosure

Corporate Business & Governance: 050/20 Month 2 Finance Report David Cooper

Chief Finance Officer

Enclosure

051/20 Report of Urgent Issues Committees (Committees in common) held on 1st July 2020

David Merrill UIC Committee Chair (01.07)

Enclosure

052/20 Review of Governance Arrangements Dr Andy Davies

Clinical Chief Officer Enclosed

053/20 Equalities and Inclusion: a) Direct and Indirect Impacts of COVID-19 on Health and Wellbeing; b) Equality and Inclusion

Eileen O’Meara Director of Public Health Maria Austin Chief of Public Affairs and Communication & Jen Molloy CSU E & D Service

Enclosed Enclosed

Any Other Business

All

Date and Time of Next Meeting: 2.00pm Wednesday 12th August 2020

Item D Public Halton CCG and Warrington CCG

Joint Governing Bodies Meeting Wednesday, 10th June 2020 2.00pm to 3.30pm

Virtual Meeting via Teams

Halton CCG Members in Attendance:

Name Position Organisation Ruth Austen-Vincent Lay Member NHS Halton CCG Bryan Webb Acting Chief Finance Officer NHS Halton and NHS

Warrington CCG Dr David Wilson GP Governing Body Representative NHS Halton CCG Gareth Hall Lay Member NHS Halton CCG & NHS

Warrington CCG Dr Claire Forde GP Governing Body Member NHS Halton CCG Dr Julie Langton Secondary Care Doctor NHS Halton CCG & NHS

Warrington CCG Leigh Thompson Chief Commissioner NHS Halton CCG Dr Andy Davies Chief Clinical Officer NHS Halton CCG and NHS

Warrington CCG Dr Latha Meda GP Governing Body Representative NHS Halton CCG Michelle Creed Chief Nurse NHS Halton CCG and NHS

Warrington CCG David Merrill (meeting Chair)

Interim Chair NHS Halton CCG

Warrington CCG Members in Attendance:

Name Position NHS Warrington CCG Gareth Hall Lay Member NHS Halton CCG & NHS

Warrington CCG Dilys Quinlan Lay Member NHS Warrington CCG Bryan Webb Acting Chief Finance Officer NHS Halton and NHS

Warrington CCG Dr Julie Langton Secondary Care Doctor NHS Halton CCG & NHS

Warrington CCG Dr Andy Davies Chief Clinical Officer NHS Halton CCG and NHS

Warrington CCG Dr Lalit Sakhi GP Governing Body Member NHS Warrington CCG Dr Sangeetha Steevart GP Governing Body Member NHS Warrington CCG Dr Aparna Rao GP Governing Body Member NHS Warrington CCG Dr Golam Chowdhury GP Governing Body Member NHS Warrington CCG Michelle Creed Chief Nurse NHS Halton CCG and NHS

Warrington CCG Nick Atkin Lay Member NHS Warrington CCG Kevin Goucher Patient Representative NHS Warrington CCG

In Attendance:

Name Position Organisation Carl Marsh Chief Commissioner NHS Warrington CCG Suzanne Barker Chief of Corporate Services NHS Halton CCG and NHS

Warrington CCG

Maria Austin Chief of Public Affairs and Engagement NHS Halton CCG and NHS Warrington CCG

Louise Murtagh Senior Committee Administrator NHS Halton CCG Pam Broadhead Chief Primary Care Officer NHS Warrington CCG

Apologies: None received Minutes:

Welcome and Introductions The Chair welcomed all present to the meeting. All attendees introduced themselves. It was noted that the joint meeting was quorate for both Halton and Warrington CCGs.

A. Apologies Apologies for absence were received from Eileen O'Meara, Kath Parker and Dr Ian Watson.

B. Declarations of Interest The Chair reminded attendees of their obligation to declare any interest they may have on any issues arising at the meeting which might conflict with the business of the CCG. For the purposes of this meeting, a conflict of interest was defined as “a set of circumstances by which a reasonable person would consider that an individual’s ability to apply judgement or act, in the context of delivering, commissioning, or assuring taxpayer funded health and care services is, or could be, impaired or influenced by another interest they hold”. Declarations made by members of the Governing Bodies were listed in the respective CCGs’ Registers of Interests. The registers were available on the CCGs’ websites. C. Chair's Remarks and Questions from the Public Members were advised that a question from a member of the public had been received as follows from Stephen Meadows: ‘What the current state of the medicines management budget is and the financial risk it represents to the CCG?’ Bryan Webb advised that a financial breakdown of the medicines management budget was provided in item 042-20 on this agenda. For reasons of expediency the question would be covered in full during this agenda item. In summary however, Bryan Webb explained that across the Cheshire and Merseyside footprint Covid-19 had led to a circa £5m increase in the prescribing budget. There were plans in place to address this increase. Mr Meadows was not present at the meeting but would be sent a written response. The Chair took the opportunity to thank staff for their tremendous efforts during this difficult period. Members were reminded that discussions on agenda items should be strategic and not operational in nature. Papers would be taken as read by Governing Body Members and report authors were asked to summarise key highlights from their reports prior to questions and discussions. D. Minutes of the Joint HCCG and WCCG Governing Body Meeting held on 13th May 2020 The minutes of the meeting held on 13th May 2020 were agreed to be an accurate record of the meeting subject to Pam Broadhead being listed as present. Members approved the Governing Bodies meeting minutes of 13th May 2020

E. Action Log and Matters Arising There were no actions or matters arising to report on currently. F. Clinical Chief Officer Report Dr Andy Davies presented the Clinical Chief Officer Report to Members highlighting topics as follows: • Incident Coordination Centre (ICC) remained operational but with a reduced staff covering

Monday to Friday during office hours. Weekend and evenings were covered by the lead manager on the on-call rota.

• Recent Guidance – Dr Andy Davies had advised at the last Governing Body meeting of the letter received from Simon Stephens. The action plan to address all areas outlined in the letter remained under review. This action plan is due to be updated to reflect the need to complete any service changes via a template, which was required to be submitted to NHS England each time a service change was proposed.

• Care Homes Resilience Plans – All local authorities were required in May 2020, to lead on the development of a Care Home Resilience Plan with input and oversight from healthcare partners. Dr Andy Davies and Michelle Creed had oversight and commented on these plans prior to being submitted nationally

• Lessons Learned from the Covid-19 response to date. A template had been developed to help capture good practice and identify were further work was required. Governing Body members would be asked to continue to this process and a meeting to discuss would be arranged. An action plan would be developed following this capture exercise.

• Governance Issues – Dr Davies reminder Members of the interim governance arrangements in place during the pandemic. A review of these arrangements would be undertaken for further discussion at the next Governing Body Meeting. This would also include reference to the handling of the updated draft Constitution and outcomes of the Member Practice ballots undertaken prior to the pandemic.

• BAME Review – Members were advised of an addition to Dr Andy Davies’ report since agenda publication. The CCGs had been asked by Bill McCarthy to nominate Governing Body representatives to join the Regional Strategic Advisory Group. Ruth Austen-Vincent referred to the Community Development Project that was funded by the CCG and its work with asylum seekers and those new to the area such as recently released ex-offenders. This group needed to be kept informed of any progress made regionally. Dr Golam Chowdhury and Dr Sangeetha Steevart both volunteered to join the group. Suzanne Barker would ensure nominations were put forward.

• Staffing – Members commented on the positive response to the recent staff survey and congratulated the Integrated Management Team on its leadership during this difficult time.

The Governing Bodies noted the updates provided by Dr Andy Davies. 041/20 Chief Nurse Report MC’s report provided an update and assurance position in respect of quality, safety and experience of services commissioned by the CCG. Highlights included: • There were several sections under the heading of Safeguarding highlighted to attendees.

o Asylum Seekers - A significant number of asylum seekers had been placed in Halton due to the requirement to place in accommodation for safety. There had initially been issues relating to communication problems, but these were now resolved

o The Care Homes Covid-19 Programme Group had been formed for Halton and Warrington, and Michelle Creed was the Senior Responsible Officer for this. Each sub-group in the programme was headed by a member of staff representing the CCGs

• Infection Prevention and Control (IPC) had been monitored during the Covid-19. In care homes specifically the infection rate, mortality rate and the quality of provision had been monitored. As

previously reported, a Train the Trainers IPC programme was in place locally. In Halton 100% of home had received the training with the Warrington rate standing at 95.3%

• NHS Providers were still being subject to Clinical Quality and Performance Group (CQPG) and Quality Surveillance were appropriate.

Members moved on to discuss the report, asking questions around the heading above. In respect of the 95.3% training compliance in Warrington, a question was raised regarding how were care homes allowed to decline the invitation? Michelle Creed confirmed that these were homes run by large national companies who employed their own trainers. The number had been lower, however, when IPC issues were identified at one home, they agreed to receive training. For the other two homes the CCG was seeking assurance data and if they were non-compliant, the CCG would provide the training. Members also discussed the rise in Serious Incidents (SIs) relating to pressure sores. Michelle Creed advised that the CCG had asked providers for information. Once received it would be considered at an Urgent Issues Committee meeting. Members at this committee meeting would also review SIs at BPAS. A question was raised about measures put in place to protect vulnerable children whilst schools have been closed? Michelle Creed confirmed that Safeguarding Boards have continued to meet and there were weekly calls with the Police and Local Authority. All families were receiving calls and / or visits. Where-ever possible these children had been encouraged to attend school. Referrals into the service had also started to rise in the past 2-3 weeks. There had initially been communication problems relating to vulnerable children included in the cohort of asylum seekers referred to earlier in the report. Leigh Thompson added that the 0-19 Local Authority Service had commissioned PC24 to rapidly assess these children and emergency measures had been put in place where needed. Runcorn surgeries were now registering these patients too. Any attendance at acute service, by this group, were also being reported. North West Boroughs and Migrant Help were also involved. All actions listed above had been arranged by organisations in Halton and Dr Andy Davies joined Leigh Thompson in commending the CCG and Halton Local Authority. Any defects in national inter-departmental communications had been fed-back to the Home Office. Governing Bodies noted the report. ACTION: Michelle Creed to take a report to the Urgent Issues Committee on the rise in Serious Incidents (SIs) relating to pressure sores. Members would also be asked to review SIs at BPAS. 042/20 Financial Reports In the absence of clear national guidance, the Urgent Issues Committees and Governing Bodies had approved the 2020/21 Budgets based on the Draft Financial Plan submissions, issued to the Regional Office in March 2020. National Guidance was issued during May 2020 and outlined the designated budgets to CCGs over the COVID-19 response period. A consistent methodology had been applied to all CCGs that considers 2019/20 reported expenditure levels with national growth assumptions applied to each of the CCGs’ expenditure elements. The presentation provided members with information relating to individual CCGs and their respective 202/21 Covid-19 Budget.

The key information was • Allocations have been crudely split equally into 12ths to cover the period until the end of July,

which would not be reflective of local planning arrangements • Additional allocation of £0.347m per month, £1.386m cumulatively for Halton CCG • Additional allocation of £0.669m per month, £2.676m cumulatively for Warrington CCG • True-Up exercise to be undertaken against actual expenditure reported for periods • The planned deficit for NHS Halton CCG at the Draft Financial Planning stage was £8.6m,

revised to a planned deficit of £11.6m following the emergence of initial guidance to support COVID-19 response. With the Covid-19 allocations, and the assumption that the CCG will break even against these, the financial outlook is improved to a £9m deficit.

• The planned deficit for NHS Warrington CCG at the Draft Financial Planning stage was £13.9m, revised to a planned deficit of £15.3m following the emergence of initial guidance to support COVID-19 response. With the Covid-19 allocations, and the assumption that the CCG will break even against these, the financial outlook is improved to a £11m deficit.

Members moved on to questioning block contract payments and the reasons for additional costs. Bryan Webb advised that the additional contributions by commissioners reflected the true cost of provision and not necessarily the income received historically or within planned contracts from commissioners, as the two are not always aligned, hence historic deficits being reported within providers. Nick Atkin queried whether the backlog of referrals was understood and would present a financial risk to CCGs beyond the COVID-19 response period. Bryan Webb confirmed the referrals had not been quantified yet; but that this would be managed through the block contractual arrangements that are anticipated to be maintained for the remainder of 2020/21. This information would be made available as we moved through phases 2 and 3 of the pandemic response and would be shared with Governing Body. The risks and next steps for the Governing Body were also listed in the report. The Governing Body was then advised of the National Debt Write-Off Process: Locality Impact with Bryan Webb focussing on the local impact of the £13.4bn (nationally) of loans that will be converted to Public Dividend Capital. The value for Warrington & Halton Teaching Hospitals NHS Foundation Trust amounted to £56.836m and £26.040m for Bridgewater Community Healthcare Foundation Trust. The cumulative debt with these system provider partners was £82.876m. Without this policy the Trusts would be required to identify the cash resources to repay the £82.876m during the next three years. The original NHS England / Improvement plan was that through transformation, improvement and efficiency plans all Trusts would by now have returned to surplus thereby having the cash reserves to repay loans. This plan had not been uniformly delivered. Bryan Webb advised that the policy had been received positively within public perception, and the intention to recycle resources through the Government rather than other lenders is a positive step. However, the net impact from a revenue perspective was adverse for the locality and increased reported expenditure. This increase did not secure additional health provision for the population served and as the CCGs moved closer to contracting on a cost basis, this prohibited equivalent levels of investment in service delivery by commissioners as we move to payments more reflective of provider cost. Members discussed the report and asked if a link between debt and performance management and leadership had been considered. The figures provided in the report highlighted the high level of debt at these providers. Governing Body considered if comparisons with other areas / regions could be

considered. This type of comparison was not always deemed appropriate as it did not consider the local abilities to invest (CCG Allocations) and wasn’t always a true reflection on the financial performance of an organisation. Deficits were often the result of systemic issues. The Governing Bodies • noted the process for Public Dividend Capital issue • noted the impact that this approach has upon revenue expenditure within the locality; and • acknowledged that, as the CCGs moved closer to contract payments with system partners

based upon the cost of provision, and may have separate repayment arrangements for NHS Halton CCG, this acted as a prohibitive factor for investment in services.

043/20 Urgent Issues Committees (Committees in common) held on 20th May 2020 and 3rd June 2020 The report detailed the key discussion points and matters for approval as discussed at the Urgent Issues Committees of 20th May 2020 (chaired by Ruth Austen-Vincent) and 3rd June 2020 (chaired by Dilys Quinlan). As agreed in April 2020, Governing Body had established the Urgent Issues Committee to consider urgent business that would normally be presented to the Quality Committee, Performance and Finance Committee and Finance and Performance Committee during this current period. There had been four Urgent Issues Committee meetings to date. At the meeting of 20th May 2020 members had discussed proposed enhanced discharge; planning additional capacity in Halton and Warrington in response to Covid-19; effective management of various End of Life scenarios; and Enhanced Health in Care Homes support across Halton and Warrington during Covid-19 Topics on 3rd June 2020 included a presentation on the current data set around the Covid-19 pandemic; budget setting update for 2020/21; an update on the National Debt Write Off process for the NHS in 2020/21 and the impact of the Public Dividend Capital approach; the risk management agenda throughout the Covid-19 pandemic and also actions taken to re-establish the usual risk management arrangements; the request from NHSE/I on the offer to 100% of care homes of infection prevention and control training; and the ongoing works streams related to Equality and the impact of COVID-19. Governing Bodies noted the update. 044/20 Primary Care Response to COVID-19 Pam Broadhead presented the report to inform Members on the COVID-19 Primary Care response to the national pandemic. The guidance changes and requests to amend processes to and by primary care, had been numerous. The pivotal changes required since 19th March 2020 were listed in the report and Governing Body were asked to take these as read. Once the COVID-19 response had eased and the CCG was able to adopt more of a business as usual approach, a more detailed review would be undertaken and presented to the Primary Care Commissioning Committees. Governing Bodies noted the update. Any Other Business

Members were reminded of the Audit Committee and Governing Body meetings being held on the morning of Wednesday, 17th June 2020. Individual invitations had been sent to members for their respective meetings. The next regular meeting of the Joint Governing Body had been scheduled for a 2pm start on 8th July 2020.

Actions Key on track to be completed by due in progress but due date has been overdue and no update has been completed

001/20 10 June 2020041/20 Chief Nurse Report

Michelle Creed to take a report to the Urgent Issues Committee on the rise in Serious Incidents (SIs) relating to pressure sores. Members would also be asked to review SIs at BPAS

Michelle Creed 01/07/2020 Open Reports to be presented to Urgent Issues Committee on 1 July 2020

Date Due Status Update

Public Halton CCG & Warrington CCG Joint Governing Body Action log 1 April 2020 to 30

March 2021

Action Number Date and Report Action Responsible Officer

AGENDA ITEM: F

Clinical Chief Officer Report NHS Halton CCG and NHS Warrington CCG Joint Governing Body Meeting July 2020

GOVERNING BODY MEETING:

Joint Governing Body Meeting of NHS Halton CCG and NHS Warrington CCG

DATE OF MEETING:

8th July 2020

REPORT AUTHOR AND JOB TITLE:

Dr Andrew Davies, Clinical Chief Officer NHS Halton CCG and NHS Warrington CCG

REPORT TITLE:

Clinical Chief Officer Report

STRATEGIC OBJECTIVES:

Please tick which strategic objectives the paper relates to

Improve quality of services

Sustained financial balance

Build an effective and motivated whole system workforce

X

Sound governance arrangements

X

Ensure integration and joint working arrangements

OUTCOME REQUIRED (tick)

Approval

Assurance

Discussion

Information

EXECUTIVE SUMMARY The purpose of the report is to provide members of the Governing Body with: • An update on any key corporate issues that members need to be apprised and

aware of • An update on any key national and local issues relevant to the CCG • A summary of key activities that support delivery of the CCGs strategic

objectives (not referred to elsewhere in the Governing Body papers) RECOMMENDATIONS The Governing Body is asked to:

AGENDA ITEM: F


• Receive this report

Outline any engagement – staff, clinical, stakeholder and patient / public

Not applicable

Are there any conflicts of interest which may be associated with this paper?

Not applicable

Does this paper address any existing risks which are included on the Assurance Framework or Risk Register?

Not applicable

Have the following areas been considered whilst producing this report?

Yes

N/A

Equality Impact Assessment (if yes, attach to paper)

Quality Impact Assessment (if yes, attach to paper)

Regulation, legal, governance and assurance implications (reference in the report if applicable)

Procurement process (reference in the report if applicable)

Document development Has this document been presented to any other Committee or Forum? If yes, please list which meeting, date and outcome of presentation Not Applicable

AGENDA ITEM: F


1) Purpose

The purpose of this report is to provide Members of the Governing Body with:

• information on key issues that may have not been covered elsewhere in an individual report

• information in respect of relevant local and national initiatives and priorities

2) Updates for Governing Body

• Coronavirus (COVID-19)

Incident Coordination Centre (ICC): The ICC remains operational, however, the formal operating hours for all ICCs have been modified to 8am to 5pm Monday to Friday and 9am to 4pm Saturday and Sunday. The ICC staff will continue to work normal working hours between Monday to Friday and the email account will be kept under review at the weekend by staff on the on-call rota.

Recent guidance: No further guidance has been received following the letter received from Sir Simon Stevens (NHS Chief Executive) on 29th April 2020 outlining the second phase of the NHS response. The focus is still the immediate restoration of priority non-COVID services across all settings, including Primary Care, Community Care, Mental Health and Acute services. Systems are required to develop detailed plans to create as much capacity as possible. A letter is expected from Sir Simon Stevens in the coming week to outline the third phase of the NHS response and further detail will be provided when this is available. Local Outbreak Plans: All local authorities were required, towards the end of June 2020, to lead on the development of local outbreak management plans, with input from system partners. Links to the plans are below: Halton: https://www4.halton.gov.uk/Pages/health/Covid-19-Preventing-and-Responding-to-Local-Outbreaks.aspx Warrington: https://www.warrington.gov.uk/OutbreakPlans

https://www4.halton.gov.uk/Pages/health/Covid-19-Preventing-and-Responding-to-Local-Outbreaks.aspx



https://www.warrington.gov.uk/OutbreakPlans

https://www.warrington.gov.uk/OutbreakPlans

AGENDA ITEM: F


Staffing: We continue to implement several workstreams to ensure we effectively manage workforce issues during this period and continue to support the health and well-being of our staff at this time. Our COVID-19 staffing plan has included an evolving programme of work in response to national guidance, local need and staff feedback and was developed with the aim of “preserving and protecting the health, safety and wellbeing of staff is critical for NHS organisations as we respond to COVID – 19”. Our staffing response has focussed on 4 key areas:

We have led a regular forum with local HR CCG leads, CSU HR Senior Business Partner and Health Care Partnership Organisational Development Leads to ensure implementation of best practice and effective system working.

The focus of our staffing plan and local initiatives during the pandemic has included:

AGENDA ITEM: F


As we move into the reset and recovery phase the focus of our work plans and priorities in relation to staffing are developing around the following areas:

As referenced above a key strand of our on-going work is Staff Wellbeing:

• We have a dedicated Staff Engagement and Wellbeing workstream. Using TEAMs for all staff to use to engage with each other.

• The channel is also a repository of information for staff including top tips for working from home, health and safety at home, keeping safe and safeguarding information, cyber security information and national information on resilience. In addition, there is a dedicated section for mental health and wellbeing information including bereavement, suicide support, domestic abuse and information.

• The Staff Engagement Group (SEG), established for approximately over six months across both CCGs, have adapted their wellbeing activities for the current circumstances. The SEG have planned weekly themed information for staff based on national awareness days

AGENDA ITEM: F


• Wellbeing activities have included staff blogs, Make May Purple selfies for Stroke Awareness Month and to tie in with the NHS Open for Business messages, in addition to social activities such as Friday Night quiz and Bingo.

• Daily activities for staff have also included the use of a 30-day coping calendar and a 30-day song challenge to encourage to keep interacting with each other

• Working with our Mid Mersey CCGs colleagues and North West Boroughs we have all agreed for May to have a dedicated focus on mental health for staff. The month will focus on the Five Ways to Wellbeing (with IMT staff blogs), the importance of sleep (with tips and encouraging staff to keep sleep diaries), the importance of kindness and information on the link between physical health and mental health.

• The Staff Survey Results were presented to all staff as part of our weekly staff briefs and also including as part of the Accountable Officers report in June 2020. An action plan and You Said / We Did (will) is being produced in response to the outcome of the staff survey undertaken in May. This will be led by the SEG.

• We are also producing artwork for the new Lakeside offices dedicated to how staff have positively coped with COVID-19 and to remind staff that “when the world stayed apart, we stayed together”.

Approach to Communications: Working across the system (Halton and Warrington)

• Continue to work collaboratively as a system with a system wide strategic

approach to support all communication and media related activity. Local Authority communication colleagues are leading on the approach to communications in respect of Test and Trace and Outbreak Plans, with the CCG communications team supporting all activity.

• In June a special COVID-19 feature was produced which was published across both boroughs (Warrington Guardian print / Runcorn Weekly News Online) to highlight the exceptional work of everyone who works in and supports the local health and care sector.

• In response to Phase 2 the regular weekly system wide Meetings have been stepped down, although system working continues. Discussions are being held with regards to maintaining and building on the system wide working arrangements for communication and engagement and how to retain this as we move to more business as usual activity to support the system at ‘place’.

• Local media continue to be very supportive and discussions are ongoing with regards to how to continue to capture and highlight the ‘local response’ story over the next 3-6 months.

• The weekly COVID Round-UP continues to be issued every Friday to all key stakeholders. Given feedback from recipients, although this was due to move to a monthly publication in response to requests this will continue to be shared weekly.

Internal approach:

• Virtual staff brief continues to be held twice a week – Monday (3pm) and Friday (10am). Monday staff brief focusses on an IMT update and other updates whilst the Friday staff brief focusses on a sector update – led by each sector lead.

AGENDA ITEM: F


• The written staff brief continues to be issued twice weekly (Monday and Thursday) ahead of the virtual staff brief.to work collaboratively as a system with a system wide strategic approach to support all communication and media related activity. Local Authority communication colleagues are leading on the approach to communications in respect of Test and Trace and Outbreak Plans, with the CCG communications team supporting all activity.

Information and guidance:

• The latest from the UK Government can be found here:

www.gov.uk/coronavirus • Detailed NHS information is available at: www.nhs.uk/coronavirus

Equality and Inclusion:

• It was been agreed for COVID-19 specific enquires and activities there will be one point of contact for both CCGs to support our equalities and inclusion work programme. This is from Midlands and Lancashire CSU.

• An overarching Equality Impact Assessment (EIA) was undertaken for COVD-19 as a whole in addition to individual EIAs have been undertaken for specific service changes.

• A separate paper has been submitted to the GB Agenda in respect of Equality and Inclusion.

Implementation of the COVID-19 Patient ADVICE Line:

• The Halton & Warrington COVID Patient Advice Line was set up in response to the increasing number of patient calls to Primary Care during the COVID-19 pandemic. It was widely anticipated that having a single point of access for COVID related enquires would help ease the burden on the CCG, general practice teams, pharmacies and other local health services as the COVID-19 crisis escalated.

• Following discussions at the start of April, the COVID Patient Advice Line was mobilised in 3 days - with a small team of staff, dedicated email address, phone line and voicemail facility being secured before the 6th April.

• The infrastructure to support the service, including a Standard Operating Procedure (SOP), Call Handling Scripts, Daily Sitrep Report and Contact Database were all developed in the following 2 weeks, post launch. Internal staffing resource was stepped up and down in line with demand.

• In total, between the 6th April and 5th June 2020 the service dealt with and closed 1485 individual enquiries. Key themes emerged soon after launching the COVID Patient Advice Line and included Shielded letter enquiries, access to food parcels, letters for employers and access to COVID swabbing.

• The COVID Patient Advice Line was established as a temporary service in response to COVID-19. With IM&T approval and following on-going discussions, it was agreed to transition the service back to the mainstream PALS service hosted by Midlands & Lancashire CSU.

• The transition took place on the 8th June 2020 and to between the 8th June and 1st July, the CSU PALS Team have dealt with an additional 75 COVID related enquiries from Halton and Warrington patients. To support a seamless transition, weekly calls took place between CCG Leads and CSU PALS Leads. In terms of on-going reporting, any COVID related activity data will

http://www.gov.uk/coronavirus

http://www.nhs.uk/coronavirus

AGENDA ITEM: F


now be included in the quarterly PALS activity report which goes to the CCG’s Quality Committee.

• A detailed outcome report has been produced including further details of establishment, utilisation and patient case studies is available.

b) Mid-Mersey CCG Merger

As reported to the Governing in previous months, work on exploring CCG integration was scaled back during COVID-19.

During June, interviews have been completed with all Governing body members across Halton, St Helens and Warrington, and a draft feedback report has been prepared for the Accountable Officers.

Work in July will focus on what CCG functions should continue to be delivered at a Local Authority “place” level, and which would benefit from being consistently commissioning on a larger scale. Further engagement with key stakeholders will also be planned during this period as appropriate.

A Joint Governing body workshop has been provisionally scheduled for the 16th September 2020 subject to local lockdown rules permitting.

c) Governance

i) NHS Halton CCG and NHS Warrington CCG Annual Report and Accounts

Following the Audit Committee and Governing Body on the 17th June, we have now successfully uploaded the Annual Reports and Accounts for 2019/2020. Any non-material changes to the documents following external auditor review were logged and approved by the Interim Chief Finance Officer in line with delegated approval from the Governing Bodies. Remuneration information included within the reports will be shared with those who have requested this once it has been audited and prior to the reports being published on the 8th July 2020. Colleagues in Communications will now support the production of the public facing document and easy read version of the Report. Plans are also underway in relation to this year’s AGM which will be held virtually for each CCG on the 10th September (timings to be confirmed for each CCG). ii) Governance Arrangements As previously discussed at recent Governing Body meetings, the CCG continues to handle the governance arrangements and statutory responsibilities during this period in line with the national guidance “Reducing burden and releasing capacity”. A review of these arrangements has recently been undertaken and is reported as part of a separate paper within the Public Governing Body.

d) Contractual and financial arrangements

AGENDA ITEM: F


The CCGs continue to operate and report against the COVID-19 Phase 2 guidance, issued mid-May 2020, with prescribed budgets informed by 2019/20 expenditure levels and centrally determined inflationary increases and block contractual arrangements with NHS providers. The term of this operating parameter will be until the end of July 2020. National Guidance to support the Phase 3 COVID-19 response period is anticipated mid July 2020 to inform both the budgetary and contractual arrangements during that term.

e) Place updates

The Cheshire & Merseyside Health & Care Partnership are holding a Place and Programme virtual network meeting on the 2nd July. The focus of the event will be an opportunity for representatives to share COVID Place based activities to reflect and inform restart operations. IMT leads have worked with local authority colleagues to inform the content of the presentations for Halton and Warrington. A verbal update will be shared with Governing Body Colleagues at the meeting.

f) Urgent Treatment Centres

With the gradual return to business as usual NHS Halton CCG published the Urgent Care Centre Voluntary Ex Ante Transparency (VEAT) notice to enable the direct award of the two Urgent Treatment Centre contracts. By way of a timeline, the VEAT notice was published Monday 15th June 2020 with a 10-day standstill period closing on midnight Wednesday 24th June 2020. On Thursday 25th June 2020 we wrote to the providers to notify them that notice was without challenge.

The next steps are that we will vary in the UTC specification within the contract with effect from the 1st August. This will include any associated quality schedules and Service Development Improvement Plans previously agreed, as amended by agreement. The Financial Schedules are subject to the regional review of prospective service changes and should reflect this position.

Commissioners and providers have re-established the formal working arrangements to revisit the work plan and continue with the work supported by Trifolium. Both centres have moved to new opening hours and compliance to the new social distancing requirements. Both centres are utilising the telephone triage and booking systems and will be maintaining this operating procedure until further notice. Staff consultation has recommenced including staffing and workforce requirements considering Covid-19 and financial discussions across the two centres has begun. GP Leadership has been secured from our two Primary Care Networks (PCN’s) and work is progressing in this area with a view of enhanced tele health and video tele conferencing where and when applicable. A process map has been completed with clinical oversight in place with an option for digital rostering, electronic prescribing, shared care records and direct booking. Work is underway in respect of NHS111 and Phase One testing of the Triage & Booking system is in place in Widnes with a wider rollout programme for post mobilisation of the contract and specification.

The CCG maintains its intention to incorporate this variation of the UTC specification within the NHS Standard Contract between parties with effect from 1st August 2020, when it is currently anticipated that the current national block funding arrangement will revert to standard contractual arrangements. Should national guidance contradict this assessment, the date will move accordingly.

AGENDA ITEM: F


3) Recommendations The Governing Body is asked to:

i) Note the contents of this report.

AGENDA ITEM NO: 049/20

Chief Nurse Report NHS Halton CCG and NHS Warrington CCG Joint Governing Body Meeting Date 8th July 2020


Joint Governing Body Meeting of NHS Halton CCG and NHS Warrington CCG

DATE OF MEETING:

8th July 2020


Michelle Creed, Chief Nurse

REPORT TITLE:

Chief Nurse Report




X



X


X


X


Approval

Assurance

Discussion

Information

EXECUTIVE SUMMARY The purpose of the paper is to provide assurance from the Chief Nurse to the Governing Body with regard to the quality, safety and patient experience in services commissioned by NHS Halton CCG and NHS Warrington CCG.

RECOMMENDATIONS The Governing Body is asked to receive this report by way of assurance regarding the Quality, Safety and Experience of Commissioned Services during the Covid-19 pandemic period.




As detailed within the report


None


Yes


Yes

N/A





Document development Has this document been presented to any other Committee or Forum? If yes, please list which meeting, date and outcome of presentation Not Applicable



1 PURPOSE

The purpose of the paper is to provide assurance from the Chief Nurse to the Governing Body regarding the quality, safety and patient experience in services commissioned by NHS Halton CCG and NHS Warrington CCG.

2 QUALITY, SAFETY AND EXPERIENCE

2.1 NEVER EVENTS AND SERIOUS INCIDENTS

At the time of writing this report there has been one Never Events reported by Warrington and Halton Teaching Hospital Trust (WHHT). This was in relation to a patient receiving a wrong sided ureteral stent- this was corrected with no harm to the patient. This Never Event Is following the appropriate process with a 72-hour report submitted and a Root Cause Analysis investigation in progress which will any potential learning is identified, and appropriate actions implemented.

2.2 INFECTION PREVENTION AND CONTROL 2.2.1 There has been one case of Methicillin-resistant Staphylococcus Aureus

(MRSA) reported at WHHT, in relation to an NHS St Helens CCG patient. A full Post Infection Review is underway and the CCG, as co-ordinating commissioner are part of this to enable whole organisation oversight and system learning.

2.3 INFLUENZA PLANNING

The CCG is cognisant of the impact of Covid 19 and the impending influenza season. In preparation for this planning has commenced to ensure an appropriate response at the earliest opportunity. The Flu planning group has continued throughout the year which has a wide representation of the CCG; Local Authority, Communication teams, Public Health England (PHE), Pharmacy, Commissioners, Quality Team, School Health. This group collaborates jointly within the Halton and Warrington boroughs. A robust action plan has been developed with an increasing trajectory of actions as time progress with clearly identified ownership.

Assurance has been gained from Primary Care providers regarding flu vaccines procured and ordered and currently the CCG are assured that appropriate vaccines have been ordered for the current identified cohort that has been identified via PHE criteria. A meeting is planned to discuss options to meet the vaccination programme due to Covid 19 limitations on face to face appointments within the current Primary Care Estate. Flu training is also planned with dates being given for both July and September 2020 to ensure that all staff are appropriately updated to immunise.

2.3 SPECIAL EDUCATIONAL NEEDS AND DISABILITY (SEND)

The Governing Body will be aware that the CCG has a responsibility to ensure that the nationally identified requirements for SEND are implemented



locally following the Children and Families Act 2014 placing a new requirement on local partners to work effectively together to improve outcomes for disabled children and young people and those with Special Education Needs (SEN). The Act provides a statutory framework with a degree of flexibility in how areas implement these requirements.

During Covid 19 there was a clear directive that SEND and particularly the provision of assessment and care was to continue to be a priority and continue as business as usual. This proved quite challenging for both CCG’s in local arrangements. There have also been some excellent examples of innovative work to meet the needs of children, young people and their families.

Due to the above requirements the Department of Education and NHS England/NHS Improvement undertook an individual review of each CCG Partnership in June 2020. NHS Warrington CCG was Thursday 11th June 2020 and NHS Halton CCG was Monday 15th June 2020. Each virtual partnership meeting was a question and answer session giving the CCG’s an opportunity to highlight challenges; risks; positive practice and areas for learning and we await the outcome of this review. Both CCG’s demonstrated some case study examples of excellent practice and some of the positive work that has taken place over this time with successful outcomes for children who were experiencing difficult times. The report will be shared with the Governing Body once received.

2.4 TRANSFORMING CARE

The Governing Body are aware of the work being undertaken in relation to the Transforming Care workstream which supports people living with a learning disability and/or Autism and/or behaviour that challenge across both Halton and Warrington CCGs. During Covid 19 some of the transformational work has been paused due to the redeployment of staff to frontline services during this unprecedented time.

However, following a risk assessment much of the business as usual work has continued, regarding:

• Admissions to in-patient assessment and treatment units • Learning Disability Health Checks • Care and Treatment Reviews • Learning Disability Mortality Reviews (LeDeR)

The following data provides an end of year 2019/20 position. For 2019/20 the number of people with learning disabilities in an in-patient bed was as follows:



HALTON 2019/20 Target Q1 Q2 Q3 Q4 CCG 0 1 1 1 1 Specialised Commissioning - Adult 2

2 2 1 1

Specialised Commissioning - Child

0

0 1

0

TARGET 2 3 3 3 2

WARRINGTON 2019/20 Target Q1 Q2 Q3 Q4 CCG 3 4 3 2 4 Specialised Commissioning - Adult 1

1 1 1 1

Specialised Commissioning - Child

0 0 0

0

TARGET 4 5 4 3 5

All inpatients are supported by Halton and Warrington services to expedite a safe discharge back into their community and the focus of the partnership work across health and social care system has been admission avoidance.

The CCGs work to the guidance concerning Care and Treatment Reviews which should be undertaken to prevent an avoidable admission (Blue Light CTR), post admission to plan for discharge and 6 monthly to review care planning. During 2019/20 3 Blue light CTRs were undertaken in Halton and 9 blue light CTRs were undertaken in Warrington. All patients in an in-patient setting had a CTR completed.

The Governing Body are aware of the requirement for each person with a learning disability to receive an annual health check due to the increased vulnerability; with the target goal to achieve a year on year increase in uptake of annual health checks from the baseline in 2016/17.

HALTON WARRINGTON

Target Achieved Target Achieved 2016/17 60% 58.80% 2016/17 60% 49.30% 2017/18 70% 59.51% 2017/18 70% 54.20% 2018/19 70.6% 59.22% 2018/19 70.6% 40.3% 2019/20 75% 51.7% 2019/20 75% 65.3%

Please note in 19/20 Halton have experienced significant issues with data quality for some practices due to a translation of EMIS codes to the new SNOMED codes, work underway to resolve.

The Covid-19 Pandemic led to a rapid change in the delivery model of General Practice with practices overnight operating a total triage model and undertaking consultations remotely. These changes undoubtedly will have interrupted or delayed



learning disability health checks for Q1 2020/2021. Whilst, it is important to practices and the CCG that all patients are kept informed and kept well we also recognise that patients with a learning disability are a vulnerable cohort who may need additional support to stay well and access services.

I can therefore confirm that both Halton CCG and Warrington CCG have offered a local enhanced service to practices to support the health needs of those with a diagnosis of a learning disabilty. The focus is support to stay well during the pandemic but a number of practices have already said what a great opportunity this will be to offer a health check in a secure and safe environment during this period of complete change.

This area continues to be a priority for the CCG and a task and finish group are currently developing a model to address meeting the needs of this cohort of people. 2.4 LEARNING FROM DEATHS REVIEW (LEDER) As Covid 19 has progressed the LEDER panels previously described to the Governing Body have required pausing due to the impact of the pandemic on practitioners and a virtual solution sought. Alongside this all deaths that occur during the Covid 19 pandemic require an initial rapid review, followed by a full review to be undertaken and submitted to NHSE/I North by 8th July 2020, both CCG’s will meet this requirement. LEDER Position 2019/20

No. deaths

Reviews on track for submission

Reviews delayed

Reviews completed going to QA for closure

Reviews scheduled for panel

Reviews Paused

Halton 5 2 1 1 1 0 Warrington 10 3 2 1 2 2 All 15 cases are within the process of review. Of the 2 paused reviews this is in relation to investigation support from other agencies. For noting 2 of the 5 deaths for Halton CCG and 3 of the 8 deaths for Warrington CCG were deaths notified during the Covid-19 pandemic. Initial rapid review findings are:

• Some good practice in end of life care • No Covid related deaths in Halton or Warrington • Health checks screening uptake is low • Aspiration pneumonia emerging theme

Retrospective Review Cases When the LEDER programme was established a retrospective review of deaths was required pre-December 2018. This caused a backlog of cases nationally due to capacity and capability issues to undertake them. NHS England and NHS Improvement commissioned North East Commissioning Support (NECS) Unit and Farley Dwek to undertake the retrospective reviews to support the system.



NHS Halton have 13 retrospective cases and NHS Warrington have 11 retrospective cases being reviewed by North East Commissioning Support Unit (NECS) and 1 Halton case being reviewed by Farley Dwek (Total 25). We are currently awaiting return of the reviews to enable them to go via our internal Quality Assurance process to enable closure. Sharing the learning from all deaths of people with Learning Disabilities and/or Autism has been undertaken and further learning events planned:

• Sharing the Learning Conference February 2020 undertaken in Halton and Warrington with over 200 practitioners, service users and advocates attending.

• Work undertaken with Halton and Warrington Speak Out with Merseyside Frist regarding early detection of caner signs and symptoms and a Video was produced by service users which can be seen here https://www.youtube.com/watch?v=2ve16vQ4UGE

• Quality Committee Bi-annual reporting • Adult Safeguarding Board annual reporting • Quality Team have a Learning Tracker for themes and trends to enable real

time learning cascades or planning • Learning into action group being established.

LeDer Annual Report The LeDer annual report 2019/20 submission date was originally June 2020 however, due to the impact of Covid-19 this has been deferred until August 2020. This will be presented to Halton and Warrington Quality Committees and to Halton Safeguarding Adult Board and Warrington Safeguarding Adult Board for assurance. 2.5 NHS PROVIDERS 2.5.1 BRIDGEWATER COMMUNITY HEALTCARE FOUNDATION TRUST

The CCG has continued to complete the Clinical Quality Performance Group meetings with BCHFT due to the Provider Care Quality Commission rating ‘Requires Improvement. Assurance has been achieved in terms of raised issues and plans are in place to address any new concerns.

The CCG have identified an increased reporting of Pressure Ulcers by the Trust in the months of April; May and June 2020. This has been raised with the Trust to understand if this was due to the Covid 19 response, i.e. patients and families not wishing staff to enter their homes; reduction in carers due to sickness; reduced BCHFT staff due to redeployment and sickness; or for any other reason. The Trust has agreed to the CCG request to complete a ‘Deep Dive’ into the Serious Incidents to understand any themes and areas for learning. A position paper was taken to Urgent Issues Committee to advice. Initial findings have indicated that the review needs to be a system review to include the Local Authorities and Care Home Leads as initial feedback is that not all Pressure Ulcers are attributable to BHCT. However, BCHT were the organisation that has reported them on STEIS to achieve best learning. There is a clear Terms of Reference for this week with a timeframe of 4 weeks. The findings; learning and actions will be shared in a future Chief Nurse report once known.

https://www.youtube.com/watch?v=2ve16vQ4UGE

https://www.youtube.com/watch?v=2ve16vQ4UGE



The Child Protection Medical Contract Performance Notice remains for NHS Halton CCG regarding voluntarily suspension of service (currently delivered by Warrington & Halton Hospitals Trust) with a meeting planned for the 8th July 2020 to share the developing model. The Chief Commissioner; Chief Nurse and Clinical Lead for children will be attending this meeting.

The CQPG has highlighted some positive practice and quality outcomes during the response to the pandemic so both the CCG and the Trust have developed a pro-forma to document all changes to practice to highlight what worked well and what didn’t; what would be useful to keep and learning form other actions. This document will be used to evidence best practice and inform future service specification developments. Evidence of service user engagement and feedback is also included in the pro-forma.

2.5.2 WARRINGTON AND HALTON TEACHING HOSPITAL TRUST (WHHT) The CCG continues monthly Quality meetings with the Trust. Although the C&M Quality Surveillance Group had recommended to move to ‘light touch’ surveillance for providers who have a CQC rating of Good during Covid 19, the Trust requested we continue with our quality surveillance oversight which has been undertaken virtually. The formal CQPG arrangements will recommence on Wednesday 1st July 2020. The Trust reported a possible outbreak of Hospital Acquired (Nosocomial) Covid-19 Infection on 4th June 2020 within one Orthopaedic Ward. The term outbreak is strictly defined in PHE guidance as two or more cases in a single setting (for example, in a single ward or having shared a location) that have become symptomatic or detected on screening on or after day eight of hospital admission. There were 9 patients Covid positive at this point affected on one ward and a full review and report has been completed. This has shown 2 patients to have hospital acquired infections and 7 community acquired. The Trust will be presenting an assurance paper at the next PQG meeting in July. This was considered a notifiable incident to which NHSE/I had developed a Standard Operating Procedure (SOP) to enable escalation and management of Hospital outbreaks of Covid-19. The Primary function of the North West Response to Hospital Onset of COVID-19 infections (HOCI) is to have systems and processes in place to enable prompt recognition and response to any identified increasing incidents.

The principle being that effective monitoring and surveillance will be central to understanding COVID-19 transmission within hospitals, providing transparency on performance, and supporting a focus on continuous improvement. The expectation is that provider organisations will utilise their established incident management and governance processes. Reflections from the Trust

• No PPE failures • All Protocols followed in Trust • IPC Audits undertaken and no concerns raised • No red flags raised in terms of staff sickness/swab results.



o Have currently tested 1081 staff and reporting third positive, not an outlier with other trusts

o Staff sickness currently 10.9% down from beginning of pandemic from 17%

o Staff working on affected ward did not work on any other ward. • Changes screening guidance 24/4/20 • Repeat testing negatives 14/5/20 • Nosocomial sitrep 21/5/20 • Trust doing daily PPE audits • Prioritised Antibody testing • Daily incidents meetings from 3/6/20 • Reported to CQC and on STEIS

Communications:

• Trust had daily safety huddle meetings in which all staff are appraised of current status

• All patients and families have had discussions/leaflets/information • The communication plan will form a blueprint for how NHSE/I will mark

other Acute Trusts handling of outbreaks nationally. • Trust, CCG and NHSE/I Communications Teams worked

collaboratively.

The Trust should be recognised for the open, honest, and transparent way they have managed this outbreak. For assurance, the CCG were included in daily sitrep reporting to NHSE/I North.

2.5.3 NORTH WEST BOROUGHS FOUNDATION TRUST (NWB)

The Governing Body will be aware that following a CQC inspection November 2019 with the report being published 20th February 2020 the Trust were CQC rated ‘Good’ in all 5 domains. The CCG are aware that the Learning Disability Assessment and Treatment ward (Byron ward) was rated ‘requires improvement’. This is the same grading as the previous report in 2018, which is disappointing as the CCG completed a Quality Visit with subsequent action plans and had seen significant improvements. A further Quality Visit was planned for Friday 26th June 2020, however, due to Covid-19 visiting restrictions put in place by the Trust Executive Board at the Hospital site, this was undertaken virtually and the Trust have been requested to provide as suite of information and performance data for assurance on planned actions, implementation phase and timescales to completion. Once the information has been reviewed a Microsoft Teams meeting will be arranged to discuss themes, trends and actions being undertaken.

2.5.4 BRITISH PREGNANCY ADVISORY SERVICE (BPAS)

The CCG has been working with the British Pregnancy Advisory Service (BPAS) to implement and sustain system learning in relation to Serious Incidents from a reporting perspective through to the evidence of embedded learning as per NHSE (2015) Serious Incident Framework guidance. This



has significantly improved; however, both the Provider and the CCG are facing significant challenges with other CCG’s outside of the Cheshire and Merseyside footprint who utilise the RASCI model. The RASCI model is an acronym derived from the five key criteria: Responsible, Accountable, Supporting, Consulted and Informed whereby one CCG completes the functions on behalf of the other CCGs and informs them through a report of all learning. From a Halton CCG perspective this is ordinarily completed via a Quality Report to the Cheshire and Merseyside Quality Surveillance Group.

The CCG has worked with BPAS following a previous aggregated review and completion of a year long action plan. Significant improvements have been made and now the Provider are facing challenges in being able to report Serious Incidents in other CCG’s nationally. This has been raised with Cheshire and Merseyside NHSE/I and the CCG has provided a report to support the raising of the issue nationally. It is hoped that this will progress to resolution as the Provider has progressed and is keen to demonstrate learning.

3 PRIMARY CARE PROVIDERS

There are currently two Primary Care Providers subject to enhanced surveillance following CQC inspections. These are:

• Newtown Surgery, Halton, last inspection 6th April 2020 • Culcheth Medical Centre Warrington, last inspection 19th July 2019

Both practices are receiving support from the CCG to address identified issues and improve quality. Monthly quality meetings continue with CQC to enable partnership approach to supporting Primary Care.

4 NHS SUPPORT TO CARE HOMES

NHS Halton and NHS Warrington CCGs continue with a programme of work to support care homes during Covid-19 and a number of workstreams are in place (Table1) to ensure the NHS offer is meeting the needs of the residents and requests from Care Home owners for support.

Table 1



Regarding the management of Covid-19 infection in Care Homes on 30th June 2020:

• of the 25 Care Homes in Halton 24 are infection free and 1 still has active infection (plus 1 independent sector hospital).

• of the 55 Care Homes in Warrington 53 are infection free and 2 have action infection.

The Care Homes have responded positively to all training opportunities offered and are fully engaged in discussions. Discussions are underway to undertake a Mortality Review in selected care homes as a lesson learned exercise to support future service improvement support and practice changes. The Cheshire & Merseyside NHS Support offer to Care Homes workstream continues. A gap analysis has been undertaken to establish a baseline assessment of NHS support currently in place, were there are gaps and to establish the opportunities to work together at pace and scale over the coming months.

5 CONCLUSION

The governing bodies should be assured that the system surveillance process is in place to identify best practise and sport early warning signs of system failure. However, this system and process will need to be reviewed in light of changing organisational forms, the financial recovery climate and engagement and involvement public requirements. This report has focused on business critical quality and safety oversight during Covid-19 period.

The Chief Nurse will submit a monthly report to the Governing Body for consideration and challenge.


2020-21 Month 2 Financial reporting COVID-19 response period Joint Governing Body 8th July 2020

MEETING:

Joint Governing Body

DATE OF MEETING:

8th July 2020


David Cooper, Chief Finance Officer

REPORT TITLE:

2020-21 Month 2 Financial reporting COVID-19 response period









Approval

Assurance

X

Discussion

X

Information

EXECUTIVE SUMMARY This presentation outlines the financial performance of NHS Halton CCG and NHS Warrington CCG at Month 2 of the 2020/21 financial year, and the midpoint of the COVID-19 financial reporting period for Phase 2 arrangements. RECOMMENDATIONS The Joint Governing Body is asked to: Note the financial position at the end of May 2020; Note the risks identified; and Note the anticipated guidance for Phase 3.




Insert details of any staff, patient, public or stakeholder engagement activity. If this section is not relevant to the paper, state ‘not applicable’


Include details of any known conflicts of interest


If yes, identify which risk it addresses and include a section on the mitigation provided within the main body of the report (strategic risks in Appendix)


Yes

N/A


X


X


X


X

Document development

Has this document been presented to any other Committee or Forum? If yes, please list which meeting, date and outcome of presentation A similar paper has been presented to the Governing Body of NHS Wirral CCG.



Strategic Objectives and Risks 2019/20

Continually improve the quality of services to the population of Warrington A1 – Failure to ensure clear arrangements are in place for the monitoring of quality, safety and patient experiences of commissioned services in the NHS (NEW) A2 - Failure to ensure clear arrangements are in place for the monitoring of quality, safety and patient experiences of non-commissioned services in the independent sector (REWORDED) A3 – Failure to deliver digitally enhanced care (NEW) A4 - Failure to deliver the Commissioning Plan to meet the needs of the population for 2019/20 (NEW) Achieve financial balance B1 – Failure to implement the financial strategy B2 – Failure to deliver against the system recovery plan (NEW) B3 – Failure to secure best value B4 - Failure to adequately provide for external factors, which impact on financial sustainability B5 - Failure to reduce CCG running costs by 20% for 2020/21 onwards (NEW) Build an effective and motivated whole system workforce C1 - Failure to continuously develop the organisational culture, that meets the changing need of our workforce Ensure sound governance arrangements are in place D1 – Failure to ensure we evidence compliance with our statutory duties D2 – Failure to ensure patient and public engagement D3 – Failure to improve the CCG rating as a result of monitoring performance via the Improvement and Assessment Framework (NEW) Ensure integration and joint working arrangements for the benefit of local people E1 - Failure to ensure that a health and care infrastructure is in place, which retains the local needs-based commissioning approach (NEW)

2020/21 Financial ReportingCOVID-19 Response – Month 2

David Cooper, Chief Finance Officer

Contents • CV-19 Financial Arrangements (recap)• Month 2 Reporting – NHS Halton CCG• Variance Analysis – NHS Halton CCG• Month 2 Reporting – NHS Warrington CCG• Variance Analysis – NHS Warrington CCG• Risks• CV-19 Financial Tracker (as at 26/06/20)• Hospital Discharge Programme• Phase 3 Update• Next Steps

CV-19 Financial ArrangementsNational Guidance was issued late May 2020 to outline the designated budgets to CCGs over the

COVID-19 response period , which considered the impact of guidance issued to support NHS Providers for the same period (April to July 2020).

Consistent methodology applied to all CCGs that considered 2019/20 reported expenditure levels with national growth assumptions applied to all CCGs’ expenditure elements.

2020/21 Month 2 Reporting

• £3.8m adverse variance reported at month 2 against prescribed COVID-19 Budgets.

• GP Transformation £2m, Prescribing £0.6m, and MH OOA placements £0.5m key variances

• True-Up exercise to be undertaken against actual expenditure

NHS HALTON CCG M2 YTD Budget YTDExpenditure

YTDVariance

Net Expenditure of which Covid

19Net Variance

£'000 £'000 £'000 £'000 £'000

Acute Services (ISFE) 21,576 21,358 218 0 218

Mental Health Services (ISFE) 3,934 4,589 (655) 0 (655)

Community Health Services (ISFE) 3,166 3,565 (399) 0 (399)

Continuing Care Services (ISFE) 1,883 1,654 229 55 284

Primary Care Services (ISFE) 5,026 7,677 (2,650) 61 (2,589)

within which:

Prescribing 4,114 4,702 (589) 0 (589)

Other 913 2,974 (2,062) 61 (2,000)

Primary Care Co-Commissioning (ISFE) 3,246 3,297 (51) 0 (51)

Other Programme Services (ISFE) 1,967 2,485 (518) 0 (518)

Total Commissioning Services 40,799 44,625 (3,825) 116 (3,709)

Running Costs (ISFE) 400 410 (10) 10 0

Total CCG Net Expenditure 41,200 45,035 (3,835) 126 (3,709)

variance analysis month 2 reporting

2020/21 Month 2 Reporting

• £1.3m adverse variance reported at month 2 against prescribed COVID-19 Budgets.

• Prescribing £0.5m, and FNC £0.5m key variances

• True-Up exercise to be undertaken against actual expenditure

M2 NHS WARRINGTON CCG YTD Budget YTDExpenditure

YTDVariance

Net Expenditure of which Covid

19Bet Variance

£'000 £'000 £'000 £'000 £'000

Acute Services (ISFE) 30,304 30,565 (262) 13 (249)

Mental Health Services (ISFE) 5,994 6,142 (148) 0 (148)

Community Health Services (ISFE) 5,003 5,005 (1) 0 (1)

Continuing Care Services (ISFE) 3,378 3,592 (214) 16 (198)

Primary Care Services (ISFE) 7,232 7,915 (683) 278 (406)

within which (as memo items)

Prescribing 5,582 6,033 (451) 0 (451)

Other 1,650 1,883 (233) 278 45

Primary Care Co-Commissioning (ISFE) 4,756 4,774 (19) 0 (19)

Other Programme Services (ISFE) 1,541 1,502 39 0 39

Total Commissioning Services 58,207 59,495 (1,288) 306 (982)

Running Costs (ISFE) 640 639 0 14 15

Total CCG Net Expenditure 58,847 60,134 (1,287) 320 (967)

variance analysis month 2 reporting

Risks• Confirmation of True-up resource, treatment of brought

forward pressures to be clarified.• Accounting estimates, such as prescribing (2 months), for

data in arrears. Potential under / over statement.• MHIS delayed for new investments• Contract variations (i.e. Urgent Treatment Centres)

prohibited.

CV-19 Financial Tracker (as at 26/06/20)Headlines:• c£2.4m of approved

expenditure schemes to support COVID-19 response

• Largely Primary Care related and Hospital Discharge Programme related expenditure

• Most schemes have been attributed to WCCG but are reflective of both localities – emphasis on limiting number of transactions (i.e. limited dissection of cost to each CCG)

Hospital Discharge Programme (Month 2)

HOSPITAL DISCHARGE PROGRAMME

Cumulative cost to date

Cumulative number of

people supported by a package to

dateCumulative cost to date

Cumulative number of

people supported by a package to

dateTotal cost to

date

Total number of people

supported by a package to

date£'000 NUMBER £'000 NUMBER £'000 NUMBER

Local Authority CommissionedCare Home 132 48 253 148 385 196Other care accomodation 23 0 0 0 23 0Domiciliary/Home care 137 67 14 13 151 80Reablement/intermediate care 191 147 0 0 191 147Other (please specify) 10 119 70 2 80 121Total Local Authority Commissioned 493 381 337 163 830 544

CCG CommissionedCare Home 11 12 75 34 86 46Other care accommodation 0 0 21 1 21 1Domiciliary/Home care 150 56 57 42 207 98Reablement/intermediate care 209 0 0 0 209 0Total CCG Commissioned 370 68 153 77 523 145

Total Hospital Discharge Programme 863 449 490 240 1,353 689

NHS Halton CCG NHS Warrington CCG Both CCGsHalton:• Largely LA led and focussed on

stepped increases to care packages during CV-19 response period

• Lily Cross provision (Reablement / Intermediate Care) endorsed through Regional OOH Cell is supported by the CCG.

Warrington:• Aligned budgets established

with both partners.• Care Home management key

consideration.• Additional Hospice capacity

supported by the CCG.

Phase 3 Update• National guidance expected in July 2020 to inform Phase

3 response requirements for CCGs.• Mental Health Investment Standard (MHIS) expectations

to be clarified.• Allocation detail for periods 5 to 12 to be outlined.• Contractual arrangements with NHS providers to be

confirmed.• Regional Capital and Revenue Resource limit expected.• Period of financial constraint anticipated.

Next Steps• Review month 3 expenditure, escalate issues.

• Optimise opportunities for Hospital Discharge allocations.

• Further guidance expected for periods 5 onwards.



Joint Meeting of the Governing Bodies of NHS Halton CCG and NHS Warrington CCG

DATE OF MEETING:

8th July 2020


Report presented by David Merrill, NHS Halton CCG Chair Report prepared by Suzanne Barker, Chief of Corporate Services

REPORT TITLE:

Joint Urgent Issues Committee – Key Issues Report from meetings held on Wednesday 1st July 2020




x


x


x


x


x


Approval

Assurance

Discussion

Information

EXECUTIVE SUMMARY This report provides an overview of the key discussion items from the Joint NHS Halton CCG & NHS Warrington CCG Urgent Issues Committee Meetings held on Wednesday 1st July 2020. RECOMMENDATIONS The Governing Body is asked to:

• Note the discussions and decisions made at the Joint Urgent Issues Committee Meetings.



Not specifically referenced in this report – information within the minutes of the Urgent Issues Committee meetings






Yes

N/A






Has this document been presented to any other Committee or Forum? If yes, please list which meeting, date and outcome of presentation? No


1. Purpose This report provides an overview of the key discussion items from the Urgent Issues Committee meeting held on Wednesday 1st July 2020. On the 8th April, the Governing Bodies agreed to establish a temporary Urgent Issues Committee for the current Covid-19 period to have oversight of any urgent discussions and decision-making requirements (particularly linked to the business of Committees that had been paused due to the current Covid-19 response). The Governing Bodies reviewed, updated and approved the terms of reference of the Urgent Issues Committee and agreed to establish a two-week meeting cycle. A rotational chair arrangement from the Lay Members of both CCGs is in place for the joint meetings.

2. Key Issues from Urgent Issues Committee held on Wednesday 1st July 2020

The table below details the key discussion points and matters for approval as discussed at the Urgent Issues Committee held on Wednesday 1st July 2020. This meeting was Chaired by David Merrill, Chair, NHS Halton CCG.

Item No

Agenda Item

Briefing Note of Committee Discussions UIC Action

1. 029/20 The Committee received a paper outlining the current situation in Adult ADHD services in both Warrington and Halton. Members received an overview of the place based approaches that have been taken and the rationale for the different risk ratings in the two CCGs. It was noted that there are links to other risks within other services and agreed that these would be addressed by a report to the Quality Committee in September or October 2020.

The Committee noted the information provided as supporting evidence and rationale for the risks scores documented on the Risk Register.

2. 022/20 The Committee received a presentation outlining the financial performance of NHS Halton CCG and NHS Warrington CCG at month 2 of the 202/21 financial year and the midpoint of the Covid-19 financial reporting period for Phase 2 arrangements.

The Committee noted the financial position at the end of May 2020 and the risks identified. The Committee noted the anticipatory guidance for Phase 3

3. 023/20 The Committee received a briefing around COVID-19 Hospital Acquired Infections from the Chief Nurse and members noted that a Standard Operating Procedure has been developed by NHS England/Improvement to manage the escalation and management of hospital outbreaks of Covid-19 and to ensure that the correct systems and processes are in place.

The Committee noted the contents of the report and were assured that the NHS/I Hospital Acquired Infection Standard Operating Procedure has been followed and all appropriate actions are being taken.


4. 024/20 The Committee received a paper around the British Pregnancy Advisory Service (BPAS): Serious Incidents. Members were appraised of the work that has been undertaken with BPAS to develop their internal processes to report serious incidents in line with the NHSE (2015) Serious Incident Framework and were assured that this has been achieved.

The Committee noted the contents of the report.

5. 025/20 The Committee received a paper around the Transforming Care for People with Learning Disabilities in the boroughs of Halton and Warrington as a year-end position statement and during COVID-19. The Committee noted the work that had been undertaken around admissions to in-patient assessment and treatment centres, Learning Disability Health Checks and Learning Disability Mortality Reviews. The committee acknowledged that a COVID-19 local enhanced service to support patients with a Learning Disability has been commissioned in both Halton and Warrington.

The Committee noted the report and noted that a further report around the full action plan progress and review of priorities will be presented to the Quality Committee in September 2020.

6. 026/20 The Committee received a paper around the Reset and Recovery Plan for Children in Care Health Services, as an update to the papers received by the Committee in June 2020. Members noted that the plan has been developed to consider the next phase of interventions.

The Committee approved the document for use with commissioned providers for NHS Halton CCG and NHS Warrington CCG.

7. 027/20 The Committee received an update to the DVT Pathway following new NICE Guidance released in March 2020. It was noted that the pathway is already part of the Local Enhanced Service in Warrington and is being extended for use across Halton practices. Members discussed the management of patients with DVT during the Covid-19 pandemic.

The Committee approved the DVT Pathway for use across practices in Halton and Warrington.

8. 028/20 The Committee received an overview of risk management, handling arrangements and an update on moderate and low rated risks, outlining the handling arrangements of the Risk Management Agenda throughout the COVID-19 Pandemic, and actions taken to re-establish the usual Risk Management Assessment and Reporting Process. Members noted that this paper supported the previous reporting in respect of high rated risks to UIC in June.

The Committee discussed and noted the content of the paper and received assurance that there is a robust process in place for the management of risk.

9. 030/20 The Committee received a paper around ensuring review for Covid-19 probable patients continue in line with publications reference

The Committee endorsed the proposal to


001559 and the national Standard Operating Protocol for Primary Care. It was noted that permission is required from NHS England around the proposed spend to enable solutions to be mobilised and therefore members discussed what course of action would be taken if the spend was not endorsed by NHS England.

commission a Covid-19 assessment services until 30th September however noted that the endorsement would only apply if permission is granted from NHS England to authorise the proposed spend.

3. Recommendations The Governing Body is asked to note the discussions and decisions made by the Urgent Issues Committee at their meeting on Wednesday 1st July 2020.

Report Prepared by: Suzanne Barker, Chief of Corporate Services NHS Halton CCG & NHS Warrington CCG 1st July 2020




DATE OF MEETING:

8th July 2020


Paper presented by Dr Andrew Davies, Clinical Chief Officer Paper prepared by Suzanne Barker, Chief of Corporate Services

REPORT TITLE:

Review of Governance Arrangements







X



Approval

X

Assurance

X

Discussion

X

Information

EXECUTIVE SUMMARY This report presents the updated review of the current Governance Arrangements across NHS Halton CCG and NHS Warrington CCG with particular focus on Committee arrangements. This follows previous reporting to Governing Bodies prior to the pandemic period and also in respect of agreed transitional arrangements during COVID as implemented in line with national guidance “reducing burden and unleasing capacity”. RECOMMENDATIONS The Governing Body is asked to:

• Review and discuss the content of the Report in the light of the current pandemic


• Review and approve respective recommendations for updated arrangements.


Outlined within the content of the Report






Yes

N/A






Has this document been presented to any other Committee or Forum? If yes, please list which meeting, date and outcome of presentation? Previous governance reports to the CCGs Governing Body in March 2020. Updates in respect of Governance Arrangements have been included in the Clinical Chief Officers Reports during the pandemic period.


1. Purpose This report provides a review of current Governance Arrangements across NHS Halton Clinical Commissioning Group and NHS Warrington Clinical Commissioning Group, respectively. The report updates on previous discussions pre and during the COVID-19 period in respect of governance matters.

2. Background Pre COVID-19 Background Governing Body Members will be aware of the extensive work undertaken as part of the Governance Work Plan during quarter 4 of 19/20. This included:

• Review of core Governance infrastructure, documentation and committee arrangements

• Engagement with Member Practices in respect of the CCG Governance arrangements via engagement events

• A ballot of Member Practices (supported by the LMC) to engage and seek opinions around pertinent matters that required a view from Practices to inform the development of the revised CCG Constitutions

• All development work was to support arrangements for a one-year Constitution for 20/21

• The revised Constitutions and supporting documentation including terms of reference of statutory committees and standing orders were presented and approved in principle by the Governing Bodies in March 2020 (some minor matters for review in NHS Halton CCG) and were then subject to final engagement with the LMC and submission for approval to NHSE.

COVID-19 Period to date In light of the pandemic and national/local requirement to amend our governance infrastructure to focus on the COVID Response, the overarching work above was paused and interim arrangements put in place as reported and approved by Governing Bodies on the 8th April. This included:

• Revised arrangements were aligned to the national directive of “Reducing burden and releasing capacity to NHS Providers and commissioners to manage the COVID-19 Pandemic”. This related to changes to arrangements across 3 key areas of activity including Governance and Meetings, Reporting & Assurance and HR & staff related activities to enable resources and capacity to be fully released to support the COVID Response.

• Streamlined requirements for GB Meetings in terms of key issues and meetings held virtually with additional streamlining or temporary cessation of other Committees

• Establishment of an Urgent Issues Committee (Terms of Reference reviewed and approved by the Governing Bodies on the 8th April 2020). The UIC has met on five occasions during this period and a key issues report is provided as part of the Governing Body Agenda to inform of key discussion items and approvals.

• The current composition of the two Governing Bodies remains in line with current constitutions (pre-March) and operating arrangements

• In line with national guidance, it was required to pause the work in respect of the updates to the Constitution (reviewed by Governing Bodies in March 20)


Current Operating Position To date the CCG is operating under the regulations of the Civil Contingencies Act. As detailed in the NHSE Guidance note from the Regional Director in June, that whilst we do not know how long the emergency will continue it would not be surprising if it extended through much of the financial year. The letter also clarifies that in this situation, the Governing Body (or Board) retains all of their responsibilities for oversight and scrutiny (e.g. quality, safeguarding, staff welfare, equalities, financial probity) apart from those brought into the emergency governance arrangements. Once a level 4 incident is declared, in health, NHSE take responsibility for “running the emergency”. This means that new governance arrangements are established for decision making within the scope of the emergency. We must therefore consider our governance arrangements in this context.

3. Proposal for on-going arrangements 20/21 Following review, the following Committee Arrangements are proposed:

• Continuation of a monthly Joint Governing Body between NHS Halton and NHS Warrington CCG with individual CCG meetings as required in line with business (with review in October)

• Utilisation of part of this monthly time for Governing Body developmental activity outside of the formal Governing Body meeting setting

• Continuation of Audit Committee in a Committees in Common model with meetings five times a year (model already in operation)

• Remuneration Committee to meet in a Committees in Common model (as previous discussed at Remuneration Committee) with meeting scheduled three times a year

• “Place” based Primary Care Commissioning Committees to meet 6 times a year (model is in line with current arrangements)

• Urgent Issues Committee to continue to run until August 2020 when Quality and Finance & Performance Committees will resume

• Quality Committees for NHS Halton and NHS Warrington CCG will be held jointly and will run ten times a year to address statutory requirements

• Finance & Performance Committee for NHS Halton and NHS Warrington CCG will be held jointly and will run ten times a year to address statutory requirements

• Quality and Finance & Performance Committee will meet consecutively to create space for any shared agenda items to be discussed collectively to allow for joined up review and effective decision making (including service changes, change programmes).

All formal Governance Committees will be chaired by a Lay Member (in line with good governance) with membership made up of clinical representatives of the Governing Bodies, IMT Leads, relevant lead officers and representatives (aligned to the current terms of reference). All Committees will continue to have a dedicated IMT Lead Officer who will work with Chairs and members to ensure committee effectiveness. Outside of the formal governance arrangements:

• a joint Commissioning and Service Development Group will be formed to allow for any “shared” service development and transformation activity with space for “place” based discussions


• the existing Clinical Advisory Group at NHS Halton CCG will continue on a transitional basis for further review with Members

• a new model of PLTs will be introduced (in line with previous discussions with Member Practices) and building upon good practice established during COVID

• member engagement events will be reviewed and introduced in line with the outcomes of the February Ballot, learnings from the recent COVID-19 period and the Member Practice engagement work detailed above.

In support of the arrangements above and our current position, the terms of office of current Governing Body members has been extended to 31st March 2020 to ensure continuity of governance arrangements and decision making. This has been discussed with Member Practices as part of the Primary Care Call on 26th June with no questions or issues raised (slide pack shared with all Practices post call). Subject to agreement of the proposal above the following work will be progressed in July and August to enable us to be fully operational with the above arrangements in September:

• cross check and update of the terms of reference and work plans of all Committees

• review Committee Chairs, Deputy Chairs and Governing Body membership across all committees to ensure effective decision making and engagement

• review job plans of all Governing Body members to ensure clarity of arrangements and time commitments

• review of the strategic objectives and governing body assurance framework for reporting in September (please note risk reporting has been brought back on stream through the Urgent Issues Committee since May 2020)

• updates to the draft Constitutions (approved March 20) to reflect required changes as detailed above – engagement with LMC, Member Practices and NHSE in respect of this work

• ensure processes in place for ongoing review of effectiveness of arrangements.

4. Recommendations The Governing Body is asked to

• Review and discuss the content of the Report in the light of the current pandemic

• Review and approve respective recommendations for updated arrangements.

Report Prepared by: Suzanne Barker, Chief of Corporate Services NHS Halton CCG & NHS Warrington CCG 1st July 2020

Direct and indirect impacts of COVID-19 on health and

wellbeingRapid evidence briefing by the Health & Equity in Recovery Plans

Working Group

Lisa Jones, Reader in Public Health, Liverpool John Moores University

Health & Equity in Recovery Plans Working Group

Purpose

Identify what the evidence tells us about the direct and indirect impacts of COVID-19

1. Health and wellbeing impacts associated with the disease itself (1st wave)

2. Impacts of the social distancing and lockdown measures on the wider determinants of health and wellbeing (the factors that drive the 3rd and 4th waves)

3. Indirect health and wellbeing impacts that may arise in the medium to longer term (2nd, 3rd and 4th waves)

4. What can we learn from previous disasters, outbreaks or crises?

COVID-19 infection Social distancing and lockdown measures

Direct health impacts

Directly attributable morbidity &

mortality

Individual health

behaviors

Social determinants

Economic determinants

Environmental determinants

Access to health and social care

Indirect health and wellbeing impacts

Adapted from Douglas et al. BMJ 2020; 369:bmj.m1557

Wider determinants

of health


Methods

• Carried out at pace

• Rapid searches of the academic and grey literature(e.g. COVID-END, key sources such as The Health Foundation)

• Evidence scoped and collated: 18th May – 8th June

• Ongoing work to provide an open access inventory of the sources of evidence used in the briefing

Likelihood of the impact:

Definite = Strong direct evidence (e.g. from a range of sources) or direct evidence from official statistics.

Probable = Good direct evidence to support the impact (e.g. from primary research studies or representative cross-sectional study)

Possible = Direct evidence to support the impact but drawn from limited source(s) (e.g. news articles, blogs or commentaries).

Speculative = No direct evidence but issue raised or reported as a potential impact


Impact on family, friends & communities

Some positive…• Evidence of increased civic participation and a positive

impact on social cohesion

• Thousands of new volunteer groups established; majority of adults believe the country will be more united and kinder

Some negative…• Social isolation and loneliness have impacted on wellbeing

• Greater “toxic stress” and increased risk of family violence and abuse

• Hidden safeguarding issues; LGA has raised concerns about the decline in referrals to social care

Social isolation and loneliness associated with a 30% increased risk of heart disease

and stroke.

Valtorta et al. Heart 2016;102:1009-1016.


Impact on money and resources

• Increase in people signing up for Universal Credit and Jobseeker’s Allowance benefits

• Young workers and low earners have been impacted the most

• Household incomes have fallen particularly among the lowest earners

• Predicted economic downturn will have significant health impacts in the short and longer term

Employment changes during and after the

2008 financial crisis had a strong adverse effect on chronic health, with the strongest effects on

mental health conditions.

Janke et al. The impact of COVID-19 on chronic health in the UK: VOX CEPR Policy Portal; 2020


Impact on education and skills

• Various strands of emerging evidence suggest that children and young people may be hit hardest by the social distancing and lockdown measures

• Surveys suggest that the richest households are more likely to be offered active help from school, and that they are spending more hours a day on home learning

People with the lowest healthy life expectancy

are three times more likely to have no

qualifications compared to those with the highest

life expectancy.

ONS. An overview of lifestyles and wider characteristics linked to Healthy Life Expectancy in

England: June 2017.


Impact on the food we eat

• The lockdown has exacerbated food insecurity and food need; particularly among children

• The number of adults who are food insecure is estimated to have quadrupled

• Food banks have experienced a rapid increase in demand and reduced volunteer numbers

Poor diet is the one of the biggest risk

factors for preventable ill health

in England

Health Foundation. What makes us healthy? An introduction to the social determinants of health:

2018


Impacts on health behavioursAlcohol

• People who drank the most often before lockdown are drinking more often and more on a typical drinking day

• People already drinking the least often have cut down in the greatest number

Smoking

• Increased motivation to quit and to stay smoke free

Diet & physical activity

• Non-UK studies show decreased physical activity and increased eating and snacking

• In England, physical activity behaviours among children and adults have been disrupted.

• Groups that were least active before lockdown are finding it harder to be physically active (e.g. people on low incomes)

The wider determinants of health

both shape the distribution of, and

trigger stress pathways associated

with unhealthy behaviours

Marmot & Bell. BMJ 2019;364:l251


Direct & indirect health & wellbeing impacts

Physical health

• Long-term conditions may have worsened for many people over the course of lockdown

• Concerns about the impact of delayed cancer diagnoses and the knock-on effects

• Increasing evidence of a “long-tail” of COVID-19 related illness

Mental health

• Likely that mental ill health will increase widely; scale is currently difficult to predict

• A range of factors may be drivers of poor mental health during the pandemic

• General worry and anxiety about COVID-19; effects of social isolation; financial insecurity; loss of family and friends to COVID-19; working in a front-line service; and recovery from COVID-19 severe illness


Next steps

Report and slide set to be circulated.

Please feedback back any comments to the Working Group co-chairs:

Lisa Jones

[email protected]

Andy Turner

[email protected]

AcknowledgementsFunded via the Champs Intelligence & Evidence Service at LJMUReport prepared by:• Cath Lewis & Janet Ubido, Public

Health Institute, LJMU• Sharon McAteer & James Watson,

Halton Borough Council• Cath Taylor, Public Health England and

University of Liverpool• Cat Hefferon, Blackpool Council and

University of Liverpool• Sophie Baird, Liverpool City CouncilWith support from Andy Turner (Liverpool City Region Combined Authority) and the wider Health & Equity in Recovery Plans Working Group

mailto:[email protected]

mailto:[email protected]

AGENDA ITEM NO: 053/20a



DATE OF MEETING:

8th July 2020


Maria Austin, Chief of Corporate Affairs and Engagement Jen Molloy, E & D Service, Midlands and Lancashire CSU

REPORT TITLE:

Equality and Inclusion




x



x Sound governance arrangements

x


x


Approval

Assurance

X

Discussion

X

Information

EXECUTIVE SUMMARY The purpose of this paper is to update and provide assurance to the Governing Body of the work programmes underway in respect of Equalities and with particular reference to the emerging issues from COVID-19. The paper highlights matters in relation to:

• General Equality and Inclusion • Governance • Workforce Race and Equality Standard / Workforce Disability and Equality

Standard • Black and Minority Ethnic support • Staff Wellbeing & Engagement • Assurance Mechanisms


RECOMMENDATIONS The Governing Body is asked to:

• Review and discuss the content of the Report and support the various work programmes in development








Yes

N/A






Has this document been presented to any other Committee or Forum? If yes, please list which meeting, date and outcome of presentation?


1. Purpose

The purpose of this paper is to update and provide assurance to the Governing Body of the work programmes underway in respect of Equalities and with particular reference to the emerging issues from COVID-19. The paper highlights matters in relation to:

• General Equality and Inclusion • Governance • Workforce Race and Equality Standard / Workforce Disability and Equality

Standard • Black and Minority Ethnic support • Staff Wellbeing & Engagement

2. Background

The COVID-19 outbreak means that the NHS is currently operating under unprecedented emergency measures. From an equality perspective there are a number of issues that all NHS organisations needed to consider as part of their response in addition to the core standards for Emergency Preparedness, Resilience and Response (EPPR). The restrictions extended by the emergency coronavirus legislation are designed to protect those in vulnerable situations and safeguard futures. They have significant implications for all, but as they came into effect it was important to consider carefully the specific impacts they may have on groups who are already disadvantaged in other ways. Organisations must ensure these groups are not left further behind. Recent research has shown that specific groups of staff, notably BAME staff, are more likely to have health conditions that make them vulnerable to COVID-19. We also know that BAME staff may be vulnerable to adverse treatment within the workplace which may exacerbate other risks, so particular attention should be paid to the risks to these staff. As well as BAME staff other staff groups were also highlighted as being particularly at risk these included men, over 70s and those with long term conditions.

3. Overview of Matters 3.1 General Equality and Inclusion Support Specifically relating to COVID – 19 a range of equality measures have been implemented to ensure staff and patients are not disadvantaged or put at an increased risk. Early COVID related advice for equality considerations was shared with the CCG from the Commissioning Support Group’s (CSU) Equalities and Inclusion Team which provided guidance for rapid decision making. This was based on guidance from the Equality and Human Rights Commission and implementation of the Coronavirus Act. An overarching Equality Impact Assessment (EIA) relating to governance arrangements for equality considerations and rapid decision making was undertaken. There was continued support and awareness for CCG staff completing equality impact assessments with 1:1 support and meetings via Microsoft Teams. EIAs were undertaken for primary care arrangements and care home support. Resources were shared with links to COVID-19 information in differing formats to meet the NHS Accessible Information Standard and updates provided to the CCG on equality reporting due to COVID planning in line with NHS England directives.


A virtual equality awareness session was delivered to NHS Warrington’s Health Forum to raise awareness of equality impact assessment and how the CCG demonstrates due regard. This session was planned pre-COVID but was undertaken in June 2020. This session will be delivered to the Halton Engagement and Involvement Group in July 2020. Implications due to COVID – 19 were discussed. Members of the Warrington Health Forum and the Halton Engagement and Involvement Group will be involved in the completion of EIAs. 3.2 Governance The CCG implemented new arrangements regarding staffing to ensure that we captured data on COVID-19 related sickness by protected characteristic, department, and grade. Due to the low number of staff affected this data cannot be published as this would be personally identifiable. From 16th March 2020 all staff were instructed to work from home and this has been the default for the vast majority of staff to date. A skill scan and individual circumstances capture process was implemented for all staff. This process proactively engaged all staff to ensure that all circumstances were identified and ensured that all staff were supported appropriately and individual risks were assessed not just health risks but any exacerbating workplace (home) factors. For a minority of staff who were still working from their office base on a ad hoc basis a high level desk top risk assessment was undertook and all staff identified as being in an at-risk group was instructed to work from home. Roll out of Phase 2 of the Risk Assessment process commenced early July to all staff. This process is in line with the NHS Employees guidance and includes risk assessments on the workplace, workforce and individuals. A Risk Assessment and Individual Circumstances document pack has been produced and will ensure all staff are continually supported:

1. Whilst working from home, with an agile working checklist which ensures staff health and safety at home is considered

2. With a COVID – 19 risk assessment – to highlight any staff who are in the at-risk category, including BAME, and what support is needed.

3. With their individual circumstances, including caring responsibilities, mental health and wellbeing concerns

This will be supported by a Risk Assessment on Lakeside with the support of the CSU’s Health and Safety Team. There will also be an assurance process for any other venues that staff will be expected to work including GP Practices and Care Homes. Assurance regarding the effective management and governance process in terms of follow up risk assessments both for individuals and at employer wide basis will be reported to the CCG Integrated Management Team via the regular staffing report. 3.3 Workforce Race Equality Standard (WRES)/ Workforce Disability Equality Standard (WDES) The CCGs WRES submission 2018/19 and subsequent action plan has been reviewed to enable the CCG to triangulate the data with other workforce profiles to


ensure there is an effective risk assessment process in place and can enable us to act on any concerns. One outstanding action from the WRES Action Plan is the promotion of unconscious bias training for recruiting managers and the Governing Body. This will be actioned over the 3-6 next months. For 2019/20 we now have official notification confirming the reinstatement of WRES / WDES reporting. The WRES reporting submission is between 6 July to 31st August with published plans and approval by the Governing Body by 31 October 2020. NHS Halton CCG and NHS Warrington CCG will submit separate data however will produce a joint Action Plan. We have been informed there will be an additional data set requested relating to COVID – 19. The CCG will monitor and ensure our providers submit their WDES data with the same reporting period. 3.4 BAME Matters Recent research has shown that specific groups of staff, notably BAME staff, are more likely to have health conditions that make them vulnerable to COVID-19. We also know that BAME staff may be vulnerable to adverse treatment within the workplace which may exacerbate other risks, so particular attention should be paid to the risks to these staff. In the risk assessment process all BAME staff have been identified and are all working from home (since 16th March 2020) therefore any work place risk to exposure to COVID – 19 has been mitigated. Due to the low number of BAME staff and the CCG predominantly not being patient facing the impact is low and the mitigation is the default work from home position. For those staff who do work in patient facing roles, a full risk assessment will be carried out prior to them returning to any front-line work. The risk assessment process will also be rolled out to our Clinical Leads and Governing Body members to ensure we have a true understanding, as our higher proportion of BAME staff are our clinical leads and Governing Body members. A new BAME Strategic Advisory Group has been established by NHS England with one representative from NHS Halton CCG Governing Body and two representatives from NHS Warrington CCG Governing Bodies. The aim of the Advisory Group is to advise from a BAME perspective on the management of COVID and advise on the progress of WRES other matters relating to BAME. It has also been recommended that a BAME Network should be established locally. A proposal paper has been drafted for discussion which recommends an NHS Halton CCG, NHS Warrington CCG and Primary Care Networks BAME network. This network will then feed into the three representatives on the BAME Advisory Group to ensure a wider voice. This is for further discussion and development. COVID disparities and Beyond the data report. A presentation to the Governing Boddy will be provided by Public Health colleagues. To include: What the figures are telling us in terms of the Halton and Warrington population; what we don't know / questions we still need to answer and any learning points / recommended actions to take to address the inequalities moving forward. To support the wider action planning being led by Public Health, NHS Halton CCG and NHS Warrington CCG have developed a local action plan. Outline recommendations include the need to ensure all quality indicators within contracts


include all protected characteristics, strengthening engagement with BAME third sector groups, the establishment of a BAME Network, to focus on BAME patient experience in the Equality Delivery System assessment for 2020/21 and demographic data with and COVID – 19 data sets being shared with PCNs. COVID – 19 related data sets have been produced by the CSU Equality and Inclusion Team to inform decision making. The paper highlights there is a variation for vulnerability factors. These vulnerability factors will be used to inform commissioning and commissioning intentions. 3.6 Staff Communications, Engagement and Wellbeing Throughout COVID – 19 there has been an emphasis on strong staff engagement to both receive suggestions and hear concerns. The Staff Engagement Group (SEG) have been an invaluable resource in terms of staff engagement and have received information to feed in any concerns or suggestions. The SEG facilitated a Staff Survey to gain insight, specifically relating to wellbeing and support. The results were extremely positive and the SEG are in the process of producing a ‘You Said, We Did/ Will’ report. There were no issues relating to equalities that were highlighted. There have been clear and repeated messages from our Integrated Management Team and communications to staff was rated extremely positive by staff in the staff survey. Staff have been reminded of the contacts for HR, Equality and Inclusion and staff engagement on a regular basis. The Freedom to Speak Guardians contact details has been communicated to staff. IMT are reviewing this role with the potential to increase the numbers of Freedom to Speak Guardians and to expand the role to cover primary care. Promotion of the role and how the guardians can support staff will then be undertaken. Staff Wellbeing There has been a clear narrative about staff wellbeing and engagement, including equality implications, owned by IMT and the Staff Engagement Group. Staff who are self-isolating or have been affected by COVID-19 are able to access support via Occupational Health in addition to management support in line with the CCG absence management policy. The Staff Engagement section on TEAMs includes a range of information and support for staff including physical and mental wellbeing. Staff wellbeing and engagement has been a priority for the CCG. The SEG has taken the lead in producing several information packs with mental health and wellbeing support, bereavement support and suicide prevention information. This includes an enhanced Employee Assistance Programme offer and additional support from our local IAPT service. A dedicated staff engagement and wellbeing channel on Microsoft teams has been created to replace the office environment at home. This includes a place where staff can interact with colleagues, post photographs and share their news. This was highlighted through the staff survey as being extremely beneficial for staff, with some staff who live alone particularly commenting on how much they have appreciated it.


The role of Mental Health First Aiders will be introduced, with 16 staff members being trained. The role will be to support all staff with their mental health and wellbeing and signpost to services.

4. Assurance Reporting to Governing Body It is proposed to include a regular update report as part of the Clinical Chief Officers Report with a twice-yearly Equality and Inclusion report to the Governing Body.

5. Recommendations

The Governing Body is asked to: • Review and discuss the content of the Report and support the various work

programmes in development

Report Prepared by: Maria Austin Chief of Public Affairs & Engagement Suzanne Barker Chief of Corporate Services Katie Horan Engagement Manager and SEG Representative

AGENDA - haltonccg.nhs.uk Body Meeting... · approach to support all communication and media...

Documents

Transcript of AGENDA - haltonccg.nhs.uk Body Meeting... · approach to support all communication and media...