AGENDA NHS Leeds CCGs Partnership: Leeds Health ......Barnsley Clinical Commissioning Group...

AGENDA NHS Leeds CCGs Partnership:

Leeds Health Commissioning & System Integration Board

Date: Thursday 25 January 2018

Time: 14:00 – 17:00

Venue: Owlcotes Room, Pudsey Civic Hall, Dawson’s Corner, LS28 5TA

Item Description Lead Paper Time

LHCB 17/69

Welcome and Apologies

Purpose: To record apologies for absence and confirm the meeting is quorate

Philip Lewer N 14:00

LHCB 17/70

Declarations of Interest

Purpose: To record any Declarations of Interest relating to items on the agenda:

a) Financial InterestWhere an individual may get direct financial benefit fromthe consequences of a decision they are involved inmaking;

b) Non-Financial professional interestWhere an individual may obtain a non-financialprofessional benefit from the consequences of a decisionthey are involved in making;

c) Non-financial personal interestWhere an individual may benefit personally in ways that arenot directly linked to their professional career and do notgive rise to a direct financial benefit, because of thedecisions they are involved in making; and

d) Indirect InterestsWhere an individual has a close association with anotherindividual who has a financial interest, a non-financialprofessional interest or a non-financial personal interestwho would stand to benefit from a decision they areinvolved in making.

Philip Lewer N

LHCB 17/71

Patient Voice – Child and Adolescent Mental Health Services (CAMHS)

Purpose: To receive patient experience information to inform the Board’s decision making

Jo Harding N 14:05

LHCB 17/72

Questions from Members of the Public

Purpose: To receive questions from members of the public



FINANCE

LHCB 17/73

Finance Report Purpose: To receive the finance report and consider any issues escalated by the Finance & Commissioning for Value Committee

Visseh Pejhan-Sykes

Y 14:30

LHCB 17/74

Shared Employment Arrangements – Re-Charge Policy Purpose: To agree the proposed re-charge arrangements for Leeds CCGs staff

Visseh Pejhan-Sykes

Y 14:40

GOVERNANCE

LHCB 17/75

Minutes of the Previous Meeting held on 22 November 2017 Purpose: To approve the minutes of the previous meeting

Philip Lewer Y 14:50

LHCB 17/76

Matters Arising Purpose: To consider any matters arising that are not considered elsewhere on the agenda


LHCB 17/77

Action Log Purpose: To review the outstanding actions from previous CCG Governing Body meetings

Philip Lewer Y

ASSURANCE

LHCB 17/78

Corporate Risk Register Purpose: To receive the corporate risks for review

Phil Corrigan Y 15:00

STRATEGY

LHCB 17/79

System Integration Purpose: To receive an update in relation to system integration

Nigel Gray Y 15:10

BREAK FOR 5 MINUTES

COMMITTEE CHAIRS’ SUMMARIES

LHCB 17/80

Primary Care Commissioning Committee – 23 November 2017 and verbal update from 24 January 2018 Purpose: To receive the summary for information and assurance


LHCB 17/81

Finance & Commissioning for Value Committee – 18 January 2018 Purpose: To receive the summary for information and assurance

Ben Browning Y


LHCB 17/82

Interim Patient Assurance Group – 22 November 2017

Purpose: To receive the summary for information and assurance

Angie Pullen Y

LHCB 17/83

Clinical Commissioning Forum – 17 January 2018


Alistair Walling Y

LHCB 17/84

Quality & Performance Committee – 11 January 2018


Steve Ledger Y

COMMISSIONING

LHCB 17/85

Integrated Quality & Performance Report (IQPR)

Purpose: To receive the IQPR and consider any issues escalated by the Quality & Performance Committee

Sue Robins / Jo Harding

Y 15:40

LHCB 17/86

Chief Executive’s Report

Purpose: To receive an update on key issues from the CCGs’ Chief Executive

Phil Corrigan Y 15:55

17/87 Primary Care Rebate Scheme Policy

Purpose: To receive the policy for approval

Simon Stockill Y 16:05

STANDING ITEMS

LHCB 17/88

Questions from Members of the Public

Purpose: To receive questions from members of the public


LHCB 17/89

Forward Work Programme 2017

Purpose: To receive, accept and input to the programme


LHCB 17/90

Any Other Business Philip Lewer N 16:35

Dates of Future Meetings: 21 March 2018

The Leeds Health Commissioning and System Integration Board is recommended to make the following resolution: ‘That representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest’ (Section 1 (2) Public Bodies (Admission to Meetings) Act 1970): LHCB 17/91

Private Minutes of the Previous Meeting held on 22 November 2017

Purpose: To approve the private minutes of the previous meeting



LHCB 17/92

Award of Domiciliary Care Contracts

Purpose: To receive the proposed contract awards for approval

Sue Robins Y 16:45

ITEMS FOR INFORMATION

IFI1. Minutes of the West Yorkshire & Harrogate Joint Committee meeting held on 7 November 2017

Purpose: To receive the minutes for information

Phil Corrigan Y N/A

Forename Surname

GP

CC

G M

em

ber

Go

vern

ing

Bo

dy

Mem

ber

Oth

er

Co

mm

itte

e

Me

mb

er

Ban

d 8

d a

nd

ab

ove

or

Emp

loye

e D

ecis

ion

Mak

er

Emp

loye

e N

on

-Dec

isio

n

Mak

er

Co

ntr

act

or

Pra

ctic

e M

anag

er

Job Title

(where

applicable)

Lee

ds

Sou

th a

nd

Eas

t

Lee

ds

No

rth

Lee

ds

Wes

t Name of

practice

(where

applicable)

No

Interests

Declared

Declared Interest-

(Name of the

organisation and

nature of business)

Fin

anci

al In

tere

sts

No

n-F

inan

cial

Pro

fess

ion

al In

tere

sts

No

n-F

inan

cial

Per

son

al

Inte

rest

s Is the

interest

direct or

indirect?

Nature of Interest Interest From Interest Until Action Taken to Mitigate Risk

Ben Browning X X GP NED X Lofthouse

Surgery

GP Partner in

Lofthouse surgery

X Direct Could bid to provide healthcare

services to LSE CCG

19/06/1905 Declare conflict or perceived

conflict within context of any

relevant meeting or project work


Surgery

Shareholder in Leodis

Care Ltd


services to LSE CCG

Declare conflict or perceived




Surgery

Member of Leodis

LLP (Shell company)

X Direct Now a dormant and non-trading

company





Surgery

Spouse is a GP

Partner in Lofthouse

surgery

X Indirect Could bid to provide healthcare

services to LSE CCG





Surgery

Spouse is city-wide

lead for Learning

Disability services

X Indirect Declare conflict or perceived



Philip Lewer X Lay Chair X Present at various

leadership

programmes within

Tees, Esk and Wear

Foundation Trust and

Northumbria NHS

Foundation Trust

X Direct The Trusts could bid to provide

services to the CCG

2006 - to date Declare conflict or perceived



Philip Lewer X Lay Chair X Lay Chair of NHS

Leeds West Primary

Care Commissioning

Committee

X Direct 1 April 2016 to

date




Victoria Eaton PCCC Public Health

Consultant

X Public Health

Consultant in Leeds

City Council

X Direct Any decisions affecting joint

working with Leeds City Council

including policy and resource

decisions





Consultant

X Fellow of Faculty of

Public Health/Royal

College of Physicians

X Direct Involvement in professional

standards work nationally,

including influence on national

policy





Consultant

X Assessor for

Approved

Appointments

Committee - Faculty

of Public Health

X X Direct Direct involvement in senior

public health appointments




Gordon Tollefson X Lay Member -

Patient &

Public

Involvement

X Advisor on Standards

& Conduct - Leeds

City Council

X Direct LSE CCG engages with Leeds City

Council on provision of services

2007 Declare conflict or perceived




Patient &

Public

Involvement

X Chairman of the

Board of Trustees -

The Prince of Wales

Hospice, Pontefract

X Direct The hospice could seek financial

support for patients treated from

the LSE area





Patient &

Public

Involvement

X Son is a Chartered

Accountant employed

by Mazars LLP

X Indirect Declared due to being a member

of LSE CCG's Audit & Governance

committee

08/07/1905 08/12/2016 Declare conflict or perceived



Brian Roebuck X Lay Member -

Audit &

Governance

X Stonewater Limited -

Member of Group

Board/Chair

Designate of Risk and

Assurance

Committee/Member

of Finance Committee

X Direct A small number of tenants of

Stonewater Limited may be

patients within Leeds





Audit &

Governance

X Symphony Housing

Group - Member of

Group Board

X Direct Symphony Housing is a group of

housing associations. It is based

in Liverpool and works

exclusively in the North West of

England





Audit &

Governance

X Member of NHS

Barnsley Clinical

Commissioning Group

Governing Body

X Direct None 18/07/2016 Declare conflict or perceived




Audit &

Governance

X Chair of NHS Barnsley

Clinical

Commissioning Group

Audit Committee

X Direct None 18/07/2016 Declare conflict or perceived



David Mitchell X Secondary

Care

Consultant

X British Association of

oral and maxillofacial

surgeons . British

Association of

Surgeon Oncologists.

X Direct Desire to improve clinical

services at a national level





Care

Consultant

X Yorkshire &

Humberside Clinical

Sentate

X Direct None envisaged Declare conflict or perceived




Care

Consultant

X Grant to conduct

research in West

Yorkshire

administrated by

Leeds Teaching

Hospitals NHS Trust

X Direct None envisaged Declare conflict or perceived



Ian Cameron X Public Health

Consultant

X X X Director of Public

Health Leeds City

Council

X Direct Any decisions affecting joint

working with Leeds City Council

including policy and resource

decisions

01/04/2016 current Declare conflict or perceived



Philomena Corrigan X X Chief

Executive

X X X Trustee for the

Foundation of

Nursing

X Trustee for the Foundation of

Nursing




Jo Harding X X Director of

Nursing and

Quality

X X X Husband is athe

Director of a property

development

company in York and

the company has

made an offer on a

property which is

currently owned by

the NHS Property

Company.

X Indirect 30/08/2017 Declare conflict or perceived



Simon Hulme X X GP Non

Executive

Director

X Leigh View

Medical

Practice

GP Partner of Leigh

View Medical Practice

X GP Partner of Leigh View Medical

Practice




Simon Hulme X X GP Non

Executive

Director

X Leigh View

Medical

Practice

Shareholder of Leeds

West Primary Care

Network

X Shareholder of Leeds West

Primary Care Network




Stephen Ledger X Lay Member

Assurance

X Declare conflict or perceived



Mark Liu X GP Non

Executive

Director

X GP Partner at Abbey

Grange Medical

Practice, Kirkstall,

Leeds

X GP Partner at Abbey Grange

Medical Practice, Kirkstall, Leeds




Mark Liu X GP Non

Executive

Director

X Wife is a GP Partner

at Manor Park

Surgery, Bramley,

Leeds

Indirect Wife is a GP Partner at Manor

Park Surgery, Bramley, Leeds

09/ Declare conflict or perceived



Mark Liu X GP Non

Executive

Director

X Director of Leeds

General Practice

Limited

X Director of Leeds General

Practice Limited




Mark Liu X GP Non

Executive

Director

X Abbey Grange

Medical Practice is a

shareholder of Leeds

West Primary Care

Limited

X Abbey Grange Medical Practice is

a shareholder of Leeds West

Primary Care Limited




Julianne Lyons X GP Non

Executive

Director

X GP Partner at Leeds

Student Medical

Practice

X 08/07/1905 Declare conflict or perceived




Executive

Director

X Leeds Local Medical

Committee Member





Executive

Director

X Spouse is a Director

of Leeds

Haematology plc

Indirect Declare conflict or perceived




Executive

Director

X Spouse is a trustee of

the British Society for

Haematology





Executive

Director

X Spouse is a trustee of

UK Myeloma Forum





Executive

Director

X Spouse is an

employee of the

University of Leeds





Executive

Director

X Spouse has an

honorary contract

with Leeds Teaching

Hospitals NHS Trust





Executive

Director

X Shareholder of Leeds

West Primary Care

Limited

X Direct 01/10/2015 Declare conflict or perceived



Visseh Pejhan-

Sykes

X X Chief Finance

Officer

X X X Parent Governor at

Oxspring Primary

School

X 01/12/2014 15/11/2017 Declare conflict or perceived



Visseh Pejhan-

Sykes

X X Chief Finance

Officer

X X X Vice Chair of

Governing Body at

Oxspring Primary

School




Visseh Pejhan-

Sykes

X X Chief Finance

Officer

X X X Niece works for CCG

as Digital

Communications

Officer

X Indirect 11/12/2017 Not to participate in any decisions

which may affect this post, e.g.

cut budget

Angie Pullen X PPI Lay

Member

X Senior Manager at

Epilepsy Action




Angie Pullen X PPI Lay

Member

X NHS England

Collaborative

Commissioning &

Engagement

Programme




Sue Robins X X Director of

Commissionin

g

X X X Member of Leeds

North CCG’s

Governing Body and

Management Team in

an executive capacity.

X 01/01/2017 31/03/2017 Declare interests to both Leeds

West CCG and Leeds North CCG

and at relevant meetings both

with CCGs and across external

organisations in Leeds.

Chris Schofield X Lay Member

Governance

X X X Member, Schofield

Sweeney LLP





Governance

X X X Member, Church

Bank House LLP





Governance

X X X Director of JBA Group

Ltd





Governance

X X X Trustee, St Gemma’s

Hospice




Gordon Sinclair X X Clinical Chair X Partner at Burton

Croft Surgery




Gordon Sinclair X X Clinical Chair X Director of Sinclair

Healthcare (Sole)




Gordon Sinclair X X Clinical Chair X Partner of Viva

Healthcare LLP




Gordon Sinclair X X Clinical Chair X Headingley Pharmacy

LLP – Viva Healthcare

has a 25% interest

Indirect 04/07/1905 Declare conflict or perceived



Gordon Sinclair X X Clinical Chair X Burton Croft Surgery

is a shareholder of

Leeds West Primary

Care Network Ltd

Indirect 01/01/2016 Declare conflict or perceived



Simon Stockill X Medical

Director

X X X Partner at Sleights

and Sandsend

Medical Practice,

Whitby (Hambleton,

Richmondshire &

Whitby CCG)





Director

X X X GP Appraiser, NHS

England (Yorkshire &

Humber)





Director

X X X Clinical Lead for

Quality Improvement

Ready Programme,

Royal College of GPs




Jason Broch X X Clinical Chair X Partner Oakwood

Lane Medical Practice

X 10/05/2012 current Declare conflict or perceived



Jason Broch X X Clinical Chair X Director Jemjo

Healthcare Ltd




Jason Broch X X Clinical Chair X Spouse business

Airtight International

Ltd




Jason Broch X X Clinical Chair X Spouse business Nails

17 Ltd




Jason Broch X X Clinical Chair X Director Leeds Jewish

free school




Jason Broch X X Clinical Chair X Shareholder Alpha

Dealing Ltd




Jason Broch X X Clinical Chair X Director Brodetsky

Primary School

Foundation




Jason Broch X X Clinical Chair X Foundation Trust

Governor Local

Authority Brodetsky

Primary School




Mark Freeman X Secondary

care

consultant

Mid Yorks

Hospitals

X Consultant Mid

Yorkshire hospitals





care

consultant

Mid Yorks

Hospitals

X Advisor Univadis

ScientifIc Committee





care

consultant

Mid Yorks

Hospitals

X Brother owner of

Freemans Pharmacy





care

consultant

Mid Yorks

Hospitals

X Member BMA X 01/08/1992 current Declare conflict or perceived



Nigel Gray X Chief Officer -

System

Integration

Bevan Healthcare

Board (Non Exec

Director)





System

Integration

Spouse employed by

Leeds Teaching

Hospital Trust





System

Integration

X X X Sister employed by

Leeds Community

Healthcare (on

secondment to NHS

England from

11/1/2017)





System

Integration

X X X Wetherby St James

Cof E Primary school -

Federated with

Scholes

X 14/09/2016 Left - date unconfirmedDeclare conflict or perceived



Diane Hampshire X Non Executive

Board Nurse

X X Declare conflict or perceived



Nick Ibbotson X GP Non-

Executive

Director

X Employee One

Medicare Arthington

Leeds




Nick Ibbotson X GP Non-

Executive

Director

X Holder of the GMS

contract and the

lease for the

Wetherby LIFT

building.

X 2006/08

Petra Morgan X Practice

Manger -

Street Lane

Practice

Management

executive

X General Manager

Street Lane Practice.

Services provided

over and above GMS

contract - cardiology,

Dermatology, Minor





Manger -

Street Lane

Practice

Management

executive

X Enhance Primary Care

Ltd. Company set up

by SLP to host non

not core

GMS/Enhanced

Contracts - LNCCG

contracts including:

Wound care and

catheter service,

innovation





Manger -

Street Lane

Practice

Management

executive

X Changing Faces -

Close links with the

charity as they

provide services

based at the practice

through our

Dermatology Service




Peter Myers X Non-Executive

Lay Member -

Governance

X Chief Executive

Beverley Buidling

Society





Lay Member -

Governance

X Director Finance

Yorkshire Ltd





Lay Member -

Governance

X Chairman of the

Equine and Livestock

Insurance Group

X 03-Aug-17 current Unlikely to cause conflict due to

nature of interest. If conflict

arises to declare and withdraw if a

decision is being taken.

Graham Prestwich X Non-Executive

Lay Member -

PPI

X X X Astra Zeneca -

Pension provider





Lay Member -

PPI

X X X Pfizer Ltd - Pension

provider





Lay Member -

PPI

X X X Pfizer Ltd - Shares X 01/08/2013 current Declare conflict or perceived




Lay Member -

PPI

X X X Graham Prestwich Ltd

- Director





Lay Member -

PPI

X X X Bradford school of

Pharmacy - joint

chair, external

advisory board





Lay Member -

PPI

X X X University of Leeds -

Member of

Consensus

Development panel

for action to support

practices

implementing

research - a 5yr £2m

research project





Lay Member -

PPI

X X X Change - member of

the Board of Trustees

X 13/04/2013 Ended 2016 Declare conflict or perceived




Lay Member -

PPI

X X X British Standards

Institute - member,

clinical service spec

Steering Group





Lay Member -

PPI

X X X Leeds Area

Prescribing

Committee - patient

representative





Lay Member -

PPI

X X X National Blood

Transfusion Audit

programme -

member fo PPI panel

X 15/01/2014 Left in 2016 Declare conflict or perceived




Lay Member -

PPI

X X X Faculty of medical

leadership and

management -

associate member of

the faculty





Lay Member -

PPI

X X X Medicines

Communications

Charter task and

finish group





Lay Member -

PPI

X X X Leeds Teaching

Hospitals Trust - sister

is employee

X 11/11/2015 Left in 2017 Declare conflict or perceived




Lay Member -

PPI

X X X Wakefield Hospitals -

Sister is an employee

X In 2017 current


Lay Member -

PPI

X X X Allied Health

Professionals

Medicines Project

Board





Lay Member -

PPI

X X X Royal College of

physicians, Joint

advisory group on

gastrointestinal

endoscopy - member





Lay Member -

PPI

X X X Royal College of

physicians, Endoscapy

Services Quality

Assurance group





Lay Member -

PPI

X X X Clinical standards

accreditation alliance -

lay member of

project board





Lay Member -

PPI

X X X NHS England Medical

Directorate Quality

and Outcomes

Working Group -

member





Lay Member -

PPI

X X X NHS England Patients

and Information

Directorate PPI lay

member network

facilitator





Lay Member -

PPI

X X X Yorks and Humber

AHSN, Medicines

Safety Expert

Reference Group m-

member





Lay Member -

PPI

X X X Journal of Medicines

Optimisation Clinical

Editorial Group -

member





Lay Member -

PPI

X X X Journal of Patient

Preference and

Adherence Editorial

Board Member

X c.2016 current


Lay Member -

PPI

X X X NHS England - cross

system sepsis

programme board -

member





Lay Member -

PPI

X X X Chief Professional

Officers Project Board

Medicines Prescribing

non pecuniary - lay

member





Lay Member -

PPI

X X X Primary Care PPG

Research Group

Leeds University -

group member





Lay Member -

PPI

X X X NHS England

Independent

Investigation

Governance

Committee for

mental health

homicides





Lay Member -

PPI

X X X NHS England North

Region Independent

Investigations review

group





Lay Member -

PPI

X X X Improvement Fellow

Bradford

Improvement

Academy





Lay Member -

PPI

X X X Steering Group

member, LJWB

Dementia Living

Project





Lay Member -

PPI

X X X Lay Member

Pharmacy Supply

Chain and Secondary

Uses Advisory group





Lay Member -

PPI

X X X Lay Member Health

Foundation Q

Network





Lay Member -

PPI

X X X Lay Member

Independent Advisory

Group National

Mortality Case Record

Review





Lay Member -

PPI

X X X Lay Member of the

Board of the School

of Medicines

Optimisation





Lay Member -

PPI

X X X BME Health and

Wellbeing sub Group -

member

X 2016 current Declare conflict or perceived




Lay Member -

PPI

X X X Yorkshire and

Humber Academic

Health Science

Network Strategic

Advisory Board

Member





Lay Member -

PPI

X X X Cancer Diagnosis

Safety Netting

Research Steering

Group Member





Lay Member -

PPI

X X X People Voices Group

Healthwatch Leeds

Member





Lay Member -

PPI

X X X West Yorkshire

Patient Experience

Network - Member





Lay Member -

PPI

X X X NHS Clinical

Commissioners Lay

Members Network

Steering Group

Member





Lay Member -

PPI

X X X West Yorkshire and

Harrogate STP Lay

Members PPI

Assurance group




Manjit Purewal X Medical

Director

X X X North Leeds

Medical

Practice

Partner - North Leeds

Medical Practice





Director

X X X North Leeds

Medical

Practice

Tutor - Primary Care

Training Centre





Director

X X X North Leeds

Medical

Practice

Member - BMA X 10/08/2015 current Declare conflict or perceived




Director

X X X North Leeds

Medical

Practice

Member - Diabetes

UK





Director

X X X North Leeds

Medical

Practice

Member - Local Care

Direct

X C. 2004 c. 2016 Declare conflict or perceived




Director

X X X North Leeds

Medical

Practice

Member Circle Group X C. 2004 c. 2016 Declare conflict or perceived




Director

X X X North Leeds

Medical

Practice

Brother partner at

PWC





Director

X X X North Leeds

Medical

Practice

Sister in law partner

at PWC

X c. 2015 Declare conflict or perceived




Director

X X X North Leeds

Medical

Practice

Owner/part owner

Reborne Healthcare

Ltd




Arshad Rafique X X GP Non-

Executive

Director

X Whitfield

Practice

GP Partner at

Roundhay Road

surgery


services to LSE CCG




Arshad Rafique X X GP Non-

Executive

Director

X Whitfield

Practice

Zayan Healthcare

Limited - Director

X Direct Declare conflict or perceived



Amal Paul X X GP Non

Executive

Director

X Roundhay Road

Surgery

GP Partner X Direct Could bid to provide healthcare

services to LSE CCG





Executive

Director

X Roundhay Road

Surgery

Director, Sindhu Deb

Company; may

provide Locum GP

service to the GPs





Executive

Director

X Roundhay Road

Surgery

G P Appraiser, NHS

Leeds, provides

appraisal work for

GPS




Alistair Walling X X X Clinical

Director of

Primary Care

X Ashfield

Medical Centre

Ashfield Medical

Centre & The Grange

Medical Centre. GP

Partner, also my wife

is a GP partner here.

X Direct and

Indirect

31/12/2007 Ongoing To declare and not to take part in

discussion related to practice.May

need to leave for discussions,

dependent on circumstance


Director of

Primary Care

X Ashfield

Medical Centre

South and East Leeds

GP Group,

Shareholder via

practice

X Direct Shareholder 01/03/2016 Ongoing To declare this in any relevant

discussions and handle it at

discretion of chair as issues

require.


Director of

Primary Care

X Ashfield

Medical Centre

Member of Leodis

LLP, which is a

dormant and non

trading company

X Direct Shareholder 01/03/2008 Ongoing To discuss if this ever became

active and relevant


Director of

Primary Care

X Ashfield

Medical Centre

British Medical

Association, Member,

X Direct Lobbying: Department of Health 01/08/2007 Ongoing Declare if relevant and discuss

with chair.


Director of

Primary Care

X Ashfield

Medical Centre

Royal College of

General Practitioners,

Member

X Direct Lobbying: Department of Health 01/08/2007 Ongoing Declare if relevant and discuss

with chair.


Director of

Primary Care

X Ashfield

Medical Centre

Fourteen Fish,

Brother – Director of.

company (provides gp

appraisal software

and other online

tools).

X Indirect 01/08/2012 Ongoing Declare and discuss if ever

became relevant. Exclude myself

from any dsicussions around

procurement decisions for

software in this area.

Dawn Jarvis X X X Associate

Director of

Corporate

Services

X X X Declare conflict or perceived



Patricia Newdall X PAG Member X X



Patricia Newdall X PAG Member X X Need to add in other

committee members

having reviewed the

list

Richard Killington X PAG Member X X

Edward Walley X PAG Member X X

David Tomkins X PAG Member X Member of Leeds

Community

Healthcare Trust

X Indirect Member 01/01/2013 Ongoing

David Tomkins X PAG Member X Trustee of Thackray

Medical Research

Trust

X Direct 10/12/2015 Ongoing

Lesley Stirling-

Baxter

X X Director of

Healthwatch Leeds

Community Interest

Company from April

2016

X Direct Healthwatch could bid to provide

to supply a service

Lesley Stirling-

Baxter

X X Husband works for

the Leeds

Safeguarding Adults

Board as a training

officer

X Indirect If the operation of the Leeds

Safeguarding Adults Board were

to be discussed

Lesley Stirling-

Baxter

X X I coordinate a support

network for people

with Ehlers Danlos

syndrome

X Direct If discussion affected service

provision for those with Ehlers

Danlos syndrome

Lesley Stirling-

Baxter

X X Director of

Healthwatch Leeds

X Direct If Healthwatch were to benefit

from the awarding of a contract

Apr-16

Tanya Matilaine

n

X X Chief Executive of

Healthwatch Leeds

X Direct Healthwatch Leeds may enter

into paid work with LSE CCG

about people's experiences of

health and care. Also a minor

contract delivery partner in the

social prescribing pilot through

Youthwatch

15/09/2015

John Beal X Healthwatch

Representativ

e (PCCC)

X Honorary Senior

Lecturer in Dental

Public Health,

University of Leeds

X

John Beal X Healthwatch

Representativ

e (PCCC)

X Chair, Healthwatch

Leeds

X

Robert Turner X PAG Member X Co-applicant with

Leeds and Bradford

University Staff for

research funding to

NJHR for the Iscomat

X Direct 2014 Ongoing Declare at PAG meetings if there

is a conflict

Robert Turner X PAG Member X Lead patient

representative on the

above Iscomat Rojaru

Programme

X Direct 2012 Ongoing Declare at PAG meetings if there

is a conflict

Roy Wilson X PAG Member X

Trevor Thewlis X PAG Member X X

Suzie Shepherd X PAG Member X Not returned form

Ansa Ahmed X PAG Member X Not returned form

Margaret Wilkinson X PAG Member X X Direct Chair of Shadwell Medical Centre

Patient Participation Group.

2012 Present

THIS PAGE IS INTENTIONALLY BLANK

of 2

Agenda Item: LHCB 17/73 FOI Exempt: N

NHS Leeds CCGs Partnership – Leeds Health Commissioning & System Integration Board Meeting

Date of meeting: 25 January 2018

Title: Finance Report for the nine months ended 31st December 2017

Lead Board Member: Visseh Pejhan-Sykes, Chief Finance Officer

Category of Paper Tick as

appropriate

()

Report Author: Judith Williams, Head of Corporate Reporting and Strategic Financial Planning

Decision

Reviewed by EMT/SMT: N/A

Discussion

Reviewed by Committee: N/A

Information

Checked by Finance (Y/N/N/A): N/A

Approved by Lead Board member (Y/N): Y

Joint Health & Wellbeing Strategy Outcomes – that this report relates to:

1. People will live longer and have healthier lives

2. People will live full, active and independent lives

3. People’s quality of life will be improved by access to quality services

4. People will be actively involved in their health and their care

5. People will live in healthy, safe and sustainable communities

Corporate Impact Assessment: Does the Report have any of the following key implications? - Insert brief commentary or refer to body of report or N/A

Statutory/Legal/Regulatory/Contractual requirements

Financial Implications

Communication and Involvement Issues N/A

Workforce Issues N/A

Equality Issues including Equality Impact assessment

N/A

Environmental Issues N/A

Information Governance Issues including Privacy Impact Assessment

N/A

of 2

EXECUTIVE SUMMARY: This report provides an update on the combined financial positions of the Leeds CCGs for the nine months to 31st December 2017, and the expected outturn position for the 2017-18 financial year. Details of the performance of the individual CCGs is provided in Appendix 1. The CCGs are on track to achieve the key financial targets. The biggest risk is around non achievement of QIPP.

NEXT STEPS: Updates on the 2017-18 financial position will continue to be presented to the Leeds Health Commissioning and System Integration Board and/or Senior Management Team (SMT) on alternate months to ensure that the CCGs’ financial position is formally reported and reviewed each month under the CCGs’ governance arrangements.

RECOMMENDATION: The Leeds Health Commissioning & System Integration Board is requested to:

Note the Month 9 financial position; and

Discuss, comment and highlight actions required to progress and report to the next meeting of the Senior Management Team.

Leeds Clinical Commissioning Groups Partnership

Finance Report for the Nine months ended 31st December 2017

Page 1

Financial Performance Report 31st December 2017

Leeds Clinical Commissioning Groups Partnership Revenue

Expenditure 2017-18

Target Performance RAG Target Performance RAG

£'000 £'000 £'000 £'000CCG Expenditure does not exceed planned level 889,267 889,267 1,194,620 1,194,620

Programme spend less than allocation 793,973 795,347 1,067,869 1,069,703

Running costs spend less than allocation 13,093 12,194 17,459 16,259

Delegated Co-commissioning less than allocation 82,201 81,726 109,292 108,658

Planned Surplus in year 0 0 0 0

QIPP 26,175 17,850 34,900 23,800

Cash

Cash amount

requested for

month

Balance at month

end

Balance at month

end as % of

requested RAG Annual Cash LimitCash at bank balance within 1.25% of the monthly amount reqested or

£250k, whichever is greater £'000 £'000 % £'000Leeds North CCG 21,314 53 0.25% 290,660

Leeds South and East CCG 29,225 541 1.85% 421,436

Leeds West CCG 33,921 44 0.13% 476,791

Better Payment Practice Code (BPPC)

The BPPC requires the CCG to aim to pay 95% of valid invoices by the due

date or within 30 days of receipt of a valid invoice, whichever is later. By Value By Number By Value By Number RAGLeeds North CCG 100.00% 99.67% 99.84% 98.99%

Leeds South and East CCG 100.00% 99.79% 99.43% 99.86%

Leeds West CCG 100.00% 99.30% 99.07% 99.97%

Year to Date Forecast

NHS Non NHS

Page 2

Overview 31st December 2017

This report provides an update on the financial performance of the Leeds Clinical Commissioning Groups Partnership for the nine months to 31st December 2017 and the expected

outturn position for the 2017-18 financial year. Details of the performance of the individual CCGs are provided in Appendix 1.

The Leeds CCG's have submitted balanced plans to NHSE for 2017-18, with a citywide QIPP target of 3% (£34.9m) to achieve this position. The CCG is currently forecasting a breakeven

position. Relevant risks are highlighted in the commentary for each specific area below. But a key risk is that the QIPP targets remain unachieved. For 2017-18 a risk reserve is held to

mitigate this however the CCG's financial position moving forward is untenable without the realisation of this QIPP requirement.

In M7 a forecast underspend of £1.2m on running costs was released. It is possible to vire from running costs to programme and it is planned that this will be now spent within

programme areas, therefore the CCGs are still showing a balanced position overall, but an overspend on the programme element.

Page 3

Financial Position Summary 31st December 2017

Budget Actual Variance Budget Forecast Variance

£'000 £'000 £'000 £'000 £'000 £'000Programme Services

Acute Services 422,706 423,958 1,252 563,607 565,290 1,683

Mental Health Services 98,609 97,649 -960 131,479 130,208 -1,271

Community Health Services 103,028 102,808 -220 136,810 136,491 -319

Continuing Care Services 39,601 39,236 -365 52,801 52,386 -416

Prescribing and Primary Care Services 114,112 113,690 -422 152,331 151,889 -442

Other 4,513 4,521 8 6,017 6,086 69

Primary Care Co-Commissioning 82,201 81,726 -475 109,292 108,658 -634

Total Programme Services 864,770 863,588 -1,182 1,152,338 1,151,008 -1,330

RUNNING COSTS 13,093 12,194 -900 17,459 16,259 -1,200

RESERVES 11,404 13,485 2,081 24,823 27,353 2,529

CCG Net Expenditure 889,267 889,267 0 1,194,620 1,194,620 0


Expenditure 2017-18Year To Date Annual

Page 4

Allocations 31st December 2017

£'000 £'000 £'000 £'000

Opening Baseline Allocation 1,056,938 17,416 109,288 1,183,642

Subtotal Month 2 Adjustments 600 0 0 600

Subtotal Month 3 Adjustments 1,033 35 0 1,068

Subtotal Month 4 Adjustments 534 8 0 542



Subtotal Month 7 Adjustments -284 0 0 -284


Latent TB Qrt 3 non recurrent allocation 35 35

Diabetes Qrt 3 non recurrent allocation 157 157

Additional Winter Funding - Mental Health bids 600 600

Additional Winter Funding - (GP Winter Access Bid etc. ) 171 171

Quality Premium 16/17 stage one payment - All QP measures except for performance on cancers diagnosed at an early stage.132 132

GP WIFI - rounding correctn to M3 Allocation -2 -2


Closing Allocation 1,067,873 17,459 109,288 1,194,620

A bid was submitted for additional winter monies for mental health and a non recurrent allocation of £600k has been received across all 3 CCGs. Additional winter funding for GP access

etc has been received by LW CCG. Targets for Latent TB screening were met in Q3 and so the non recurrent allocation of £35k was received. Ongoing Diabetes non recurrent alloction

for Q3 has been received (spend will be across LTHT and LCH). The quality premium non recurrent allocation was received at LN. There is unlikely to be any quality premium at LW and

LSE as have failed on the national targets of A&E, RTT etc.

Running Costs Co-commissioningIN YEAR

ALLOCATIONLeeds Clinical Commissioning Groups Partnership

Allocations 2017-18

Programme

Page 5

Risks and mitigations 31st December 2017

Commentary

Key Risks £m £m £m £m

Acute Services 1.5 2.4 0.8 4.8

Mental Health Services 0.2 0.2 0.2 0.6

Community Health Services 0.2 0.2

Continuing Care Services 0.1 0.4 0.3 0.8

Primary Care Services/Prescribing 0.1 0.4 1.6 2.0

Primary Care Co-Commissioning 0.0

Other Programme Services 0.2 0.2 General other minor risks

1.9 3.4 3 8.6

Mitigations/Reserves £m £m £m £mContingency 1.5 2.1 2.4 6.0

Reserves 0.4 1.3 0.9 2.6

Delay/Reduce Investment Plans 0.0

1.9 3.4 3.3 8.6

£m £m £m £mTOTAL NET (RISK) / MITIGATION 0.0 0.0 0.0 0.0


Expenditure 2017-18 Leeds North CCG

Leeds South &

East CCG Leeds West CCG

TOTAL

for city

Reflects risks inherent in contract envelopes

set currently and resilience pressures in the

system. Recurrent unless mitigating action

taken

Unforeseen Pressures arising from integration

pilots and systems resilience

Potential service pressures, new national

demands, pressure on LD. Recurrent unless

mitigating actions taken

An area of growing pressure every year, risk

estimate follows past trends. Recurrent unless

mitigating action taken

NCSO risk at M08 is £4.03m, currently covered

within prescribing budgets by forecast

underspend based on PPA data. Risk is

reduced compared to previous month,

however anticipate that this is likely to go back

up given the increase in the number of

recommended products on the NCSO list.


Expenditure 2017-18 Leeds North CCG

Leeds South &


TOTAL

for city

Leeds North CCG

Leeds South &


TOTAL

for city

Page 6

Acute Services 31st December 2017


£'000 £'000 £'000 £'000 £'000 £'000Leeds Teaching Hospitals NHS Trust 304,496 304,496 0 405,994 405,994 0

Mid Yorkshire NHS Trust 19,110 19,909 799 25,480 26,545 1,065

Harrogate Foundations Trust 18,746 19,707 962 24,994 26,277 1,282

Bradford Foundation Trust 3,560 3,725 165 4,747 4,967 220

York Foundation Trust 1,738 1,959 221 2,318 2,613 295

Other NHS Trusts 3,574 2,031 -1,543 4,765 2,720 -2,045

Non contract Activity 5,911 5,910 -1 7,880 7,880 0

Non NHS Acute 32,596 33,041 446 43,461 44,056 595

Urgent Care 32,976 33,179 203 43,969 44,239 270

Total Acute Services 422,706 423,958 1,252 563,607 565,290 1,683

Year To DateLeeds Clinical Commissioning Groups Partnership Revenue

Expenditure 2017-18

Leeds Teaching Hospital Trust (LTHT) – The CCG and LTHT have agree a final position for 2017-18 at planned levels to allow the system to focus on winter and the basis of the new contract for

2018-19 onwards.

The CCG and LTHT are having regular discussions to agree the financial envelope for the 2018-19 contract and exploring the system benefit of moving away from a full payment by results

(PbR) contract. For the next contract management board (CMB) on 22nd January, the CCG is producing 2 papers looking at the principles of how the aligned incentives contract would work

detailing a number of scenarios which highlight potential risks and solutions for each party. The second paper focuses on the contract and system governance arrangements.

Mid Yorkshire Hospital Trust (MYHT) – An overtrade position of £1,065k is being forecast for Mid Yorkshire, this is an increase from last month due to a significant increase in activity at Month

8.

In Month 8 a number of patients have been discharged from critical care which has contributed to the increased forecast. We have also seen an increase in elective geriatric medicine which is

due to kidney or urinary tract infection and a high cost stroke procedure.

The year to date overspending position is due to elective and day case trauma and orthopaedic procedures and within critical care costs. The orthopaedics overtrade is driven by major knee

procedures which are overtrading at month 8 by £262k and major hip procedures by £260k. The activity increase at Mid Yorkshire is thought to be due to capacity issues at Spire Methley Park

but as this is now running close to full capacity we would expect trauma and orthopaedic activity to reduce at Mid Yorkshire over the remainder of the year. Outpatient Procedures are also

now significantly overspending due to Age Related Macular Degeneration which is overtrading by £227K at Month 8.

Harrogate District Hospital Foundation Trust (HDFT) - After reviewing the Month 8 data the Harrogate contract is overtrading by £1,282K. The overtrade is driven by critical care procedures

which are overtrading by £325K at Leeds North, this is a 229% overtrade due to a number of patients spending longer than average in critical care beds. Non-elective data continues to

overtrade within General Medicine, Geriatric Medicine and General Surgery. There are also significant overtrades due to outpatient procedures in specialties General Surgery, Urology and

Gynaecology.

Other Acute Contracts – The main forecast overspends are with Bradford Teaching Hospitals where the contract is overtrading by £220K due to non-elective activity in the geriatric & general

medicine specialties. The contract with York Hospital is also overtrading by £295K, this is due to general surgery, ophthalmology and trauma and orthopaedic day case activity. The CCGs are

holding specific reserves which will cover the overtrades

Non NHS Acute – The forecast for the Independent Sector hospitals at Nuffield and Spire Methley Park has increased due to an increase in activity in November in comparison with the phased

forecast at these hospitals. These relate to an increase in trauma and orthopaedic and gynaecology elective surgery at Nuffield and an increase in trauma and orthopaedic and spinal elective

surgery at Spire Methley. We have also seen an increase in activity within the Gastroenterology AQP due to the inter-provider transfer of patients, from Leeds Teaching Hospital Trust into the

community, who were on the waiting list at LTHT. Activity fluctuations over the remainder of the year can significantly impact on the forecast, and so are continually monitored. These

overtrades have been offset by the release of reserves, earmarked for the growth within these specialties. We have reduced the forecast for the Yorkshire Clinic contract to bring these

contracts closer in line with budget due to duplicated activity which the CCG challenged in the trading report data. We have also reduced the forecast within the Hearing Care AQP closer in

line with the budget due to reduced activity levels at Living Care.

Urgent Care - For urgent care contracts we are showing an overtrade of £172K overall, this is an increase of £98k from last month, this is predominately due to the Shakespeare WIC contract

which as seen a high level of activity in November increasing the forecast by £79K. The main budget areas within urgent care such as the Yorkshire Ambulance contract and non-contract

activity remain on plan.

Annual

Page 7

Mental Health Services 31st December 2017


£'000 £'000 £'000 £'000 £'000 £'000Leeds and York Partnership Foundation Trust 70,389 70,389 0 93,853 93,852 0

Tees Esk and Wear Valley NHS Foundation Trust 825 785 -39 1,099 1,099 0

Bradford District Care NHS Foundation Trust 58 53 -5 77 71 -6

Independent/Voluntary Sector/LCC 3,733 3,628 -105 4,977 4,784 -193

Learning Disabilities 19,821 19,459 -362 26,428 25,946 -482

IAPT 869 869 0 1,158 1,158 0

Mental Health Specialist Services 1,316 1,106 -210 1,754 1,484 -270

Mental Health NCAs 401 324 -77 534 431 -103

Mental Health Other 1,198 1,036 -162 1,597 1,381 -216

Total Mental Health Services 98,609 97,649 -960 131,479 130,208 -1,271

Mental Health and Learning Disabilities (LD) services is forecast to underspend by £1,271k, this is a deterioration of £31k from AP08.

The Learning Disability forecast has increased by £190k due to the approval of 3 new CHC packages in AP08. There is continued scrutiny of this budget with Local Authority colleagues.

The Elective Funding forecast has reduced by £53k. This is due to a number of movements within the cohort including delayed discharges, changes to funding responsibility and

package costs. The forecast also includes two mental health S117 cases that, in the absence of a clear S117 agreement, have been approved by the CCG for joint funding with the LA.

There is a S117 review currently underway with CCG and LA colleagues and the CCG needs to consider all the risks and financial impact associated with any funding agreement.



Page 8

Community Health Services 31st December 2017


£'000 £'000 £'000 £'000 £'000 £'000Leeds Community Healthcare NHS Trust 73,654 73,655 1 98,206 98,206 0

Voluntary Sector/Local Authority 14,947 14,935 -12 19,929 19,913 -16

Community Beds 6,433 6,252 -180 8,577 8,336 -241

Hospices 3,841 3,826 -15 4,589 4,569 -20

Reablement 2,105 2,105 0 2,807 2,807 0

Children's Services excluding Continuing Care 1,513 1,504 -10 1,990 1,955 -34

Safeguarding 535 531 -4 713 704 -9

Total Community Health Services 103,028 102,808 -220 136,810 136,491 -319

The Community bed service went live on 1st November.We are actively working with commissioners and providers to ensure there is no disruption to services during the

implementation phase of the new Community beds model.We are currently forecasting an underspend on the Community beds service but will be closely monitoring this during the

next few months as the new model comes on line. Childrens Services forecasts have remained stable since month 8. The Childrens LTP budget is all now committed to various CAMHS

projects.



Page 9

Continuing Care Services 31st December 2017


£'000 £'000 £'000 £'000 £'000 £'000Continuing Healthcare 24,847 24,657 -190 33,129 32,908 -221

Continuing Healthcare PHBs 3,834 3,987 153 5,112 5,317 206

Funded Nursing Care 6,609 6,553 -56 8,812 8,738 -75

Children Continuing Care including PHBs 945 1,096 151 1,260 1,459 199

Continuing Healthcare - operational 1,727 1,515 -211 2,302 2,060 -242

Neuro-rehab 1,640 1,428 -212 2,187 1,904 -283

Total Continuing Care Services 39,601 39,236 -365 52,801 52,386 -416

CHC is a demand led service and can vary significantly month on month, and in AP09 the forecast has decreased by £38k citywide to a £416k forecast underspend as compared to a £377k forecast

underspend in AP08.

Continuing Healthcare – The forecast for Continuing Care current spend has increased this month. This is due to a notable increase in the amount of Fast Track patients received in December. However

this is more than offset by the amount of provision discharged in December, resulting in an overall small reduction in the forecast spend this month. As a demand led service the forecast may continue to

fluctuate throughout the year.

Continuing Healthcare PHBs – forecast spend has increased by £57k this month. PHBs must now be offered on commencement of a care plan, therefore the current trend of increases to the FOT is likely

to continue.

Funded Nursing Care – Small increase in forecast spend (£21k) this month. This is due to it being a demand led service.

Children’s Continuing Care incl PHB’s – Forecast spend has reduced by £13k this month, due to clawback of monies after audits of PHB accounts. Still forecasting an overspend overall, which is due to

JDAR costs.

Continuing Healthcare Operational – Forecast spend has decreased this month by £23k. Largely due to vacancies that remain unfilled.

Neuro Rehab – Forecast spend has reduced by £16k this month. Actively being case managed and regular meetings with case manager. Risk that forecast can fluctuate largely by admission of single

patients as care plans are high cost.

AnnualLeeds Clinical Commissioning Groups Partnership Revenue

Expenditure 2017-18Year To Date

Page 10

Prescribing and Primary Care Services 31st December 2017


£'000 £'000 £'000 £'000 £'000 £'000Prescribing 94,945 94,891 -55 126,594 126,485 -109

Ex centrally funded drugs 2,560 2,600 40 3,414 3,446 32

Oxygen contract 876 928 52 1,168 1,235 67

Prescribing staff 1,161 1,103 -58 1,548 1,489 -59

Primary Care Schemes 12,452 12,052 -400 16,783 16,411 -372

Primary Care - GP IT 2,118 2,117 -1 2,824 2,823 -1

Total Prescribing & Primary Care Services 114,112 113,690 -422 152,331 151,889 -442

Annual

Prescribing - Prescribing information is received two months in arrears, so the data received covers the period April to October 2017. Currently the true forecast based on national

expectations we would be showing an under trade position but there remains significant risks in the system around no cheaper stock obtainable (NCSO). The risk has reduced slightly in

month to £4.7M, significantly lower than the predicted risk in October of £7M. NCSO is effectively a concessionary price agreed by the Department of Health to reimburse pharmacies

for increased procurement costs when a particular generic product is in short supply or unavailable. Once agreed it is applied to all prescriptions dispensed for that product for the

whole month it is declared in. Currently the number of NCSO products has risen and so has the price agreed. At this stage it has been agreed with budget holders to forecast in line

with the budget until we have more information around the length of time the NCSO will continue for.

Primary Care – it should be noted that some schemes are still in development and some costs are back loaded towards later in the year but the main change from AP08 is in the new

models of care cost centre where the forecast has reduced by £170K as the full budget is no longer required.


Expenditure 2017-18Year To Date

Page 11

Other Services 31st December 2017


£'000 £'000 £'000 £'000 £'000 £'000Non Recurrent Projects 4,513 4,521 8 6,017 6,086 69

Total Other Services 4,513 4,521 8 6,017 6,086 69

AnnualYear To Date

Non Recurrent Projects includes a variety of schemes. The largest schemes which involve all 3 ccgs are the care homes and social prescribing. Leeds West CCG care homes project is

now showing an underspend of £155k as notice has been given on the therapies element of the contract and there will be no costs for this in Q4. Additional funding to keep the gypsy

and traveller service running for Q4 at LW has been agreed, and also funding for an ethnic marketing campaign, showing as an overspend of £28k. The Leeds Integrated Discharge

Service is showing an underspend across the city of £95k due to vacancies within the service at LCH. The costs of Hospital to Home are now being shown here, £161k citywide, although

these may come out of the iBCF. Other costs included here but under discussion are a range of invoices from Community Health Partnerships, £125k citywide. All other smaller

schemes are currently forecast to spend in full in this financial year.


Expenditure 2017-18

Page 12

Primary Care Co-Commissioning 31st December 2017


£'000 £'000 £'000 £'000 £'000 £'000GMS 18,115 18,059 -55 24,154 24,154 0

PMS 35,040 35,183 143 46,720 46,660 -60

APMS 3,189 3,258 69 4,252 4,217 -35

QOF 7,070 7,029 -41 9,428 9,428 0

Enhanced Services 2,109 2,042 -67 2,813 3,273 460

Premises - Reimbursed Costs 11,011 10,975 -36 14,405 15,000 595

Premises - Other 121 332 211 161 161 0

Prof Fees Prescribing & Dispensing 1,017 962 -55 1,356 1,156 -200

Collaborative Payments 13 15 2 17 17 0

Other GP Services (inc. PCO) 1,958 2,154 196 2,612 2,217 -395

Other Non GP Services 1,080 1,716 636 1,441 768 -672

Reserves (91811030) 1,477 0 -1,477 1,933 1,605 -327

Total Primary Care Co-Commissioning 82,201 81,726 -475 109,292 108,658 -634

The forecast for Primary Care Co-Commissioning in December has remained in line with the November forecast to show an underspend of £634K. The reason for the under spend is

business rates reductions due to the national review and in particular Leeds West CCG practices who are seeing reductions later than other CCGs. At Leeds North and Leeds South &

East a surplus reserve of 0.5% had been previously held within the budgets, this is no longer required as it will be funded from the main CCG reserves so the spend against this has been

released.

The LIFT buildings rent uplifts have been confirmed and paid for in December in line with RPI, this increase is £192.5k.

Year To Date AnnualLeeds Clinical Commissioning Groups Partnership Revenue

Expenditure 2017-18

Page 13

Running Costs 31st December 2017

Budget Actual Variance Budget Forecast Variance£'000 £'000 £'000 £'000 £'000 £'000

Pay 7,669 6,882 -787 10,226 9,466 -759

Non Pay/Income 5,424 5,312 -113 7,233 6,793 -440

Total Running Costs 13,093 12,194 -900 17,459 16,259 -1,200

£1.2m has been released as a forecast underspend in Month 7, as a result of vacancies and some areas of non pay,and this will effectively be available to spend in programme areas.

This will be kept under review as other savings may come on line in relation to one voice and accomodation changes, however it is anticipated that these will be offset by non recurrent

costs to do with aligning the organisation and the ledgers.



Page 14

Consolidated Statement of Financial Position 31st December 2017

31st December

2017 31st March 2017

£'000 £'000

Current AssetsTrade & Other Receivables 7,030 6,110

Cash & Cash Equivalents 224 156

Total Current Assets 7,254 6,266

Total Assets 7,254 6,266

Current LiabilitiesTrade & Other Payables: (79,127) (55,652)

Borrowings (640)

Provisions (649) (766)

Total Current Liabilities (80,416) (56,418)

Total Assets less Current Liabilities (73,162) (50,152)

Non-current LiabilitiesProvisions (1,290) (1,414)

Total Non-current Liabilities (1,290) (1,414)

Total Assets Employed (74,452) (51,566)

Financed by Taxpayers’ EquityGeneral Fund (74,452) (51,566)

Total Taxpayers’ Equity (74,452) (51,566)

Page 15

Appendix 1

Leeds Clinical Commissioning Groups Partnership

Finance Report by CCG for the Nine months ended 31st December 2017

Financial Performance Report by CCG 31st December 2017

Leeds North Clinical Commissioning Group Revenue Expenditure

2017-18


£'000 £'000 £'000 £'000CCG Expenditure does not exceed planned level 215,634 215,634 292,166 292,166

Programme spend less than allocation 192,447 192,809 261,248 261,730




QIPP 6,450 4,399 8,600 5,865

Leeds South & East Clinical Commissioning Group Revenue

Expenditure 2017-18







QIPP 9,375 6,393 12,500 8,524

Leeds West Clinical Commissioning Group Revenue Expenditure

2017-18







QIPP 10,350 7,058 13,800 9,411




Financial Position Summary by CCG 31st December 2017



Acute Services 102,935 103,771 835 137,247 138,362 1,115

Mental Health Services 24,069 23,806 -263 32,092 31,751 -341




Other 610 635 25 813 862 49


Total Programme Services 210,963 211,145 182 281,288 281,590 302

RUNNING COSTS 3,297 3,071 -226 4,396 4,094 -302

RESERVES 1,373 1,418 44 6,482 6,482 0

CCG Net Expenditure 215,634 215,634 0 292,166 292,166 0

Leeds North Clinical Commissioning Group Revenue Expenditure

2017-18Year To Date Annual




Acute Services 150,338 150,798 459 200,450 201,075 625





Other 1,749 1,798 49 2,332 2,448 116


Total Programme Services 307,960 307,351 -609 410,052 409,315 -737

RUNNING COSTS 4,109 3,826 -283 5,480 5,103 -377

RESERVES 4,704 5,595 891 8,133 9,247 1,114


Leeds South and East Clinical Commissioning Group Revenue





Acute Services 169,433 169,390 -43 225,910 225,853 -57


Community Health Services 41,249 41,314 65 54,998 55,083 85


Prescribing and Primary Care Services 45,253 45,203 -50 60,518 60,550 32

Other 2,154 2,087 -66 2,871 2,775 -96


Total Programme Services 345,847 345,092 -755 460,998 460,104 -894

RUNNING COSTS 5,687 5,297 -391 7,583 7,062 -521

RESERVES 5,326 6,472 1,146 10,208 11,623 1,415


Leeds West Clinical Commissioning Group Revenue Expenditure

2017-18Year To Date Annual

of 2




Title: Shared Employment Arrangements – Recharge Policy and Memorandum of Understanding

Lead Board Member: Visseh Pejhan-Sykes, Chief Finance Officer


appropriate

()

Report Author: Rosemary Reynolds, Deputy Chief Finance Officer - Corporate

Decision


Discussion


Information











Financial Implications


Workforce Issues


N/A



N/A

of 2

EXECUTIVE SUMMARY: NHS Leeds South and East Clinical Commissioning Group, NHS Leeds North Clinical Commissioning Group and NHS Leeds West Clinical Commissioning Group have established transitional collaborative arrangements for the 2017/2018 financial year. The associated Collaborative Agreement was approved on the 24th May 2017 (Leeds West and Leeds North CCGs) and 25th May 2017 (Leeds South and East CCG). This is attached at Appendix 1 to the Memorandum of Understanding (MOU). This MOU sets out the framework for the shared employment arrangements between the three statutory organisations and the associated sharing of pay and non-pay running cost expenditure. This MOU supersedes the three separate Memorandum of Understandings which were established in April 2013 between the three CCGs This MOU shall come into effect on 1 April 2017 and shall continue until it is terminated. This MOU is a formal agreement between three NHS bodies and is intended to set out the obligations between each CCG as parties to this agreement. This MOU sets out the principles which have been agreed between the CCGs in relation to shared management appointments and arrangements and the associated sharing of pay and non-pay running cost expenditure.

RECOMMENDATION: The Leeds Health Commissioning & System Integration Board is requested to:

Discuss and agree the MOU framework and associated sharing of pay and non-pay running cost expenditure.

MEMORANDUM OF UNDERSTANDING IN RELATION TO SHARED EMPLOYMENT ARRANGEMENTS AND SHARED RUNNING COST NON-

PAY ARRANGEMENTS

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1. Introduction NHS Leeds South and East Clinical Commissioning Group, NHS Leeds North Clinical Commissioning Group and NHS Leeds West Clinical Commissioning Group have established transitional collaborative arrangements for the 2017/2018 financial year. The associated Collaborative Agreement was approved on the 24th May 2017 (Leeds West and Leeds North CCGs) and 25th May 2017 (Leeds South and East CCG). This is attached at Appendix 1. This Memorandum of Understanding (MOU) sets out the framework for the shared employment arrangements between the three statutory organisations and the associated sharing of pay and non-pay running cost expenditure. This MOU supersedes the three separate Memoranda of Understanding which were established in April 2013 between the three CCGs. This MOU shall come into effect on 1 April 2017 and shall continue until it is terminated. This MOU is a formal agreement between three NHS bodies and is intended to set out the obligations between each CCG as parties to this agreement. This MOU sets out the principles which have been agreed between the CCGs in relation to shared management appointments and arrangements and the associated sharing of pay and non-pay running cost expenditure. The Leeds CCGs have established joint governance arrangements including the Leeds Health Commissioning and System Integration Board (“the Board”). The Board is a joint committee of the Leeds CCGs. In addition to the Board the following joint committees have also been established to support the Leeds CCG governance arrangements:

Joint Quality and Performance Committee

Joint Finance and Commissioning for Value Committee

Joint Patient Assurance Group

Joint Clinical Commissioning Forum The governing bodies of the 3 CCGs and the following statutory committees meet in common:

Remuneration and Nomination Committee

Audit Committee

Primary Care Commissioning Committee 2. Shared appointments and arrangements Executive Director appointments to the joint governance and committees in common arrangements are treated as shared appointments and therefore associated costs are recharged between the three separate statutory Leeds CCGs on an equal split basis (i.e. one third to each statutory CCG organisation) on the basis that it is the most appropriate split based on time spent and value added. Non-Executive and lay member posts which are CCG-specific are allocated wholly to the respective CCG. Appendix 2 details arrangements for specific positions.

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3. Employment Arrangements All posts within the shared management structure are employed by one of the three CCGs – these being NHS Leeds South and East CCG, NHS Leeds North CCG and NHS Leeds West CCG. Joint HR policies across the 3 CCGs are now in place. Supervision of staff will take place through the relevant line management arrangements as per the functions of the shared management arrangements. NHS Leeds South and East CCG, NHS Leeds North CCG and NHS Leeds West CCG, shall bear the costs of remuneration, any liability issues or redundancy/dismissal costs as well as any pension/early retirement costs arising in connection with the employment of the shared management posts based on an equal apportionment split for Director and above, and anything below Director level will be split based on weighted capitation split. 4. Funding of Shared Appointments The CCGs shall bear the remuneration and associated employee costs arising in connection with each of the shared posts, which include but are not limited to income tax and national insurance. This will include any authorised expenses, on-costs and training and development costs. The funding for the joint Executive posts will be allocated equally across each CCG. For all other CCG appointments the funding shall be allocated on the basis of the weighted capitation population of each CCG. For the avoidance of doubt, the funding arrangements referred to above shall continue notwithstanding that the staff may not be performing their duties by reason or absence through sickness, leave or otherwise provided always that reimbursement shall be limited to the value of the payments payable in respect of the Staff by the CCG. 6. Non Pay Expenditure As a result of the shared management and governance arrangements, all non pay expenditure including costs associated with HQ property rents will be recharged on a weighted capitation basis between the three Leeds CCGs, with the exception of external audit costs which are specific to individual CCGs.

1 CCG Collaborative Agreement NHS Leeds North Clinical Commissioning Group NHS Leeds South and East Clinical Commissioning Group NHS Leeds West Clinical Commissioning Group V3

Transitional Collaborative Agreement between

NHS Leeds North Clinical Commissioning Group,

NHS Leeds South and East Clinical Commissioning Group, and

NHS Leeds West Clinical Commissioning Group

May 2017

Appendix 1


This Agreement constitutes the entire agreement and understanding of the

CCGs and supersedes any previous agreement between the CCGs relating to the

subject matter of this Agreement.

Version Control

Date of amendment Details

27.02.2017 V1: Initial draft for consultation

12.05.2017 V2: revised version following comments

26.05.2017 V3: revised following comments from Governing Body meetings

Version: 3

Approved by:

NHS Leeds North Clinical Commissioning Group, NHS Leeds South and East Clinical

Commissioning Group, NHS Leeds West Clinical Commissioning Group

Date approved: 24 May 2017 (Leeds West & Leeds North CCGs), 25 May 2017 (Leeds South

& East CCG)

Date issued: May 2017

Responsible Director: Philomena Corrigan

Review date: November 2017


1. Background

1.1 Leeds has set out a bold ambition to be the best city for health and wellbeing. It has a

clear vision to be a healthy, caring city for all ages, where people who are poorest

improve their health the fastest. To realise this vision, the CCGs and Leeds City Council

need to change how we commission services so that the health and care system is

sustainable, services are of high quality and we make best use of the ‘Leeds pound’.

1.2 The three CCGs aim to ensure more integrated care, based on the needs of local people.

To do this, the Leeds CCGs and Leeds City Council will work together to change how care

is commissioned, and work with current and future providers to develop a new, more

integrated health and social care system.

1.3 The three CCGs have recognised that in a similar way to many healthcare economies

around the world, it will be necessary to adopt a Population Health Management (PHM)

approach. The key building blocks of PHM are:

Commissioning needs to be more strategic and outcomes-based rather than

activity-based.

Some current commissioning functions would be more effectively used to

develop a new provider landscape of integrated, accountable providers

working towards common goals.

This would be enabled by new payment and incentive mechanisms supported

by better use of information and technology.

1.4 To enable progress towards this vision, the CCGs have established transitional

governance arrangements that support joined-up, speedy and effective decision-making.

To oversee some functions, joint committees have been established to enable greater

co-ordination and integration of commissioning, whilst at the same time overseeing

leadership of system integration to develop provider relationships and new commercial

relationships. The governance arrangements will be reviewed after six months of

operation.

1.5 To oversee this transitional phase, the three CCGs in Leeds have set up the Leeds Health

Commissioning and System Integration Board (“the Board”). The Board is a joint

committee of NHS Leeds North Clinical Commissioning Group, NHS Leeds South and East

Clinical Commissioning Group and NHS Leeds West Clinical Commissioning Group. In

addition to the Board the following committees have been established to support the

CCG governance arrangements:


Remuneration and Nomination Committee

Audit Committee

Primary Care Commissioning Committee

Joint Quality and Performance Committee

Joint Finance and Commissioning for Value Committee

Joint Patient Assurance Group

2. Functions of the Leeds Health Commissioning and System Integration Board

2.1 The Board will be responsible for ensuring that the three Leeds CCGs work together

effectively to:

improve the health and wellbeing of the poorest, the fastest;

help people to live healthier, independent lives; and

ensure that people have access to quality health and care services.

2.2 Through transition, the Board will also oversee the development of a blueprint for

delivering PHM, which will clearly define the developmental journey for both strategic

commissioning and system integration. This means the CCGs working with partners, the

public and patients to commission services that are high quality, sustainable, and make

better use of scarce resources. It also requires the CCGs to support a more integrated

health and care system and develop, with providers, new service models.

2.3 Bringing together strategic commissioning and innovative, integrated, provider

responses will enable delivery of the Leeds Plan, within the West Yorkshire Sustainability

and Transformation Plan.

2.4 The Board will be responsible for:

a) ensuring delivery of a single set of joint priorities;

b) driving the strategic, outcomes and needs-based commissioning of health and

care services across Leeds;

c) ensuring a focus on tackling health inequalities and improving the health and

wellbeing of the poorest, the fastest;

d) designing health and care provision around the needs of patients, with greater

emphasis on prevention and self- care;

e) shaping innovative approaches by health and care providers, which enable them

to respond to our proposed approach to commissioning for outcomes;

f) driving new service models, which provide more integrated care for a specific

population, based on their needs and not disease pathways; and


g) driving the better use of business intelligence and technology, which will provide

the information that we need to commission effectively for outcomes.

2.5 The Board will be responsible for exercising the following functions, to the extent

permitted, including:

a) the strategic commissioning of health and care services that meet the

reasonable needs of our population;

b) agreeing and monitoring the annual work programme to support the delivery of

the Leeds Plan, shared CCG objectives and operational plans;

c) reducing health inequalities, by identifying high risk, high priority populations

and targeting resources, prevention and care to meet their needs;

d) making efficient and effective use of our collective resources by developing new

financial flows, monitoring the CCGs’ financial plans and the delivery of financial

targets set by NHS England;

e) ensuring continuous improvement in the quality of services commissioned on

behalf of the CCGs through the development of a common quality assurance and

reporting framework and quality improvement strategy;

f) ensure that arrangements are in place to secure public involvement in the

planning, development and consideration of proposals for changes and decisions

affecting the operation of commissioning arrangements;

g) supporting organisational development by establishing a single culture where

our staff adopt one set of values and behaviours;

h) promoting the integration of health and care services by driving new provider

approaches and service models;

i) monitoring provider performance and taking remedial action where necessary;

j) driving a consistent approach to understanding the needs of our population

through the better use of business intelligence and technology;

k) establishing a single risk management and Board Assurance Framework and

thereby ensuring all principal risks are identified, managed and mitigated with

appropriate plans, controls and assurance reported; and

l) setting up and overseeing the effectiveness of sub committees deemed

necessary, agreeing terms of reference and membership of any such sub

committees.

2.6 In exercising its functions, the Board will comply with the statutory duties set out in

chapter A2 of the NHS Act and included within the CCG Constitutions.


3. Roles and Responsibilities

3.1 The CCGs agree that where a Deputy assumes the role of its nominated Board Member

(subject to the agreement of the Board Chair) for a meeting, all references, within this

agreement, to a member that are relevant to the meeting will be read as referring to the

deputy as well. Each CCG must:

1. Ensure its nominated members attend every meeting of the Board, or at least 75% of

the meetings each year;

2. Make all reasonable efforts to inform the Chair in advance if a member is unable to

attend a meeting;

3. Ensure all members have considered all documentation and are prepared to discuss

matters at the meetings;

4. communicate openly and in a timely manner about concerns, issues or opportunities

relating to this Agreement; and

5. respond promptly to all requests for, and promptly offer, information or proposals

relevant to the operation of the Board.

4. Governance and Monitoring Arrangements

4.1 There are three levels of decision making:

i) Those that are reserved to the CCG Membership;

ii) Those that are reserved to the Governing Body; and

iii) Those that are delegated, by each CCG, to the Board.

4.2 Each CCG must ensure that the matters set out within the CCG Scheme of Reservation

and Delegation are reserved to each CCG membership, governing body or committee as

appropriate.

4.3 The CCGs acknowledge and agree that the role and remit of the Board will be as set out

in the terms of reference and it is the Board that makes decisions which bind the CCGs

and not the nominated members. The Board shall implement reporting mechanisms to

ensure that all decisions are notified to the CCG Governing bodies, the public, all

relevant stakeholders and other partner organisations as appropriate.

4.4 CCGs cannot delegate or share their liability for their respective statutory functions.


5. Principles for Commissioning

5.1 To benefit from the advantages of the CCGs working collaboratively the following 25

principles are to be endorsed.

1. Patients should always be at the centre of our focus as commissioners and services

are designed to wrap around the patient.

2. Commissioning must focus on the needs of the population, with a particular focus on

addressing inequalities and unwarranted variation.

3. Needs assessments should be comprehensive and holistic with consideration of

those most vulnerable to ensure equity and parity of esteem.

4. Commissioned services should lead to better outcomes for service users and their

families and must move towards providing integrated care for a specific population,

based on their needs and not on service activity and outputs.

5. Commissioning should be based on best practice, supported by professional

guidelines and informed by local clinicians with local knowledge

6. Services must be consistent as well as equitable, ensuring high quality and safe care

and enhancing the patient experience.

7. Decisions will balance population needs with individual needs, prioritising health

promotion and preventative health care where possible.

8. Ensure integration of services within the NHS and between the NHS and other key

partners, in particular the local authority, social care, emergency services, third

sector etc.

9. Commissioned services will be provided in the best place for the patient and their

family which should be within the community or people’s homes where it is safe and

appropriate to do so.

10. Commissioning will adhere to statutory requirements

Commissioning Culture

11. The CCGs must have a positive and trusting relationship, acting in good faith towards

each other and will seek:

i. To understand difference in opinion

ii. Solutions and consensus within these principles

iii. A positive and proactive approach to commissioning

iv. A system wide perspective whilst informing the local one

v. To hold each other to account when deviating from this agreement.


12. Accountability to public bodies, regulators and the public at large will be shared and

owned by all in a transparent and honest way, with particular reference to the Duty

of Candour where relevant.

13. Communication will be proactive and timely, agreed in an enabling manner and

shared with all stakeholders and the public, as much as possible

14. Leadership within commissioning structures will have lay and clinical leadership at

the most senior level

15. System leaders will act on behalf of the public and consider the population interest

above organisational interest, engaging with the public and public representatives

16. Conflicts of interest will be managed in a proactive and transparent manner and

those with conflicts of interest will be absent from relevant decision making, and will

accept and enact the decision of others.

17. Commissioning processes will ensure efficiency and effectiveness of systems and

processes, avoiding duplication where possible, mitigating risk and sharing

information, data and experience.

18. Act in a timely manner, recognising the time critical nature and respond accordingly

to requests

19. Learn from best practice of other commissioning organisations and seek to develop

as a collaborative to achieve the full potential of the relationship.

Commissioning Decision Making

20. Decisions will be transparent and include reference to public engagement, clinical

expertise and publically accountable governance structures.

21. Decisions will encourage innovation and new ways of working where required, public

and stakeholder participation and engagement, provider development where that

addresses identified needs and should build on previous learning.

22. Commissioners will place value at the heart of decision making to develop a

sustainable health and care system, referencing cost-effectiveness, resource

maximisation and return on investment. Prioritisation for decisions should be

balanced, just and safe.

23. Decisions will be explicit about the outcomes expected and the evidence of success.

24. Decisions will be explicit about the impact on geography and/or populations,

considering impact on localities when at large scale.

25. The CCGs will collaborate and co-operate to work towards ensuring that the

commissioning ambitions and intentions of each of the CCGs is met


6. Data Protection

The CCGs acknowledge their respective duties under the Data Protection

Legislation and shall give all reasonable assistance to each other where

appropriate or necessary to comply with such duties.

The CCGs may share information with each other which may comprise

anonymised and pseudonymised data to support decision-making by the Board,

but will not include any patient identifiable data.

Each CCG acknowledges that the other CCGs are subject to the requirements of

the FOIA and each CCG shall assist and co-operate with the others (at their own

expense) to enable the other CCGs to comply with their information disclosure

obligations.

MEMORANDUM OF UNDERSTANDING IN RELATION TO SHARED EMPLOYMENT ARRANGEMENTS AND SHARED RUNNING COST

NON-PAY ARRANGEMENTS (Appendix 2)

Leeds Partnership CCGs

Joint Committee Membership and associated split of costs between the three statutory Leeds

Clinical Commissioning organisations

Membership Basis of Split Post reference

Chair – Leeds S&E CCG 100% Leeds S&E A

Chair – Leeds North CCG 100% Leeds North B

Chair – Leeds West CCG 100% Leeds West C

CCG Accountable Officer 1/3 split D

Chief Officer for System Integration 1/3 split E

CCG Chief Finance Officer 1/3 split F

CCG Director of Nursing 1/3 split G

CCG Medical Director 1/3 split H

CCG Director of Commissioning 1/3 split I

Locality chairs and other lay members and other non-executive directors

100% to appointing CCG J

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Draft Minutes NHS Leeds CCGs Partnership – Leeds Health Commissioning & System Integration Board Meeting

Wednesday 22 November 2017 2:00pm – 5:20pm

Britannia Leeds Bradford Airport Hotel

Members Initials Role Present Apologies

Philip Lewer (Chair) PL Lay Chair

Dr Jason Broch JB Clinical Chair

Dr Ben Browning BB GP Representative

Philomena Corrigan PC Chief Officer

Nigel Gray NG Chief Officer System Integration

Jo Harding JH Director of Nursing and Quality

Dr Nick Ibbotson NI GP Representative

Dr Steve Ledger SL Lay Member - Assurance

Dr Julianne Lyons JL GP Representative

Peter Myers PM Lay Member - Governance

Dr Amal Paul AP GP Representative

Visseh Pejhan-Sykes VPS Chief Finance Officer

Graham Prestwich GP Lay Member - PPI

Manjit Purewal MP Joint Medical Director

Susan Robins SR Director of Commissioning,

Strategy and Performance

Dr Gordon Sinclair GS Clinical Chair

Dr Simon Stockill SS Joint Medical Director

Gordon Tollefson GT Lay Member - PPI

Additional Attendees

Paul Bollom PB Chief Officer Health Partnerships

(item 50)

Dr Ian Cameron IC Director of Public Health

Dylan Roberts DR Chief Information Officer

(items 42-58)

Cath Roff CR Director of Adults & Health

Tanya Matilainen TM Healthwatch Representative

Steve Walker SW Director of Children & Families

Dr Alistair Walling AW Clinical Leader

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Laura Parsons (Minutes) LP Head of Business and Corporate

Services

Members of the Public Observing the Meeting – 0

No. Agenda Item Action

LHCB

17/42

Welcome and Apologies for absence PL welcomed everyone to the meeting. Apologies had been received on behalf of BB, NI, and SS. The Chair welcomed Tanya Matilainen, who had been appointed as the Healthwatch representative following the resignation of Lesley Sterling-Baxter.

LHCB

17/43

Declarations of interest Members were asked to make any declarations of interest in relation to agenda items. No declarations of interest were raised.

LHCB

17/44

Patient Voice JH presented a proposed patient voice schedule for 2018, aligned to the Leeds Health and Care Plan workstreams. The Leeds Health Commissioning and System Integration Board:

a) approved the proposed schedule of patient voice topics for 2018.

LHCB

17/45

Questions from Members of the Public There were no questions from the public.

LCHB 17/46

Minutes of the Meeting held on 21 September 2017 The minutes of the meeting of the Leeds Health Commissioning and System Integration Board of 21 September 2017 were agreed and approved as a correct record, subject to an amendment to section 17/36 (Finance Report) to clarify that spend differentials had been highlighted in relation to prescribing budgets across the county, and there would be a review to check for any inconsistencies. The Leeds Health Commissioning and System Integration Board:

a) approved the minutes of the meeting held on 21 September 2017, subject to the amendment noted above.

LP

LCHB 17/47

Matters Arising There were no matters arising.

LHCB

17/48

Action Log PL presented the actions from previous meetings of the Board. Updates were provided as follows: 17/35 – Include performance implications for Leeds CCGs as a result of West Yorkshire performance in the Integrated Quality & Performance Report – this was under development and an update would be provided in January 2018.

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17/37 – Provide a progress report about delivery of the Electronic Referral Service – SR informed members that this was in progress with a roll out plan in place. An update would be provided at the next meeting. The Leeds Health Commissioning and System Integration Board:

a) noted the action log and the update provided.

LHCB

17/49

Corporate Risk Register PC presented the corporate risks. The risks relating to underperformance against the18 week referral to treatment and 62 day cancer targets continued to be rated as red. The system resilience risk had increased in score from 12 to 16. There were concerns within the system due to an increase in delayed transfers of care. The procurement of community beds had created additional capacity, but further work was needed to co-ordinate the movement of patients into those beds. There was a new corporate risk relating to a practice receiving a rating of ‘inadequate’ from the Care Quality Commission (CQC). An action plan was being developed. JH and SS were involved with supporting the practice and this would be reported to the Primary Care Commissioning Committee. The Leeds Health Commissioning and System Integration Board:

a) reviewed the corporate risk register, and b) noted the controls, assurances and mitigating actions in place to

manage the risks.

LHCB

17/50

Leeds Health and Care Plan The Chair welcomed PB to the meeting to present an overview of the progress made to date in developing a Leeds Health and Care Plan. The Plan outlines the city’s approach to closing the gaps in health inequalities, quality of services and financial sustainability. The Board was asked to support the content of the Plan and agree that conversations with the public and staff continue on the basis of the draft. Engagement had already started through discussions with the Council’s Community Committees Project Initiation Documents (PIDs) had been agreed to support the programmes within the Plan, including quantitative information. The PIDs had been agreed by the Partnership Executive Group and each one is led by a Senior Responsible Officer. Managing the interplay between the different PIDs was a challenge. It was acknowledged that further discussions may be required in relation to the ‘fair shares’ approach to funding and the basis of this, to ensure that all organisations were signed up and supportive. TM highlighted the need for wide-ranging engagement, which would be critical to the success of the Plan in achieving a social movement. PB suggested that

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Patient Participation Groups could be used better to ensure effective engagement. The need to join up thinking around health and education was also highlighted, for example to help to address childhood obesity. It was agreed that there would need to be influence at a national level to support this. In relation to intelligence, it was agreed that a dashboard would need to be developed for the city to demonstrate progress against the Plan, which should be understandable for members of the public as well as commissioners. The Leeds Health Commissioning and System Integration Board:

a) approved the Leeds Health and Care Plan content as a basis for consultation with staff and members of the public;

b) approved the approach outlined in the paper for communication and consultation;

c) approved a commitment to align where appropriate CCG financial planning, quality improvement and commissioning to support the Leeds Health and Care Plan;

d) noted the requirement for further discussion of financial planning in partnership to detail the impact and benefits of the Plan; and

e) noted the requirement to continue to evolve the Plan, particularly in light of System Integration developments.

LHCB

17/51

System Integration and Population Health Management Progress Update NG presented an update on progress to establish a population health management (PHM) approach to commissioning and accountable care provision in Leeds. The progress made since 2014/15 was outlined, and the 10 PHM programme workstreams were confirmed. An outcomes workshop was planned to take place in the next week, and a partnership agreement was being developed with legal input. Partner organisations were already forming relationships such as GP federations and Local Care Partnerships. A public facing narrative had been developed and adapted in line with feedback from members of the public. Emerging risks included the need to ensure alignment with the Leeds Health and Care Plan, and potential regulatory and legislative issues. CR queried the governance around the shaping of commissioning, including the role of the Integrated Commissioning Executive (ICE) and implications for the local authority. It was acknowledged that the development of PHM has been inclusive, but alignment with other frameworks (such as the national frameworks for commissioning for better outcomes) needed consideration. It was agreed that there should be discussions at ICE around the development of system integration and strategic commissioning. It was acknowledged that the outcomes required further development with patient and public involvement, and to ensure that there were no conflicts with existing principles.

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It was suggested that the community asset based approach should be more prominent, as the success of the approach will rely on changing mindsets and focusing on what communities can do for themselves. It was requested that the workstreams be set out in a clear table to enable the Board to track progress against key milestones. The Board congratulated NG and his team on the progress made so far, and noted the points raised around alignment with existing frameworks, governance arrangements, focus on patient and public involvement and the measurement of progress against milestones.

The Leeds Health Commissioning and System Integration Board: a) noted the progress made to date in the establishment of the population

health management programme and underpinning workstreams and key next steps.

LCHB 17/52

Chair’s Summary of the Primary Care Commissioning Committees meeting in common – 20 September 2017 PL presented the summary of the Primary Care Commissioning Committees meeting held in common on 20 September 2017. The Leeds Health Commissioning and System Integration Board:

a) received the report.

LCHB 17/53

Chair’s Summary of the Audit Committees meeting in common - 27 September 2017 PM presented the summary of the Audit Committees meeting held in common on 27 September 2017. GT advised that the members of the Leeds South & East CCG Audit Committee had confirmed their agreement with the decisions taken, as the Leeds South & East Committee was not quorate at the meeting. The Leeds Health Commissioning and System Integration Board:


LCHB 17/54

Chair’s Summary of the Remuneration & Nomination Committees meeting in common - 22 November 2017 GP provided a verbal update in relation to the Remuneration and Nomination Committees meeting held in common on 22 November. Four updated HR policies had been approved, and some recommendations had been agreed for approval by the individual CCG Governing Bodies. The Leeds Health Commissioning and System Integration Board:


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LHCB

17/55

Chair’s Summary of the Finance and Commissioning for Value Committee meeting - 16 November 2017 PM presented the summary of the Finance and Commissioning for Value Committee meeting held on 16 November 2017. The Leeds Health Commissioning and System Integration Board:


LCHB 17/56

Chair’s Summary of the Patient Assurance Group meeting - 25 October 2017 GT presented the summary of the Patient Assurance Group meeting held on 25 October 2017. An update on the prescribing engagement and over the counter medicines guidance would be provided at a future meeting. The Leeds Health Commissioning and System Integration Board:


LHCB

17/57

Chair’s Summary of the Clinical Commissioning Forum meetings - 27 September and 15 November 2017 AW presented the summaries of the Clinical Commissioning Forum meetings held on 27 September and 15 November 2017. The purpose of the Committee had been discussed and there would be developments to the Terms of Reference, including the membership. The first iteration was included on today’s agenda for approval (agenda item LHCB 17/63). The Leeds Health Commissioning and System Integration Board:


LHCB

17/58

Chair’s Summary of the Quality and Performance Committee meeting - 9 November 2017 SL presented the summary of the Quality and Performance Committee meeting held on 9 November 2017. There were concerns regarding the number of Delayed Transfers of Care (DTOCs) reported by Leeds and York Partnership NHS Foundation Trust (LYPFT), which appeared to have nearly tripled. Clarification was being sought as to whether this reflected a worsening position or a change in reporting method. PC explained that NHS England had been asked if the original baseline figures could be reviewed but had refused. The formula was complicated and was causing issues. It was agreed that a proposal should be made at the next Health and Wellbeing Board meeting to write to NHS England on behalf of the health and care partnership in Leeds to request that the baseline is changed. The Committee had requested further information on the risks being reported at West Yorkshire level and how this is aligned with the CCG risks. PC agreed that this should be considered by the Senior Management Team, and then report back via the Chief Executive’s report or the Quality & Performance Committee.

PC

PC

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IC highlighted the Emergency Preparedness, Resilience and Response self assessment which had been reviewed by the Committee and was being presented to the Board for information. It was clarified that the target date to reach substantial compliance was April 2018 rather than April 2017 as noted in the report. The Leeds Health Commissioning and System Integration Board:


LHCB

17/59

Integrated Quality and Performance Report (IQPR) SR presented the IQPR. The four hour A&E target continued to be a challenge. Leeds Teaching Hospitals NHS Trust (LTHT) had submitted a target of 90% in 2017/18 and 95% in March 2018. Referral to treatment times also continued to be below the required standard. In relation to quality, JH advised that there had been no MRSA infections reported during September 2017, and a total of four had been reported to date during the current year. NHS England had reviewed the previous three instances of MRSA and accepted that LTHT was not at fault. LTHT was reporting within the expected numbers for C.difficile infection. Since the report was written, a measles outbreak had been confirmed in Leeds with 5 confirmed cases. Awareness raising exercises were being undertaken in the relevant areas of the city and via social media. An outbreak control meeting had been held today with a bronze command meeting taking place tomorrow. The Leeds Health Commissioning and System Integration Board:

a) received and reviewed the IQPR dashboards and noted the current areas of underperformance and mitigating action; and

b) supported the continued development of the IQPR.

LHCB

17/60

Finance Report VPS presented an update on the combined financial positions of the Leeds CCGs up to 31 October 2017 and the expected outturn position for the 2017/18 financial year. The CCGs were on track to meet their key financial targets. The main area of concern was the Quality, Innovation, Productivity and Prevention (QIPP) schemes which were not on track to deliver in full this year. As requested at the last meeting, additional information had been provided to the Board in relation to the QIPP schemes. Projects were in progress, but the financial impact had not yet materialised. A specification was put to tender in October to procure support to develop a systematic programme approach to QIPP, and the successful bidder had started this piece of work. Assurance was sought that the CCGs were on target to meet their budget position at the end of the year. VPS confirmed that the target would be met and contingency was available to ensure this if required, albeit on a non recurrent basis.

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In relation to the running costs underspend, VPS explained that there was an expectation to reduce running costs by 20% as part of the merger of the CCGs. NHS England would need approve the CCGs’ use of the savings. The Leeds Health Commissioning and System Integration Board:

a) noted the month 7 financial position.

LHCB

17/61

Public Sector Off Payroll Legislation (IR35 Rules) VPS presented an update on the revised HM Treasury off payroll rules, including the potential implications and risks to the CCGs and the mitigating actions being taken. Specialist employment tax advice had been sought from Ernst and Young (EY). Options relating to the payment mechanism for Clinical Leads had been considered by the Remuneration and Nomination Committees which had agreed that all Clinical Leads should be paid via payroll unless they formally request and alternative method of payment and approval is sought from HMRC. One such request had been received so far.

There was some concern that requiring payment via payroll may result in some Clinical Leads choosing to step down from the role. It was agreed that there should be a further report to the Board if difficulties arise in recruiting and retaining Clinical Leads. The Leeds Health Commissioning and System Integration Board:

a) noted the organisational risks identified as a result of the revised public sector off payroll legislation and the associate mitigating actions.

LHCB

17/62

Chief Executive’s Report PC presented the report and particularly highlighted the following:

The Leeds Better Care Fund (BCF) plan had been rated as ‘good’ by NHS England.

A review of transport services in Leeds was being undertaken and was being led by the CCG.

The West Yorkshire and Harrogate Joint Committee had met on 7 November. An update was provided on the stroke programme and it was agreed to ask CCGs to support the aspiration to detect and treat 89% of patients with Atrial Fibrillation. In relation to the elective care programme, the Committee had agreed an approach whereby prior to surgery, patients would be offered a choice of services to address lifestyle factors. The Executive Group had received a paper on innovation which showed that Leeds was ahead of other areas, and demonstrated the good work of the Leeds Academic Health Partnership.

Members were pleased to note that patients were driving the progress made against the Future in Mind plan relating to children and young people’s mental health and wellbeing.

9


The Leeds Health Commissioning and System Integration Board: a) received the report; and b) in relation to the West Yorkshire & Harrogate stroke programme, the

Board agreed the aspiration to detect and treat 89% of patients with Atrial Fibrillation and the proposal to work collaboratively with the Yorkshire and Humber Academic Health Science Network on implementing a targeted and phased approach to working with local practices.

LHCB

17/63

Clinical Commissioning Forum – Terms of Reference PC presented the Terms of Reference of the Clinical Commissioning Forum for approval. The operation of this Committee would continue to develop as required and any resulting amendments to the Terms of Reference would be presented to the Board for approval. The Leeds Health Commissioning and System Integration Board:

a) approved the Terms of Reference of the Clinical Commissioning Forum as attached to the report.

LHCB

17/64

Questions from Members of the Public There were no questions from members of the public.

LHCB

17/65

Forward Work Programme 2017/18 PL presented the forward work programme for comments.

The Leeds Health Commissioning and System Integration Board: a) received the forward work programme.

LHCB

17/66

Any Other Business SL raised a query in relation to the summary of the Clinical Commissioning Forum (CCF) and the cost of commissioning additional primary care capacity over Christmas, New Year and Easter 2017/18, and assurance on value for money. MP confirmed that this was based on data and discussions with Local Care Direct to ascertain what extra capacity was required. This point had been considered at the CCF meeting. PL advised members that the interviews for the Clinical Chair position of the single Leeds CCG would take place in the next week, and following this a Chief Officer would be appointed.

The Leeds Health Commissioning and System Integration Board agreed that representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest’ (Section 1 (2) Public Bodies (Admission to Meetings) Act 1970).

10


LHCB

17/67

2017/18 Financial Support Considered following the resolution to exclude the press and public.

LHCB

17/68

Transition Update Considered following the resolution to exclude the press and public.

IFI1 Minutes of the West Yorkshire & Harrogate Joint Committee Meetings held on 4 July 2017 and 5 September 2017 The Leeds Health Commissioning and System Integration Board:

a) received the minutes of the West Yorkshire & Harrogate Joint Committee meetings held on 4 July and 5 September 2017 for information.

IFI2 Emergency Preparedness, Resilience and Response Self Assessment The Leeds Health Commissioning and System Integration Board:

a) received the Emergency Preparedness, Resilience and Response Self Assessment for information.

Date of Next Meeting: 25 January 2018, 2pm at Pudsey Civic Hall

Approved and signed by: Philip Lewer, Chair Date:

MINUTES ACTION LOG – LEEDS HEALTH COMMISSIONING AND SYSTEM INTEGRATION BOARD

1

ITEM NO:

ACTION NO:

ACTION: ACTION BY: COMPLETED/UPDATE

21 September 2017

LHCB

17/35

1 To include the performance implications for Leeds CCGs as a result of West Yorkshire performance within the IQPR

Phil Corrigan In progress - PC is leading the STP business intelligence programme. Verbal update to be provided in January.

LHCB

17/37

1 To bring a progress report about the delivery of the Electronic Referral Service (as part of the IQPR).

Sue Robins In progress – verbal update to be provided in January.

22 November 2017

LHCB

17/46

1 Minutes to be amended as agreed. Laura Parsons Completed

LHCB 17/58

1 SMT to consider alignment of risks reported at West Yorkshire level with CCG risks and report back to Board/Quality & Performance Committee.

Phil Corrigan In progress.

LHCB

17/58

2 Letter to be sent to NHSE (on behalf of the health and care partnership) relating to the baseline for DTOCs within LYPFT. To be proposed at Health and Wellbeing Board.

Phil Corrigan The Health and Wellbeing Board supported the suggestion that a letter be submitted to NHS England to challenge the current baseline and include support for a revised baseline for Leeds. The letter will be signed off by Cllr Charlwood, Chair of the Health and Wellbeing Board. Completed

LHCB

17/67

1 Board to be kept updated in relation to financial support decisions. Visseh Pejhan-Sykes

Completed

1


NHS Leeds CCGs Health Commissioning and System Integration Board

Date of meeting: 25th January 2018

Title: CCG Risk Register Report

Lead Governing Body Member: Phil Corrigan, Chief Officer


appropriate

()

Report Author: Joanna Howard, Head of Governance

Decision

Reviewed by EMT/SMT/Date: N/A

Discussion

Reviewed by Committee: Quality and Performance Committee 11 January 2018 Finance and Commissioning for Value Committee 18 January 2017 Primary Care Commissioning Committees in Common 24 January 2018

Information

Checked by Finance: N/A

Approved by Lead Governing Body member (Y/N): Y

Joint Health & Wellbeing Strategy Outcomes – that this report relates to








The CCG is required to have a robust risk management process in place

Financial Implications N/A




N/A



N/A

2

EXECUTIVE SUMMARY: The CCG utilises Datix as an internal risk management system which enables risks to be recorded and managed by all members of staff. Each risk is aligned to a CCG committee for overview and scrutiny. The risks are included on the CCG operational risk register and reviewed within individual directorates and by the executive management team on a regular basis. The CCG committees receive and review the risks rated as high amber (12) and risks that are scored at 15 or above. The Leeds Health Commissioning and System Integration Board receive the corporate risk register (all red risks scored at 15 and above) for review at each meeting in association with the CCG Board Assurance Framework. The CCG Board Assurance Framework is currently under review following the approval of the CCG ambitions. The revised framework for 2018/19 will be presented at the March meeting for approval. As per the CCG risk management strategy all risks at a score of 12 and above are presented to the relevant CCG committee for review and assurance. Assurance or areas of concern are reported from the CCG committees to the Leeds Health Commissioning and System Integration Board (LHCSIB) via the CCG committee chair report. There are currently 54 active risks on the CCG risk register, six of which have been escalated to the CCG Corporate Risk Register and include:

Risk 541: System Resilience; impact on the health and social care system within Leeds. This risk has remained at a red 16 due to the increased likelihood of the risk occurring during the winter period. There is a robust local system delivery plan in place which is being monitored by the System Resilience Assurance Board as well as supporting escalation plans across all providers.

Risk 466: Achievement of the national ambulance standards. This risk has been reviewed and remained at a score of red 16 since the last meeting. The Joint Strategic Commissioning Board continues to provide oversight for the 999 and 111 contracts across Yorkshire and Humber.

Risk 532: Commissioner and/or Lead provider fails to achieve the operational standard for the 18 week Referral to Treatment Time. This risk has remained at a score of red 16 as LTHT continues to be non-compliant.

Risk 339: Cancer waiting times. The under achievement of overall performance for 62 day urgent GP referral to treatment of all cancers overall at LTHT remains a concern and therefore continues to be at a risk score of red 16. Under new arrangements the reporting of performance for patients referred later than 38 days, by a referring Trust, will be reviewed and there is a shared responsibility in the performance breach.

Risk 660: CQC inadequate practice. This risk has remained at the same level due to the concerns raised following a CQC inspection. The CCG is in discussion with the practice and a remedial action plan has been drafted. The practice level quality surveillance group is responsible for the monitoring of that action plan and will report to the CCG

3

Primary Care Commissioning Committee.

Risk 659: System resilience variable risk. This is a new risk that was added at a risk score of 16 in December 2017. Due to the current situation of stretched services and continued increasing demand there is a risk that this will impact system capability and capacity to respond to need.

The corporate risk register detailing the red risks can be found in appendix 1. The risk register includes a summary of the current controls and assurances in place to mitigate the risks. The Leeds Health Commissioning and System Integration Board is asked to review the risks on the corporate risk register, including the controls and assurances as well as the supporting information from the committees which can be found within the committee Chair summaries. Whilst some areas of performance and quality are not in line with agreed targets there is reasonable mitigation and action being taken to rectify the issues as well as established risk management systems and processes in place within the CCG. The CCG Quality and Performance Committee accepted the recommendation of reasonable assurance.

NEXT STEPS:

All risks will be reviewed as per the bi monthly cycle in accordance with the CCG risk management strategy and presented to the assigned committee for review.

Development of the new Board Assurance Framework which is aligned to the CCG ambitions.

The corporate risk register will be presented to the Leeds Health Commissioning and System Integration Board at each meeting.

RECOMMENDATION: The Leeds Health Commissioning and System Integration Board is asked to:

(a) Review the corporate risk register as presented to the Board and note the controls,

assurances and mitigating actions that are in place to manage the risks.

1. Risk Register - January 2018

ID

Rev

iew

dat

e

Title Description Secondary Risks

Co

nse

qu

ence

(in

itia

l)

Like

liho

od

(in

itia

l)

Rat

ing

(in

itia

l)

Ris

k le

vel (

init

ial)

Controls Gaps in controls

Co

mm

itte

e R

esp

on

sib

le

Acc

ou

nta

ble

Dir

ecto

r

Man

ager

Costs Assurance Gaps in assurance Synopsis

Co

nse

qu

ence

(cu

rren

t)

Like

liho

od

(cu

rren

t)

Rat

ing

(cu

rren

t)

339

14

/12

/20

17

Cancer under

achievement

of 62 day

urgent GP

referral to

treatment

standard

overall at LTHT

Cancer waiting times - under

achievement of overall

performance 62 days urgent

GP referral to treatment of all

cancers, LTHT total.

Failure to deliver NHS

Constitution standards

required nationally.

Maj

or

Exp

ecte

d t

o o

ccu

r at

leas

t d

aily

. M

ore

like

ly t

o o

ccu

r th

an

no

t.

20

Ver

y H

igh

Pri

ori

ty -

Red

uce

urg

entl

y in

volv

ing

Sen

ior

Man

agem

ent

LTHT have weekly Access

Meetings to monitor. All

patients tracked and clinically

prioritised. Reports received

by LTHT Cancer Board.

Limited ability to influence

pathways in referring trusts,

leading to higher proportions of

patients referred later than day

38.

Qu

alit

y an

d P

erfo

rman

ce C

om

mit

tee

Susa

n R

ob

ins

- D

irec

tor

of

Co

mm

issi

on

ing

Fost

er,

Cat

her

ine

We await

conclusion of

national work

on breach

allocation.

Performance monitored monthly at

Elective Care Working Group and

actioned appropriately. LTHT has a

Cancer Board to oversee delivery of

recovery plans. reporting to LTHT Trust

Board. West Yorkshire actions being

developed.

There have been some improvements in the local CCG

position, but the LTHT Trust total position continues to

underperform; this is due to a variety of issues including the

number of patients who are cancelled due to bed or theatre

capacity due to the very significant bed and critical care

pressures particularly at the St James's site. There has been

no improvement in the late referrals position and 54% of

patients from other providers still arrive at LTHT after day 38.

The national Cancer Intensive Support Team has recently

reviewed the lung pathway again, with further

recommendations, and there is some additional funding to

increase the level of cancer tracking within LTHT.

Maj

or

Exp

ecte

d t

o o

ccu

r at

leas

t w

eekl

y. L

ikel

y to

occ

ur.

16

532

14

/12

/20

17

Commissioner

and/or Lead

provider fails

to achieve the

operational

standard for

the 18 week

Referral to

Treatment

Time

Failure to achieve the

Referral to Treatment Time

standard of no more than 8%

of patients waiting more than

18 weeks from Referral To

Treatment in each reporting

specialty at month end either

as a CCG or within LTHT as

lead provider for Leeds

residents.

Maj

or

Exp

ecte

d t

o o

ccu

r at

leas

t w

eekl

y. L

ikel

y to

occ

ur.

16

Ver

y H

igh

Pri

ori

ty -

Red

uce

urg

entl

y in

volv

ing

Sen

ior

Man

agem

ent

All relevant specialties have

clearance plans agreed with

Chief Operating Officer at

LTHT. Funding for additional

capacity agreed within

contracts. Work is ongoing to

create the capacity but there

are risks given the increased

demand on beds through non

elective pressures. Monthly

review of demand growth

against commissioned activity.

Focus on outpatient capacity

Qu

alit

y an

d P

erfo

rman

ce C

om

mit

tee

Susa

n R

ob

ins

- D

irec

tor

of

Co

mm

issi

on

ing

Lew

is,

Hel

en

Monthly update at joint LTHT /CCG

Elective Care Working Group to review

progress and identify any further

actions that can be taken by CCGs

Many of the pathways with high volumes of over 18 week

waits are commissioned by NHSE (dental, clinical genetics

and paediatric subspecialties) For CCG commissioned

specialties the specialties underperforming are: ENT (mostly

OP capacity issues being addressed by offering choice);

General surgery (mostly bed/theatre capacity where some

choice can be offered but not for more complex patients);

Plastics (mostly theatre capacity); orthopaedics (mainly

spinal outpatients); urology (mix of outpatients and

inpatients); ‘other’ mostly Paediatric ENT (mix of OP and IP).

There was an improvement in the number of waiters in

November, due to the focus on outpatient and day case

waiting times, and the Leeds CCG position has improved in

consequence. Inpatient/overnight stay capacity remains

exceptionally constrained, which is impacting on the

numbers of long waiters, particularly those who cannot be

operated on in the Independent Sector. There was a

colorectal 52 week breach at LTHT in November and this

patient has been cancelled again in December. A number of

patients have been contacted and offered choice in the

independent Sector to try to address some of the long

waiting issues, but some procedures cannot be carried out at

tariff in the private sector.

Maj

or

Exp

ecte

d t

o o

ccu

r at

leas

t w

eekl

y. L

ikel

y to

occ

ur.

16

541

17

/10

/20

17

System

Resilience Risk -

Impacts to the

health and

social care

system within

Leeds

There is a continual risk to

the delivery of a resilient

health and social care system

for the population of Leeds.

This is due to a multitude of

factors that hinder the

system’s ability to maintain

effective system flow

including: the increased

demand of referral into

community nursing services,

capacity to respond to

increased pressures resulting

from an incident, demand

exceeding capacity of

commissioned community

beds at time of surge and

demand exceeding in area

capacity of Mental Health

services at times of surge.

The impact is all partners'

ability to maintain quality

care delivery and may result

in all partners' ability to

maintain elective, urgent and

cancer activity, the

cancellation of services and

in extended waits for both

There is an additional risk in

the increased demand in

community services

including primary care, that

may result in additional

pressures at the front end of

the system which may

impact admission rates,

length of stay and which

ultimately affects system

flow.

Maj

or

Exp

ecte

d t

o o

ccu

r at

leas

t d

aily

. M

ore

like

ly t

o o

ccu

r th

an n

ot.

20

Ver

y H

igh

Pri

ori

ty -

Red

uce

urg

entl

y in

volv

ing

Sen

ior

Man

agem

ent

Robust escalation plans and

escalation process in place

across all providers with co-

ordination and system

management co-ordinated by

the CCG

Robust Local System Delivery

Plan monitored by the

Operational Resilience Group

and the System Resilience

Assurance Board.

Processes in place to ensure

all national, regional and local

requirements in terms of

planning and providing

assurance are in place.

Alignment with

commissioning agendas

including BCF

There is not full System wide

participation in the Leeds

Escalation process

The qualitative level of provider

reporting is varied occasionally

resulting in limited information

about operational challenges

Mutual Aid principles are not

being fully followed so there is

occasionally delay in obtaining

appropriate support

Syst

em R

esili

ence

Ass

ura

nce

Bo

ard

Qu

alit

y an

d P

erfo

rman

ce C

om

mit

tee

Susa

n R

ob

ins

- D

irec

tor

of

Co

mm

issi

on

ing

Tayl

or-

Tate

, D

ebra

The Leeds plan has focus on a longer

more strategic aims but recognises the

importance of the operational system

input as a timely check

City wide enabling groups to the Leeds

Plan include estates, workforce

development, transport

Partners have agreed to develop a

approach of support of mutual aid

Insufficient workforce skill,

capability and capacity and

the national agency cap to

deliver the commissioned

services, resulting in a

fatigued workforce and

poor quality experience for

patients.

To review the effectiveness of the agreed Escalation process

in managing current System escalations and helping system

recovery. Specifically the quality of provider triggers,

reporting and the mutual Aid principles which require

proactive provider to provider dialogue outside of any CCG

facilitated SitRep

To obtain system wide participation in providing daily

information to aid identification of pressures and the

remedial actions required

Maj

or

Exp

ecte

d t

o o

ccu

r at

leas

t w

eekl

y. L

ikel

y to

occ

ur.

16

659

07

/12

/20

17

System

Resilience

Variable Risks

There is a risk that surges in

demand may impact system

capability and capacity to

respond to need. This is due

to the current situation of

stretched services and

continued increasing

demand, which oftentimes

occurs at inappropriate

points of access There are

additional risks that will be

generated by variable factors

including, extreme weather

aging population and acuity

of need, flu and workforce

issues. i.e industrial action.

The result of this risk is that

patient safety may be

compromised and the system

is saturated and unable to

deliver key services such as

cancer.

Maj

or

Exp

ecte

d t

o o

ccu

r at

leas

t d

aily

. M

ore

like

ly t

o o

ccu

r th

an n

ot.

20

Ver

y H

igh

Pri

ori

ty -

Red

uce

urg

entl

y in

volv

ing

Sen

ior

Man

agem

ent

There is a Leeds CCG wide

business continuity plan that

enables the CCG emergency

response to be enacted

EPRR Steering group is in

place

There are robust emergency

response plans in place across

all providers that provide

assurance to the CCG

There is a robust On Call

process and appropriate levels

of On call managers

On call personnel are upskilled

in our Incident Management

process and their roles and

responsibilities within

The BCP plan is not reflective of

the new organisation structure

Susa

n R

ob

ins

- D

irec

tor

of

Co

mm

issi

on

ing

Exle

y, S

arah

The EPRR action plans is monitored by

the EPRR steering group.

CCGP Contact details are up to date

Leeds System Escalation process with

Mutual Aid principles agreed

On Call Personnel training

Not all On Call personnel

have completed their

training

There has been intermittent meetings during 2017. The EPRR

steering group has been re-established with member

attendees from across the CCGP. The meeting will have

updated TOR and schedule of meets across all 2018. It will

review our EPRR submission and associated action plan and

provide an update to SRAB by the end Feb

Ensure that Escalation Distribution list is up to date so that

key stakeholders receive weather alerts

To keep a record of which On Call managers have completed

appropriate training/ upskill that enables them to meet their

obligation as a cat 2 responder in an emergency or a system

escalation

To complete the On Call training programme for On Call

Managers so that they are able to respond effectively to OOH

emergencies

On Call managers register for Leeds Alert notifications so that

they are able to receive timely alerts independently of

notification from Unplanned care Team

Maj

or

Exp

ecte

d t

o o

ccu

r at

leas

t w

eekl

y. L

ikel

y to

occ

ur.

16

466

06

/10

/20

17

The

achievement

of the national

Ambulance

standards

There is risk to the quality of

care provided to all patients

requiring the assistance of

the Yorkshire Ambulance

Service (YAS). This is due to

the continued failure of the

ambulance service to meet

the national performance

targets across the city of

Leeds. As a result for

patients requiring this level of

service there is an escalated

risk with the potential to

impact on their health

condition, treatment and

recovery.

There is a continued risk to

the achievement of the

national standards for

ambulance services across

the Leeds CCG's. This is due

to increased demand,

insufficient workforce and

the process for managing

calls and the dispatch of

vehicles. This has the

potential to result is an

escalated risk for patients

with life threatening need

and failure.

There is a further risk in

continued development and

improvement of the

ambulance services due to

the current pressures

associated with workforce

challenges resulting in a lack

of engagement and a

strategic development

aligned with the

commissioners and local

populations needs.

Maj

or

Exp

ecte

d t

o o

ccu

r at

leas

t d

aily

. M

ore

like

ly t

o o

ccu

r th

an n

ot.

20

Ver

y H

igh

Pri

ori

ty -

Red

uce

urg

entl

y in

volv

ing

Sen

ior

Man

agem

ent

NHS Wakefield CCG are the

lead for the YAS 999 contact

and the newly formed the

Joint Strategic Commissioning

Board (JSCB).This will see the

System resilience Groups and

the West Yorkshire Urgent

and Emergency Care

Network/Vanguard directly

input into a new established

Joint Strategic Commissioning

Board for both 999 and 111

and GP out of hours. These

separate contracts will report

directly to their individual

contract management boards

and a joint quality board.

The SRAB will monitor YAS

performance to inform the

commissioning board.

The Leeds CCG partnership

Provider management Group

(PMG) are responsible for the

regular monitoring of both

999 & 111 performance in

terms of activity, quality and

finance.

The Ambulance Response

As the YAS 999 contract is a

Yorkshire and Humber wide

contract, individual

commissioners have limited

flexibility and influence to make

targeted improvements

specifically to their populations.

Qu

alit

y an

d P

erfo

rman

ce C

om

mit

tee

NLL

01

, SED

C, S

EMW

01

, Su

san

Ro

bin

s -

Dir

ecto

r o

f C

om

mis

sio

nin

g

Tayl

or-

Tate

, D

ebra

Agreement to

spend centrally

allocated

system

resilience

monies on

commissioning

extra capacity

within YAS

through sub

contracting

arrangements

within YAS.

Assurance is provided to Leeds CCG

through governance process across,

Yorkshire, West Yorkshire and Leeds

System Resilience Assurance Board

(SRAB).

NHS Wakefield CCG are the lead for the

YAS 999 contact and the newly formed

the Joint Strategic Commissioning

Board (JSCB).This will see the System

resilience Groups and the West

Yorkshire Urgent and Emergency Care

Network/Vanguard directly input into a

new established Joint Strategic

Commissioning Board for both 999 and

111. These will report directly to

separate contract management boards

and a joint quality board

The Leeds CCG Partnership Provider

Management Group (PMG) will be

responsible for the regular monitoring

of both 999 and 111 performance

including activity, quality and finance at

a local (Leeds) level

Maj

or

Exp

ecte

d t

o o

ccu

r at

leas

t w

eekl

y. L

ikel

y to

occ

ur.

16

660

10

/11

/20

17

CQC

Inadequate

Practice

There is a risk that a practice

that has been rated as

inadequate by the Care

Quality Commission will be

unable to deliver the

required improvements in

the identified timescale.

Maj

or

Exp

ecte

d t

o o

ccu

r at

leas

t d

aily

. M

ore

like

ly t

o o

ccu

r th

an n

ot.

20

Ver

y H

igh

Pri

ori

ty -

Red

uce

urg

entl

y in

volv

ing

Sen

ior

Man

agem

ent

CCG Quality Surveillance

Process activated to ensure

robust monitoring

arrangemetns

Quality review identified and

action plan requested from

the practice

Discussion with practice

planned with representatives

from the Local Medical

Committee

Scoping long term solutions to

address sustainability and

resilience plans

Pri

mar

y C

are

Co

mm

issi

on

ing

Co

mm

itte

e

Sim

on

Sto

ckill

CC

G M

edic

al D

irec

tor

Kir

sty

Turn

er

Quality Surveillience Group to monitor

progress against action plan

Enahnced surveillance monitoring

process

Multi team approach to review

approach (Medicines Optimisation,

Quality, Primary Care, Clinician)

Maj

or

Exp

ecte

d t

o o

ccu

r at

leas

t w

eekl

y. L

ikel

y to

occ

ur.

16

The YAS Ambulance Response Pilot (ARP) is now complete and national recommendations

in July 2017 stated that the new control measures will come into effect as of the 1st April

2018. These standards are focused on patients’ clinical needs and will help to ensure

consistent, rapid responses to those who genuinely need them, reduce long waits for

ambulance responses and bring all 999 calls under a consistent national framework. The

new standards are as follows:

Respond to Category 1 calls - in 7 minutes on average and respond to 90% of Category 1

calls in 15 minutes

Respond to Category 2 calls in 18 minutes on average and respond to 90% of Category 2

calls in 40 minutes

Respond to 90% of Category 3 calls in 120 minutes

Respond to 90% of Category 4 calls in 180 minutes

1


NHS Leeds CCGs Partnership – Leeds Health Commissioning and System Integration Board Meeting


Title: Strategy – System Integration update

Lead Governing Body Member: Nigel Gray, Chief Officer System Integration


appropriate

()

Report Author: Becky Barwick and Gina Davy

Decision

Reviewed by EMT/SMT/Date: N/A Discussion

Reviewed by Committee/Date: Content discussed at Leeds Health and Care Partnership Executive Group 11th January 2018

Information

Checked by Finance (Y/N/N/A - Date): N/A










There are a number of legal, contractual, statutory and regulatory implications which are being scoped through the Procurement and Assurance Workstream 8.

Financial Implications Work continues as part of workstream 7 (Finance) to scope and refine the existing spend on services and schemes currently being commissioned to support the initial population cohort (people living with frailty and at the end of life).

Communication and Involvement Issues A comprehensive Communications and Engagement Plan and public-facing narrative has been developed through the Communications and Engagement Workstream (Workstream 9)

Workforce Issues As part of the wider primary care workforce strategy for Leeds, the workforce requirements of delivering a PHM approach and in particular the design and delivery of new workforce models within Local Care Partnerships are being scoped


An EIA will need to be carried out before there is any service change or redesign.



An assessment of IG issues is being undertaken through Workstream 10.

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EXECUTIVE SUMMARY: The purpose of this paper is to provide a summary to the Board of the work of the System Integration team. It also provides an update on the core interdependent components of the Leeds approach to Population Health Management (PHM) and progress of the delivery programme and its ten workstreams. The paper outlines the key next steps for the programme, which include developing the commissioning approach to delivering the outcomes framework for people who are frail including those at the end of life.

NEXT STEPS: The programme continues to make good progress and is on track to deliver its aims. There are a number of key risks to delivery however actions have been put in place to mitigate against these risks. A key task for the System Integration Team in January / February 2018 will be to continue to meet with system leaders and offer ongoing support to help organisations understand the impact of the programme from an individual organisational perspective. Following the agreement of the outcomes framework for frailty and end of life and the supporting approaches to commissioning and governance, there will be a need to review and potentially refine workstream scope and delivery milestones.

RECOMMENDATION:

The Leeds Health Commissioning and System Integration Board is asked to:

a) RECEIVE this report and note the progress made to date in the

establishment of the PHM programme and underpinning workstreams and key next steps.

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1. SUMMARY 1.1 The purpose of this paper is to provide a summary to the Board of the work of

the System Integration team. It also provides an update on the core interdependent components of the Leeds approach to Population Health Management (PHM) and progress of the programme and its ten workstreams.

1.2 The paper outlines the key next steps for the programme, which include

developing the commissioning approach to delivering the outcomes framework for people who are frail including those at the end of life.

2. BACKGROUND 2.1 Since May 2017 the Leeds CCGs Partnership System Integration Team has

been working with partners to develop the vision and approach to progress accountable care and strategic commissioning. In Leeds this programme of work is called Population Health Management (PHM). A delivery programme has been established with 10 workstreams.

2.2 The vision is to deliver the ambitions of the Leeds Health and Wellbeing

Strategy - to make sure that care is personalised and more care is provided in people’s own homes whilst making best use of collective resources to ensure sustainability, building on the strong assets of Leeds. Commissioning for outcomes and accountable care provision is seen by partners as our best opportunity to deliver the above ambition, close the health, care and finance gaps in our health and care system for the long term.

2.3 The Leeds approach to Population Health Management consists of four

interdependent components:

1. Strategic commissioning for outcomes 2. Incremental approach (starting with frailty and end of life segment) 3. Accountable care provision for alliance(s) of providers 4. Delivery of community based care through Local Care Partnerships

2.4 To deliver the above components a programme has been developed with ten

workstreams:

Workstream Title Lead Team / Organisation

Workstream 1 Commissioning Development

Sarah Lovell Leeds CCG Partnership

Workstream 2 Alignment with the Leeds Plan

Becky Barwick System Integration (Leeds Clinical Commissioning Partnership)

Workstream 3 Population Segmentation

Lucy Jackson Public Health (Leeds City Council)

Workstream 4 Commissioning for Population Outcomes

Sarah Lovell Leeds CCG Partnership

Workstream 5 Development of Provider Alliance(s)

Jim Barwick GP Federation

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Workstream 6 Local Care Partnerships Development

Gaynor Connor & Chris Mills

Leeds CCG Partnership

Workstream 7 Finance Martin Wright System Integration (Leeds Clinical Commissioning Partnership)

Workstream 8 Procurement and Contracting

Michelle Van Toop


Workstream 9 Communications & Engagement

Carolyn Walker


Workstream 10 Analytics, Information Governance and IT

Nichola Stephens

Leeds Clinical Commissioning Groups Partnership, GP IT and Adults & Health Directorate Leeds City Council

2.5 The pace and momentum of work undertaken through the Population Health

Management programme has continued through November and December 2017 with positive progress made across all workstreams.

2.6 Following a request by the Leeds Health and Care Partnership Executive

Board (PEG) and Leeds Health and Care Board to Board Summit in September 2017, the System Integration Team developed detailed proposals and updates relating to the implementation of a PHM approach in Leeds. These included:

A Public Facing Narrative: The draft public facing narrative for the development of Local Care Partnerships as the delivery model for the Leeds approach to PHM, describing what this could mean for local people. There is a plan to further develop this narrative and then commence public engagement on the model early in the New Year.

Programme Brief: The draft PHM programme brief describes the technical detail around implementing the proposed Leeds approach including introducing the concept of a ‘System Alliance Agreement’ for consideration as a method of progressing with the initial segment.

Programme Highlight Report: A highlight report from the PHM programme plan describing each of the workstreams and key milestones.

Financial Context: The draft financial context provides a background to the system to understand current spend on each of the segments and supports further discussion in the system around the potential to use resources differently.

2.7 The proposals outlined above were developed through discussions with stakeholders including the Leeds CCG Partnerships Senior Management Team, Population Health Management Group and the Accountable Care Development Board during November / December 2017. In December 2017,

5

the proposals were presented to the Board to Board Summit and PEG as a suit of documents for consideration.

2.8 The proposals were positively received by both the Board to Board Summit

and PEG with key feedback as follows:

The need to ensure that messages and narrative are simple and clear to understand.

The need for a greater understanding about what this means for local organisations in 2018/19.

Members of PEG requested responses from provider organisations regarding implications and next steps for individual provider organisation at the PEG meeting in February 2018.

2.9 Following discussions and feedback from the PEG and the Board to Board

Summit, members of the System Integration Team are meeting with leaders from individual organisations to discuss implications and impact of the proposals from individual organisational perspectives.

3. WORKSTREAM HIGHLIGHTS 3.1 The workstreams that constitute the programme continue to report on an

exception basis. Workstream leads continue to meet ‘face to face’ to discuss progress, risks and dependencies on a 6 weekly basis. A summary of progress across the ten workstreams that form the programme is provided at Appendix A.

Key highlights to note are as follows:

Workstream 2 - Alignment with the Leeds Plan: Members of the System Integration Team and Leeds City Council Health Partnerships Team attended all ten Community Committees in December 2017 to engage with local Councillors and members of the public about the Leeds Plan and Local Care Partnerships. The presentation, supporting workshops and discussions were well received and provided a wealth of valuable feedback.

Workstream 4 - Commissioning for Population Outcomes: Attended by over 90 people representing 32 individual organisations, a hugely successful workshop was held on the 29th November 2017 to review and refine the draft Outcomes Framework. Reflecting feedback received, the draft outcomes framework will be presented, (along with proposals relating to supporting commissioning and governance approaches) to the Integrated Commissioning executive (ICE) in January followed by the Population Health Management Group and Accountable Care Development Board in February.

Workstream 8 - Procurement & Assurance: Work has continued to engage with legal experts to understand alternative models for the commissioning, provision and procurement of outcomes. This work is also considering the potential benefits of a local System Alliance Agreement to support the local approach.

6

Workforce (Enabler): The draft Primary Care Workforce Strategy, led by the Lead Nursing Officer for System Integration, is currently out for consultation. The strategy sets out the vision and strategic direction for the Primary Care Workforce in the context of the Leeds Plan, increasing system and provider integration and the development of Local Care Partnerships as well as ensuring the key national workforce deliverables are addressed within the Strategy.

3.2 None of the workstreams within the programme are currently reporting

significant slippage against initial delivery timescales. However, there will be a need to review (and where necessary refine) workstream delivery timescales and scope in early February. This will follow decision making regarding the draft outcomes framework, provider responses as well as implications for governance and commissioning approaches.

4. IMPLICATIONS FOR ORGANISATIONS IN THE LEEDS HEALTH AND

CARE PARTNERSHIP 4.1 Following discussions and feedback from the PEG and the Board to Board

Summit, members of the System Integration Team have been meeting with leaders from individual organisations to discuss implications and impact of the proposals from individual organisational perspectives.

4.2 Meetings that have already taken place with PEG members and other senior

leaders from; LTHT, Adults and Health, GP Federations, LYPFT, Third Sector and LCH. They have been a helpful opportunity to clarify the detail and allay some of the concerns that have arisen as the approach has been developing.

4.3 Some of the emerging themes from discussions that have already taken place

are detailed below:

The principles around collaboration and shared objectives are well

supported.

All partners can see the mutual benefits of accountable care and accept

the need to change.

Need to ensure full alignment with the Leeds Health and Care Plan.

The proposed System Alliance approach to collaborative commissioning

and provision has been well received – further work needed to understand

the detail and implications.

There is wide support for the Local Care Partnership neighbourhood

delivery model.

There is support for taking an incremental approach however there are

some concerns around beginning with the frailty population segment with

some feeling that the segment is too large – further work needed to

understand the implications of this.

There is some concern that a common definition of frailty is complex,

however all organisations can identify benefits and opportunities to work

7

differently with this cohort for the overall improvement of population

outcomes.

There are some concerns about the outputs of the financial modelling work

as this has flagged that there is significant current spend on this cohort –

need to make sure that the approach is well communicated.

Concerns have been flagged about ‘dual-running’ of the current and

emerging ways of working, the potential confusion this could cause and

how transformation will be resourced.

There has been clear message that we must continue to focus on long

term transformation and not allow ourselves to detract from this whilst

addressing current risks.

4.4 Each organisation will report back further detail on implications and levels of

support at the next PEG meeting in February. This will be supported by a detailed paper outlining the responses from each organisation, as well as more detail around what the ‘shadow year’ will entail.

5. NEXT STEPS

5.1 The PHM programme continues to make good progress and is on track to

deliver its aims. There are a number of key risks to delivery however actions have been put in place which should mitigate against these risks.

5.2 A key task for the System Integration Team in January / February 2018 will be

to continue to meet with system leaders and offer ongoing support to help organisations understand the impact of the programme from an individual organisational perspective.

5.3 Following the agreement of the outcomes framework and the supporting

approaches to commissioning and governance, there will be a need to review and potentially refine workstream scope and delivery milestones.

6. STATUTORY / LEGAL/REGULATORY / CONTRACTUAL

6.1 The procurement and assurance workstream is reviewing the statutory,

regulatory and legal requirements and consideration in relation to different models of procurement, and contracting. The workstream is in the process of securing legal expertise the provide specialist advice and support in the consideration of options, selection and design of the chosen approach to procurement, contracting and external assurance including the Integrated Service Assurance Process (ISAP).

7. FINANCIAL IMPLICATIONS AND RISK 7.1 This programme seeks to address the triple aim described in the Leeds Plan

and therefore greater sustainability, use of resources and value for money is a key outcome of full implementation. Through the finance workstream, work has been undertaken to quantify existing services (and associated spend) commissioned to support people living with frailty and at the end of life. In

8

addition, a set of draft principles have been drafted to support joint working as well as approaches to financial risk and gain share.

8. COMMUNICATIONS AND INVOLVEMENT

8.1 A Communications and Engagement ‘Plan on a Page’ and public-facing narrative has been developed through the Communications and Engagement Workstream (Workstream 9). The public facing narrative focuses on the neighbourhood delivery model and the development of Local care Partnerships.

8.3 The public engagement will begin in earnest with a deliberative event planned

for Saturday 24th February. A market research company has been engaged to recruit a demographically representative group of members of the public to attend the event where they will be asked to consider how Local Care Partnerships should work and what the engagement messages should be.

9. WORKFORCE

9.1 As outlined above the draft Primary Care Workforce Strategy is currently out

for consultation. The strategy sets out the vision and strategic direction for the Primary Care Workforce in the context of the Leeds Plan, increasing system and provider integration and the development of Local Care Partnerships as well as ensuring the key national workforce deliverables are addressed within the Strategy.

10. EQUALITY IMPACT ASSESSMENT 10.1 The PHM approach means that the needs of diverse groups can be better met

in individual communities in the future and also allows outcomes to be set for the population that take account of specific needs of people with protected characteristics or other minority or groups where identified.

10.2 An Equality Impact Assessment will be carried out as part of the process to

redesign services. 11. ENVIRONMENTAL

11.1 Environmental impact and considerations of the programme will be scoped in

due course.

12. RECOMMENDATION

The Leeds Health Commissioning and System Integration Board is asked to:

a) RECEIVE this report and note the progress made to date in the establishment of the PHM programme and underpinning workstreams and key next steps.

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Workstream Key Activities Undertaken Key Activities Planned Progress Against Plan

Workstream Risks and Issues

Commissioning Development

Meeting with BDO to scope commissioning development programme open to all commissioners in Leeds (CCG and LA) and 2-3 sessions will be open to providers.

Programme Implementation: Feb-Mar ‘Building Blocks’ (Populations, Outcomes, Integrated Care)

Potential capacity gaps to support commissioning development programme

Alignment with Leeds Plan

Joint presentations on Leeds Plan and PHM programme to 10 Community Committees with Health Partnerships Team.

Work underway to further align communications, engagement and marketing activities

None stated

Segmentation

Support to development of outcomes framework and finance workstreams completed.

Work within initial plan completed. Further discussion required as to whether to undertake detailed analysis for all population segments or commence detailed analysis for second population segment in Q1 18/19.

None stated

Development of Outcomes

Hugely successful and well received workshop session with 97 people from 32 review and refine outcomes framework.

Draft outcomes framework to be presented to ICE in Jan.

Attend and present to ACDB and PHM in Jan-Feb.

Insufficient time to engage with population groups widely and a delay to approvals process and implementation from April could delay shadow year and system learning.

Development of Provider Alliance

Series of three development workshops now complete. Clarity regarding, mission, purpose, values and membership.

Establish protocols for information sharing and understand existing data across providers.

Establish structure, roles and leadership within the team and approach to governance, decision making and accountability.

Partnership working is delayed and/or stalled due to historical cultural differences between orgs.

Progress is slowed due to increased and/or unexpected pressures on the system.

Local Care Partnerships

General Practice leads identified for all 13 LCPs.

Agreement of LCP geographical boundaries.

Detailed scoping around 6,9 and 12 month deliverables and development of LCPs

Capacity to delivery workstream deliverables.

APPENDIX A Workstream Highlights Risks and Progress Update

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Pro

gre

ss

Key

C R A G NS

Complete Behind and irretrievable

Behind but retrievable

On track Not due to

start

Finance

Financial values for population segments

Further development of Leeds Data Model to support PHM

Development of draft joint working and risk gain share principles

Complete financial modelling from commissioner (price/tariff) perspective and provider cost perspective.

Test high level risk gain share principles and agree joint working principles.

Completion and agreement of financial inputs based on clarification of services ‘in scope’.

Procurement & Assurance

Discussions in various groups, (SMT, ACDB, Provider Alliance) regarding potential approaches to contracting.

Exploration of benefits of a System Alliance Agreement.

Further discussions with Provider organisations and at the ICE regarding the use of a System Alliance Agreement.

Work to scope potential System Alliance Agreement for Leeds to enable further understanding and discussion.

System partners do not agree the contracting approach so work stream cannot continue.

Comms & Engagement

Communications ‘Plan on a Page’ completed.

Significant support to Outcomes Workshop

Deliberative Event planned February 2018.

Engagement support in development of patient reported outcomes & supporting images.

None identified.

Info Gov, Analytics & IT

This enabling workstream supports multiple programmes, including the Leeds Plan. It supports numerous workstreams but does not formally report through the PHM programme.

Agenda Item: LHCB 17/80 FOI Exempt: No

NHS Leeds CCGs Partnership Leeds Health Commissioning and System Integration Meeting


Title: Chairman’s Summary – Primary Care Commissioning Committees meeting in common 23 November 2017

Lead Governing Body Member: Philip Lewer, Lay Chair


appropriate ()

Report Author: Helena Coates, Governance Manager

Decision

Discussion

Information


EXECUTIVE SUMMARY:

This report provides the Leeds Health Commissioning and System Integration Board with a summary of items discussed, outcomes and risks identified at the Primary Care Commissioning Committees meeting held in common on 23 November 2017.

RECOMMENDATION: The Board is asked to: (a) RECEIVE the report.

Description of key items of business discussed and key outcomes

Please note that this is a brief summary of the items considered and decisions taken at the meeting of Primary Care Commissioning Committees (PCCCs) meeting held in common on 23 November 2017. Further information can be obtained by reference to the minutes of that meeting.

1. Chief Executive’s Update –The Chief Executive provided an update on the accommodation review, an estimated £400k would be saved by reducing the number of offices. It was noted that the Healthy Futures work programme had been agreed and included stroke and arterial fibrillation.

2. Local Primary Care Schemes - Leeds North, Leeds South and East and West CCGs had schemes in place last year and a single scheme was proposed from 2018 which would incorporate a number of key priorities identified across the organisation and would support change at practice level as well as supporting the strategic priority relating to the development of local care partnerships.

2

3. Feedback following Patient Participation Group Event - The event was very well attended and the feedback was very positive. It was recommended to set up a citywide PPG network and steering group to improve the quality of PPGs in Leeds.

4. Chair’s Summaries from Primary Care Operational Group - The Committees discussed the updates from October and November 2017 Primary Care Operational Group meetings. The Committee agreed to have an update regarding GP workforce including local challenges at a future meeting.

5. Application for closure of Green Road Surgery, Meanwood (Branch Surgery of The Avenue, Alwoodley) – Following public consultation the Committee approved the recommendation for The Avenue Surgery to close the branch surgery at Green Road.

6. Primary Care Finance Report - The Committee was presented with a paper providing an update on the overall co-commissioning allocation which included an update on local primary care and prescribing budgets and expenditure. Across Leeds there was a total of c.£900k owed by Leeds practices to the Community Health Partnerships (CHP). This was as a result of increased charges by CHP to reflect market costs. The Committee agreed to contact London CCGs to understand how issues with the increase of practices charges made by Community Health Partnerships was addressed. It also noted the risks around the Estates and Technology Transformation Fund.

7. Chair’s Summary from Joint Quality and Performance Committee - The Chair’s Summary from the meeting of the Joint Quality and Performance Committee of 9 November 2017 was discussed.

8. Primary Care Integrated Quality & Performance Report (IQPR) - The mechanism and process for sharing the IQPR had been agreed and the report was being shared with practices. Through the review of clinical leads, a GP lead had been identified who would further support the review of the data and associated mitigating factors.

9. Primary Care Risk Report - The Primary Care Commissioning Committees were presented with an updated review of the risks shared at the last meeting, which reflected the single risk register for the City. An additional risk had been identified specifically with regard to Highfield in Bramley.

10. Estates and Technology Transformation Fund, St. Martins House – There was a discussion concerning and application which had been submitted to NHS England.

Strategies/Policies approved

None

Items of positive assurance or issues to be raised with Leeds Health Commissioning and System Integration Board

None

Any additional comments

None


NHS Leeds CCGs Partnership Leeds Health Commissioning and System Integration Board Meeting


Title: Chair’s Summary – Joint Finance and Commissioning for Value Committee of 18 January 2017

Lead Governing Body Member: Peter Myers Category of Paper Tick as

appropriate

()


Decision

Discussion

Information

Approved by Lead Governing Body member (Y/N): Yes

EXECUTIVE SUMMARY:

This report provides the Leeds Health Commissioning and System Integration Board with a summary of items discussed, outcomes and risks identified at the Joint Finance and Commissioning for Value Committee held on 18 January 2018.



Please note that this is a brief summary of the items considered and decisions taken at the meeting of the Joint Finance and Commissioning for Value Committee held on 18 January 2018. Further information can be obtained by reference to the minutes of that meeting. 1. Financial performance

Performance remained on target.

2. Quality, Innovation, productivity and Prevention (QIPP)

The Committee was provided with an update on progress in establishing a process to manage QIPP. A summary list of identified QIPPs was discussed, including that related to Leeds Community Healthcare (LCH). The commissioning plans in relation to LCH were further discussed in a detailed presentation about Neighbourhood Teams and Community Beds later in the meeting.

2

3. Database of Commissioning Activity The Committee was updated about the development of the data bank of information which would assist across the CCG, notably for commissioners in commissioning services, and for identifying the impact of changes on different patient groups.


None


The Committee was impressed by the developments in relation to the data bank, and the amount of work which had gone into establishing this flag ship project.


None.

1




Title: Chair’s Summary – Interim Patient Assurance Group of 23 November 2017

Lead Governing Body Member: Angie Pullen, PPI Lay Member


appropriate

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Decision

Discussion

Information


EXECUTIVE SUMMARY:

This report provides the Leeds Health Commissioning and System Integration Board with a summary of items discussed, outcomes and risks identified at the Interim Patient Assurance Group (PAG) meeting held on 23 November 2017.



Please note that this is a brief summary of the items considered and decisions taken at the meeting of the Interim Patient Assurance Group (PAG) held on 23 November 2017. Further information can be obtained by reference to the minutes of that meeting.

1) The Commissioning Cycle – The Interim PAG had received information about the commissioning cycle and the process for identifying commissioning priorities and decommissioning and the points in that process when engagement took place. It requested that if there were a diagram produced setting out the structure of West Yorkshire, city wide and locality commissioning and decommissioning that this be provided to the members of the Interim PAG.

2) Patient Assurance Group Tracker and Outstanding Action List – The Interim PAG had requested that the PAG Tracker which recorded information about engagements including low level engagements upon which the Interim PAG were not consulted be updated.

2

3) Interim Patient Assurance Group Code of Conduct – The Interim PAG had considered a Code of Conduct and explored whether or not one was necessary. It determined to consider the issue at a forthcoming workshop.


None

Items of positive assurance or issues to be raised with Governing Body/Leeds Health Commissioning and System Integration Board

The Interim PAG was assured of public and patient engagement in respect of the following:-

1) Grange Medicare Limited

2) Maternity Homebirth Pathway (Level 2)

3) Maternity Bereavement Pathway (Level 2)


A workshop was held on 14 December 2017 which assisted the Interim PAG in looking at what a Leeds PAG could look like from April 2018. Prior to the workshop members were given the opportunity to complete a Committee Effectiveness Survey which enabled exploration of:-

how the meetings should be managed and chaired,

the benefit of having suggested questions to aid, but not prescribe, discussion;

views about how wide the debate should be permitted to go, and whether this should focus on the assurance of engagement, and

the different expectations of the members of the Interim PAG as to how long the meetings should run.

Role of the Interim PAG Following discussion, there were no amendments proposed to the Terms of Reference. Code of Conduct Following significant discussion it was determined that there was no need for a Code of Conduct at present. Recruitment to new PAG It was confirmed that existing PAG members would be formally notified of the end of their term of office. This was a formality which was required in order to build the new CCG’s PAG. There was a unanimous view that there needed to be a proper induction for members of the new PAG, supported by a role description and development sessions/team building sessions.




Title: Chair’s Summary – Clinical Commissioning Forum of 17 January 2018

Lead Governing Body Member: Dr Alistair Walling Category of Paper Tick as

appropriate

()


Decision

Discussion

Information

Approved by Lead Governing Body member (Y/N): Yes

EXECUTIVE SUMMARY:

This report provides the Leeds Health Commissioning and System Integration Board with a summary of items discussed, outcomes and risks identified at the Clinical Commissioning Forum (CCF) held on 17 January 2018.



Please note that this is a brief summary of the items considered and decisions taken at the meeting of the Clinical Commissioning Forum (CCF) held on 17 January 2018. Further information can be obtained by reference to the minutes of that meeting. 1. Terms of Reference and Role of the Clinical Commissioning Forum

There was a discussion concerning changes to the Terms of Reference. Some changes are proposed for the new organisation. It was recognised that the landscape will probably look very different in the future as the accountable care system develops, and that the Terms of Reference will need to be revisited again later in the year. One of the current challenges was a lack of understanding about the different roles of CCF, Members Meetings, TARGET, Practice Newsletter etc. The CCF was supportive of the changes proposed.

2. Quality Improvement Schemes (QIS)

The Forum considered proposals for changing the QIS. There was a discussion about

2

whether to adopt a more prescriptive approach in terms of outcomes, which reflected feedback which had been given by practices at members meetings. While the CCF were supportive of the indicators being put forwards there was concern and discussion around whether these offer any drive for practices to collaborate and work together. Members discussed the need to look at schemes supporting this as well as schemes which help practices individually.

3. TARGET Looking to the future it was proposed that TARGET report through to the CCF, and no objections were raised to this proposal. The annual TARGET primary care conference would take place on 21 June 2018.

4. Local Care Partnerships There was a presentation about the development of leadership and Local Care Partnerships. Models for the operation of this were discussed. GPs were asked to focus on what their role was and what they needed around them to deliver this. There was agreement of these as a way forwards and discussion around a need to help these develop and allow them to grow. It was discussed how they will vary in capability and also how population needs will vary and a need in future schemes to support this work to give the best impact for the population, working from current baselines.

5. Draft Primary Care Workforce Strategy The CCF was presented with the draft strategy and comments were welcomed. There was until 31 January 2018 to provide a response.


None


There is a need to clarify the different roles of the clinical groups, e.g. the CCF, Members Meetings, TARGET, Practice Newsletter etc. to ensure that there is not duplication and that the right body is involved in decisions being taken by the CCGs.


1




Title: Chair’s Summary of Quality & Performance Committee Meeting held on 11 January 2018

Lead Board Member: Dr Steve Ledger, Lay Member, Assurance and Chair – Quality & Performance Committee


appropriate

()

Report Author: Dr Steve Ledger

Decision

Discussion

Information


EXECUTIVE SUMMARY:

1. This report provides the Leeds Health Commissioning and System Integration Board with a summary of items discussed, outcomes and risks identified at the Quality & Performance Committee meeting held on 11 January 2018.

RECOMMENDATION: The Leeds Health Commissioning & System Integration Board is asked to: (a) RECEIVE the report.

Description of key items of business discussed

1. Please note that this is a brief summary of the items considered and decisions taken at the

meeting of the Quality & Performance Committee on 11 January 2018. Further information can be obtained by reference to the minutes of that meeting.

Actions from Previous Meetings 2. At previous meetings the Committee has considered delayed outpatient appointments and

discussions have taken place around the social impacts of delays. Leeds Teaching Hospitals NHS Trust (LTHT) has confirmed that there is a process in place for clinical prioritisation, followed by a validation process. LTHT will present details of the validation process at their next Quality Meeting and will consider any suggested improvements.

3. An update was provided in relation to stroke performance, particularly Early Supported Discharge (ESD). Local trusts and CCGs have been contacted to clarify how they interpret the guidance around ESD, however no response has been received. It was agreed that this should be progressed with colleagues working as part of the STP stroke workstream.

4. Assurance on performance around ESD is currently limited, given a current lack of clarity

2

as to how many stroke patients are having their needs met in the out-of-hospital setting, with some further concerns over recruitment gaps in the relevant clinical teams. Confirmation is also awaited around the level of proposed further investment in this service. Further updates will be provided.

Information Governance 5. The Committee received assurance in relation to the CCGs’ information governance (IG)

arrangements. The newly appointed Data Protection Officer attended the meeting and provided an overview of her role and the General Data Protection Regulations, which come into force in May 2018. The Committee noted that IG training levels were behind target, and it was agreed that there was limited assurance in relation to the oversight and management of workforce related issues within the CCG. It was agreed to escalate this issue to the Board.

Integrated Quality & Performance Report (IQPR) 6. The Committee was informed that the three key areas of underperformance were the 62

day cancer target, referral to treatment times and the A&E four hour standard. It was noted that the 62 day cancer target had not been achieved in Leeds since December 2016, and was being impacted by continued pressures on beds. The Leeds Cancer Strategy has been developed and the Accelerate, Coordinate, Evaluate (ACE) project is being implemented. The aim is to increase early diagnosis and reduce emergency presentations. Any serious harm resulting from delays is reported as part of the Serious Incident framework.

7. Referral to treatment times are being impacted by cancelled elective surgery, and a small number of patients are waiting over 52 weeks. The number of patients waiting over 40 weeks is also increasing.

8. In relation to the A&E standard, demand is at a similar level to the previous year.

Admissions are marginally lower but length of stay has increased. Delayed Transfers of Care have been reviewed and it was found that further action could have been taken in relation to only two patients.

9. Assurance had been sought at the LTHT Quality Meeting regarding the trust’s processes

for patients staying in non designated areas. The CQC have visited to assess this and feedback is awaited. This will be discussed at the next Quality Meeting with LTHT.

10. The Urgent Care Contract Manager presented the Urgent Care Dashboard to provide assurance of the monitoring and oversight of performance in this area.

Quality Surveillance Process 11. The Head of Clinical Governance presented the Quality Surveillance Process, which has

been produced as an interactive tool to provide a coordinated structure to quality monitoring within the CCG. The tool includes four levels of quality surveillance:

1- Routine Surveillance 2- Routine Plus Surveillance 3- Enhanced Surveillance 4- Formal Action

3

12. The Committee was supportive of the process which is designed to be used with all types of provider. It is already in use within the CCG. An example was given as to how its application recently has provided a coordinated approach to supporting a GP practice (in enhanced surveillance) to improve.

Providers Under Enhanced Surveillance 13. The Committee received a summary of the seven providers that were currently under

enhanced surveillance and the actions being taken as a result.

CCG Risk Register 14. The risk register was presented. There was one new red risk, relating to the risk of surges

in demand impacting on system capability and capacity to respond to need. Members discussed the mutual aid approach which had been agreed across organisations. It was acknowledged that the approach was being tested and changed as appropriate.

15. It was confirmed that successful bids had been made to NHS England for additional funding, including £1.2m for LTHT for additional transitional beds, £600k to support the flow of Elderly Mentally Infirm (EMI) patients, and £100k to support additional capacity in primary care.

Safeguarding Update 16. The Deputy Director of Nursing provided assurance of the CCG’s safeguarding

arrangements. The implications of the ‘Working Together to Safeguard Children’ statutory guidance were being considered. Any concerns about the CCGs’ ability to fulfill its new responsibilities would be reported to the Committee.

Ambulance Response Pilot 17. The Director of Commissioning presented an update on the Ambulance Response Pilot,

which has led to an improvement of 8% in the 8 minute emergency target. The programme is now live in all ambulance trusts nationally and a Spring Review is expected from NHS England to finalise the standards.

Patient Experience Update 18. The Committee received an update on the outcomes of the Patient Insight Group, which

reviews patient experience information from a variety of sources. The outcome of the review into patient experience of cancer services in Leeds has been provided to the CCG Programme Manager for cancer. It was agreed to check how this feedback has been used by the commissioning team and an update will be provided to the Committee at the next meeting.

Committee Work Plan 19. The Committee will receive assurance on the Transforming Care Programme in March. It

was agreed that the six monthly safeguarding updates were not required as the Committee receives the minutes of the Safeguarding Committee at each meeting, as well as annual reports from the CCG Safeguarding Team, Leeds Safeguarding Children Board and Leeds Safeguarding Adults Board.


The Committee approved the following updated policies:

4

Information Governance Strategy

Information Governance Policy and Framework

Confidentiality and Data Protection Policy

Items of positive assurance or issues to be raised with the Leeds Health Commissioning and System Integration Board

The Committee wishes to highlight the following issues:

Limited assurance in relation to the oversight and management of workforce related issues, including statutory and mandatory training.

Any other Comments

N/A

1


NHS Leeds CCGs Partnership: Leeds Health Commissioning & System Integration Board


Title: The Integrated Quality and Performance Report

Lead Governing Body Members: Sue Robins, Director of Commissioning Jo Harding, Director of Nursing and Quality


appropriate

()

Report Author: Various

Decision

Reviewed by EMT/SMT/Date: n/a

Discussion

Reviewed by Committee/Date: Quality & Performance Committee, 11h January 2018

Information

Checked by Finance (Y/N/N/A - Date): n/a










N/A





N/A



N/A

2

EXECUTIVE SUMMARY:

This report provides assurance to the organisation that we are delivering against the requirements of the NHS Mandate and Constitution which embed the priorities of our local populations. Where performance falls below the expected standards, remedial action is described.

The narrative provides an update by exception on key themes and current issues and should be read in conjunction with the dashboards. The dashboards provide a high-level view of how the CCG is progressing in delivering is strategic objectives. The dashboards included with this report are:

NHS Constitution and Operational Planning

CCG Improvement and Assessment Framework

Quality and Safety

Commissioning for Quality and Innovation (CQUIN)

The indicators and metrics in each dashboard have been chosen to provide a balanced view for each sector. Please note that the metrics are flexible and may change depending on sustained performance.

NEXT STEPS:

The key actions which will be undertaken in relation to performance are as follows:

To continue to closely monitor the commissioner and provider-led actions in relation to areas of underperformance.

The key actions which will be undertaken in relation to the development of the IQPR are as follows:

To continue working closely alongside colleagues in local and citywide commissioning teams, Informatics and Quality in the development of the report and identification of local measures;

To work with commissioning teams to develop a minimum of three-year work plans as part of a broader commissioning and performance management framework, which will provide strategic milestones for inclusion within the IQPR.

RECOMMENDATION:

The Board is asked to:

a) RECEIVE AND REVIEW the IQPR dashboards; discuss the information, note the current areas of underperformance and mitigating action; and

b) SUPPORT the continued development of the IQPR.

3

PURPOSE OF REPORT

1.1 This report provides assurance to the organisation that we are delivering against the

requirements of the NHS Mandate and Constitution which embed the priorities of our local populations. Where performance falls below the expected standards, remedial action is described.

1.2 The narrative provides an update by exception on key themes and current issues and should be read in conjunction with the dashboards. The dashboards provide a high-level view of how the CCG is progressing in delivering is strategic objectives. The dashboards included with this report are:

NHS Constitution and Operational Planning

CCG Improvement and Assessment Framework

Quality and Safety

Commissioning for Quality and Innovation (CQUIN)

1.3 The indicators and metrics in each dashboard have been chosen to provide a balanced view for each sector. Please note that the metrics are flexible and may change depending on sustained performance.

2. SUMMARY OF KEY PERFORMANCE ISSUES

2.1 Planned Care and Long Term Conditions

Referral to Treatment times continues to be below the required standard although performance is improving gradually through a continued focus on outpatient and day case work to offset the difficulties in treating patients requiring beds for overnight stay.

There were 2 Leeds patients who had waited over 52 weeks at the end of September, one of whom had still not been treated at the end of October. Staffing and capacity issues were cited as reasons for delay in both cases. Both breaches have been investigated and some administrative issues identified as part of the investigation. These have been addressed and staff supported to ensure implementation.

Underperformance against the three 62 day cancer targets continues to be a problem although there are some improvements and the numbers for screening and upgrades are low. There are continued pressures on beds, particularly on the St James’s site which have led to some cancellations both for diagnosis and treatments on cancer pathways. Late referrals from other providers continue to impact on overall performance.

4

2.2 Unplanned Care

The 4 hour A&E waiting time was delivered in 79.7% of cases at LTHT during November 2017 (against the 95% standard). A&E demand is similar to the same period last year, admissions are marginally lower yet length of stay and bed occupancy has increased. The number of long stays (ie. 30+ and 90+ days) has increased also. Flow out of the hospital is restricting timely flow in to it. A review of delayed transfers of care has been undertaken but it found only two patients had further action that could be taken to extradite discharge. Further work is required to understand why there remains an issue with flow out of the hospital.

In July 2017, the Secretary of State for Health accepted NHS England’s recommendation to implement new ambulance performance standards. These standards are focused on patients’ clinical needs, and will help to ensure consistent, rapid responses to those who genuinely need them, reduce long waits. This change is a result of the Ambulance Response Pilot (ARP) which Yorkshire Ambulance Service (YAS) have been part of since August 2015.

From the 1st April 2018 YAS and all ambulance trust will be measured nationally on the following revised performance measures:

o Respond to Category 1 calls in 7 minutes on average, and respond to 90% of Category 1 calls in 15 minutes

o Respond to Category 2 calls in 18 minutes on average, and respond to 90% of Category 2 calls in 40 minutes

o Respond to 90% of Category 3 calls in 120 minutes o Respond to 90% of Category 4 calls in 180 minutes.

YAS, with support from commissioners have agreed to implement these performance measures from September 2017 at a Trust level.

2.3 Mental Health and Learning Disabilities

Improving Access to Psychological Therapies (IAPT) access continues to be below target. The target for 17/18 is for 16.8% of the prevalent population to be accessing IAPT support by the end of March 2018; the latest performance for Leeds is 7.9% against a year-to-date target of 9.8%. Considerable work is being carried out by providers to increase access. A recovery plan is in place which is monitored by monthly submissions to MH commissioners and quarterly performance meetings.

2.4 Children’s and Maternity

Although the one week waiting time for urgent referrals to the eating disorder service was not met in the 12 months ending in September 2017 for Leeds, this represents one child not being referred within 1 week out eleven. Performance for the city has been at 100% for the last three months (Sept-Nov).

5

2.5 Continuing Healthcare (CHC)

We are currently underperforming against the two Continuing Healthcare Quality Premium measures. We are placing a Continuing Care Nurse to work with the Leeds Integrated Discharge Service in LTHT to provide support and determine if further actions can be put in place to facilitate discharge and are developing the Discharge to Assess pathways to ensure potential CHC patients have access.

Following the successful pilot, the Leeds Frailty Unit, situated at SJUH Emergency Department, has reopened. The unit will run weekdays and supported by geriatricians, advanced nurse practitioners and therapists from the LIDS team. During the pilot phase the clinical and system flow outcomes were very positive and this was mirrored in the patient experience measures.

2.6 Neighbourhood Care

There are a total of 227 Community Intermediate Care beds commissioned of which 213 are currently mobilized. Full capacity will be available in January 2018. We are beginning to develop a process for the identification of delayed discharges in conjunction with the bed bureau and adult social care and intend to report these against the delayed transfer of care definitions.

The number of patient contacts in the neighbourhood teams has been below profile since February 2017 although it is thought that the decrease in contacts is due to a positive change in care delivery. Higher numbers of interventions are now being delivered in fewer contacts as the service is delivered more efficiently to patients.

2.7 Proactive Care and Population Commissioning

The rate of uptake of Personal Health Budgets (PHBs) across the city is currently below our trajectory although we remain focused on achieving the mandated target of delivering 540 PHBs by March 2019 (a rate of 62.2 per 100,000). PHBs are currently being offered to those in receipt of continuing healthcare (children and adults) and people with a learning disability. There is also a small pilot underway in mental health (due to end soon).

We are working towards offering personal wheelchair budgets from April 2018; this will enable us to significantly increase our PHB figures. Approximately 500 patients are referred into the wheelchair service per quarter. We are aiming for 100% coverage (i.e. all patients referred into the service will be offered a Personal Wheelchair Budget) from April 2018.

6

3. CCG IMPROVEMENT AND ASSESSMENT FRAMEWORK – 2017/18 Q1 UPDATE 3.1 The CCG Improvement and Assessment Framework (CCG IAF) was introduced in 2016/17

and provides a focus on assisting improvement alongside the statutory assessment function of NHS England. It aligns with NHS England’s Mandate and planning guidance, with the aim of unlocking change and improvement in a number of key areas. This approach aims to reach beyond CCGs, enabling local health systems and communities to assess their own progress from ratings published online.

3.2 For 2017/18, a small number of indicators have been added, a number of updates have been made to existing indicators, and some indicators have been removed. The framework includes a set of 51 indicators (a reduction from 60), although data for 10 indicators is currently unavailable.

3.3 The table below lists the measures within the framework where performance is shown to be within the worst quartile nationally for the Leeds CCGs. 2017/18 CCG IAF - Within the ‘worst quartile’ nationally North South/East West

Children aged 10-11 classified as overweight or obese

People with diabetes diagnosed less than a year who attend a structured education course

Injuries from falls in people aged 65 and over

Provision of high quality care: adult social care

Cancers diagnosed at early stage

Improving Access to Psychological Therapies – recovery rate

Improving Access to Psychological Therapies – access rate

People with first episode of psychosis starting treatment with a NICE-recommended package of care treated within 2 weeks of referral

Proportion of people with a learning disability on the GP register receiving an annual health check

Emergency admissions for urgent care sensitive conditions

Population use of hospital beds following emergency admission

7

3.4 The table below lists the measures within the framework where performance is shown to be within the best quartile nationally for the Leeds CCGs. 2017/18 CCG IAF - Within the ‘best quartile’ nationally North South/East West

Antimicrobial resistance: appropriate prescribing of broad spectrum antibiotics in primary care

Provision of high quality care: hospital setting

Provision of high quality care: primary medical services

Cancers diagnosed at early stage

One-year survival from all cancers

Cancer patient experience

Improving Access to Psychological Therapies – recovery rate

Maternal smoking at delivery

Neonatal mortality and stillbirths

Women’s experience of maternity services

Estimated diagnosis rate for people with dementia

Dementia care planning and post-diagnostic support

Patient experience of GP services

Percentage of NHS Continuing Healthcare full assessments taking place in an acute hospital setting

Effectiveness of working relationships in the local system

3.5 Actual performance against the measures used in the CCG IAF is displayed in the

indicator tables accompanying this report.

4. COMMISSIONING FOR QUALITY AND INNOVATION (CQUIN) – 2017/18 Q1 UPDATE 4.1 The CQUIN scheme is intended to deliver clinical quality improvements and drive

transformational change. With these objectives in mind the scheme is designed to support the ambitions of the Five Year Forward View and directly link to the NHS Mandate and it now focuses two areas covering Clinical quality and transformational indicators, and supporting local areas by providing consideration to Sustainability and Transformation Plans and local financial sustainability.

4.2 Reducing impact of serious infections – LTHT has partially achieved this CQUIN at Q1. There has been a lot of progress towards providing timely treatment of sepsis in emergency departments and acute inpatient settings however the 90% target for intravenous antibiotics within 1 hour has been identified as a challenge and there is debate nationally about the appropriateness of the 1 hour target. It is recognised that prompt treatment is important but this may not always mean within 1 hour in terms of outcome. Local audits of this measure have shown that the median time to antibiotics is around 1.5 to 2 hours. Mortality for this group of patients is also monitored and is with the ‘expected’ range. This CQUIN will continue to be overseen by the sepsis group.

4.3 Transitions out of Children and Young People’s Mental Health (CYPMH) Services – This CQUIN requires effective partnership working between LCH, provider of CYPMH services and LYPFT as the provider of adult services to collaborate in order to meet the requirements. During Q1 and Q2 efforts have been made by LYPFT to engage with LCH in order to progress this, unfortunately this has not been successful and the requirements

8

have not been met in this quarter. However commitment and agreement is now in place to progress this work and ensure that by the end of Q3 the milestones required for Q2 (no milestones specified for Q1 and Q3) will be met and on track to achieve the requirements for Q4. LYPFT acknowledge that this is an unsatisfactory position and that achieving effective, safe, and good quality transfer of young people from CYPHM services to our services is essential in achieving safe clinical care and a positive experience for young people. In recognition of this however LYPFT has had in place with LCH a focus on young people transitioning to our services over many years, this has led to the development of joint protocols to support effective transitions of care. Partnership working and collaboration between clinicians and operational managers is in place along with mechanisms and approaches to review the effectiveness of this. LYPFT has assured the CCG that whilst the CQUIN requirements for this quarter have not as yet been met this is not indicative of the focus and importance the Trust place on achieving successful transfer/transition of care.

5. NEXT STEPS

5.1 The key actions which will be undertaken in relation to performance are as follows:

To continue to closely monitor the commissioner and provider-led actions in relation to areas of underperformance.

5.2 The key actions which will be undertaken in relation to the development of the IQPR are as

follows:

To continue working closely alongside colleagues in local and citywide commissioning teams, Informatics and Quality in the development of the report and identification of local measures;

To work with commissioning teams to develop a minimum of three-year work plans as part of a broader commissioning and performance management framework, which will provide strategic milestones for inclusion within the IQPR.

6. RECOMMENDATION

The Board is asked to:

a) RECEIVE AND REVIEW the IQPR dashboards; discuss the information, note the

current areas of underperformance and mitigating action; and b) SUPPORT the continued development of the IQPR.

Indicator Tables

NHS Constitution and Operational Planning Measures Page 2‐3

CCG Improvement and Assessment Framework Page 4‐5

Quality and Safety Page 6

Commissioning for Quality and Innovation (CQUIN) Page 7

RAG Rating

92.5%

88.0%

85.0%

Interpreting Trends

'Green' performance would be ≥ 92%

'Amber' performance would be 87.4% ≤ x < 92%

'Red' performance would be < 87.4%

Performance measures shown to be 'Amber' should still be interpreted as

underperforming ‐ a RAG rating has only been applied to serve as a visual guide

to understand how close performance is to the expected standard.

They should not be interpreted as being currently within a tolerance level.

Trend analysis is currently based upon comparing the latest performance with

the performance in the previous period.

A green arrow represents an improvement in performance

An amber arrow represents no change in performance

A red arrow represents a deterioration in performance

The Integrated Quality and Performance Report

Report Period: October 2017

Contents

Report Key

Note: The RAG rating applied within this report is based upon calculating a limit

of 5% higher/lower relative to the expected standard/target.

For example, if the expected Standard is a minimum of 92%...

Measure Period Target Leeds

North

Leeds S&E Leeds

West

Leeds Leeds (YTD) Leeds

Trend

NHS Constitution

RTT Incomplete Pathway Oct‐17 92% 92.3% 91.3% 91.5% 91.6% 91.1%

Diagnostic Waiting Times Oct‐17 99% 99.8% 99.9% 99.8% 99.8% 99.6%

Cancer ‐ 2 Week Wait Oct‐17 93% 95.7% 94.0% 95.2% 94.9% 95.1%

Cancer ‐ 2 Week Wait (Breast) Oct‐17 93% 95.3% 89.5% 96.0% 93.6% 95.5%

Cancer ‐ 31 Day First Treatment Oct‐17 96% 97.6% 96.9% 97.8% 97.5% 96.7%

Cancer ‐ 31 Day Surgery Oct‐17 94% 96.0% 92.0% 95.8% 94.6% 95.9%

Cancer ‐ 31 Day Drugs Oct‐17 98% 100% 100% 100% 100% 99.9%

Cancer ‐ 31 Day Radiotherapy Oct‐17 94% 100% 100% 100% 100% 100%

Cancer ‐ 62 Day GP Referral Oct‐17 85% 83.7% 75.0% 82.6% 80.6% 83.5%

Cancer ‐ 62 Day Screening Oct‐17 90% 91.7% 50.0% 62.5% 71.9% 86.3%

Cancer ‐ 62 Day Upgrade Oct‐17 90% 100% 66.7% 90.9% 83.3% 84.1%

A&E

A&E Waiting Times ‐ % 4 hours or less (LTHT) Nov‐17 95% 79.7% 86.1%

Ambulance

Ambulance Calls Closed by Telephone Advice

(YAS Trust Total)Aug‐17 9.2% 8.7%

Incidents Managed Without Need for Transport to A&E

(YAS Trust Total)Oct‐17 30.9% 32.0%

Mental Health

Dementia ‐ Estimated Diagnosis Rate Nov‐17 66.7% 69.7% 81.5% 74.2% 75.3% 74.6%

IAPT Access (YTD) Oct‐17 9.8% 7.1% 7.2% 8.8% 7.9% 7.9%

IAPT Recovery Oct‐17 50% 53.4% 56.8% 53.8% 54.6% 54.6%

IAPT Waiting Times ‐ 6 Weeks Oct‐17 75% 93.5% 98.2% 94.9% 99.7% 96.0%

IAPT Waiting Times ‐ 18 Weeks Oct‐17 95% 100% 100% 99.3% 95.5% 98.9%

EIP ‐ Psychosis treated within two weeks of referral Oct‐17 50% 75.0% 80.0% 80.0% 78.6% 73.2%

Improve access rate to CYPMH 30%

Waiting Times for Routine Referrals to CYP Eating Disorder Services ‐ Within 4

Weeks

12 months to

Q2 2017/1860% 88.5% 91.2% 89.3% 89.8%

Waiting Times for Urgent Referrals to CYP Eating Disorder Services ‐ Within 1

Week

12 months to

Q2 2017/1895% 100% 100% 75.0% 90.9%

Other Commitments

E‐Referral Coverage Nov‐17 80% 71.0% 64.6% 68.3% 67.7%

Personal Health Budgets (per 100,000) ‐ YTD 2017/18 Q225.6

(Leeds)16.7 14.1 15.9 15.5

Children Waiting no more than 18 Weeks for a Wheelchair 2017‐18 Q2 92% 97.1% 98.3% 94.7% 97.6% 95.5%

Extended access (evening and weekends) at GP services Dec‐1750% by

March 0.0% 31.0% 100% 53.0%

LD Patient Projections

Reliance on Inpatient Care for People with LD or Autism ‐ CCGs Nov‐17 18 24

Reliance on Inpatient Care for People with LD or Autism ‐ NHS England Nov‐17 23 20

NHS Constitution and Operational Planning MeasuresPerformance Measures (1 of 2)

No data currently available

Page 2

Measure Period Target Leeds

North

Leeds S&E Leeds

West

Leeds Leeds (YTD) Leeds

Trend

Quality Premiums (QP)

Cancers diagnosed at early stage (detected at stage 1 and 2)*12 months to

Q1 2016/17tbc 53.2% 47.1% 51.2% 50.4%

Overall experience of making a GP appointment Jan‐Mar 17 tbc 74.5% 69.6% 78.7% 74.9%

NHS CHC eligibility decision made within 28 days 2017/18 Q2 >80% 47.0% 56.0% 47.0% 50.0% 50.0%

Full NHS CHC assessments taking place in an acute hospital setting 2017/18 Q2 <15% 14.1% 26.1% 19.4% 20.5% 20.5%

Recovery rate of people accessing IAPT services identified as BAME Sep‐17 tbc 40.0% 42.1% 38.7% 39.0% 15.7%

Proportion of people accessing IAPT services aged 65+ Sep‐177.3%

(Leeds)5.1% 5.7% 3.9% 4.7% 4.7%

Whole health economy ‐ E. coli blood stream infections (12 months) Oct‐17480

(Leeds)139 236 244 619 347

Whole health economy ‐ collection and reporting of a core primary care data

set for all E coli BSI from Q2 2017/18Q2 2017/18 n/a

Antibiotic prescribing for UTI in primary care ‐ Trimethoprim: Nitrofurantoin

prescribing ratio*

12 months to

Sept 20170.67 0.48 0.48 0.42 0.46

Antibiotic prescribing for UTI in primary care ‐ number of trimethoprim items

prescribed to patients aged ≥70 years*

12 months to

Sept 201711,803 2,283 3,077 3,423 8,783

Prescribing in primary care ‐ items per STAR‐PU*12 months to

Sept 20171.161 1.007 1.110 0.977 1.031

Reported to estimated prevalence of hypertension (%) Q2 2017/1857.6%

(Leeds)57.8% 59.5% 54.4% 56.3%

* Average of CCGs

No data currently available

NHS Constitution and Operational Planning MeasuresPerformance Measures (2 of 2)

Page 3

Value Trend Value Trend Value Trend

Percentage of children aged 10‐11 classified as overweight or obese13/14 to

15/160.0% 31.4% 37.0% 33.7%

Diabetes patients that have achieved all the NICE recommended treatment targets: three (HbA1c,

cholesterol and blood pressure) for adults and one (HbA1c) for children2015‐16 0.0% 37.5% 38.2% 39.1%

People with diabetes diagnosed less than a year who attend a structured education course 2014 0.0% 0.8% 0.6% 0.4%

Injuries from falls in people aged 65 and over 16‐17 Q4 0.0% 1,824 2,599 2,462

Personal health budgets ‐ rate per 100,000 17‐18 Q1 0.0% 16 12 14

Inequality in unplanned hospitalisation for chronic ambulatory care sensitive and urgent care

sensitive conditions16‐17 Q4 0.0% 1,946 2,290 2,273

Antimicrobial resistance: appropriate prescribing of antibiotics in primary care 2017 06 1.161 1.018 1.117 0.984

Antimicrobial resistance: appropriate prescribing of broad spectrum antibiotics in primary care 2017 06 10.0% 6.1% 6.6% 6.4%

The proportion of carers with a long term condition who feel supported to manage their condition

Provision of high quality care: hospital 17‐18 Q1 0.0% 62 61 61

Provision of high quality care: primary medical services 17‐18 Q1 0.0% 67 67 70

Provision of high quality care: adult social care 17‐18 Q1 0.0% 57 58 57

Cancers diagnosed at early stage 2015 0.0% 56.2% 48.0% 52.6%

People with urgent GP referral having first definitive treatment for cancer within 62 days of referral 16‐17 Q4 85.0% 83.6% 81.2% 82.5%

One‐year survival from all cancers 2014 0.0% 72.5% 70.8% 70.5%

Cancer patient experience 2016 0.0% 8.8 8.9 8.8

Improving Access to Psychological Therapies – recovery 2017 06 50.0% 52.1% 48.1% 56.5%

Improving Access to Psychological Therapies – access 2017 07 0.0% 2.3% 2.2% 2.5%

People with first episode of psychosis starting treatment with a NICE‐recommended package of

care treated within 2 weeks of referral2017 08 50.0% 61.5% 72.2% 67.0%

Children and young people’s mental health services transformation

Mental health out of area placements

Mental health crisis team provision

Reliance on specialist inpatient care for people with a learning disability and/or autism 17‐18 Q1 0.0% 67 67 67

Proportion of people with a learning disability on the GP register receiving an annual health check 2015‐16 0.0% 36.5% n/a 30.2% n/a 38.2% n/a

Completeness of the GP learning disability register

Maternal smoking at delivery 17‐18 Q1 0.0% 5.6% 11.9% 10.8%

Neonatal mortality and stillbirths 2015 0.0% 3.63 n/a 5.39 n/a 1.75 n/a

Women’s experience of maternity services 2015 0.0% 80.12 n/a 83.26 n/a 78.93 n/a

Choices in maternity services 2015 0.0% 67.34 n/a 67.73 n/a 63.99 n/a

Estimated diagnosis rate for people with dementia 2017 08 66.7% 70.6% 80.6% 73.3%

Dementia care planning and post‐diagnostic support 2015‐16 0.0% 80.4% 82.1% 81.9%

Emergency admissions for urgent care sensitive conditions 16‐17 Q4 0.0% 2,361.2 3,383 2,786

Percentage of patients admitted, transferred or discharged from A&E within 4 hours 2017 09 95.0% 88.0% 86.6% 86.8%

Delayed transfers of care attributable to the NHS per 100,000 population 2017 08 0.0% 14.4 15.5 15.1

Population use of hospital beds following emergency admission 16‐17 Q4 0.0% 562.5 628.8 584.2

Percentage of deaths with three or more emergency admissions in last three months of life

Patient experience of GP services 2017 0.0% 86.5% 84.7% 89.6%

CCG Improvement and Assessment FrameworkPerformance Measures (1 of 2)

Measure Period Standard /

Target

Leeds North Leeds S&E Leeds West

Better Health

Better Care

Data currently unavailable






Page 4

Value Trend Value Trend Value Trend

Primary care access – percentage of registered population offered full extended access

Primary care workforce 2017 03 0.0% 1.01 0.98 0.97

Patients waiting 18 weeks or less from referral to hospital treatment 2017 08 92.0% 91.6% 91.1% 90.4%

Achievement of clinical standards in the delivery of 7 day services

Percentage of NHS Continuing Healthcare full assessments taking place in an acute hospital setting 17‐18 Q1 0.0% 4.1% n/a 11.4% n/a 5.1% n/a

Evidence that sepsis awareness raising amongst healthcare professionals has been prioritised by

the CCG

In‐year financial performance 17‐18 Q1 0.0% Green 0 Green 0 Green 0

Utilisation of the NHS e‐referral service to enable choice at first routine elective referral 2017 06 0.0% 67.2% 50.6% 56.7%

Probity and corporate governance 17‐18 Q1 0.0%Fully

Compliant

Fully

Compliant0

Fully

Compliant0

Staff engagement index 2016 0.0% 3.8 3.7 3.8

Progress against the Workforce Race Equality Standard 2016 0.0% 0.11 n/a 0.12 n/a 0.12 n/a

Effectiveness of working relationships in the local system 16‐17 0.0% 78.6 68.1 72.5

Compliance with statutory guidance on patient and public participation in commissioning health

and care

Quality of CCG leadership 17‐18 Q1 0.0% Green 0 Green 0 Green 0

Assessment Rating 2016/17 Good Good Good

CCG Improvement and Assessment FrameworkPerformance Measures (2 of 2)

Measure Period Standard /

Target

Leeds North Leeds S&E Leeds West

CCG IAF Rating





Better Care

Sustainability

Well Led

Page 5

in period YTD in period YTD in period YTD in period YTD

Patient Safety

Serious Incidents n/aJun17‐Jul

1710 19 9 23 6 12 1 6

Never Events n/aJun17‐Jul

172 5 0 0 0 0 0 1

Mortality Rate (Standardised Hospital Mortality Index) 1.00Apr 16‐

Mar 170.967

MRSA Blood Stream Infection 0 Sep‐17 0 4

Clostridium difficile Infection 119 Total Sep‐17 12 58

Classic Safety Thermometer (Harm Free Care) 94.3% Sep‐17 95.4% No Data 98.5%

Mental Health Safety Thermometer (% feeling safe) 87.5% Sep‐17 82.2%

Patient Experience

Friends and Family Test (% recommended) ‐ A&E 87% Aug‐17 87.0% 85.8%

Friends and Family Test (% recommended) ‐ Inpatient 96% Aug‐17 95.0% 95.2%

Friends and Family Test (% recommended) ‐ Outpatient 94% Aug‐17 93.0% 93.0%

Friends and Family Test (% recommended) ‐ Maternity Antenatal 96% Aug‐17 100% 97.9%

Friends and Family Test (% recommended) ‐ Maternity Birth 96% Aug‐17 95.0% 94.3%

Friends and Family Test (% recommended) ‐ Postnatal Ward 94% Aug‐17 99.0% 98.0%

Friends and Family Test (% recommended) ‐ Postnatal Ward (Community) 98% Aug‐17 100% 98.2%

Friends and Family Test (% recommended) ‐ Mental Health 88% Aug‐17 81.0% 84.0% 100% 78.7%

Friends and Family Test (% recommended) ‐ Community 96% Aug‐17 96.0% 97.0%

Friends and Family Test (% recommended) ‐ See and Treat/Non‐Conveyance (YAS) 98% No Data

Friends and Family Test (% recommended) ‐ Patient Transport Service (YAS) 86% 67% No Data

Complaints ‐ Total Received Sep‐17 23 (Jun) 21 128

Staffing

Staff Turnover Q1 17/18 12.56%11.8%

(YAS)

Sickness Jun‐17 3.80% 5.21% 4.65%5.31%

(YAS)

Performance Measures

Quality and Safety

Measure Target /

Nat Av

Period LTHT LCH LYPFT Other*

Page 6

Improving staff health and wellbeing

Improvement of health and wellbeing of NHS staff 2017/18

Healthy food for NHS staff, visitors and patients 2017/18

Improving the uptake of flu vaccinations for frontline clinical staff 2017/18

Reducing the impact of serious infections

Timely identification of patients with sepsis in emergency departments and acute inpatient settings 17‐18 Q1

Timely treatment of sepsis in emergency departments and acute inpatient settings 17‐18 Q1

Assessment of clinical antibiotic review between 24‐72 hours of patients with sepsis who are still

inpatients at 72 hours.17‐18 Q1

Reduction in antibiotic consumption per 1,000 admissions 17‐18 Q1

Improving physical healthcare to reduce premature mortality in people with serious mental illness (PSMI)

Improving Physical healthcare to reduce premature mortality in people with SMI: Cardio Metabolic

Assessment and treatment for Patients with Psychoses17‐18 Q1 (unavailable)

Improving Physical healthcare to reduce premature mortality in people with SMI: Collaboration with

primary care clincians17‐18 Q1 (unavailable) N/A

Improving services for people with mental health needs who present to A&E

Improving services for people with mental health needs who present to A&E 17‐18 Q1

Transitions out of Children and Young People’s Mental Health Services

Transitions out of Children and Young People’s Mental Health Services (CYPMHS) 17‐18 Q1 N/A

Offering Advice and Guidance

Advice & Guidance 17‐18 Q1

e‐Referrals

e‐referrals 17‐18 Q1

Supporting proactive and safe discharge

Supporting proactive and safe discharge 17‐18 Q1 (unavailable)

Preventing ill health by risky behaviours – alcohol and tobacco

Tobacco screening 17‐18 Q1

Tobacco brief advice 17‐18 Q1

Tobacco referral and medication 17‐18 Q1

Alcohol screening 17‐18 Q1

Alcohol brief advice or referral 17‐18 Q1

Improving the assessment of wounds

Improving the assessment of wounds 17‐18 Q1

Personalised care and support planning

Personalised care and support planning 17‐18 Q1

Ambulance conveyance

Proportion of 999 incidents which do not result in transfer of the patient to a Type 1 or Type 2 A&E

Department17‐18 Q1 (unavailable)

NHS 111 referrals

Increasing the proportion of NHS 111 referrals to services other than to the ambulance service or A&E

departments17‐18 Q1 (unavailable)

End to End Reviews 17‐18 Q1

Mortality Reviews 17‐18 Q1

PTS Patient Portal 17‐18 Q1

Operational Pressures Escalation Levels Framework 17‐18 Q1

High Volume Service Users 17‐18 Q1

Patient Education 17‐18 Q1

Commissioning for Quality and Innovation (CQUIN)National Measures

Measure Period Acute Integrated

Care Prov.

Care HomeCommunity Mental Health Ambulance 111

N/A

The Leeds Alliance

(co‐located services)

Yorkshire Ambulance Service

Unknown until Spring 2018



Local Measures

One Medical Group

(Walk‐in Clinic)

Measure Period

Page 7




Title: Chief Executive’s Report

Lead Board Member: Phil Corrigan, Chief Executive


appropriate ()

Report Author: Phil Corrigan, Chief Executive Decision


Discussion


Information











N/A


Communication and Involvement Issues

N/A



N/A



N/A

2

EXECUTIVE SUMMARY: 1. The Chief Executive’s report informs the Board of: Commissioning 2. The CCG is progressing the implementation of SKYPE for business. This will provide the functionality for teams to interact across sites remotely and support remote working and teleconferencing. In addition teams are thinking about how this medium can support patients care. 3. Winter continues to challenge the Leeds system with increasing numbers of admissions of frail elderly patients. The St James site is particularly pressured. Daily calls occur with all system partners to support the flow of patients out of hospital into community beds and services. Admissions for patients with influenza have risen over the Christmas period, but numbers are not yet deemed to be in excess of what could be expected. 4. Work is progressing to address the issue around EMI – Elderly Mentally Infirm and the services we commission for this vulnerable group. We are seeing an increasing number of complex EMI cases that are increasingly difficult to place in local long term care. The Director of Integrated Commissioning with Adult Social Care is looking into several options to support short and long term care for this group. Communications and Engagement Winter pressures 5. Leeds, like other parts of the country, has experienced an increase in pressure on services. However ahead of the expected winter pressures a communications plan was developed and put into action to look to alleviate some of the pressures being experienced. The main aim has been to encourage people to use appropriate services for common health conditions with a focus on promoting pharmacies and NHS 111 as a first port of call. In addition to this we have been providing alerts linked to health conditions that worsen during periods of colder weather – such as asthma – to ensure people have appropriate self care support in place. Our partners, in particular Leeds Teaching Hospitals NHS Trust, have been undertaking proactive media work to encourage people to think through their options rather than attending A&E where it is not appropriate to do so. 6. We have also been undertaking insight work with members of the Eastern European community with Polish, Romanian, Czech and Lithuanian people to find out more about how they currently access services, their knowledge of what support is available to them should they fall ill and what they would do in certain health scenarios. This is helping to inform a focused health awareness campaign targeting members of these communities. The work has already seen a leaflet drop take place, supported by community ambassadors such as church leaders, at targeted venues most frequented by those belonging to the communities we are looking to help. In late January we will have four language specific webpages set up providing information and advice including videos showing where people should go for common health conditions. The site will be promoted through advertising and social media and language specific media sites.

3

Patient engagement 7. Grange Medicare Limited provides GP primary care services at New Cross Surgery (Rothwell), Middleton Park Surgery and Swillington Health Practice. The contract with Grange Medicare Limited ends on 31 October 2018 meaning that we need to look at future plans for the practices. An engagement process to gain the views of patients, the public and stakeholders in relation to the re-procurement of services has been undertaken to understand the primary care needs and preferences of people registered at the three practices and wider stakeholders. An engagement report will be produced and the Primary Care Commissioning Committee will use this, and other information, to make a decision about the future service model of people registered at the three practices. Workshop for Developing Outcomes for People Living with Frailty 8. The CCG Partnership hosted an event on 29 November at Weetwood Hall attended by 97 people from 32 Leeds-based stakeholders and organisations including patients, carers, commissioners, third sector, Leeds Beckett and University of Leeds, Local Authority, primary care, community care, mental health, acute trust and Yorkshire Ambulance Service. Attendees reviewed the Outcomes Framework for people living with frailty and older people at end of life, which is being developed to help test our approach to commissioning and delivering population outcomes. A final draft has been prepared and will be considered by the Leeds Integrated Commissioning Executive at the end of January. The Outcomes Framework is intended to support the delivery of our Health and Wellbeing Strategy and Leeds Health and Care Plan in that it helps bring together commissioners and providers more easily to deliver care around the needs of people, communities and population groups.

Third Sector Health Outcomes Showcase Event 9. The CCG Partnership hosted an event in collaboration with Leeds Community Foundation and New Philanthropy Capital on 8 December at Horizon Leeds. Attended by over 111 people, the event show-cased the third sector health grants programme run by the CCGs’ in Leeds over the course of 2016 and 2017. A full evaluation report of the health grants programme is currently at the printers and will made available to members of the Governing Body as soon as it is available. Draft People and Organisation Development (OD) Strategy: update 10. Between October and December 2017, as part of working towards creating a single CCG for Leeds, we undertook a period of discussion and engagement across the organisation to help us begin to develop our People and OD strategy. This included:

half day sessions for all staff where more than three hundred individual comments and

suggestions were gathered;

further engagement in focus groups on the then three sites; and

opportunities to leave additional comments and suggestions on posters.

11. We received hundreds of comments and views, and every single piece of feedback has been analysed. This will be used to help shape the strategy as feedback shows that as well as incorporating our organisational ambitions, it is important to recognise what the future needs of our people will be as our system changes around us. For example: flexibility, ability to work within change, great management and leadership skills, collaboration, working across boundaries, influencing others and so on.

4

12. The strategy is still in early draft form as we are currently awaiting additional information,such as the most up to date joint workforce information. Once outstanding information is included in the draft, everyone will have the opportunity for further comment. Following any updates, the KPI baselines will be proposed in a short paper to SMT and included in the final version along with the proposed targets for the next three years.

West Yorkshire and Harrogate Joint Committee

13. Key messages from the meeting of the West Yorkshire and Harrogate Joint Committeemeeting held on 9 January 2018 are attached at Appendix 1.

RECOMMENDATION:

The Leeds Health Commissioning & System Integration Board is asked to: (a) Receive the Chief Executive’s report.

Notes

The Joint Committee has delegated powers from the WY&H CCGs to make collective decisions on specific, agreed WY&H work programmes, including mental health, urgent care, cancer and stroke. It can also make recommendations to the CCGs. The Committee supports the wider STP, but does not represent all of the partners.

Agenda papers and further information are available from the Joint Committee web pages: http://www.wyh-jointcommiteeccgs.co.uk/ or contact Stephen Gregg, Governance Lead [email protected].

West Yorkshire & Harrogate (WY&H) Joint Committee of Clinical Commissioning Groups

Meeting held in public on Tuesday 9 January 2018

Summary of key decisions

West Yorkshire and Harrogate Cancer Alliance update

The Joint Committee viewed videos about the experience of patients with cancer, highlighting variation in general practice and the need for effective early diagnosis, supported by high quality, timely information.

The Committee noted the Cancer Alliance vision. Partnership working had enabled the Alliance to bid successfully for additional funding, linked to delivery of the 62 day standard for cancer waits. The cancer workstreams were tobacco control, early diagnosis, high quality services, patient experience and living with and beyond cancer.

The Committee noted awareness-raising campaigns to improve early diagnosis and screening take-up. Campaigning involved the NHS and public health working closely together. Cancer work was being co-ordinated with other STP programmes, including primary care and support for healthier lifestyle choices. The Committee noted the need for strong links between the Alliance and place and for effective diagnosis for groups such as young people. The Alliance was only as strong as the weakest place, and all partners needed to work together effectively.

The Committee noted the focus on awareness raising and early diagnosis, but questioned whether the system had the capacity to cope. It heard about the difficulties of early diagnosis and the need to stop people ‘ping-ponging’ around the system. A multi-disciplinary team approach to assessment was more efficient and used resources more effectively. It could reduce demand on general practice by finding the right answers more quickly for cancer and non-cancer patients.

The Committee explored diagnostic capacity, smoking cessation and maximizing ‘every contact counts’ efforts across the acute sector. It heard about the need to understand and support carers and to ensure strong patient engagement. The Committee heard about the important contribution of local authorities to the prevention agenda.

The Alliance was not a separate entity, but consisted of all partners working collaboratively. There was a need to move towards delivery of a common set of agreed outcomes, with stronger system leadership. A key role of the Alliance was to support all partners to make good, evidence-based decisions.

The Joint Committee:

1. Noted Cancer Alliance progress to date:2. Noted that the brief for the Alliance is expanding beyond the scope of the original WY&H

programme objectives due to national expectations and the coordination and leadership needs ofthe local system;

3. Supported the Alliance ambition to develop a stronger system leadership role to drive improvedoutcomes and experience and requested a progress update and options for how this could bedelivered in practice at the development session in February 2018

Next Joint Committee in public

Tuesday 6th

March 2018, Kirkdale Room, Junction 25 Conference Centre, Armytage Road, Brighouse, HD6 1GF

Appendix 1

http://www.wyh-jointcommiteeccgs.co.uk/

http://www.wyh-jointcommiteeccgs.co.uk/

mailto:[email protected]

1


NHS Leeds CCGs Partnership – Leeds Health Commissioning and System Integration Board Meeting


Title: Primary Care Rebates Scheme Policy

Lead Governing Body Member: Dr Simon Stockill, Medical Director


appropriate

()

Report Author: Heather Edmonds, Head of Clinical Pharmacy Development

Decision

Reviewed by EMT/SMT/Date: 12th July 2017 Discussion

Reviewed by Committee/Date: N/A Information

Checked by Finance (Y/N/N/A - Date): N/A










Yes

Financial Implications Yes

Communication and Involvement Issues No

Workforce Issues No


No

Environmental Issues No


Yes

2

EXECUTIVE SUMMARY: This paper summarises the key points around Primary Care Rebate Schemes (PCRS), which is being put forward for adoption citywide.

1. The Leeds CCG Partnership is asked to support the principle of accepting PCRS.

2. If The Leeds CCG Partnership is supportive then they are asked to agree to the adoption of the policy attached.

Background Since February 2015 Leeds North CCG has had a system in place for reviewing and accepting PCRS. To date Leeds North has signed up to 2 rebate schemes. One of the schemes has been in effect for about 1 year and the other 6 months. To date this has resulted in a total rebate of £110K paid to Leeds North CCG since September 2016. Leeds CCGs Partnership has been offered a number of schemes. Schemes offered to date would result in a rebate of around £24,000/year to £80,000/year citywide, based on current prescribing. During the summer we consulted with our member practices, who raised concerns about transparency of the process, which we have taken on board and adapted the policy to address these concerns. There is no need for this policy to go to public consultation as this policy is not intended to affect service or treatment. Key facts re PCRS

Are contractual arrangements, usually for 2 years.

These schemes are essentially a financial and transactional relationship between the pharmaceutical industry and CCGs.

They are financial arrangements and are paid retrospectively on the volume of drug prescribed.

CCGs may not solicit, request or tender for rebate schemes for branded medicines but are at liberty to accept such schemes offered by the pharmaceutical industry. The scheme offered is not negotiable.

Pharmaceutical companies offer rebates to CCGs to maintain their market share when there are several drugs within the same class and newer drugs are cheaper than theirs.

The clinical decision about where the drug sits within a clinical pathway should be made first before any rebates are considered – this is highlighted within the policy attached.

Pharmaceutical companies have streamed lined the process to access the rebates and review the prescribing data on behalf of the CCGs so that payments can be sent automatically on a quarterly basis, this minimises the workload on the medicines optimisation team.

All schemes have a clause referring to FOIs within the contract. These contracts are checked by the finance and governance team to ensure they allow the CCG to comply with FOI requests. Contracts to date allow the CCG to:

o Acknowledge existence of the rebate scheme; o Publish the drug name; and

3

o Publish the company name. Leeds North CCG has received FOI requests on rebate schemes that have only asked for this information. The Pharmaceutical companies offering the PCRS are happy if we had this information added to our website to reduce FOI requests.

Our proposed policy goes further and includes a more open and transparent approach with us detailing any approved PCRS on our website and in our annual accounts.

Contacts can be terminated usually by giving 3 months written notice by either side.

Other neighbouring CCGs have similar policies and accept similar rebates schemes, e.g. Harrogate and Rural District CCG, Wakefield CCG.

PCRS are separate to Joint/Partnership working with the pharmaceutical industry.

Having a policy for PCRS does not mean you have to accept all rebate schemes offered.

Pros for accepting PCRS

The CCGs get the drugs at a cheaper price, which allows for the rebated money to be off set against prescribing cost pressures, or service improvement/ diagnostic and monitoring equipment.

Increases cost-effective prescribing.

Reduces the time spent by the medicines optimisation to do cost saving switches, so frees the team up to do more quality improvement work, to support improved patient care and outcomes.

Reduces the need to switch patient’s medication, thereby less confusion for patients and/or carers and fewer queries for practice staff.

Cons for accepting PCRS

There is some concern that PCRS only offer short-term savings and could lead to drugs cost to go up long-term. In reality this does not seem to have occurred and has actually resulted in prices coming down e.g. Rivaroxaban.

Risk If we choose not to accept appropriate PCRS there is an increasing risk of prescribing budgets overspending.

NEXT STEPS: Should the policy be approved, then the next steps would be identification of the members of the panel to review rebate schemes that are offered to the CCG and to feedback to SMT on what schemes have been accepted and the financial impact at regular intervals.

RECOMMENDATION: The Board is asked to approve the Primary Care Rebate Schemes Policy.

4

Policy for the review, acceptance and monitoring of rebate schemes offered by the pharmaceutical

industry

Version: Version 6

Name & Title of originator/author(s): Heather Edmonds, Head of Medicines Optimisation

Sally Bower, Head of Medicines Optimisation

Helen Liddell, Head of Medicines Optimisation

Name of responsible committee/individual:

Senior Management team and board.

Date issued:

Review date:

Target audience: Medicines management

Finance

Governance

Quality

Senior Management Team

5

1. Introduction The Pharmaceutical Price Regulation Scheme (PPRS) is the mechanism by which the Department of Health ensures that the NHS has access to branded medicines at a reasonable price. The PPRS balances setting reasonable prices for the NHS against delivering a fair return for the pharmaceutical industry so that investment and innovation in pharmaceuticals is incentivised. The PPRS does not apply to devices or nutritional products; nor does it apply to generic medicines whose prices tend to be controlled by their Drug Tariff agreed pricing. The view of the Department of Health expressed in the consultation document on value based pricing is that the existing PPRS does not promote innovation or access to medicines, as the freedom of companies to set the price of new drugs results in the NHS often paying high prices which are not justified by the benefits of the drug and/or of having to restrict access to the drug. A number of manufacturers have established ‘rebate schemes’ for drugs used in primary care to support the NHS QIPP agenda. The NHS is charged the Drug Tariff price for primary care prescriptions dispensed, then the manufacturer provides a rebate to the primary care organisation based on an agreed discount price and verified by ePACT data. Primary care rebate schemes (PCRS) are contractual arrangements offered by pharmaceutical companies, or third party companies, which offer financial rebates on GP prescribing expenditure for particular branded medication. These schemes usually reimburse organisations retrospectively with an agreed percentage discount of the total amount of a particular branded medication prescribed and dispensed. PCRS, underpinned by robust assessment and governance procedures, can lead to significant cost savings. This policy describes how the Leeds CCGs will adopt and implement good practice recommendations to ensure a clear and transparent process for the review, acceptance and monitoring of PCRS. Some schemes are straight discounts and are not volume based, whilst others have varying discount rates available dependent upon the volume of drug prescribed. The discount schemes are confidential to the NHS enabling manufacturers to maintain a higher price in global markets. 2. Purpose and scope This policy is designed to ensure that any PCRS that are adopted deliver financial benefits to the CCG and: • are in the best interests of patients • do not adversely influence prescribing behaviour • do not adversely affect other parts of the local health community The NHS faces a significant challenge in achieving efficiency savings. PCRS can contribute to reduce primary care prescribing costs which can be re-invested into service development and quality improvement work or off set against prescribing budget. It has been reported that at least 30% of CCGs accept PCRS, with potential savings of up to £100,000 in some localities. Pharmaceutical companies offer PCRS for a number of reasons:

Pharmaceutical prices are often set by the European office of multinational companies

Reference pricing – advertised prices in the UK may affect prices in other countries.

This may mean that a price set centrally is not competitive in the UK

To manage this through competition law, companies have the option to discount to the purchaser.

This is managed retrospectively as a rebate to the NHS statutory body purchasing at a local level.

6

There are examples of similar schemes running within the NHS, such as:

Patient access schemes. These usually relate to high cost specialist drugs, which NICE has approved, allowing for the drug to be prescribed for a patient at a cheaper cost for a specified period of time.

Hospital and dispensing doctors can negotiate prices for medication direct with the manufacturers, either on a local or national level.

There are some concerns regarding PCRS in relation to legislation such as the Bribery Act, Competition Act and Public procurement law. There are also concerns around:

potentially creating incentives to prescribe drugs with PCRS

undermining the Pharmaceutical Price Regularity Scheme - a voluntary agreement to control the prices of branded drugs sold to the NHS

financial governance and audit requirements

administrative burden of the schemes The legal status of rebate schemes has been reviewed by a number of organisations. The London Primary Care Medicines Use and Procurement QIPP Group sought legal advice on such schemes in 2012. Based on this advice, this Group recommended a set of good practice principles for primary care organisations to use to facilitate robust scrutiny and identification, adoption and implementation of PCRS. This policy incorporates those good practice principles. 3. General principles Before entering into a PCRS with a pharmaceutical industry partner, all proposals will be rigorously tested against clear criteria to ensure that they are in the best interests of both patients and the CCG. All proposals will be treated equally and decisions made will need to stand up to scrutiny if questioned:

Any drug where a PCRS is offered will only be considered by Leeds CCGs which has been reviewed by Leeds Area Prescribing Committee (LAPC) and a recommendation given as to the traffic light classification. The recommendation made by LAPC will take into account the clinical need and safety for the medicines and its place in the care pathway. Black light drugs and those classified for safety reasons will not be considered. LAPC is made up of doctors, pharmacists and nurses from the whole Leeds health economy and includes a lay patient representative.

To reduce the effect of influencing prescribing inadvertently. The details of rebates schemes will not be circulated to prescribers, but Leeds CCGs will publish the acceptance of PCRS from pharmaceutical companies on their web site and will include the company name and drug, however total value for the rebates received will be included in the CCG accounts which is available publically.

Any Medicine considered under a PCRS must be licenced in the UK. Leeds CCGs will not accept any rebate schemes for unlicensed or off-licence uses.

All PCRS offered to Leeds CCGs will be reviewed by the assessment process outlined below to ensure a robust process that follows Leeds CCGs governance procedures.

Any PCRS offered that encourages exclusive use of a particular drug will not be accepted by Leeds CCGs.

Leeds CCGs will only accept PCRS where there is a formal contract that is signed by both parties to ensure:

7

That the terms of the scheme are clear,

To maximise legal protection.

Leeds CCGs will not accept any PCRS unless it includes a right to terminate on notice with a sensible notice period (usually no more than 3 months).

Leeds CCGs will only accept PCRS that require submission of volume of use level data available from EPACT relating to the drug the rebate scheme refers to. Leeds CCGs will not provide market share data for competitors’ products or patient identifiable data. Patient confidentiality will be maintained at all times.

Any financial gains received as a result of accepting PCRS: o Will not contribute to the Leeds CCGs CCG Prescribing engagement scheme freed up

resources. o Will be used to offset against non-recurrent costs for service/treatment improvement

projects identified and supported by Leeds CCG’s Medicines Optimisation Team’s, which have been approved by the senior management team (SMT).

o Will be used to address any unexpected shortfall in primary care prescribing costs.

In the cases where a PCRS is agreed, Leeds CCGs will ensure that the agreement entered in to states that the pharmaceutical company that is offering the PCRS will not use our engagement in the scheme to promote their company’s activities that are related to this agreement, or in any other promotional activity for their benefit.

4. Freedom of Information Leeds CCG supports the principles of transparency enshrined in the Freedom of Information Act. Rebate agreements often contain confidentiality clauses which may restrict what information may be disclosed under Freedom of Information. The CCG will publish its policy for accepting rebate agreements along with the list of products for which rebate agreements exist on its publically available website. Section 43 of the Freedom of Information Act sets out an exemption from the right to know if: • The information requested is a trade secret, or • Release of the information is likely to prejudice the commercial interests of any person. (A person may be an individual, a company, the public authority itself or any other legal entity.) The UK is a reference pricing country for pharmaceutical and medical device products and any change to publically available UK prices can impact on the international profitability of pharmaceutical and medical device companies. Pharmaceutical and medical device companies often consider their pricing structures to be trade secrets and there are precedents within the NHS in restricting access to pricing information for these products. NICE negotiates a number of patient access schemes as part of the NICE Technology Appraisal programme. The details of the products that are available to the NHS under a patient access scheme (or discount scheme) are published on the NICE website. The commercial and operational details of the individual schemes are not made publically available and are the subject of confidentiality clauses. Greater Huddersfield CCG benefits from many of these schemes through the prices charged to it for PbR excluded drugs. Section 43 is a qualified exemption. That is, it is subject to the public interest test which is set out in section 2 of the Act. Where a public authority is satisfied that the information requested is a trade secret or that its

8

release would prejudice someone’s commercial interests, it can only refuse to provide the information if it is satisfied that the public interest in withholding the information outweighs the public interest in disclosing it. Leeds CCG will consider all Freedom of Information requests on rebate agreements on their individual merits taking into account the public interest and whether the release of information will prejudice other parties to the agreements.

5. Assessment process The assessment process will be in 2 stages: Stage 1 - initial screening (outlined overleaf) Stage 2 - detailed assessment

9

NO

NO

YES

NO

Stage 1 The initial screening process is outlined below:

This initial screening will be undertaken by the Head of Medicines Optimisation, for Leeds CCG, using the Stage One screening questionnaire in Appendix 1. On satisfactory completion of stage one all PCRS proposals will go to stage 2 of the process. PSRC which are deemed to have not fulfilled stage 1 will be rejected and the relevant Pharmaceutical Company will be informed by email. Stage 2 All PCRS that have satisfactory passed the Stage 1 screening process will be assessed by a review panel consisting of;-

Head of Medicines Optimisation/or their deputy

Finance representative

Governance team representative

Quality team representative

Lay member

Does the proposed rebate scheme have a benefit for the whole local health community? i.e. it would not adverse effect another sector such as secondary care with higher prescribing costs, or community pharmacy

Does the proposed rebate scheme require a change in current prescribing practice?

YES

NO

Are the anticipated net (financial or improvement in quality/safety) rewards through the proposed scheme of sufficient value to warrant engagement?

YES

The proposed scheme is accepted and will be progressed by the CCG

The scheme will not be taken any further by Leeds CCGs

NO

NO

Proposal will be taken forward

to the formal review process YES

Will the integrity of Leeds CCG’s be compromised in any way by engaging in the proposed rebate scheme?

YESS|S

YES

10

Prescribing lead GP

GP non-exec member

Medical director or deputy

All PCRS will be assessed against the Stage 2 assessment template in Appendix 2. If the PCRS is accepted to be taken forward then the pharmaceutical company will be contacted and arrangements will be made for the contract to be signed by the Director of Finance. 6. Monitoring, compliance and effectiveness Once the PCRS has been signed, the prescribing data will be collected as outlined in the contract by the Medicines Optimisation team and submitted to the pharmaceutical company, if required. Once PCRS have been agreed, prescribing trends of the drugs involved will be monitored on a quarterly basis to detect any unexpected effects on prescribing trends. This will be undertaken by Leeds CCG medicines optimisation team. If any unexpected effects on prescribing trends are seen this will be reported to the Leeds CCG Senior management team. A summary of all PCRS that been offered to Leeds CCG will be submitted to SMT, together with the outcomes every 6 months. Any changes in prescribing practice which necessitates the cessation of a PCRS will be brought to the attention of the director who signed the original agreement or the clinical director and the pharmaceutical company offering the PCRS will be notified as soon as possible following the agreed exit strategy. An example where this may be necessary is when a drug may be withdrawn off the market due to safety concerns.

11

Appendix 1

Stage 1 screening questionnaire

Pharmaceutical company offering the scheme and representative.

Name of Medicines Optimisation representative undertaking the screening.

Brand of drug PCRS refers to

Date of initial offer/approach

Does the proposed rebate scheme fulfil all the general principles outlined in the Leeds CCG policy on receiving and handling PCRS?

Yes / No

If No - outline which general principle(s) the PCRS does not fulfil.

If Yes – Progress to stage 2 Date result fed back to Pharmaceutical company.

Date completed

12

Appendix 2

Stage 2 detailed assessment questionnaire

PCRS review questionnaire

Date of review panel

Names and designation of review panel

Pharmaceutical Company

Product(s)

Brief outline of proposal

Y/N/ value

Additional comments

1. Has the stage 1 screening questionnaire been completed?

Only progress this stage if the screen questionnaire is positive.

2. Has place in therapy been agreed? Or is it subject to review Only those agreed will be taken forward

3. Has this product been given a traffic light drug?

4. What is the current volume of use?

5. Will this increase or decrease?

6. What is the anticipated financial benefit (£)?

13

7. If tied into volume what increase in volume would we need to achieve in order to achieve cost benefit vs use of currently used therapies?

8. What would be the impact on other products currently being used +/- , and would this be beneficial to patients?

9. What is the impact on partner organisations, such as secondary care and community pharmacy?

10. How would the scheme be administered?

11. What data would the organisation need to share with the pharmaceutical company supplier in order to quantify current / future product usage and time commitment?

12. Is there a fixed term to which the organisation has to agree to participate on the scheme?

13. Is there an agreed exit strategy written into the agreement?

14. Impact on supply chain, including risk of failure of supply of available product

Outcome of panel Agree to take forwards Y/N

14

Appendix 3

Equality Impact Assessment

Title of the guidance Policy for approving primary care prescribing rebate schemes

Names and roles of people completing the assessment

Heather Edmonds – Head of Medicines Optimisation

Date assessment started/completed 5.7.17 5.7.17

1. Outline

Give a brief summary of the guidance

The policy provides a transparent framework to support evaluation and approval of rebate schemes to ensure that schemes are only approved where they provide good value for money to the public purse and the schemes’ terms are in line with the organisation’s vision, values, policies and procedures

What outcomes do you want to achieve

The objective evaluation of schemes submitted to the CCG and a clear process for approving and scrutinising agreements.

4. Analysis of impact

This is the core of the assessment, using the information above detail the actual or likely impact on protected groups, with consideration of the general duty to; eliminate unlawful discrimination; advance equality of opportunity; foster good relations

Are there any likely impacts? Are any groups going to be affected differently? Please describe.

Are these negative or positive?

What action will be taken to address any negative impacts or enhance positive ones?

Age N

Carers N

Disability N

Sex N

Race N

Religion or belief

N

Sexual orientation

N

Gender reassignment

N

Pregnancy and maternity

N

Marriage and civil partnership

N

15

Other relevant group

N

If any negative/positive impacts were identified are they valid, legal and/or justifiable? Please detail.

NA

5. Monitoring, Review and Publication

How will you review/monitor the impact and effectiveness of your actions

Assessment via the Medicines Optimisation Group will be scheduled for 2 years after ratification of policy

Lead Officer Heather Edmonds Review date: TBA

6. Sign off

Lead Officer

Director Date approved:

Key: * Items will only be included on the agenda if there is any information to report

LEEDS HEALTH COMMISSIONING & SYSTEM INTEGRATION BOARD

WORK PROGRAMME 2017-18

ITEM SEP

2017

NOV

2017

JAN

2018

MAR

2018

Notes

STANDING ITEMS

Welcome & apologies X X X X

Declarations of interest X X X X

Minutes of previous meeting X X X X

Matters arising X X X X

Action log X X X X

Patient Voice X X X X

Questions from Members of the Public X X X X

GOVERNANCE ITEMS

Committee Terms of Reference X X

Committee Annual Reports X

Committee Chairs’ Summaries X X X X

Review of governance arrangements X

ASSURANCE

Board Assurance Framework and Risk Register X X X X

STRATEGY

Leeds Health & Care Plan X X

CCG Strategic Objectives X X

System Integration X X X X

CCGs Operational Plan X

Organisational Development Strategy X

COMMISSIONING

Integrated Quality & Performance Report X X X X

Finance Report X X X X

Chief Executive’s Report X X X X

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Agenda item: LHCB 17/89

WY&H Joint Committee of CCGs – 07/11/2017

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West Yorkshire & Harrogate Joint Committee of Clinical Commissioning Groups

Minutes of the meeting held in public on Tuesday 7 November 2017

Kirkdale Room, Junction 25 Conference Centre, Armytage Road, Brighouse, HD6 1QF

Members Initials Role and organisation

Marie Burnham MB Independent Lay Chair

Fatima Khan-Shah FKS Lay member

Richard Wilkinson RW Lay member

Dr Akram Khan AK Chair, NHS Bradford City CCG

Dr James Thomas JT Chair, NHS Airedale, Wharfedale and Craven CCG

Dr Andy Withers AW Chair, NHS Bradford Districts CCG

Helen Hirst HH Chief Officer, NHS Bradford City, Bradford Districts and AWC CCGs

Dr Alan Brook ABr Chair, NHS Calderdale CCG

Neil Smurthwaite NS Chief Finance Officer, NHS Calderdale CCG

Dr Steve Ollerton SO Chair, NHS Greater Huddersfield CCG

Carol McKenna CMc Chief Officer, NHS Greater Huddersfield CCG and North Kirklees CCG

Dr Alistair Ingram AI Chair, NHS Harrogate & Rural District CCG

Amanda Bloor ABl Chief Officer, NHS Harrogate & Rural District CCG

Dr Jason Broch JB Chair, NHS Leeds North CCG

Dr Alistair Walling AWa GP Clinical Lead, NHS Leeds South & East CCG

Dr Gordon Sinclair GS Chair, NHS Leeds West CCG

Philomena Corrigan PC Chief Executive, NHS Leeds CCGs Partnership

Dr Phillip Earnshaw PE Chair, NHS Wakefield CCG

Jo Webster JW Chief Officer, NHS Wakefield CCG

Apologies

Matt Walsh MW Chief Officer, NHS Calderdale CCG

Dr David Kelly DK Chair, NHS North Kirklees CCG

In attendance Initials Role

Lou Auger LA Director of Delivery, West Yorkshire, North Region NHS England

Nigel Gray NG Chief Officer - System Integration, NHS Leeds CCGs Partnership Senior Responsible Officer for Urgent & Emergency Care

Ian Holmes IH Programme Director, WY&H STP

Jonathan Webb JWe Director of Finance, WY&H STP

Stephen Gregg SG Joint Committee Governance Lead (minutes)

Karen Coleman KC Communication Lead, WY&H STP


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Tony Jamison TJ Clinical Lead for Medicines, Yorkshire and Humber Academic Health Science Network

Jacqui Crossley JC Head of Clinical Effectiveness and Governance, Yorkshire Ambulance Service

Jonathan Booker JB Senior Analyst, WY&H STP

Linda Driver LD Stroke Project Lead

Keith Wilson KW Programme Manager, Urgent and Emergency Care

Catherine Thompson CT Programme Director, Standardisation of Commissioning Policies and Elective Care

11 members of the public, and 4 observers from STPs in Cumbria and the North East were in attendance.

Item No. Agenda Item Action

20/17 Welcome, introductions and apologies

MB welcomed all to the meeting and reminded everyone of the role of the Joint Committee. Apologies were noted.

MB congratulated Carol McKenna on being appointed as shared Chief Officer for NHS Greater Huddersfield CCG and NHS North Kirklees CCG. Richard Parry had returned to his full time role at Kirklees Council as Strategic Director for Adults and Health. MB thanked Richard for his contribution to the work of the Joint Committee.

21/17 Open Forum

MB invited members of the public to make representations or ask questions about items on today’s agenda.

Q1 Wakefield CCG and N Kirklees CCGs had introduced referrals to opticians for patients who might previously have gone to A&E. How would this impact on referrals and costs?

CMc said that the aim was to ensure that patients were referred to the most appropriate professional. CMc and PE offered to follow up the issue outside of the meeting.

CMc/

PE

22/17 Declarations of Interest

MB asked Committee members to declare any interests that might conflict with the business on today’s agenda. There were no additional declarations.

MB noted the potential conflicts of interest of GP members in relation to the specification for future out of hours services in agenda item 28/17. No mitigating action was needed at this stage, but the Committee would need to ensure that any conflicts that did arise were managed appropriately.

23/17 Minutes of the meeting in public – 5th September 2017

The Committee reviewed the minutes of the last meeting.

The Joint Committee: Approved the minutes of the meeting on 5th September 2017, subject to an amendment to the initials of an attendee.

24/17 Actions and matters arising

SG presented the log, which had been updated. MB requested that, where possible, actions marked as ‘ongoing’ be assigned a specific deadline. There were no matters arising.


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The Joint Committee: Noted the action log.

25/17 Video presentations

JW introduced 3 video presentations connected to items on the agenda. In the first, Geoff talked about his experience of stroke and stroke services. The second highlighted the importance of work to prevent physical and mental health conditions. In the third, local health leaders talked about the need for services to work differently together to improve services and outcomes.

The Joint Committee: Noted the video presentations.

26/17 Improving stroke outcomes

JW introduced the item, which provided an update on the stroke programme, and included a proposal for the 11 CCGs to work together to reduce the number of people who die from stroke.

AW noted the need to improve stroke outcomes in WY&H. He highlighted the importance of preventative work and summarised progress on modelling work to help determine future stroke services.

He outlined consultation with the Clinical Forum to ensure that development work reflected current best practice. Discussions were ongoing with providers on the future care pathway. Delivering the 7 day standard for services was a key aim. A key part of effective prevention was detecting and treating atrial fibrillation (AF). AW set out an aspiration to detect and treat 89% of people with AF. A focused approach was proposed, working with the Yorkshire and Humber Academic Health Science Network to support practices where there was the greatest potential to make a difference.

FKS asked how the 89% target had been derived and noted the need to improve outcomes across WY&H. TJ said that Public Health England had carried out detailed work to estimate the benefits from addressing AF.

ABr queried the basis for the target and highlighted the need for accurate and robust diagnoses of AF. AW said that the evidence base for the target was strong. He noted the importance of effective treatment with anti-coagulants.

JW said that the ultimate aim was 100% detection and treatment. There had been extensive clinical engagement in developing the proposals, and targeted support could make a real difference. She outlined the risks to the stroke programme and ongoing work to mitigate them. A further report would be brought to the Joint Committee in March.

PC noted the need to address other aspects of the stroke programme, including diagnostics and consultant review. JW advised that these standards would be addressed by the work on 7 day services.

GS asked how the public was being engaged in the programme. LD outlined the engagement work to date and work planned to support the next steps. JC highlighted how Yorkshire Ambulance Service was drawing on the direct experience of patients and staff to help shape future services.


1. Noted progress in developing proposals to determine optimal service delivery models particularly the ‘scenario’ modelling’ exercise;

2. Noted the proposal to develop and implement a standardised care pathway and clinical standards for hyper acute and acute stroke services;


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3. Supported the proposal to request each WY&H CCG to:

agree an aspiration to detect and treat 89% of patients with Atrial Fibrillation; and

work collaboratively with the Yorkshire and Humber Academic Health Science Network on implementing a targeted and phased approach to working with their local practices;

4. Noted the key risks and actions to mitigate risks related to our work; and

5. Noted the next steps and timelines in the high level project plan.

27/17 Standardisation of Commissioning Policies and Elective Care

JT outlined the aims of the programme and the work streams. He thanked all those who had been involved so far in the programme.

There were four aims:

to improve health through better prevention and supporting healthier choices

create financial efficiency gains

reduce variation and inconsistency

reduce the perception of a ‘postcode lottery’

Supporting healthier choices

The Committee considered an approach in which, before surgery, patients are offered a choice of services to address lifestyle factors. Choice was a key element of the programme, and required effective communication with patients and the public. Work was already underway in each place and there was now an opportunity to agree a common approach.

Clinical thresholds and policies

Orthopaedics and ophthalmology had been identified as providing good opportunities to reduce variation, improve referral to treatment times and achieve productivity gains.

Follow ups and outpatients

There were clear opportunities to redesign approaches and ensure that support was built around patient needs.

Prescribing

This would focus on reducing unwarranted variation and reducing spend on high cost drugs.

JT outlined the risks to the programme and how they were being mitigated. Effective engagement with patients, the public and providers was key. Financial gains could be achieved, but were largely longer term. The work needed to contribute to reducing health inequalities.

HH felt that there was a need to be ambitious and move quickly to influence commissioning intentions, working closely with providers. This was particularly important in relation to reshaping orthopaedic and ophthalmology services.

JT noted the need to ensure that the capacity was in place to support the programme. HH said that this had been recognised at the Accountable Officer’s meeting earlier in the day.


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SO noted the need to work closely with secondary care clinicians to make changes. JT agreed that there needed to be a mixture of top down and bottom up approaches, building on what worked locally.

RW noted the need to address variation and health inequalities and deliver ‘quick wins’. FKS highlighted the need to change the conversation with the public, engage with clinicians and communicate consistent messages. JWe highlighted the benefits from addressing variation in primary care prescribing.

GS asked how patient choice would be supported, and said that not all patients were prepared to make ‘healthier choices’. CT said that the aim was to support patients, not direct them. The programme would not create barriers to those who did not choose to make healthier choices.

In response to questions from FKS, JT said that engagement with public health colleagues would be important. JT said that local discussion was needed with community pharmacists at place level. CT would investigate the extent to which Community Pharmacy West Yorkshire had been engaged in the programme. –

CT

The Joint Committee: Agreed:

1. The approach to the Elective Care Programme outlined in the report.

2. The approach of ‘patient choice’ and coherent support offer for supporting healthier choices.

3. The standardisation of commissioning policy for procedures of limited clinical value and elective orthopaedic surgery, and the policy – relationships – technology approach to implementation.

4. The development of new approaches to outpatient services in elective orthopaedic surgery and eye care services.

5. That an update on the programme be submitted to the Joint Committee in March 2018.

CT (MW)

28/17 Urgent and emergency care

NG provided an update on the work of the Urgent and Emergency Care (UEC) Programme Board.

He outlined the role of the Board and how it worked with the five A&E Delivery Boards in Airedale and Bradford, Calderdale and Greater Huddersfield, Harrogate and Rural Districts, Leeds and Mid Yorkshire. The Board aimed to ensure that systems were in place for people to get the right care, in the right place. It aimed to improve the patient experience, improve integration and reduce duplication. He noted the pressures that winter placed on the system and the need for services to work together differently to support A&E departments and ensure that the health and social care system was sustainable.

He summarised the current position on key targets in the UEC delivery plan, including NHS 111, ambulance response, GP access, hospital care, hospital to home and mental health. He outlined work to support seven day hospital services. NG highlighted the main risks to delivery of the programme, including workforce, challenges in the care homes sector and increasing demand for services. He outlined how these risks were being addressed.

CMc noted the new national service specification for the provision of an integrated 24/7 urgent care access, clinical advice and treatment service, incorporating NHS 111 call-handling and former GP out-of-hours services.


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Not all elements of the specification would be commissioned collectively but it would be important to be clear across WY&H on how everything fitted together. It was important that CCG commissioning intentions aligned to inform the future commissioning strategy across WY&H, and included 7 day services.

In response to a question from MB, CMc said that that potential ‘gaps’ between local and STP commissioning intentions would be assessed by the UEC Programme Board.

AB noted ongoing operational activity led by the A&E delivery boards to address winter pressures. Plans covered better signposting, flu vaccination and clinical escalation. AW noted the pressure in the system, and highlighted capacity constraints in primary care.

FKS asked about proposals to change the roles of health professionals. KW said that the aim was to ensure that patients presented at the right place to get the right care for their needs, regardless of the ‘badge’ of the health professional.

JW noted the need to address the seven day service challenge and adapt how different professionals and sectors fitted in to the system. She noted that the workforce strategy would be key to addressing these challenges. JW and KW highlighted the recent success of the STP engagement event with the voluntary and community sectors.


1. Noted the progress on the delivery of the UEC delivery plan.

2. Agreed the risks and mitigating actions.

3. Agreed the proposed way forward to secure a Y&H IUC service specification which involves alignment of CCG commissioning intentions, with a completion date of March 2018

CMc

29/17 Any other business

There was none.

Next Joint Committee in public – Tuesday 9th January 2018, Kirkdale Room, Junction 25 Conference Centre, Armytage Road, Brighouse, HD6 1QF.

AGENDA NHS Leeds CCGs Partnership: Leeds Health ......Barnsley Clinical Commissioning Group...

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