COVID 19 - NHS Blackburn with Darwen CCG · Mr G Burgess Dr A Black Dr N Horsfield P Hinnigan Dr Q...

NHS BLACKBURN WITH DARWEN CCG NHS EAST LANCASHIRE CCG

COVID 19

Blackburn with Darwen Clinical Commissioning Group and East Lancashire Clinical Commissioning Group

Governing Bodies Meeting in Common

Virtual Meeting : Wednesday, 15 April 2020 1:00pm – 3:00pm

No Item Lead Action Time 1 Welcome and Apologies Dr R Robinson

Chair

1.00pm

2 Items for Approval from 18th March Virtual Meeting - ICS IPA Business Case - CAHMS Transformation Schemes for 2020/21

Chair

Approval

1:05pm

3 Reducing the burden and releasing capacity at NHS providers and commissioners to manage the COVID-19 pandemic for ratification a. Review of Governance Arrangements to support

the CCGs response to the COVID-19 Pandemic

b. Financial Considerations

D Atkinson

R Parr / K Hollis

Ratification

1.10pm

4 Personal Protective Equipment (PPE) K Lord

Ratification

1.25pm to

2.05pm

5 Staff Testing

K Lord Ratification

6 Establishing COVID-19 Recovery Centre (s) for Pennine Lancashire

Dr J Higgins A Walker

Ratification

7 Wavering of Standing Financial Instructions in relation to essential equipment / enabling tools

R Parr / K Hollis

Ratification

8 Community DVT Service Redesign & Procurement A Walker

Ratification

9 Summary of Pennine Lancashire CCGs Incident Room Key Decisions

R Parr / K Hollis Assurance 2.05pm

10 Key Verbal Updates

Dr Julie Higgins / Directors

2.15pm

11 Questions and Closing Remarks

Chair 2.40pm

12 Date and Time of Next Meeting Virtual Meeting Confirmed as Wednesday, 13 May 2020, 1-3pm

3:00pm

NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group

AGENDA ITEM : 2

18 March 2020 : Items presented to the Governing Body for Approval / Decision

Item No

Description Action Required Members Comments

4.6

Individual Patient Activity Business Case

The business case is to be submitted to each CCG Governing Body for approval, enabling progress to mobilisation in 2020/21.

Supported by: BwD CCG Mr G Burgess Dr A Black Dr N Horsfield P Hinnigan Dr Q Hussain Dr Z Patel C Richardson (nv)

EL CCG Dr Robinson K Hollis Dr Mackenzie M Pilling Dr P Taylor Dr D White D Swift – support is conditional

on the extra funding being

affordable - if funding has been

identified, he is happy to

support.

4.8

Child and Adolescent Mental Health Service

(supported at the Committees in Common Meeting on 11th March 2020).

Note the report

Agree to the funding allocations for the CAMHS Transformation Schemes for 2020/21

Seek to reduce costs for East Lancashire CCG within the pooled resource but recommend considering the CAMHS Transformation funding and model on a Pennine Lancashire footprint as opposed to two separate plans.

Supported by: BwD CCG Mr G Burgess Dr A Black Dr N Horsfield P Hinnigan Dr Q Hussain Dr Z Patel C Richardson

EL CCG Dr Robinson K Hollis Dr White Dr Mackenzie D Swift Dr P Taylor D White

RECOMMENDATION: Those Members who have not responded are asked to support both Business Cases.

NHS BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP

NHS EAST LANCASHIRE CLINICAL COMMISSIONING GROUP

AGENDA ITEM : 3a

Reducing burden and releasing capacity at NHS providers and commissioners

to manage the COVID-19 pandemic

Review of Governance Arrangements to support the CCGs response to the

COVID-19 pandemic

NHS England and NHS Improvement (NHSE/I) have written to NHS Providers and

Commissioners on 28th March to provide further guidance to support commissioners and

providers to free-up management capacity and resource to allow as much capacity as

possible and prioritisation of workload to be focused on doing what is necessary to manage

the response to the COVID-19 pandemic.

This report sets out the key actions of the letter that CCGs are asked to undertake and our

local Pennine Lancashire CCGs response to these and the steps we are taking locally.

The CCGs’ Standing Orders, Delegated Financial Limits and decision making framework

have been reviewed and this report sets out proposals to strengthen our governance and

decision making structures to ensure business continuity and critical timely decision making

whilst responding to COVID-19.

There are 6 key recommendations within the paper.

A full copy of the letter can be viewed at the following link, and members are asked to note

the areas under 1 section 2 and 3 of the letter that are aimed at provider only and the further

details set out under Annex A, B and C.

Senior managers are aware of this guidance and are responding accordingly.

https://www.england.nhs.uk/coronavirus/28-March-2020-Reducing-burden-and-releasing-

capacity-at-NHS-providers-and-commissioners-to-manage-the-CO.pdf

https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C0113-28-March-2020-Reducing-burden-and-releasing-capacity-at-NHS-providers-and-commissioners-to-manage-the-CO.pdf

https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C0113-28-March-2020-Reducing-burden-and-releasing-capacity-at-NHS-providers-and-commissioners-to-manage-the-CO.pdf



1) Governance and Meetings

No. Area of Activity

Detail CCG Response Recommendations

1. Board and sub-board meetings

Trusts and CCGs should continue to hold board meetings but streamline papers, focus agendas and hold virtually not face-to-face. No sanctions for technical quorum breaches (eg because of self-isolation) For board committee meetings, trusts should continue quality committees, but consider streamlining other committees (eg Audit and Risk and Remuneration committees) and where possible delay meetings till later in the year. While under normal circumstances the public can attend at least part of provider board meetings, Government social isolation requirements constitute ‘special reasons’ to avoid face to face gatherings as permitted by legislation All system meetings to be virtual by default and organisations are to inform audit firms where necessary.

A Joint Governing Body Microsoft Teams group has been established to enable all meetings to be held virtually. The CCGs also have the provision of email communication and teleconferencing facilities to support quorum for any governing body meetings and decisions. No face-to-face meetings are being held.

Recommendation (1): a) That the CCGs hold a virtual Governing

Bodies meeting on Wednesday 15th

April. An agenda and any papers for consideration will be circulated in ad-vance of the meeting.

b) The CCGs Pennine Lancashire Quality

Committee is not a statutory Committee, and therefore will not undertake any business unless critical to support the response to COVID-19.

c) The Audit committee will be scheduled to undertake the assurance and audit of the annual report (further guidance awaited) annual accounts. MIAA aware of current arrangements. Membership and Quourm for both Audit Committees is: 4 members and any 2 members. It is proposed this remains under COVID 19.

d) The Remuneration Committees will meet by exception. Membership and Quourm is: BwD 4 members and 2 present EL 5 members and 3 present

Recommendation (1d):



That East Lancs Remuneration Committee Quourm be amended to 2 present Primary Care Committees (see recommendation 4)

4. Annual accounts and audit

Deadlines for preparation and audit of accounts in 2019/20 are being extended. Detail was issued on 23 March 2020. Organisations to inform external auditors where necessary.

CCG draft accounts are now due for submission on 27

th April (2 weeks later than usual). Audited

accounts are now due to be submitted on 25th

June. The CCGs Chief Finance Officers are ensuring that these timescales are met and that appropriate governance / approval processes are in place. Revised Audit Committee dates and virtual meeting will be share with members asap.

Recommendation (2): East Lancashire CCG has reserved the approval of the Annual Accounts to its Governing Body. It is recommended that for 19/20 this is delegated to its Audit Committee.

7. Annual Report

NHSE/I are working with DHSC and HM Treasury on streamlining the annual report requirements and further guidance is being prepared and will be shared in due course.

The CCGs are continuing to draft core elements of the Annual Report, in particular the Annual Governance Statement. Appropriate governance arrangements will be taken forward once the revised guidance has been issued. Revised Audit Committee dates and virtual meeting will be share with members asap.

Recommendation (3): East Lancashire CCG has reserved the approval of the Annual Report and Accounts to its Governing Body. It is recommended that for 19/20 this is delegated to its Audit Committee.




Detail

8. Decision making processes

While having regard to their constitutions and agreed internal processes, organisations need to be capable of timely and effective decision making. This will include using specific emergency decision-making arrangements.

CCG Response Recommendations

Covid 19 Incident Coordination Centre Group The CCGs have formed an ICC COVID 19 Group that comprises of:

Accountable Officer

BwD or EL Chief Finance Officer (ICC Commander)

EL Medical Director (also formally acting on behalf of BwD CCG)

BwD GP Deputy to MD

EL GP Deputy to MD

Director of Performance and Delivery

Director of Population Strategy and Transformation

Director of Quality & Chief Nurse

The group meets twice daily and has full oversight of national, regional and local guidance. There is a well-established command and control structure and clear operating procedures to ensure timely decisions are taken to support the COVID 19 pandemic.

Recommendation (4):

a) Commissioning Committees Subject to at least 3 of the 8 members being party to a decision (at least one clinical) and that:

a summary of all key decisions will be logged and presented to Governing Bodies for assurance.

any significant locally agreed decisions/actions will be presented to Governing Bodies for ratification.

The Terms of Reference and functions of following Sub Committees be delegated to the ICC group whilst under COVID 19:

East Lancs CCG Sustainability Committee

BwD Commissioning Business Group

b) Primary Care Committees Subject to at least 3 of the 8 members being party to a decision (at least one clinical) and that:



The following functions be delegated to the ICC group to carry out whilst under COVID 19:

Newly designed enhanced services (“Local Enhanced Services” and “Directed



Enhanced Services”); Design of local incentive schemes as an alternative to the Quality Outcomes

Framework (QOF);

Decision making on whether to establish new GP practices in an area;

Approving practice mergers; and

Making decisions on ‘discretionary’ payment (eg: returner/retainer schemes) To manage the budget for commissioning of primary [medical] care services.

Standing Orders Both organisations have provision within their standing orders for emergency powers and urgent decisions. East Lancashire CCG: Emergency powers and urgent decisions The powers which the Governing Body has reserved to itself within these standing orders may in emergency or for an urgent decision to be exercised by the Chief Officer and the Chair after having consulted with at least two voting board members. The exercise of such powers by the Chief Officer and Chair shall be reported to the next formal meeting of the CCG Governing Body in public session for ratification. Blackburn with Darwen CCG: Emergency powers and urgent decisions The powers which the Group has reserved to itself within these Standing Orders may in emergency or for an urgent decision be exercised by the Chief Officer, the Chair or Lay Member. The exercise of such powers by the Chief Officer and the Chair or Lay Member shall be reported to the next formal meeting of the CCG in public session for formal ratification.

Recommendation (5): To ensure that there is sufficient provision for emergency powers and urgent decisions should key staff be unavailable it is proposed that the following temporary deputy arrangements are adopted:

a) For East Lancashire CCG:

The Deputy Chair may undertake the role of Chair

The CFO for BwD may deputise for the CFO for EL

The Deputy Chief Officer (Chief Finance Officer) may undertake the role of Chief Officer

b) For Blackburn with Darwen CCG:


The CFO for EL may deputise for the CFO for BwD

There are currently 3 individuals undertaking role of Chair or Lay so no further deputy arrangements are proposed at this stage

A summary of those areas set out in The CCGs Standing Orders is attached at Appendix A.



Delegated Financial Limits Both CCGs have clear delegated financial limits as set out in Appendix B.

Recommendation (6): To ensure that there is sufficient provision for approval of these areas should key staff be unavailable it is proposed that the following deputy arrangements are adopted:

That the Deputy Chief Officers can act on behalf of the Chief Officer

That the BwD Chief Finance Officer can act on behalf of the EL Chief Finance Officer

That the EL Chief Finance Officer can act on behalf of the BwD Chief Finance Officer

That the Deputy Chief Finance Officer can act on behalf of the Chief Finance Officers

That the Director of Population Strategy and Transformation can act on behalf of the Director of Performance and Delivery

That the Deputy Director of Performance & Delivery can act on behalf of the Director of Performance an Delivery

2) Reporting and Assurance


Detail CCG Response Recommendations

1. Constitutional standards (eg A&E, RTT, Cancer, Ambulance waits, MH LD measures)

See Annex B CCG will maintain a flow of core operational intelligence to provide continued understanding of system pressure and how this translates into changes in coronavirus and other demand, activity, capacity and performance and ensure the majority of data collections that remain in place are supported. CCG notes suspension of a subset of existing central collections will be suspended

3. Long-Term Plan: operational planning

Paused Noted



4. Long-term Plan: system by default

Put on hold all national System by Default development work (including work on CCG mergers and 20/21 guidance). However, NHSE/I actively encourages system working where it helps manage the response to COVID-19, providing support where possible.

Noted.

5. Long-Term Plan: Mental Health

NHSE/I will maintain Mental Health Investment guarantee.

Noted.

6. Long-Term Plan: Learning Disability and Autism

As for Mental Health, NHSE/I will maintain the investment guarantee.

Noted.

7. Long-term Plan: Cancer

NHSE/I will maintain its commitment and investment through the Cancer Alliances to improve survival rates for cancer. NHSE/I will work with Cancer Alliances to prioritise delivery of commitments that free up capacity and slow or stop those that do not, in a way that will release necessary resource to support the COVID-19 response.

Noted.

9. Corporate Data Collections (eg licence self-certs, Annual Governance statement, mandatory NHS Digital submissions)

Look to streamline and/or waive certain elements Delay the Forward Plan documents FTs are required to submit We will work with analytical teams and NHS Digital to suspend agreed non-essential data collections. 10

Noted and more guidance awaited on Annual Governance Statements.

11. Continuing Stop CHC assessments. Capacity Noted and the CCG is supporting the CSU with



Healthcare Assessments

tracker, currently mandated for care homes, is now also mandated for hospices and intermediate care facilities 12

revised arrangements.

12. CCG mergers Service reconfigurations

Complete April 2020 CCG Mergers but delay work post April 2020. Expect no new public consultations except in cases to support COVID-19 or build agreed new facilities. We will also streamline or waive, as appropriate, the process to review any reconfiguration proposals designed in response to COVID-19

CCG not part of this wave. Noted and will apply streamline process where applicable.

3) Other areas including HR and Staff-related activities No. Area of

Activity Detail CCG Response Recommendations

1. Mandatory training

New training activities – refresher training for staff and new training to expand the number of ICU staff – is likely to be necessary. Reduce other mandatory training as appropriate

The CCG will support any clinical staff in undertaking necessary training and will pause on monitoring other mandatory training for wider staff.

2. Appraisals and revalidation

Recommendation that appraisals are suspended from the date of this letter, unless there are exceptional circumstances agreed by both the appraisee and appraiser. This should immediately increase capacity in our workforce by allowing appraisers to return to clinical practice. The GMC has now deferred

Noted.



revalidation for all doctors who are due to be revalidated by September 2020. We request that all non-urgent or non-essential professional standards activity be suspended until further notice including medical appraisal and continuous professional development (CPD) The Nursing and Midwifery Council (NMC) is to initially extend the revalidation period for current registered nurses and midwives by an additional three months and is seeking further flexibility from the UK Government for the future.

3. CCG Clinical Staff Deployment

Review internal needs in order to retain a skeleton staff for critical needs and redeploy the remainder to the frontline CCG Governing Body GP to focus on primary care provision

This is being taken forward and led by Kathryn Lord. Clinical staff are being redeployed within our ICP. All GP GB Members are using their Governing Body time to provide medical advice and leadership into our incident management team and are fully supporting primary care.

4. Repurposing of non clinical staff

Non-clinical staff to focus on supporting primary care and providers

All staff are now supporting primary care and providers either directly through mutual aid or indirectly through a refocus of their work to support the incident coordination centre and command and support cells. The CCG is working with the ICP and wider ISC to agree a MoU for the effective movement of staff to support COVID-19.

5. Enact business critical roles at

To include support and hospital discharge, EPRR etc

Business critical roles are being enacted through the Incident Command Centre, led by the Duty



CCGs Commander. Alex Walker is leading on support to ELHT to ensure effective hospital discharge.



Governing Body members are asked to note the CCGs response and support the following recommendations:

Recommendation (1):

a) That the CCGs hold a virtual Governing Bodies meeting on Wednesday 15th April. An agenda

and any papers will be circulated in advance of the meeting.

b) The CCGs Pennine Lancashire Quality Committee is not a statutory Committee, and there-fore will not undertake any business unless critical to support the response to COVID-19.

c) The Audit committee will be scheduled to undertake the assurance and audit of the annual report (further guidance awaited) annual accounts. MIAA aware of current arrangements. Membership and Quourm for both Audit Committees is: 4 members and any 2 members. It is proposed this remains under COVID 19.

d) The Remuneration Committees will meet by exception. Membership and Quourm is:

BwD 4 members and 2 present

EL 5 members and 3 present

Recommendation (1d):

That East Lancashire CCG Remuneration Committee Quourm be amended to 2 present

Recommendation (2):

East Lancashire CCG has reserved the approval of the Annual Accounts to its Governing Body. It is recommended that for 19/20 this is delegated to its Audit Committee.

Recommendation (3):

East Lancashire CCG has reserved the approval of the Annual Report to its Governing Body. It is recommended that for 19/20 this is delegated to its Audit Committee.

Recommendation (4):

a) Commissioning Committees

Subject to at least 3 of the 8 members being party to a decision (at least one clinical) and that:



The Terms of Reference and functions of following Sub Committees be delegated to the ICC

group whilst under COVID 19:



East Lancs CCG Sustainability Committee

BwD Commissioning Business Group

b) Primary Care Committees Subject to at least 3 of the 8 members being party to a decision (at least one clinical) and that:



The following functions be delegated to the ICC group to carry out whilst under COVID 19:

Newly designed enhanced services (“Local Enhanced Services” and “Directed Enhanced Services”);

Design of local incentive schemes as an alternative to the Quality Outcomes Framework (QOF);

Decision making on whether to establish new GP practices in an area;

Approving practice mergers; and

Making decisions on ‘discretionary’ payment (eg: returner/retainer schemes) To manage the budget for commissioning of primary [medical] care services.

Recommendation (5):

To ensure that there is sufficient provision for emergency powers and urgent decisions should key staff be unavailable it is proposed that the following temporary deputy arrangements are adopted:

For East Lancashire CCG:

The Deputy Chair may undertake the role of Chair

The CFO for BwD may deputise for the CFO for EL


For Blackburn with Darwen CCG:


The CFO for EL may deputise for the CFO for BwD

There are currently 3 individuals undertaking role of Chair or Lay so no further deputy ar-rangements are proposed at this stage

A summary of those areas set out in The CCGs Standing Orders is attached at Appendix A.

Recommendation (6):

To ensure that there is sufficient provision for approval of these areas should key staff be un-available it is That the Deputy Chief Officers can act on behalf of the Chief Officer

That the BwD Chief Finance Officer can act on behalf of the EL Chief Finance Officer

That the EL Chief Finance Officer can act on behalf of the BwD Chief Finance Officer

That the Deputy Chief Finance Officer can act on behalf of the Chief Finance Officers



That the Director of Population Strategy and Transformation can act on behalf of the Director of Performance and Delivery

That the Deputy Director of Performance & Delivery can act on behalf of the Director of Per-formance an Delivery

Debra Atkinson Head of Corporate Business



Appendix A: CCG Standing Orders:

The CCGs have within their constitutions Standing Orders that set out the arrangements and statutory framework for the following areas:

The arrangements for conducting CCG Business o Composition of the governing body and eligibility for key roles within it

How member practices are appointed

The procedures to be followed at meetings o Calling meetings o Agenda/papers o Chairing/quorum o Decision making/voting o Emergency powers and urgent decisions

How decision making powers are delegated o To committees/sub-committees and approval of such o ToRs o Scheme of Reservation and delegation o List of established committees o Use of the seal (lease/contract agreements)

Managing conflicts of interest and standards of business conduct o Refers to policies for managing COI, standards of business conduct, APBI

professional code of conduct, staff disciplinary and appeals process

Both organisations have provision within their standing orders for emergency powers and urgent decisions.

East Lancashire CCG: Emergency powers and urgent decisions

The powers which the Governing Body has reserved to itself within these standing orders may in emergency or for an urgent decision to be exercised by the Chief Officer and the Chair after having consulted with at least two voting board members (listed at 6.7.2).

The exercise of such powers by the Chief Officer and Chair shall be reported to the next formal meeting of the CCG Governing Body in public session for ratification.

Blackburn with Darwen CCG: Emergency powers and urgent decisions

The powers which the Group has reserved to itself within these Standing Orders may in emergency or for an urgent decision be exercised by the Chief Officer, the Chair or Lay Member. The exercise of such powers by the Chief Officer and the Chair or Lay Member shall be reported to the next formal meeting of the CCG in public session for formal ratification n.



Appendix B: Summary of Delegated Financial Limits

Requisitioning goods and services and approving payments: Non Healthcare – revenue and capital expenditure (including IT, Management Consultancy, Maintenance, Buildings – over lifetime contract, excluding removal expenses)

Approval and Authorisation of Requisitions and Invoice

Payments for non-healthcare contracts

East Lancs CCG BwD CCG

Chair Up to £500,000 Chair Unlimited

Chief Officer Up to £500,000 Chief Officer Unlimited

Chief Finance Officer Up to £250,000 Chief Finance Officer Unlimited

Director of Performance & Delivery

Up to £150,000 Senior Operating Officers As per their Authorised signing

levels

Director of Quality and Chief Nurse

Up to £100,000

Nominated Deputies Up to £50,000

Signing of Contracts – Health Care Contracts (including primary care & public health)


Chief Officer Over £250,000,000 Governing Body Over £110,000,000

Chief Finance Officer Over £250,000,000 Chair Up to £110,000,000


Up to £250,000,000 Chief Officer Up to £110,000,000

Chief Officer Chief Finance Officer Director of Performance & Delivery

Contract variations Chief Finance Officer Up to £110,000,000

Approving Healthcare ad-hoc payments (including Continuing Healthcare, Bespoke Care, Non contract activity etc.)


Chief Officer

Unlimited BUT over £500,000 requires Chief Officer, Chair and Chief Finance Officer approval

Chief Officer Unlimited

Chief Finance Officer Up to £500,000 Chief Finance Officer Unlimited


Up to £250,000 Senior Operating Officers As per their Authorised

signing levels

Director of Quality & Chief Nurse

Up to £100,000 Commissioning Support Unit Up to £100,000


COVID-19

Report to Governing Bodies : Wednesday, 15 April 2020 - Virtual Consideration

AGENDA ITEM : 3b

FINANCIAL CONSIDERATIONS

Area of Activity Detail CCG Response Recommendations

1 Communication Brief updates on the

COVID-19 situation at the

organisation

The Chairs of the CCGs will provide a regular

update to the governing body members by way

of a weekly briefing. This will highlight all the

key guidance that has been received and

actions that have been put in place as a result

of that guidance.

2 Decision Making

Processes

Track of decisions to

change existing financial

governance and

arrangements

Please see section 1 –Governance and Meetings

– item 8

3 Monthly Expenditure Expenditure against an

agreed benchmark for

each month

Consideration will need to be given to how to

present the financial information under the

interim financial regime. This will include the

monthly benchmark spend as calculated by NHS

England vs actual spend and additional COVID-

19 expenditure

Governing Bodies to receive a revised finance

report on a monthly basis.

4 COVID-19 Expenditure Details of COVID-19

related costs for each

month – both capital and

revenue

NHS England / Improvement require a monthly

return of all additional expenditure incurred as

a result of the COVID-19 pandemic. Additional

costs are fully reimbursable.

Irrespective, CCGs are still the custodian of

public monies and full transparency,

accountability and probity must be adhered to.

That through the monthly financial report,

Governing bodies receive an update of

additional expenditure incurred and a copy of

the return to NHS England / NHS

Improvement

A record of all decisions to incur additional

expenditure is kept on the central decision

making log.

Specific financial codes are used to identify the

expenditure and a monthly reconciliation to the

additional expenditure incurred should be

undertaken as part of the month end process

5 Statutory Requirements How they will be met –

including a review of the

approval process needed

for the annual accounts

and annual report

Please see section 1 –Governance and

Meetings– items 4 and 7

6 Workforce Update including what is

being done to support

staff

Daily sitreps are taken of staff working location,

isolation status and mutual aid offered. The

high level summary is shared in the staff

bulletin on a daily basis whilst the Cell

commanders receive the information at

departmental level.

There is a daily staff bulletin circulated to all

staff and whilst it is used to share new

guidance, it is also used as a support

mechanism, reminding staff of the importance

of checking in and sharing health and well being

advice.

Managers are asked to hold regular meetings

(virtually) with their teams to offer support

Governing body to receive – as part of their

weekly update, the summarised SITREP

7 Financial Position Consideration of key

areas that would impact

on the financial position

Financial monitoring will continue in the same

robust manner as is always present. The teams

will be responsible for their own areas of which

they have detailed knowledge.

8 Risks & Mitigations What are they and what

mitigations are put into

place

The role and functions of the incident control

centre and its links to escalate to command

centres has been established. Daily calls with

cell leads provides an active management of

risks and mitigations that are recorded and

therefore reported.

9 Communication Internal and external

communication plan

A regular sequence of internal and external

reporting has been put into place .

Daily: GP bulletin and staff bulletin

Weekly: Governing Body bulletin

On-going : social media and local media

RECOMMENDATION: Members are asked to support the decisions made and receive the report for assurance.

DATE & TIME:



COVID 19

Decision and Accountability Framework

Report to Governing Bodies

Wednesday, 15 April 2020 - Virtual consideration

Agenda Item : 4

Personal Protective Equipment (PPE)

For: Information

Decision/Action taken by: ( i.e. ICC / Community Cell )

Supported by Kathryn Lord, Director of Quality and Chief Nurse

Date of Decision / Action :

Details: The CCG has agreed to support initial supply of PPE equipment for GPs. To further support the system a PPE cell is being established to provide a clear picture of the overall ongoing need for each part of the system, to feed into Local Resilience Forums (LRF) / Integrated Care Systems (ICS). This will include broad system requirements for each of the following:

a. Primary care b. Community Health services – Physical Health c. Community Health services – Mental Health (unless LSCFT indicate this is

being co-ordinated on an ICS footprint) d. Community pharmacies e. Hospices f. Social Work teams g. Residential and Nursing Care homes h. Domiciliary Care agencies i. PHB and DP staff j. VCF services delivering Health and care support k. Non-CQC related health and care provision – eg Telecare l. Optometrists m. Dentists

This will build up level of stock required for the area through: n. Number of sites o. Number of staff p. Number of patient/person interactions for each type of standard PPE kit q. A broad understanding of weekly need from the above – people x interactions x

changes required for kit in a day r. Overall estimated requirement for each piece of kit



The Cell will be responsible for:

1. Specific monitoring of daily sitrep position for PPE across all Pennine Lancashire Health and Care organisations. Granular detail to specific position against individual items of kit to inform mutual aid discussions. At some point this may hopefully include centrally held stock.

2. Broker mutual aid discussions if required from the sitrep position.

3. Securing kit for the system: a. Ensuring understanding of ICS led / LRF allocations – liaise with

procurement at different tiers (LRF / ICS /In hospital) b. Supporting other additional ordering locally c. Being a single contact point for any aid options from local providers,

businesses etc. d. Undertaking and co-ordinating communications for Pennine Lancashire

support from business etc. e. Pursuing any other innovations, flagged up potential sources of equipment –

checking authenticity, ability to meet specification etc f. Liaising with Infection control over effectiveness or potential safe use of kit

supplied or delivered if not through normal supply chain routes g. Supporting any other PPE related mutual aid offers – FIT testing etc.

4. Overseeing Allocation if and when required

a. Organise and co-ordinate any potential storage and drop off sites across Pennine Lancashire

b. Co-ordinate any supporting transport – volunteers / LA support

5. Being a single point of contact for information and expertise a. Linked in Infection control b. Linked in Medical device expertise

Governing Body Decision/Recommendation:

Date and Time



COVID 19



Wednesday, 15 April 2020 - Virtual consideration

Agenda Item : 5

Staff Testing

For: Information

Decision/Action taken by: ( i.e. ICC / Community Cell )

Supported by: Kathryn Lord, Director of Quality & Chief Nurse

Date of Decision / Action: 09/04/2020

Details (include any financial implications / risks): The National Testing Programme provides COVID-19 tests to key NHS workers or symptomatic members of their household to support the NHS in maximising its workforce capacity during this unprecedented time. CNO Webinar Updates from the CNO webinar with Ruth May on 8th April 2020 highlight a slow start to testing with 13,000-16,000 a day being tested through the lab. University partners are adding to the capacity and national testing through Boots/Amazon has come onstream. It was advised that there is enough capacity to test all members of NHS staff or household members of NHS staff/partner organisations critical to the NHS. Swabbing is best taken between 1-3 days of onset of symptoms and not after day 5. Staff are able to return to work if swab results are negative. Local position ELHT have been allocated 60 COVID-19 antigen swabs per day to test patients and staff. 20 of these have been allocated for swabbing staff, including Primary Care Clinicians, who fit the following criteria:

Self-isolating as a result of household member displaying symptoms of new continuous dry cough and a temperature

Must not be shielding/vulnerable cohort

Must not be symptomatic themselves Additional resource has been set up at Haydock Racecourse and there are plans to open a swabbing centre in the Preston area, which potentially could be running by the end of w/c 13th April 2020.



Pennine Lancashire have identified approx. 4 GPs who fit the above criteria and have commenced their self-isolation within the last 3-4 days. At the time of writing the CCGs are awaiting appointment slots from ELHT which has not yet been finalised. A request has been made to Local Primary Care teams for daily sit-reps to be updated to ensure this information can be collated and requests can be processed in a timely manner in line with optimum timescales.


Date and Time



COVID 19


Report to Governing Bodies - Wednesday, 15 April 2020 - Virtual Consideration

Agenda Item : 6

Establishing COVID 19 Recovery Centres for Pennine Lancashire For: Ratification

Decision/Action taken by: Pennine Lancashire System Response Group (Pennine Lancashire Out of Hospital Cell)

Supported by: Dr Julie Higgins - Accountable Office & Chair of Pennine Lancashire System Response Group Alex Walker - Director of Performance and Delivery

Date of Decision / Action : 6th April 2020

Details (include any financial implications / risks): It has been agreed that the Pennine Lancashire health and care organisations will move rapidly to scope the need and identify one or more further specific cohort sites in Pennine Lancashire, where additional bed capacity can be created to provide support for people in an out of hospital setting, when critical care and overall hospital capacity within Royal Blackburn Hospital is exceeded. Along with this is has also been agreed that a Pennine Lancashire Transitional Care Cell be created as a matter of urgency on Monday 6th April, to:

Scope the likely level of need for additional capacity and identify one or more specific sites in the Pennine Lancashire area, where additional bed capacity can be created to meet the anticipated demand.

Ensure adequate staffing can be delivered to support this model and put transitional care pathways in place between the ELHT, Regulated Care Sector, Domiciliary Care Providers and Primary and Community Care.

Agree to the cell being led by Alex Walker (Director of Performance and Delivery, CCG) with senior staff identified and deployed to the cell from each partner organisation (ELHT, LSCFT, BwD and LCC LAs).

Report into the Pennine Lancashire Out of Hospital cell but will have sufficient autonomy to identify sites and initiate negotiations within an agreed process for accelerated sign off and decision making.

There are likely to be financial implications arising from this decision and these will be identified via the Transitional Care Cell in the course of their work. The key risk relating to the establishment of the recovery centres will be around identifying appropriate numbers of staff to support patients within the Centres, this will be managed by the Transitional Care Cell and will draw on the Lancashire and South Cumbria arrangements for mutual aid if required. Further details of the context for the decision are outlined within the attached document at Appendix A.

Governing Body Decision/Recommendation : Members are asked to ratify the decisions outlined.

Date and Time :

Establishing COVID-19 recovery centre (s) for Pennine Lancashire

Aim:

To shield the most vulnerable group (Care home residents) in our system from COVID-19 by

establishing a step up/ discharge recovery centre or centres within Pennine Lancashire that would

limit the potential for spread within these settings.

Objectives:

1. To reduce the risk of mortality from COVID-19 for our care home residents.

2. To reduce the risk of excess mortality for the wider population by ensuring that we can

maintain hospital flow to support the best use of hospital resources at the peak(s) of impact

from the COVID-19 virus.

3. Develop a model that gives assurance to care settings that hospital discharges to settings

will not introduce significant risk to the setting from COVID-19 where effective isolation and

infection control measures cannot be introduced in the current setting.

4. To introduce the potential for care settings to step residents who develop COVID-19

symptoms into an alternative care setting if hospital admission is not viable or effective

isolation and infection control measures cannot be introduced in the current setting.

5. To ensure that all care settings are supported fully in having the resources and training to

introduce effective isolation and infection control measures if this is feasible within their

staffing and building design constraints.

Context for decision:

The experience of China, Italy and Spain has shown that the spread of COVID-19 within care

settings can lead to a 30-50% mortality rate given the closed nature of settings and the

vulnerability of the resident group.

Report of 13 potential COVID-19 related deaths within a single care home in Glasgow

(04/04/20) and 9 confirmed or potential outbreaks across care homes in Pennine Lancashire

(04/04/20) with a number of COVID-19 deaths including a member of care staff.

Critical care capacity for COVID-19 within ELHT is beginning to increase

Latest national modelling for the impact of COVID-19 suggests that the peak of COVID-19 cases will

hit all areas during week commencing 14th

April 2020, and despite the national lockdown measures,

this peak will create more demand for critical care capacity and hospital admission than is currently

available

Our latest local modelling still currently suggests that a potential peak for infection in Pennine

Lancashire will be towards 19th

to 26th

May 2020 (week 9 and 10 on the graph below – 07/04/20 is

week 3 on the graph). However, there is some data, such as our current mortality rate, which

suggests we may be more progressed by at least one to two weeks, which would obviously see a

peak towards the end of April / start of May. There are still a number of unknowns within the

trajectory, which will continue to be refined.

It is however clear that it is highly likely that by 21st

April critical care capacity and hospitalisation

rates will exceed our local capacity and we will need to both ensure that we have a structure and

alternative capacity to support patients no longer prioritised for acute hospital admission, and an

ability to discharge appropriate patients within 1 hour in every case to support the optimum use of

acute facilities.

Fig 1 – Current COVID-19 trajectory for hospitalisation and critical care need in Pennine Lancashire - week 3 is 07/04/20 (as of 04/04/20)

Current position

We agreed as a system last week to commission an initial model in support of care home discharge

with the re-utilisation of 17 beds at Rakehead (Burnley GH site) for a COVID+ / COVID? cohort

facility for patients who are clinically safe to be discharged from the acute hospital who normally

reside in residential / nursing care facilities and who cannot for whatever reason, return to their

normal place of residence on safety grounds at that point. This has been augmented by a block

purchase of 20 General Nursing and EMI Nursing beds at Dove Court care home (Burnley) to support

non-COVID pathways of Discharge to Assess (D2A) alongside the current localised model.

Latest data shows we have around 3,800 adults across Pennine Lancashire who live in 24/7

supported care accommodation, who are at particularly high risk from COVID-19.

Proposed action

That the health and care organisations move rapidly to scope the need and identify one or more

further specific cohort sites in Pennine Lancashire, where additional bed capacity can be created to

provide support for people in an out of hospital setting, when critical care and overall hospital

capacity within Royal Blackburn Hospital is exceeded.

Recommendations

It is recommended that a Pennine Lancashire Transitional Care Cell is created as a matter of urgency

on Monday 6th

April. The purpose of this cell will be to:

Scope the likely level of need for additional capacity and identify one or more specific sites in

the Pennine Lancashire area, where additional bed capacity can be created to meet the

anticipated demand.

Ensure adequate staffing can be delivered to support this model and put transitional care

pathways in place between the ELHT, Regulated care sector, Domiciliary care providers and

Primary and Community care.

Agree to the cell being led by Alex Walker (Director of Performance and Delivery, CCG) with

senior staff identified and deployed to the cell from each partner organisation (ELHT, LSCFT,

BwD and LCC LAs).

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Pennine Lancashire: Hospital and Critical Care

Hospitalisation

Critical Care

The cell should report into the Pennine Lancashire Out of Hospital cell but should be given

sufficient autonomy to identify sites, initiate negotiations within an agreed process for

accelerated sign off and decision making.

Alex Walker

Director of Performance and Delivery

06/04/2020

Proposal Agreed:

Dr Julie Higgins

Joint Chief Officer, Blackburn with Darwen and East Lancashire CCGs and Chair Pennine Lancashire

Out of Hospital Response Group

10.55am, 6th

April 2020



COVID 19



Wednesday, 15 April 2020 - Virtual Consideration

Agenda Item : 7

Wavering of SFIs for Procurement of Essential Equipment / Enabling Tools.

For: Ratification

Decision/Action taken by: CCG Chairs, Accountable Officer and supported by Audit Chairs

Supported by (AO / lead exec) Kirsty Hollis / Roger Parr

Date of Decision / Action : 8th April 2020.

Details (include any financial implications / risks): As described by the Reducing the Burden document and to speed up the process of procurement for essential equipment / enabling tools (such as, but not limited to computers and remote access) during the COVID-19 pandemic, to reduce the requirement for sourcing multiple quotations or tenders and for undertaking single tender waivers on COVID-19 related expenditure ONLY for and initial period of 12 weeks from 06th April 2020. Risk that CCG may not achieve the best price possible for the items, but urgent supply and demand at this time will play a key factor in securing receipt of goods. Sense checks will be carried out by our procurement team and advice taken as to reasonableness of the quoted prices.


Date and Time



COVID 19



Wednesday, 15 April 2020 - Virtual consideration:

Agenda Item: 8

Community DVT Service

For: Ratification

Decision/Action taken by: Urgent Care Cell

Supported by: Alex Walker (Executive Lead) Dr David White (Clinical Lead)

Date of Decision / Action : 09.04.2020

Details (include any financial implications / risks): On 18th March 2020 a paper was due to be presented at Governing Body, seeking approval for a 2 stage procurement of the Community DVT Services in both East Lancashire CCG and Blackburn with Darwen CCG. The existing contracts are due to expire at the end of September 2020. The present circumstances around COVID-19 resulted in the paper not being considered by Governing Body. The paper recommended a 4 month extension to the current contract, to the end of January 2021, with the new service being in place by February 2021. Prior to the paper being submitted to Governing Body, the paper was presented at SMT (04.02.20), SMM (12.02.20) and CiC (19.02.20). Given the on-going position with COVID-19, the CCGs will not be in a position to go out to procurement as intended in the original paper. In collaboration with procurement, a new draft timetable has been prepared; and a 10 month extension to the current contract until to the end of July 2021 is requested. It is difficult to pre-empt when it would be possible to commence the procurement, however Governing Body is requested to approve the longer extension of the existing contracts for a period of 10 months, to enable the CCG to be in position to go out to procurement, as well allowing potential bidders to be engaged in the process and have time to submit a quality bid. This extension is supported by Alex Walker as Executive Lead, and Dr David White as Clinical Lead. Financial Implications: It is intended to extend the current contract on the same terms and conditions. The contract extension will run into a new financial year, which will be subject to national inflationary uplift for 2021/22, the value of which will be confirmed in future planning guidance.



Risks: The extension is reliant on the current provider being agreeable to extending the existing contract on the same terms and conditions. Previous extensions have been agreed by the current provider; however costs had to be negotiated. Challenge from potential bidders regarding the 10 month extension. Procurement have advised that the draft timetable would mitigate any risks of challenge from potential bidders opposing the extension, for either the extension being too long, or not enabling potential bidders sufficient time to be engaged and submit a quality bid.

Governing Body Decision/Recommendation: Governing Body is requested to approve the longer extension of the existing East Lancashire CCG and Blackburn with Darwen CCG Community DVT Service contracts, for a period of 10 months, to enable the CCG to be in position to go out to procurement, as well allowing potential bidders to be engaged in the process and have time to submit a quality bid.

Date and Time:

V:\Universal\Pennine Lancashire\COVID19\Business Continuity\Virtual Governing Body Meetings\15 April 2020\Admin\9. Summary of Key ICC Decisions.docx


COVID-19

Report to Governing Bodies : Wednesday, 15 April 2020

Summary of Pennine Lancashire CCGs Incident Room Key Decisions AGENDA ITEM : 9

Decision

Ref.

Brief Description What the decision is? Overseeing Forum

125 Mutual Aid Protocol Agreed and distributed Senior Directors Command Cell (11am 23/03)

Seven day working Agreed to commence on 30.3.20 (subject to HR sign off)

Senior Directors Command Cell (3:30pm 24/03)

New laptops for Primary Care Teams

SD’s supported. Kit ordered.


Medical Director Roles for PL CCGs

Governing Bodies and both Chairs agreed that Dr Mark Dziobon is the Interim Medical Director for Blackburn with Darwen with Dr Qashuf Hussain as his deputy. Dr Santhosh Davis will be his deputy for East Lancashire CCG.


128 LTH laptop support As an interim arrangement it was agreed to support LTH request for 15 laptops to support front line services – these will be replenished once LTH receive their delivery


144 Temporary arrangements for nursing care for residents of dual registered homes

SD’s supported a request for funding to reduce the footfall in Care Homes for 6 weeks for nursing staff to look after nursing residents to alleviate District Nurses who will the support in the Community.

Senior Directors Command Cell (11am 27/03)


157 Primary Care PPE The SDs agreed for urgent communications to go to practices outlining that the CCG has to operate within national guidelines however they will support the financial reimbursement for practices who have ordered protective equipment via their own procurement route, where they have not already received a supply. PCNS are supporting this. Dates for when the PPE for Lancashire will be delivered are not known.


Extended access closures Dr Julie Higgins confirmed she had approved the decision to close extended access.


Medicines Support Team Proposal regarding the allocation of the medicines support team at ELHT. Currently they are providing support into discharge medications for East Lancs CCG patients only therefore BwD CCG patients are not being discharged as quickly. Execs approved the decision that the medicines support team will provide the same support for BwD CCG patients.


Burnley General Hospital OOH

SDs supported a request to close the Burnley General Hospital Out of Hours (in order to consolidate workforce in the out of hours provision from ELMS). Numbers of patients attending BGH OOH has reduced and there were no attendances the previous evening. To be reviewed in three to four weeks.


Walshaw House Administrative Hub

SDs approved for PCNs to use of office space at Walshaw House to enable them to continue to provide administrative hub for a period of 1-3 months.


Swabbing in Care Homes SDs agreed to continue to use NE Guidance document as mitigation for facilitating swabbing in care homes (despite being advised not to use guidance in NW that is provided by other regions). There is currently no guidance provided by NW PHE.


ELMS – EMIS access SDs support ELMS laptop purchases and EMIS access to support the establishment of the acute visiting service and to allow for access to patient records.


174 Big White Wall SD’s supported the proposal for commissioning IAPT Services for 6 months (with an option to extend). The EL CCG specific paper was shared acknowledging that it will be funded by national ‘COVID funding’. BwD Borough Council already commission this service on behalf of BwD residents


182 Direct access to ELMS SDs agreed that healthcare professionals will have direct access to ELMS (rather than going through NHS 111).


Revised Scheme of delegation for IPA to support COVID-19 Hospital Discharge.

SDs supported the proposal to request a change to the CCG Scheme of Delegation applicable to the IPA service provision by MLCSU. This is to facilitate the faster discharge of patients from hospital during the COVID19 Emergency Period.



186 Procurement of beds at Dove Court Nursing Home, Burnley. Proposal that CCG block purchase all 20 beds for an initial period of 13 weeks.

Proposal supported - all relevant Providers advised that the development is supported and to progress mobilisation immediately.


Community Pharmacists Proposal to support with £400 per drugs £150 call out fee £50 for call out – per pharmacy. At least seven required one in each locality for response rates. Now secured 21 pharmacies to hold additional stock across Pennine Lancashire


189 Procurement Policy SDS agreed to support payment for suppliers’ activity based pay regularly, based on average activity and that there will still be services in place to refer patients to after COVID.


210 Overtime: Local Agreement whilst under COVID 19

SDs approved changes to overtime arrangements. Ordinarily overtime payments are not permitted for band 8a and above. However, it is recognised that during these challenge times overtime may be paid to these bands but only where additional activity relates specifically to the management of Coronavirus (COVID-19). In these circumstances where overtime is necessary for band 8a and above it has been agreed the overtime will be paid as plain time. This is in line with other the provision taken by other NHS Trusts locally (i.e. plan time, specific to COVID-19).


215 Staff swabbing SD’s agreed to support the proposal around staff swabbing and the use of the Pennine.ICC mail box to receive results. 60 swabs a day can be offered at ELHT (with 20 allocated to staff). Priority given to GPs then Community Pharmacists.


Donated PPE goggles SD’s agreed the distribution of 250 pairs of goggles via LCC (Tony Pounder and BwD BC / Sayyed Osman) 06

th and 7

th April.


178/179 Crisis and Home Treatment for CAMHS

SD’s supported the redirection of some of the CAMHS transformation funding to support Crisis and Home Treatment.


RECOMMENDATION : Members are asked to support the decisions made and receive the report for assurance.

DATE & TIME :

COVID 19 - NHS Blackburn with Darwen CCG · Mr G Burgess Dr A Black Dr N Horsfield P Hinnigan Dr Q...

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