Governing Body · 2016. 8. 12. · Governing Body To be held on Thursday 18 August 2016 Commencing...

Governing Body

To be held on Thursday 18

th August 2016

from 12.30pm until 3.30pm

in the Boardroom, Sovereign House, Heavens Walk, Doncaster DN4 5HZ

Governing Body

To be held on Thursday 18 August 2016 Commencing at 12.30pm – 3:30pm

In the Boardroom, Sovereign House, Heavens Walk, Doncaster, DN4 5HZ

PUBLIC AGENDA

Presenter Enc

1. Welcome and Introductions

Chair

2. Apologies

Chair

3. Declarations of Interest

Chair

4. Patient Stories / Questions from Members of the Public (Please see our website for guidance on how to submit question/story requests)

Chair

5. Minutes of the previous meeting held on 21st July 2016

Chair Enc A

6. Matters Arising

Chair

7. Strengthening Financial Performance and Accountability

Mrs Pederson/ Mrs Tingle

Presentation

Strategy

8. Children’s Services (Surgery and Anaesthesia)

Mrs Sherburn Enc B

9. Future hosting model for Previously Unassessed Periods of Care (PUPoC)

Mrs Shepherd Enc C

Assurance

10. Quality & Performance Report

Mrs Shepherd/ Mr Fitzgerald

Enc D

11. Corporate Assurance Report – Quarter 1

Mrs Atkins Whatley

Enc E

http://www.doncasterccg.nhs.uk/about-us/public-meetings/

Standing Items

12. Chair & Chief Officer Report

Mrs Pederson Enc F

13. Policies for approval Standards of Business Conduct & Conflicts of Interest Policy

Mrs Atkins Whatley

Enc G

Items to Note / Receipt of Minutes

14. Items to Note Finance Report

Mrs Tingle

Enc H

15. Receipt of Minutes from Committees

Audit Committee – Minutes from the meeting held on 14th

July 2016 will be received in September 2016. Quality & Safety Committee – Minutes from the meeting

held on 7th July 2016 will be received in September 2016.

Engagement & Experience Committee – The Minutes

from the meeting held on 7th July 2016 will be received in

September. Primary Care Commissioning Committee – Minutes

of the meeting held on 16th June and 14

th July 2016.

Executive Committee – Minutes of the meeting held on 6th

July 2016

Chair Enc I

16. Any Other Business

Chair

17. Date and Time of Next Meeting Thursday 15th September 2016 at 12.30pm

Chair

18. To resolve that representatives of the press, and other members of the public, be excluded from the remainder of this 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 1960.

Chair

Enc A

Minutes of the previous meeting

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Minutes of the Governing Body Held on Thursday 21st July 2016 commencing at 12.30pm

In the Boardroom, Sovereign House Members Present:

Dr David Crichton – NHS Doncaster CCG Chairman (Chair) Miss Anthea Morris – Lay Member and Vice Chair of the Governing Body Mrs Linda Tully – Lay Member Dr Emyr Wyn Jones – Secondary Care Doctor Member Dr Sam Feeney – Locality Lead, Central Locality Dr Jeremy Bradley – Locality Lead, North East Locality Dr Andy Oakford – Locality Lead, North East Locality Dr Niki Seddon – Locality Lead, North West Locality Dr Pat Barbour – Locality Lead, South East Locality Dr Khaimraj Singh – Locality Lead, South East Locality Dr Lindsey Britten – Locality Lead, South West Locality Dr Karen Wagstaff – Locality Lead, South West Locality Mrs Jackie Pederson – Chief Officer

Formal Attendees present

Mrs Sarah Atkins Whatley – Chief of Corporate Services Mr Anthony Fitzgerald – Chief of Strategy & Delivery Mrs Ailsa Leighton – Deputy Chief of Strategy & Delivery – Urgent Care Dr Rupert Suckling – Director of Public Health Mrs Deborah Hilditch – Healthwatch Representative (Attending on behalf of Mr Stephen Shore)

In attendance:

Mrs Jayne Satterthwaite – PA (Taking Minutes) Mr Andrew Russell – Deputy Chief Nurse (Attending on behalf of Mrs Shepherd) Mr Stephen Shore – Healthwatch, (Item 7) Mr Andrew Goodall – Healthwatch, (Item 7)

ACTION

1. Welcome and Introductions Dr Crichton welcomed everyone to the Governing Body meeting and introduced Mr Anthony Fitzgerald, our newly appointed Chief of Strategy & Delivery and introductions were made around the table. There were 8 members of the public in attendance at the meeting.

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2. Apologies Apologies were received from:

Dr Marco Pieri – Locality Lead, North West Locality

Mrs Hayley Tingle – Chief Finance Officer

Mrs Mary Shepherd – Chief Nurse

Mrs Laura Sherburn – Chief of Partnerships Commissioning and Primary Care

Mrs Kim Curry – DMBC Representative

Mr Ian Carpenter - Head of Communications & Engagement

3. Declarations of Interest There were no declarations of interest made.

4. Questions from Members of the Public/ Patient Stories Patient Story There was no Patient story or questions from Members of the Public.

5. Minutes of the Previous Meeting held on 16th June 2016 The minutes of the meeting held on 16th June 2016 were agreed as an accurate record subject to the following amendment: , Paragraph 3, Line 3 – amend ‘isolate’ to read ‘insulate’. Minutes of the Extra Ordinary Governing Body meeting held on 26th May 2016 The minutes of the meeting held on 26th May 2016 were agreed as an accurate record.

6. Matters Arising Continuing Healthcare consent to share records Mr Russell confirmed that records are available for GPs to view if necessary and stated that Mr Boldy continues to work with Mrs Tyler on this matter. Dr Crichton reminded Locality Leads to feed this information back to their Localities. System Resilience Funding Locality Leads have given feedback to their Localities that there will be no national System Resilience Funding support this year.

Locality Leads

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Working Together Joint Commissioning Proposal Mrs Atkins Whatley confirmed that this has been taken forward following the Governing Body approval of the principles of establishing a Joint Committee. Chair and Chief Officer Report – Constitutional changes and Member Engagement Mrs Atkins Whatley confirmed that an email and the paperwork regarding the Member Engagement Models had been circulated to the Membership.

7. Healthwatch Presentation Mr Shore, Mrs Hilditch and Mr Goodall from Healthwatch gave a presentation to the Governing Body and highlighted the following points:

Their purpose, vision and values as an independent Community Interest Company.

The Strategic and Operational work to date.

Future Strategic Plans which include the following: o An active strategic partner on Health and Wellbeing Board. o Representation for patient, service user and carer voice on the

design and delivery of community health services, acute health services, mental health services and social care services.

o Strengthening strategic relationships with Commissioners and Providers of local health and social care services.

o Aspirations to lead on engagement and involvement for the South Yorkshire and Bassetlaw Sustainability and Transformation Plan.

Future Engagement Plans including: o Developing thematic model for continuous improvement of

services based on insights from 100+ patient stories regarding DBH service provision and 90+ stories relating to social care provision via the digital feedback centre.

o Co-ordination and development of the Keeping Safe Forum to support Doncaster’s Safeguarding Adults Board.

o Expansion of Young Healthwatch and work with the Deaf community.

o Growth of the Healthwatch Doncaster Digital footprint to support partnership work and our own engagement plan.

o Continued implementation of our community engagement plan. o Canvassing patient and public opinion in local communities and

Doncaster town centre – Healthwatch Doncaster has a licence to distribute information and engage in conversations to gather patient and public stories about their experiences of health and social care services.

o Developing affiliate Healthwatch Doncaster membership from the Third, Private and Statutory Sectors

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Dr Oakford queried the Healthwatch strategy to reach the ‘silent majority’ groups. Mr Goodall stated that the intention is to develop a wider network and to appoint a key volunteer to access all groups. Mrs Pederson noted that the Doncaster Children’s Trust had not received reference and suggested that it would be beneficial to include the Trust in their future strategic and engagement plans. Dr Barbour explained that she is the Clinical Lead for Children’s services and is currently embarking on a piece of work regarding ‘Facing the Future’ for children with mild to acute illnesses. A Strategy Group has been established to oversee the transformation and queried if, as there was a vacant position on the Group, it was appropriate to approach Healthwatch. It was agreed that Dr Barbour liaise further with Healthwatch. The Governing Body requested that the presentation be circulated to Members. Dr Crichton thanked Healthwatch for the presentation. Post Meeting Note Mrs Satterthwaite circulated the presentation to the Governing Body on 28th July 2016.

Dr Barbour

Mrs Satterthwaite

8. Hyper-Acute Stroke Service Option Appraisal Mrs Pederson explained that over the past eighteen months CCGs have undertaken a review of Hyper-Acute Stroke services across South Yorkshire, Bassetlaw and North Derbyshire as Commissioners Working Together. The current model of delivery for Hyper-Acute Stroke services (HASU) is delivered from 5 units in Barnsley, Chesterfield, Doncaster, Rotherham and Sheffield.

Key messages from the review are:

3 out of 5 HASU centers admit less than the best practice minimum of 600 per unit.

There is a shortage of medical, nursing and therapy staffing.

Door to needle time of over 1 hour in most places.

Low thrombolysis rates across all providers.

Not achieving 1 hour scanning time.

Unsustainable medical rotas.

Gaps in early supported discharge.

Education and training required for delegated staff.

Delays in Endarterectomy. The review was shared with the Yorkshire and the Humber Senate who supported our findings and recommended that our review was considered in context of the full regional picture and any potential impact.

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In June 2015, CCGs supported the case for change with a clear mandate to develop options for future service delivery and the Yorkshire and the Humber Strategic Clinical Network (SCN) took forward the development of a ‘Blueprint’ for HAS across Yorkshire and the Humber. The principle of the Blueprint was to provide a high level overview of what would provide clinically safe and sustainable HAS services and ensure the best equity of access for all our local populations. A summary of the reconfiguration in South Yorkshire and Bassetlaw should include:

A plan to reduce the number of HAS within the South Yorkshire and move to a minimum of 2 units.

Consider the cross-boundary impact and East Midland review for Chesterfield unit.

Transformation should include a review of patient flows.

No centre should exceed the maximum stroke numbers of 1500.

Best practice average time of 45 minutes.

Steps to improve clinical outcomes and provide sustainable stroke services.

Reconfigure total number of HAS (services should deliver a minimum of 900 interventions per year) to support clinical outcomes and improve performance seen in the SSNAP reports.

The final June recommendations in the SCN Blueprint for Hyper-Acute Stroke now recommends that for South Yorkshire and Bassetlaw for HAS services should include consideration of the viability of reducing the number of HAS services to a minimum of 2. Commissioners Working Together have facilitated significant stakeholder engagement throughout the review process engaging in particular with providers and commissioners and other key partners via a series of workshops, engagement events and the stroke steering group between January 2015 and May 2016. Between January and April 2016, Commissioners Working Together, of which we are a partner, held an open pre-consultation for the review of Hyper-Acute Stroke services across South and Mid Yorkshire, Bassetlaw and North Derbyshire. Asking ‘what matters to you when accessing urgent stroke services’ the conversations were held face to face and across social media. Thousands of people accessed the website to read about the case for change, hundreds were involved in face to face discussions and several hundred responses were received. The key themes emerging were: being seen quickly when get to hospital, being seen and treated by knowledgeable staff, safety and quality of service, fast ambulance response/travel times and good access to rehabilitation services locally. A communication and engagement strategy for consultation has been developed for the next phase of this work and to enable us to progress to consultation with the public about proposed changes to HAS in the

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autumn. The development of the options appraisal framework to support improvements to the delivery of HASU has been undertaken working with the Stroke Steering Group, comprising of commissioners and providers from across our Working Together partners. The outcome of the options appraisal identifies a preferred option and it is proposed that we consult the public on this preferred option which is that we will move from a 5 Hyper-Acute Stroke Unit’s model to a 3 unit model in the first stage and that Hyper-Acute Stroke will be provided at Sheffield, Doncaster and Chesterfield. A full business case with detailed financial analysis is currently being developed based on the outcome of the options appraisal and will be completed in the next 2 months.

Mrs Pederson requested that the Governing Body note the progress of the work, support the preferred option to move from a 5 unit to a 3 unit model to consult the public on, and agree to receive the full business case with recommendation for change for final Governing Body approval, following formal consultation, in January 2017. Dr Oakford queried if the 45 minute access was the best case scenario. Mrs Pederson stated that 95% of patients should be able to access a Hyper-Acute Stroke Unit within the 45 minutes however would clarify this. Mrs Hilditch enquired if consultation was across South Yorkshire. The engagement will take place in discrete areas. The Governing Body noted the work progress, supported the option to move from a 5 unit to a 3 unit model for public consultation, and to receive a full business case at a future meeting.

Mrs Pederson

9. Chemotherapy Delivery Model Case for Change Mrs Pederson informed the Governing Body that South Yorkshire, Bassetlaw and North East Derbyshire have some of the poorest survival rates for cancer in Yorkshire and the Humber and are below the England average for both one and five year survival . It is clear from the ’Achieving World-Class Cancer Outcomes - A Strategy for England 2015–2020’ that there is an expectation that all cancer treatment services will be required to be sustainable and cost effective in the longer term, whilst flexing to meet patient demand and expectation. In December 2014, discussions took place in the South Yorkshire, Bassetlaw and North East Derbyshire Cancer Strategy Group (CSG) regarding the ongoing issues with the current provision of Chemotherapy Outreach in the locality, which had not been addressed to a satisfactory conclusion despite enthusiasm to do so from the commissioners and providers of the services. These being:

Inequitable regimes at the outreach locations.

Oncology recruitment and workforce pressures to support the

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current model(s).

The fit with long term commissioner plans.

Meeting the long term patient demand whilst remaining value for money.

Papers were presented to the CSG throughout 2015, outlining the ongoing issues with the current model and a subsequent review identified the following options:

Do nothing.

Retain current model, implementing best practice across all outreach localities.

Assess and review the needs of South Yorkshire, Bassetlaw and North East Derbyshire to inform and implement a new model.

Mrs Pederson requested that the Governing Body approve the recommendation of the review to progress with Option 3. Dr Suckling highlighted that the Chemotherapy model is part of many that are being delivered and that we must be mindful that Outreach Chemotherapy may be more expensive. Dr Feeney queried if there were any future plans regarding Radiotherapy treatment. Mrs Pederson stated that Dr Pieri is keen to encourage this going forward. The Governing Body agreed the progression of Option 3.

10. Local Digital Roadmap Mr Clayton gave the following presentation regarding the Local Digital Roadmap and requested that the Governing Body give its endorsement to the Roadmap:

All CCGs were required to identify a Digital Roadmap Footprint by 31st October 2015, which could include one or more CCGs. Local Digital Roadmaps detail how local health and care economies will achieve the ambition of being paper-free at the point of care by 2020. A Doncaster Footprint was agreed and was submitted on 30th June 2016.

The Digital Roadmap overlaps with other initiatives such as Sustainability and Transformational Plans, CCG Improvement and Assessment Framework, the National Implementation Board programme and the launch of NHS Improvement.

The Doncaster Digital Roadmap partners include NHS Doncaster CCG, 43 General Practices, Doncaster Children’s Trust, Doncaster Metropolitan Borough Council (DMBC), Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH), Doncaster and Bassetlaw Hospitals NHS Foundation Trust (DBHFT) and the Fylde Coast Medical Services (FCMS).

The content of the Roadmap includes a vision for digitally enabled

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transformation, capability deployment, a universal capabilities deployment plan, the baseline position, a readiness assessment, information sharing infrastructure and minimising risks arising from technology.

There is strong support from organisation leaders to deliver the integration, recognition by Informatic departments of the need to connect systems and infrastructure, to adopt an open and honest approach by all partners and the potential for considerable improvement.

All local partners are taking the Roadmap through their own Governance processes for endorsement. It will be received by the Health & Wellbeing Board on 1st September 2016. NHS England will review roadmaps throughout July and they will be assessed as ‘Investment ready’ or ‘Not Investment ready’. Those roadmaps which receive a classification of ‘Not Investment ready’ will receive support to revise for resubmission in November 2016. Feedback will be provided in August. Bids for national funding are expected to take place during late 2016.

The Interoperability Group will oversee delivery and the establishment of an Interoperability Sub-group is being considered. A resourced plan is to be developed and local priorities to be agreed.

Dr Crichton commented that this is an ambitious plan and that it is important for data to be shared across health and social care. Mrs Pederson commented that it is anticipated that our Roadmap will receive a rating of ‘Investment Ready’. Dr Seddon acknowledged that it would be a huge undertaking for the Acute Trust to become a paperless organisation and queried if we have details of how this may be achieved. Mr Clayton stated that he was unsure as he did not have any details however we would need to give support as necessary. Dr Feeney highlighted the need for Pharmacy and Optometry involvement. Dr Crichton informed the Governing Body that there is a realisation that the CCG may not receive all the funding therefore compromises will need to be made. The Interoperability Group meetings have been established to oversee delivery and the monitoring of the Local Digital Roadmap. He and Mrs Pederson attend along with Dr Singh, Governing Body GP Member and Dr Rumit Shah of the Local Medical Committee (LMC). The Governing Body endorsed the Local Digital Roadmap and supported the direction of travel.

11. Finance Report Mrs Wyatt apologised for an error which had been made, the report provided an update on the financial position as at the end of May 2016 and not June. At this early stage in the year the CCG is forecasting to

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achieve all of its financial targets for 2016/17. The year to date position reflects a surplus of £1,289k which is consistent with the year to date target of £1,287k. The annual target is a surplus of £7,722 which the CCG is forecasting to achieve at this early stage in the year. Limited information is available from providers yet but as information starts to come through the position will be updated. The largest financial risks identified as part of the Financial Planning process were Prescribing and High Cost Drugs. Work to address the variations in both outcomes and costs will be taken forward as part of the Primary Care Strategy, specifically the medicine optimisation work. A prior approval process has been initiated with the Acute Trust and implemented from 1st April 2016; this will address any non-compliance with both NICE guidance and correct charging through the PbR tariff mechanism. Other risks identified include the over performance on acute contracts, increased Individual placements (including Continuing Healthcare, Specialist Placement and Section 117 packages). The Funded Nursing Care (FNC) rates for Care Homes have been released in the last week and an increase by 40% has been noted, this relates to an increase of £600k per year. NHS England is collating the impact for CCGs and more information will be reported to the Governing Body in August 2016 and the non-delivery of parts of the efficiency savings has also been identified. If the efficiency savings fail to deliver there will be increased pressure on the CCGs statutory duty to breakeven. To help manage and offset these risks a small contingency fund of £2.2m has been established. This equates to 0.5% of the CCG’s allocation and is in line with planning guidance. If this is insufficient the following actions would need to be considered;

Seeking further efficiencies and decommissioning opportunities

Risk sharing with other CCGs

Seeking repayable financial assistance from other NHS organisations.

Seeking further support from NHS England In previous years flexing of investment funds have supported mitigation to manage unexpected risks however this is not an option for 2016/17. Efficiency Savings Programme - All contract values negotiated with providers are net of efficiency saving targets where appropriate. The targets for the high level efficiency plans are phased to assume delivery in the latter half of the year and savings will be reported from Quarter 3. Progress in relation to the Right Care work streams including prescribing will be reported each month to outline any risks to delivery as they arise. Better Care Fund - The overall plan has been agreed and submitted to NHS England and the fund remains broadly the same as last year at £23,907k. The governance structure surrounding the Better Care

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Fund has been reviewed and more detailed monitoring will take place in 2016/17. Dr Oakford asked if a further tranche of cases for Previously Unassessed Periods of Care (PUPoC) was expected. Mr Russell stated that the current system and processes are robust however no decision has been made regarding a further tranche. The Governing Body noted the report.

12. Assurance Framework – Quarter 1 Mrs Atkins Whatley presented the Assurance Framework Quarter 1 report. The Assurance Framework has been refreshed during the last Quarter and the position is presented as at quarter-end. There have been no new risks added to or removed from the Framework and the total number of risks on the Framework at quarter-end therefore stands at 20. Of these risks, three are being treated. Risk 1.4 relating to the challenging financial position for 2016/17, and Risk 2.4 relating to provider performance are at a score of 12 which is above the CCG’s risk toleration threshold. Risk 1.3 on health inequalities remains below the risk toleration threshold but continues to be treated to further strengthen existing controls / assurances. The key points from this report to which the Governing Body’s attention were particularly drawn are: Health inequalities (Risk 1.3): RISK BEING TREATED

This risk remains at a score of 8 (below the risk toleration threshold) but is being treated to strengthen controls and assurances with an action to “work in partnership with the Health & Wellbeing Board to identify inequalities and address these in partnership in line with the Health & Wellbeing Board Strategy”.

In the last Quarter an engagement session with Governing Body members on health inequalities was developed and it was run at the May meeting of the Strategy & Organisational Development Forum.

It has been agreed that a health inequalities plan will be developed focussing on performance data, reducing unwarranted variation in primary care, and seeking to better understand the health needs of our black, asian and minority ethnic population in Doncaster.

Work is taking place jointly with public health team members from Doncaster Council over the summer to develop these workstreams into an action plan, which we intend will then be combined with our existing Equality Strategy.

Efficiency programme (Risk 1.4): RISK BEING TREATED

A change to the national business rules for CCG allocations has resulted in an extremely challenging financial position for CCGs in 2016/17, which we have assessed in Doncaster could affect our local achievement of financial targets and our system transformation plans.

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The risk remains at a score of 12 (above the risk toleration threshold) and is being treated with an action plan to “develop and implement an efficiency programme aligned to the Right Care analysis, impact assess this against our transformation plan, and monitor progress throughout the year”.

Based on the national Commissioning for Value packs and tools, four local workstreams have been initiated in the areas of Respiratory, Endocrine, Neurology, and Musculoskeletal, and clinical leaders have been identified to these workstreams. We are also focussing on quality and value in prescribing, and July has seen the launch to General Practice of a prescribing gain-share scheme approved by the Primary Care Commissioning Committee. These areas form the basis of our efficiency programme in 2016/17. Progress will be reported to the Governing Body as the workstreams develop.

Performance management (Risk 2.4): RISK BEING TREATED

This is an ongoing risk which the Governing Body keeps sight of on the Assurance Framework. This risk remains at a score of 12 (above the risk toleration threshold) and it is being treated with an action to “continue to take all contractual and partnership measures available to the CCG to ensure provider performance is brought back on track for key performance targets”.

The Governing Body receives monthly Quality & Performance reports which identify performance areas which are off trajectory. The transformation programmes approved by the Governing Body aim to address the underpinning system issues and support care closer to home. Additional remedial action on performance issues is reported to the Governing Body e.g. in response to the pressures on the NHS system associated with Junior Doctor industrial action and ongoing performance issues nationally in urgent care systems and Ambulance Services. The risk is being maintained at its existing score and progress will continue to be reported to Governing Body through the Quality & Performance Report.

Cross-references to our new governance meeting structure, which was enacted from 1 June 2016, have also been updated within the Assurance Framework. During the last presentation of the Assurance Framework, Governing Body members suggested that consideration be given to including on the Assurance Framework or Risk Register the potential risks associated with the CCG hosting Continuing Healthcare Services on behalf of partner CCGs. Reference to this risk has been added to the Risk Register. Dr Feeney queried the definition of a high risk. Mrs Atkins Whatley explained that the formula used is ‘the consequence’ x ‘the likelihood’ = the risk score and offered to liaise with Dr Feeney outside of the meeting to explain this further. Dr Feeney also observed that prescribing was not included as an individual risk. Mrs Atkins Whatley stated that prescribing had not been added specifically but had been

Mrs Atkins Whatley/

Dr Feeney

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included within the Efficiency Programme risk. Post Meeting Note Mrs Atkins Whatley and Dr Feeney have subsequently discussed the risk scoring methodology.

13. Chair & Chief Officer Report Mrs Pederson presented the joint report and highlighted the following:

Planning Update - The draft Sustainability & Transformation Plan (STP), which has been developed across a South Yorkshire & Bassetlaw footprint, has been submitted to NHS England as part of the first ‘checkpoint’. NHS England will provide feedback to help us to continue to build on the draft plan, with the next checkpoint expected in September 2016. NHS Doncaster CCG is working with providers on the Doncaster Place Plan and the creation of the Health & Social Care Integrated Care model. It is encouraging that all organisations are committed to working together on the ambitious plan.

CCG Improvement and Assessment Framework - In 2016/17, CCGs will be assessed by NHS England against a new Improvement and Assessment Framework (IAF) which replaces both the existing CCG assurance framework and CCG performance dashboard. The Framework aligns with NHS England’s Mandate and planning guidance, with the aim of unlocking change and improvement in a number of key areas. The new Framework comprises 4 domains:

o Better Health: how the CCG is contributing towards improving the health and wellbeing of its population, and bending the demand curve.

o Better Care: care redesign, performance of constitutional standards, and outcomes, including in important clinical areas – cancer, dementia, diabetes, mental health, learning disabilities and maternity care.

o Sustainability: how the CCG is remaining in financial balance, and is securing good value for patients and the public from the money it spends.

o Leadership: the quality of the CCG’s leadership, the quality of its plans, how the CCG works with its partners, and the governance arrangements that the CCG has in place to ensure it acts with probity, for example in managing conflicts of interest.

NHS Doncaster CCG has received a rating of ‘Good’. Mrs Pederson agreed to circulate the CCG Assurance Annual Assessment 2015/16 document to the Governing Body.

Post Meeting Note

Mrs Pederson

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Mrs Satterthwaite circulated the CCG Assurance Annual Assessment 2015/16 document to the Governing Body on 22nd July 2016.

Primary Care Engagement session – 30th June 2016 - On 30th June 2016 NHS Doncaster CCG coordinated a primary care engagement session on The Future of Primary Care in Doncaster: What it looks like and how we’ll get there. After a quick update from the CCG on the national & local direction of travel, a national Primary Care Commissioning (PCC) team led a practical session on what collaborative working might mean for Practices. This was an opportunity to consider the drivers for collaboration, the routes to successful joint working, and the importance of developing the vision. This was followed by a presentation from a GP who was already involved in federation in Camden: Creating your federation - the art of the possible. 41 of our 43 Member Practices were represented at the session, and in addition there was representation from Local Pharmaceutical Committee (LPC), the Local Medical Committee (LMC), the CCG and NHS England. The session has evaluated positively.

Refreshed Conflicts of Interest Guidance - To support CCGs to improve their management of conflicts of interest, revised statutory guidance from NHS England was issued in late June 2016 Managing Conflicts of Interest: Revised Statutory guidance for CCGs which supersedes Managing Conflicts of Interest Statutory Guidance (December 2014). The key changes set out in this latest update of the guidance are:

o The recommendation for CCGs to have a minimum of three lay members on the Governing Body, in order to support with conflicts of interest management. We can “share” Lay Members with other CCGs in our STP footprint, should we choose to.

o The introduction of a conflicts of interest guardian in CCGs. It is expected that CCG Audit Committee Chairs will assume this role, which will be an important point of contact for any conflicts of interest queries or issues. The role is the equivalent of the Caldicott Guardian role, and will work closely with the CCG Governance Lead. Miss Morris is the Conflicts of Interest Guardian for NHS Doncaster CCG.

o The requirement for CCGs to include a robust process for managing any breaches within their conflict of interest policy and for anonymised details of the breach to be published on the CCG’s website for the purpose of learning and development.

o Strengthened provisions around decision-making when a member of the governing body, or committee or sub-committee is conflicted. There is an expectation conflicts of interest will be considered in advance of meetings, that minute takers will record all conflicts and how they were managed in a set format, and that any declared interests will be added to the

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central register of interests.

o Strengthened provisions around the management of gifts and hospitality, including the need for prompt declarations and a publicly accessible register of gifts and hospitality. Any gift under the value of £10 may be accepted and doesn’t have to be declared, as can modest hospitality in line with what the NHS would offer. What cannot be accepted is cash or cash equivalents, gifts/hospitality over the prescribed “£10 gift / modest hospitality” limit by existing or potential providers/suppliers, any hospitality over £25 a head, and any offers of foreign travel & accommodation.

o A requirement for CCGs to include an annual audit of conflicts of interest management within their internal audit plans and to include the findings of this audit within their annual end-of-year governance statement. The first quarterly report is due in September 2016. The annual audit by Internal Audit must take place in Quarters 3 or 4 (NHS England will publish a template). The quarterly and annual audits will form part of the CCG Improvement & Assessment Framework.

o A requirement for all CCG employees, governing body and committee members, and practice staff with involvement in CCG business, to complete mandatory online conflicts of interest training, which will be provided by NHS England. The online training will be supplemented by a series of face-to-face training sessions for CCG leads in key decision-making roles. There will be three different levels of training depending on the person’s level of influence on CCG decision making.

Further statutory guidance is expected later in the year to cover new care models and integrated care organisations. Our Standards of Business Conduct & Conflict of Interest Policy will now be revised in line with this refreshed statutory guidance, and will be received by the Governing Body at a future meeting.

Annual Audit Letter 2015/16 and Audit Committee Annual Report - Our External Auditors, KPMG, have issued their Annual Audit Letter which summarises the key issues arising from their 2015/16 audit. Although this letter is addressed to the Members of the Governing Body of the CCG, it is also intended to communicate these issues to external stakeholders, such as members of the public, and will be published on our website. The letter concludes that the CCG has put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources, and that the accounts give a true and fair view of the financial affairs of the CCG and of the income and expenditure recorded during the year. There were no significant adjusted or unadjusted audit differences that were identified as part of the audit. There were no significant matters which our External Auditors were required to report to those charged with governance. At its meeting on 14 July 2016, the Audit Committee received a Chair’s Annual Report on its activity as a Committee.

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The Governing Body noted the report.

14. Policies for Approval

Policy on Procedural Documents Mrs Atkins Whatley presented the Policy on Procedural Documents to the Governing Body for approval and explained that there had been minor changes to the policy as noted on the coversheet. The Governing Body approved the changes to the policy.

15. Items to Note

Quality & Performance Report - Mr Russell and Mr Fitzgerald stated that the Quality and Performance Report was for noting by the Governing Body. Dr Suckling highlighted the reduction in Improving Access to Psychological Therapies (IAPT) performance and stated that a Health & Wellbeing Workshop had been held in respect of Mental Health and that a range of actions had been raised as a result. Mrs Pederson commented that this will also be addressed within the RDaSH Strategic Contracting meetings. Mr Russell reported that the Care Home Strategy had been appended to the report for approval by the Governing Body following a presentation and discussion and the Strategy & Organisational Development Forum on 7th July 2016. The Governing Body approved the Care Home Strategy.

Minutes of the Commissioners Working Together Programme Board Meeting held on 26th April 2016 – The Governing Body noted the minutes.

16. Receipt of Minutes from Sub Committees The following draft minutes were received and noted by the Governing Body:

Audit Committee – The Draft Minutes of the meeting held on 14th July 2016 will be received in August.

Quality & Safety Committee – The Draft Minutes from the meeting held on 7th July 2016.

Engagement & Experience Committee – Minutes from the meeting held on 2nd June 2016. The Draft Minutes from the meeting held on 7th July 2016 will be received in August.

Primary Care Commissioning Committee – The Draft Minutes from the meetings held on 16th June and 14th Jul 2016 will be received

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in August.

Executive Committee – The Draft Minutes from the meeting held on 8th June 2016. The Draft Minutes from the meeting held on 6th July will be received in August.

17. Any Other Business There was no other business discussed.

18. Date and Time of Next Meeting 12:30pm on Thursday 18th August 2016.

19. It was resolved 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 1960.

Enc B

Children’s Service (Surgery and Anaesthesia)

Meeting name Governing Body

Meeting date 18th August 2016

Title of paper

Commissioners Working Together Programme: Review of Children’s Surgery & Anaethesia

Executive / Clinical Lead(s)

Laura Sherburn, Chief of Partnerships Commissioning & Primary Care

Author(s) Kate Laurance Head of Commissioning for Children Young and Maternity on behalf of the Working Together Programme

Purpose of Paper - Executive Summary

The purpose of this paper is to:

Summarise the work undertaken to date, by the Working Together programme on behalf of our CCGs, in reviewing Children’s Surgery and Anaesthesia across South Yorkshire, Bassetlaw and North Derbyshire.

Seek support from Governing Bodies on the options appraisal work and the emerging model of care.

Seek approval to move towards public consultation in the autumn on the preferred option outlined in the options appraisal document.

To agree to consider a full business case with recommendation for change for Governing Body approval

Background We know from the review and work undertaken to date that there is variation in provision, this can lead to a variation in the quality of provision available and potentially impact on clinical outcomes, as the care can vary dependant on where services are located. Referral thresholds to services also vary; therefore the patient journey and provision available will vary dependant on where services are accessed, and at what time, and on what day. There are problems with developing and sustaining workforce skills, as well as issues with the further development of the paediatric workforce for both anaesthesia and surgery. Clinicians are identifying that the current configuration is not consistent or sustainable in the short, medium or long term. The economic case for change is demonstrated in resource and cost pressure within the NHS overall and we know that. A needs assessment has been undertaken, which outlines the trajectory of need for future provision as well as some of the challenges to the current administrative data, workforce planning and measures of clinical outcomes. The solutions and size of change have been tested in an options appraisal around proposed future configuration of services across a tiered model of care. There would need to be a change in the provision; this could include changes in local access and where care is provided. A clinical task and finish group has been considering the specified standards of care and the options around organising services across a tiered model.

The project has been supported by the Yorkshire and Humber Strategic Clinical Network, which supported the service specification development through wider clinical engagement and supported the steering group overseeing the project. The work to date has also been referred to the Yorkshire and the Humber Clinical Senate for consideration and their recommendations have been taken on board and informed the next steps of development of both the overall case for change and the service specification specifically. The options for modelling the services have been appraised, and an emerging model is developing which requires change in provision from its current configuration. Key Messages for Governing Body Members:

The current configuration needs to change and the case for change was agreed by governing bodies in Autumn 2015.

The specification for provision has been agreed clinically and a designation toolkit has been developed to designate providers as part of a network across CCGs

A proposed model on future configuration has been drafted and considered by the clinical task and finish group, the basis of the model was clinically supported and now forms part of the options appraisal.

An options appraisal around a model has been drafted and appraised and is being discussed more widely.

A service model is emerging and needs considering as this will change pathways of care.

A managed clinical network has been funded for 16/17, as part of the provider working together vanguard to enable the mobilisation and implementation of change in line with the proposed service model.

Pre consultation is now complete and all CCGs and providers are engaged in the consultation and engagement plan for the next phases.

A full business case for mobilising change is being drafted, which will include proposals for contracting and commissioning intentions for 17/18 for CCGs.

Phases of work The outline of the approach to improve children’s surgery services for all our local populations is taking place in 3 phases. Governing Bodies will be consulted at each stage and at key milestones for their support and approval. The programme is still working within phase 2 of the plan. Phase 1 January 2015 – September 2015 - included The development of the case for change including:

Engaging with key stakeholders

Undertaking a baseline assessment of current services

Forming consensus of the issues

Identifying best practice models

Specifying the pathways that should be in place to meet standards

Exploring strengths and benefits of potential models

Considering our populations needs for the future

Seeking external clinical scrutiny of the work to date (Senate) Phase 2 October 2015 – September 2016 - current work plan The development of specification, options on a model and full business case including:

Implementation of communication and engagement strategy - Pre –engagement with patient and the public, key stakeholders (Health Overview and Scrutiny Committees) and staff

Enacting procurement advice, including a provider engagement event

Development of a service specification and gap analysis against existing provision

Development of options on a service model and assessment of options

Development of full business case including activity and financial impact

Formal consultation starts (ends December 2016)

Consideration of options to implement change Phase 3 October 2016 – March 2017 Consultation, implementation planning and mobilisation of preferred Option Critical factors to consider as part of the next phase of work

From the work completed to date we know that there are a number of issues that need consideration when thinking about changes, some of these issues have been raised from the clinical senate others from the task and finish group or local CCG commissioners.

The interface with the management of acute medical paediatrics is a vital consideration and forms part of both the planned care pathway and is a significant consideration for patients with unplanned surgery needs, and those needing overnight planned recover from a surgical episodes of care.

The impact on transport services needs further assessment and quantification in the proposed new model as entry points would change from the current configuration.

Cross border clinical pathway issues need further consideration and assessment, we would need to manage any impact of changes in the proposed model on clinical pathways already agreed throughout Yorkshire and Humber and across to East Midlands.

Contractual and financial changes in the proposed model need further consideration and assessment as part of the full business case.

The development of the work plan for the Managed Clinical Network as part of the implementation plan, as this will be a vital part of mobilisation and the enabler of sustainability of pathways of care in the future.

The development of common commissioning and contracting intentions as part of the full business case development.

5. Next Steps/Timeframe The project is now more widely discussing the options for a model, which is emerging following appraisal, and developing a business case for CCGs to consider as part of commissioning intentions for 17/18. Such a programme of work will require commitment from all Working Together members to ensure that a collective approach is taken to continue delivery of this next phase of work.

Recommendation(s)

Governing Body is asked to:

1. Note the work to date

2. Approve the options appraisal and emerging model

3. Approve the proposal for formal public consultation on the above, to begin in October 2016

4. Support the next phase of development of the full business case, and receive a full business case for approval

Impact analysis

Assurance Framework

1.2,1.3,4.1,4.2,4.3

Risk analysis

To be completed at Business Case stage

Equality impact

Full EIA to be done at Business Case stage

Sustainability impact

Review and redesign is necessary for sustainability of these services into the future

Financial implications

Not yet known, to be completed as part of the Business case

Legal implications

NA

Consultation / Engagement

Pre-consultation engagement period conducted Jan-March 2016. Planned formal public consultation October 2016 onwards.

Options appraisal so far been discussed at DCCG Children’s meeting in July 2016, DCCG Clinical Reference Group July 2016, and DCCG Strategy & Organisational Development Forum in August 2016.

1

Joint commissioners and provider Working Together Programmes

Non- specialised Children’s Surgery and Anaesthesia –

Options Appraisal

June 2016

2

June 2016

Title Non- specialised Children’s Surgery and Anaesthesia – Options

Appraisal

Author Kate Laurance/ Children’s Services Core Leaders Group

Version V11

Created Date 27/4/2016

Document Status

Final

To be read in conjunction with

3 C Children’s Surgery Options Appraisal

Document history

27/4/2016 1 KL Worked up following discussion at task and finish group

28/4/16 2 KL Options updated

29/4/16 3 KL Data with analysis and split

supported by activity

data being modelled.

13/5/2016 4 KL With feedback from Children’s Core Leaders steering Group

18/5/2016 5 KL Minor changes following

Core Leaders Group

27/5/2016 6 KW Re-formatted

30/5/2016 7 LD Expansion of

introduction, removal of

cross reference from 1.1,

reference to

assumptions in 2.7

31/5/2016 8 JCS Confirm Draft Status,

Intro statement on paper

purpose / content, minor

amendments to new

intro material,

amendment to

numbering in section 2

from 2.7 onwards,

addition of reference to

scoring tool and draft

matrix, 2.8 extended

caveat around

3

assumptions, 2.8 note on

status of following RAG

rating for options.

Changes to sections

3.2,3.3 re OA next steps

1/6/16 9 JCS Update section 3 re

process, next steps –

consultation, OA, ‘do-

ability’, Governing Body

sign support. Consistent

formatting. Data by

options added

2/6/16 10 KL With Updates to Section

2 on matrix for scoring

5/7/16 11 HS Amended numbers to

ensure non identifiable

Governance Route:

Group Date Version Purpose

Working Together Programme Board

7th June 2016 1 For Sign off and support

4

Contents Introduction and Overview ............................................................................................... 5

Proposed Model for Planned Surgery .............................................................................. 8

Options and Scenario Appraisal ...................................................................................... 9

Conclusions and Recommendations ............................................................................. 17

5

Introduction and Overview This paper has been worked up to give an overview of the potential options and

impact for redesigning children’s surgical services across South and Mid

Yorkshire, Bassetlaw and North Derbyshire (the Working Together footprint).

The paper proposes three main options, gives an early indicative assessment of

those options using a ‘traffic light’ scoring, and suggests a systematic option

scoring approach to run alongside this.

The enclosed gives an overview of the potential change in flows and impact of

redesigning services to meet quality, safety and sustainability requirements.

The impact assessment also covers change in flows from a CCG population

perspective which has been developed following the assessment panel and a

subsequent meeting of the original task and finish group on the 14th of April

2016.

It is important that the case for change for Children’s Surgery and Anaesthesia

services within the Working Together footprint is considered to enable provision

commissioned to be equitable, safe and sustainable for the future.

The case for change and subsequent Health Needs Assessment takes into

consideration quality aspects of the service, draws on national and regional

guidance and clinical best practice within services, and sets out the national

standards for Children’s surgical services.

In summary the challenges facing the future provision of children’s surgery

raised by stakeholders (surgeons, anaesthetists, Trust managers and

commissioners) and identified as the key drivers for the Working Together

Programmes (provider and commissioner) at meetings are as below.

Providing a comprehensive range of effective and sustainable children’s

surgery and anaesthetic services.

Changes in clinical practice have been influenced in recent years by

guidance from the Royal College of Surgeons (RCS) and Royal College of

Anaesthetists (RCoA) and an increased focus on clinical governance.

One of the more significant changes has been to the training of general

surgeons, with a reduction in the paediatric component of general surgical

training. Individual general surgical trainees have been given free remit to

choose any sub-specialty area, and unfortunately, the numbers training in

any given sub-specialty do not always match the needs of the service. As a

result, as surgeons retire, they are not being replaced by surgeons with the

6

same level of experience in paediatric surgery.

There is evidence, from the workforce profiling undertaken by providers, that

concern about the ability to provide safe and effective surgery for children

has caused some surgeons to limit the range of surgery that they offer, or

limit the age range of children that they treat.

Avoiding unplanned unmanageable changes to referral patterns for

children’s surgery.

Within the region there is evidence that the issues identified above have

resulted in unplanned changes to service provision and ‘activity flows’ away

from smaller DGH’s towards larger centres, leading to problems in capacity

planning. There is recognition among clinicians that transformation of

services may be required to make best use of clinical manpower, and that

this needs to be addressed strategically.

The need to consider clinical interdependencies

The provision of children’s surgical and anaesthetic services is dependent on

the provision of other children’s services and vice versa; in particular the

provision of a number of children’s services relies on the provision of

paediatric anaesthetic services. There is also interdependency between

medical paediatrics and maternity and neonatal services. Therefore,

changes to individual services can have an impact on the overall ‘portfolio’ of

services offered by individual Trusts. We are also taking into account the

urgent and emergency care review and the work of the developing South

Yorkshire and Bassetlaw Sustainability and Transformation Plan, and those

of our neighbouring regions.

Implementation of the Standards for Children’s Surgery and Anaesthesia

leads to challenges that are beyond the ability of individual organisations to

solve.

There is widespread recognition that meeting the standards in full may be a

challenge for some Trusts. The view among clinicians is that there are

options for addressing these (e.g. through the provision of in-reach and

outreach services, joint training, education and audit), but that this would

also require joint working. Alongside this, is the view that for the standards to

be effective, they should be monitored by people who understand the

services and who are able to make informed assessment against

compliance; ideally peers. Also, that the standards will need to be

reassessed in light of changes to national clinical guidance, in order to

remain relevant.

7

In light of all the above, the overwhelming view from attendees at

stakeholder meetings and engagement events was that:

There is a need for change because ‘continuing as we are is not

sustainable’.

Ensuring good quality and sustainable provision of services in future and

implementation of standards would require cross-organisational working.

There is lack of co-ordination across pathways and patient flows are not

managed.

The interdependencies of children’s services are complex.

There is a need for managerial leadership and clinical leadership across

organisations.

Recently, regional CQC visits have highlighted the need to improve staffing

levels which have led to the increased usage of locum/bank staff in various

providers of children’s surgery.

Between January and April 2016, Commissioners Working Together

gathered the views of patients and the public during a pre-consultation

phase. The following were the key themes identified as being important to

people when accessing children’s surgery and anaesthetic services:

Safe, caring, quality care and treatment

Access to specialist care – with a willingness to travel for specialist care

Care close to home

Communication – between children, parents, carers and their clinicians –

and also between hospitals

Being seen as soon as possible

Following the expert assessment panel held on 7 March 2016, which

considered all aspects of the review and advised on a way forward, and the

subsequent task and finish group discussion on the sustainable options for

modelling services held on 14 April 2016, the options detailed in the main

body of this paper emerged as requiring further consideration. This paper

moves towards a formal assessment of those options, prior to them being

circulated for public consultation.

8

1. Proposed Model for Planned Surgery

1.1 The general principles around provision of safe and sustainable planned

surgical care which providers are required to meet are outlined within

the Service Specification. The intention of commissioners is to use a

‘designation’ approach, i.e. units meeting the specification will become

designated surgical centres. This will mean designation within the tiers

described within the service designation toolkit. There will also be a

managed clinical network function in organising and sustaining provision

across tiers within the designated centres.

Levels of care for surgery will be tiered as follows:

Tier 1 = Day Case Surgery Tier 2 = Tier 1 + elective + out of hours non elective inpatient surgery

Tier 3 = Tier 2 + specialist (tertiary)

Surgery Tiers

1.2 This will be organised and planned at a sub specialty level, i.e. the

service map for one specialty may differ from that for another specialty.

The reason for this is acknowledgment of the accessibility of workforce

skills in some sub specialties, which enables some aspects of surgery

1

Day Case

2 Elective in patient / non

elective in patient

3 Tertiary

9

to be undertaken more easily than others.

The use of outreach services to support tiers 1 and 2, as well as

outpatient services will be a key function that will need to be further

developed and supported from the centre hosting the expertise. Within

the Managed Clinical Network (MCN) there should be a clear remit to

distribute the workforce across the geography in response to need and

to undertake improvement and planning activities to ensure compliant

services in the designated units.

There are some common widely acknowledged procedures that have

lower or higher thresholds or considerations when thinking of the models

of care and specified requirements. There are some procedures, for

example in general surgery where age thresholds vary, and in ENT

airway management and wider support services are critical.

We also know that there are a number of time critical procedures and

we must ensure we can respond and treat these effectively. The

example of torsion of testes is a well-sighted example. Also the skills

and expertise to respond to surgical and anaesthetic care needed

within under 3 year olds is another area of great debate and one that

consensus to transfer to an appropriately skilled unit has been reached

across clinicians.

This means that the consideration of out of hours surgery needs a clearly

defined pathway and protocols in place between centres and hospitals

within the area. 2. Options and Scenario Appraisal

2.1 The proposed service model should be tested and considered

alongside the current need for surgical care across the patch.

2.2 To enable a sustainable service to be established for the future, there

will need to be less entry points, more critical mass of planned

provision and clarity across pathways to enable out of hours, non-

elective care to be directed to the most appropriate centre.

2.3 Providing the appropriately trained workforce through a managed and

organised network will be critical to providing a sustainable model of

care, therefore the workforce challenges, new models and skills in

existence will need careful planning.

10

2.4 Following discussion at the assessment panel and subsequent service

model discussions at the task and finish group, there was a conclusion

to propose a model highlighting a range of options for the development

of tier 2 hubs for surgical care, as the tier 1 and tier 3 provision are less

debatable and easier to plan across the footprint.

2.5 The option needs to provide sustainability, with particular focus on

sustaining care across the geography and safe management of the

acutely ill child presenting non-electively out of hours.

2.6 There is also a significant interface with the acute care work stream on

ensuring that paediatric 24/7 medical care is in place that may further

impact on inpatient care levels in the future. As well as this, there is an

acknowledged interface with acute maternity and neonatal care due to

workforce interdependencies.

2.7 The criteria to assess options and impact of changes within proposals

must consider as a minimum:

12

Criterion Indicator Questions

Access Red – High Impact negative Impact Amber- Some Impact and some changes minimal Impact Green- Changes in access but equitable timeframes

Patients would access the same standard of care; ensuring care is equitable across geography and sites. Patients would access the right care within similar timeframes. Therefore population location would not mean negative impact on access.

Will populations from across the WTP footprint access provision for urgent surgery care within critical times frames for treatment? Would populations particularly from areas of high deprivation have to travel longer distances for treatment and care? What will patients value more access to right care in a location further away, or access to substandard care but in a location need by with quicker access?

13

Activity and flow Red- Deliverability of changes in activity are challenging or workforce skill maintenance would be an issue Amber- Sustainability of workforce skills although challenging Green – Activity changes should be able to be maintained

Any changes in activity or flow can be sustained and managed between providers

Are there are sufficient activity levels to maintain workforce skills? Is there sufficient activity to be able to justify planning care for a group of patients? Will there be a mechanism in place to plan for changes between providers to meet the care needs for surgery provision across the WTP? Have the providers got the ability to deliver an increase in activity or will capacity be an issue?

14

Workforce sustainability, quality and best practice Red- Workforce sustainability still a major challenge Amber –possible to maintain but challenging. Green – Should be sustainable

That workforce skills and competencies are sustainable longer term and can be developed where needed within the proposed option.

Does the proposed option enable workforce development across a whole system? Can skills be further developed to enable future needs to be met? Will provision be able to meet specified standards? Can proposed models to develop workforce be implemented?

15

Cross boundary impact Red – Significant change, high impact on transport and care across boundaries Amber – Some change, some impact Green – Change will have minimum impact or could be managed effectively within proposal

That any changes across boundaries are managed with the least possible negative impact and the potential impact on transport is scoped, understood and assessed. Cross boundary provision is considered,

Does this change have a significant impact on transport? Will there be patients from one area travelling more to another area/site for care? If so out of the proposed options which have the most cross boundary changes? Do the proposals have an impact on provision or care across boundaries to neighboring CCG’s? If so what might the negative impact of change be?

16

An indicative “Traffic Lighted” assessment of the models against the relevant

criterion (using a “Red, Amber, Green” or “RAG” rating) is included below in

sections 2.9 - 2.12. For the implementation of any recommendation it is

acknowledged that further collegiate scoring methods should be undertaken in

depth by a clinical sub group and by at specialty level in order to support

operational delivery and change management requirements.

2.8 There has been some natural migration already within the services into a Tiered

approach. This primary gap in service delivery is around paediatrics requiring

overnight stay and out of hours services.

2.9 Tier 1 proposals indicate the continued delivery of day case surgery for hospitals

that can do two things:-

Firstly, meet the service specification and associated designation to

provide day case surgery.

Demonstrate enough critical mass to warrant planning and providing this

level of activity given that some lists will be provided by an outreach

model and at sub specialty may require specific surgical skills.

Tier 2 proposals have focused on appraising and assessing options over 2-4

centre model and will be the area that the largest level of change is needed.

For tier 3 provision this would be provided over only a few centres within the

geographical boundaries of the programme.

The options appraisal is based upon current hospital sites, although we know

from the needs assessment and the map of population growth rate that the need

for provision falls across all areas over time.

Activity numbers associated with each of the options are based upon

assumptions, i.e. taking historical patient activity levels in particular sites, and

assessing, based upon the shape of each option, a) whether activity would stay

at that site or leave and b) if it leaves that site, where it is likely to go to, based

upon local geography, transport links, etc.

As this work proceeds, potentially to public consultation against a viable option

following appraisal, it may be necessary and good practice to invite further

scrutiny of those assumptions.

17

The following RAG rated / traffic lighted options assessments in sections 2.9-2.11

is based upon initial views of the core members of the programme team, with a

focus on an option in light of its ability to meet the relevant standards and meet

the intentions of the project. Section 3 will talk about the conclusions and

recommendations following the RAG rating.

RAG Rating of Options:

Completed by the Working Together Programme and Project

Management team and discussed and approved by members of the

Children’s Core Leaders Group.

Baseline Activity

The variances associated with each option should be applied to the base 2014-

15 activity data which is shown here:

19

2.10 Option One - Development of 4 tier 2 hubs:

Based upon the current providers and need across the patch, hubs would be

located at Sheffield, Doncaster, Pinderfields and Chesterfield. This would site tier

2 provision over the geography evenly to meet need. There are existing

arrangements between Nottingham and Chesterfield Royal these could be

explored further and developed further.

Criterion RAG Initial Assessed Impact

Access This would mean some cases would be transferred to the proposed Tier 2 units and not have a procedure at units providing Tier 1 care. They might be stabilised and transferred to the nearest tier 2 unit. This would mean continuation of the current configuration with most units and sites sustaining and developing full care pathways for all surgery needed. We know this is unlikely to be sustainable model of care, and from the review to date we know this will mean variation when patients access care, or pose a significant challenge in providing equitable access to care.

Activity levels and levels of change

This would mean trying to maintain the activity levels and flows with some activity in most sites, so almost status quo on activity assumptions. It is likely that there would be a level of transfer to ensure patients got the right care. This is not easy to quantify or predict.

Cross boundary impact and transport

This would mean little cross boundary impact. There would be a level of transfer needed which is not easy to quantify given the uncertainty around stabilising clinical appointments on some sites. Adequate

Workforce, safety and quality

There would not be the ability to provide the workforce to provide this cover consistently across all sites.

Impact on visitors/carers

For some care that was not planned this would mean travelling to another site.

Finance We know the current position overall is not sustainable financially across all NHS provision and there are less resources available in the future.

20

Challenge in delivery

N/A This would mean almost status quo

Total weighted score

The status quo is not an option

Option 1 : Indicative Activity Changes:

Four Hubs - Variance Impact by Selected Specialty

1. Emergency

ENT Gen Surg Ophth Oral Surg T&O Urology TOTAL

Current Activity 518 1354 19 152 1456 214 3713

Variance by Provider

BHNFT -42 -262 0 0 -197 0 -501

CRH -6 -26 -1 0 -35 0 -68

DBH -12 75 -2 27 -27 -4 57

MYH 21 106 0 0 89 -2 214

Other 0 0 0 0 0 0 0

SCH 110 401 8 67 408 16 1009

STH 0 0 0 0 0 0 0

TRFT -71 -294 -5 -94 -238 -10 -712

2. Elective with LOS >0




BHNFT -38 -1 0 0 -19 0 -58

CRH -36 0 0 0 -5 0 -40

DBH -23 0 1 -1 -1 0 -24

MYH 36 0 2 0 7 0 45

Other 0 0 0 0 0 0 0

SCH 157 6 3 6 43 0 215

STH 0 0 0 0 0 0 0

TRFT -96 -5 -6 -5 -26 0 -138

21

2.11 Option Two - Development of 3 tier 2 hubs:

To meet need equitably across the geography these would be at Sheffield,

Pinderfields and Doncaster. This would provide even distribution over the

geography and stabilise the currently established outreach approach with North

Lincolnshire and Goole (NLAG) provision. Chesterfield would need further

consideration.


Access This would mean some cases would be transferred to the proposed Tier 2 units and not present at units providing Tier 1 care, or be stabilised and transferred to the nearest tier 2 unit. This would mean all CCG populations would have equality of access to the same standards of surgical care, but mean further travel for procedures for some populations.

Activity levels change

This would change the activity and flow with some activity moving from existing sites to the designated Tier 2 units. Therefore a change in activity and flow from 2 existing sites.


This would mean populations from Rotherham, Bassetlaw and Barnsley travelling to Doncaster, Wakefield or Sheffield, if these sites were to be developed as the tier 2 sites. This would impact on transport services, this would need planning in, the number of new transfers overall would increase.

Adequate Workforce, safety and quality

There would need to be concentrated workforce planning throughout and across the 3 hub sites.


For some care that was not planned this would mean travelling to the Tier 2 centre instead of a local hospital site.

Finance Not known at this stage


This option although challenging requires a substantial change could be delivered. It would need a level of additional planning for increased capacity in the proposed tier 2 centres.

22

Total weighted scores

This option would mean a radical change across inpatient provision and moving to a planned network across outpatient and day case surgery.


Three Hubs - Variance Impact by Selected Specialty

1. Emergency




BHNFT -42 -262 0 0 -197 0 -501

CRH -34 -131 -3 0 -145 0 -313

DBH -12 76 -2 27 -27 -4 58

MYH 20 106 0 0 89 -2 214

Other 0 0 0 0 0 0 0

SCH 139 505 8 67 518 16 1252

STH 0 0 0 0 0 0 0

TRFT -71 -294 -5 -94 -238 -10 -712





BHNFT -38 -1 0 0 -19 0 -58

CRH -130 -1 0 0 -23 0 -154

DBH -23 0 1 -1 -1 0 -24

MYH 36 0 2 0 7 0 45

Other 0 0 0 0 0 0 0

SCH 251 6 3 6 62 0 329

STH 0 0 0 0 0 0 0

TRFT -96 -5 -6 -5 -26 0 -138

23

2.12 Option Three - Development of 2 tier 2 hubs across the geography:

These would be located at Sheffield and Pinderfields. This would provide a

site for inpatient care within the geography based at a larger distance apart to

the current configuration.


Access This would mean some cases would be transferred to the proposed Tier 2 units and not present at units providing Tier 1 care, or be stabilised and transferred to the nearest tier 2 unit. This would mean all CCG populations would have equality of access to the same standards of surgical care, but mean further travel for procedures and may build in a time delay to treatment.

Activity levels – levels of change

This would change the activity and flow with some activity moving from Rotherham, Barnsley, Doncaster and Bassetlaw to the tier 2 units. The level of activity needed at the 2 sites would be challenging to provide.


This would mean populations from Rotherham, Barnsley, Bassetlaw and Chesterfield travelling and would impact on transport services as there would be a significant number of transfers.

Adequate workforce

There would be the ability to plan the workforce to provide this cover apart from the acute paediatric workforce in the future for this care


For some care that was not planned this would mean travelling to the Tier 2 centre

Finance Not known at this stage


There would be bed capacity issues with this proposal as the shift of inpatient activity would be significant

Total weighted score

This could have a significant impact on patients access to care without a radical upgrade in transport and capacity at the 2 site proposed.

24


Two Hubs - Variance Impact by Selected Specialty

1. Emergency




BHNFT -42 -262 0 0 -197 0 -501

CRH -34 -131 -3 0 -145 0 -313

DBH -175 -195 -8 -12 -407 -20 -817

MYH 48 163 1 1 108 3 324

Other 0 0 0 0 0 0 0

SCH 274 719 15 105 879 27 2019

STH 0 0 0 0 0 0 0

TRFT -71 -294 -5 -94 -238 -10 -712





BHNFT -38 -1 0 0 -19 0 -58

CRH -130 -1 0 0 -23 0 -154

DBH -140 -4 0 -11 -48 0 -203

MYH 47 1 2 2 16 0 67

Other 0 0 0 0 0 0 0

SCH 357 10 4 14 100 0 486

STH 0 0 0 0 0 0 0

TRFT -96 -5 -6 -5 -26 0 -138

25

3. Conclusions and Recommendations

3.1 Governing Bodies are asked to support the designation of Tier 1 and Tier 3

surgical care, enabling the implementation of this through the Managed Clinical

Network and through commissioning and contracting teams within CCGs.

3.2 Governing Bodies are also asked to support further consideration of the options.

Building upon the initial, indicative RAG scores above, and noting that (at this

stage) the three-hub model appears to offer the greatest benefit and scope for

feasibility, and should be appraised further.

3.3 This is likely to lead to the formal classification a “Preferred Option”, with

subsequent development of a business case to examine detailed

implementation aspects.

3.4 It is acknowledged from the outset and from the RAG scoring and supporting

data that there will be potential capacity issues, to a greater or lesser degree,

with all options, as well as potential sustainability impacts upon other services at

sites not designated as Tier 2. The ‘do-ability’ of options should be a substantial

factor in their appraisal.

3.5 Following the first phase of work on the Acute Care pathway in May and the STP

initial modelling to be completed in June 2016, further consideration of the

potential impacts of these upon surgical models will need to be undertaken.

There is an acknowledged interdependency between the assessment and

management of acute care within paediatric assessment and the pathway to

surgical care for procedure and intervention.

3.6 At this stage, whilst the three-hub model presents the most promising initial

findings, the Working Together Programmes recognise that, in addition to option

scoring, all proposals will and should be subject to adequate public consultation,

and that this should take place in a transparent way. It is anticipated that this

consultation will start in September 2016. Kate Laurance on behalf of Commissioners Working Together and the Working Together Programme 1 June 2016

Enc C

Future Hosting Model for PUPoC



Title of paper

Hosted Services (PUPoC)


Mrs Mary Shepherd, Chief Nurse

Author(s) Quality Team


This paper sets out the hosted arrangements for Previously Unassessed Periods of Care (PUPoC) and other Continuing health care functions. The paper describes the historic issues around these services and the transfer from Commissioning Support Unit to CCGs, and the hosted arrangements put in place. This paper recommends the arrangements for the future.

Recommendation(s)

This paper recommends that the NHS Doncaster CCG Governing Body approve the continued hosting, on behalf of 9 CCGs within the Yorkshire and Humber region, the PUPoC service.

Impact analysis

Assurance Framework

2.1, 5.1

Risk analysis

Risks captured within the paper

Equality impact

Nil


Nil


Re-costing of the service from March 2017

Legal implications

Each CCG will retain accountability and responsibility for their own cases


Chief Officers for each relevant CCG; NHS England

Hosted functions for previously un-assessed periods of care (PUPoC)

History

In 2015 Yorkshire & Humber Commissioning Support unit were unsuccessful for gaining approval to enable them to be accepted onto the Lead Provider Framework (LPF) for all services apart from Continuing Health Care. This led to the demise of Yorkshire & Humber Commissioning Support. A transition board was established with various work streams. NHS Doncaster CCG led the work stream looking at options for the future of Continuity Healthcare (CHC) / Previously Unassessed Periods of Care (PUPoC) / Personal Health Budgets (PHB).

A business case was developed which resulted in:

CHC – each CCG in housing their teams

PHB – NHS Doncaster CCG to host on behalf of 6 CCGs 1. Doncaster 2. Rotherham 3. Wakefield 4. Calderdale 5. North Kirklees / Greater Huddersfield 6. York Partnerships

PUPOC – NHS Doncaster CCG to host on behalf of 12 CCGs 1. Doncaster 2. Rotherham 3. Bassetlaw 4. Barnsley 5. Sheffield 6. North Kirklees / Greater Huddersfield 7. Wakefield 8. 3 Leicester CCGs 9. North Lincolnshire

As the business case approval was predicated on there being no stranded costs, a small amount of staff who were not aligned to any of the above were pooled together to create a shared support service for CHC this function is hosted by Doncaster on behalf of 5 CCGs

Doncaster (21 wte in Doncaster CHC live team including business support, plus 1 vacancy Band 5 admin to replace Julia if we choose to keep that post)

Rotherham

Wakefield

Barnsley

Sheffield

The services and staff transferred over to the respective CCGs on the 1/12/15. This all resulted in safe transfer of staff, functions and business continuity.

In the shared clinical leadership team there are 9 staff, 8.24 wte. Looking at continuous service dates if the staff were to be made redundant the approximate cost would be £162,743

Following the transfer the PHB function has now been disaggregated and transferred back to each individual CCG, resulting in no hosted function for PHB.

The most complex remaining hosted function is the PUPOC function. There is a large team of both clinical and administrative staff based at Sheffield. This team are working on the formal PUPOC period, 2004-2012.

With a 47 headcount and 44.5 wte the total cost of making whole team redundant is approximately £566,000. If we take out the clinical staff from that and calculate for admin only it is £41,068.

NHS Doncaster CCG inherited a very confusing unstable service, with both workforce and performance issues.

Following a period of recruitment, stabilisation and process mapping the service performance is now improving.

To support the performance against September 2016 trajectories the collaborative have outsourced in the region of 600 cases which will bring completion date to January 2017. The collaborative are now considering further outsourcing to bring completion in line with NHS England expectations of September 2016; the original business case was developed against a service delivery of March 2017.

Future Challenges and Options

The Department of Health are now considering opening up a further PUPoC period, the parameters of which are very uncertain. However there is a delay in this being announced possibly not until after January /February 2017.

Therefore the collaborative is considering what the future collaborative arrangements may be, the current 12 CCGs, none at all, or a different Yorkshire and Humber collaborative?

Recommendation

Following discussions within the current collaborative, with NHS England and Chief Officers the recommendation is to move to a Yorkshire and Humber collaborative which will include:

Doncaster

Rotherham

Sheffield

Barnsley

Bassetlaw

North Links

Wakefield

Greater Huddersfield / North Kirklees

The three Leicester CCGs are exploring their future arrangements within their NHS England region.

The Governing Body is asked to approve the new collaborative arrangements. Mary Shepherd Chief Nurse

Enc D

Quality & Performance Report



Title of paper

Quality & Performance Report


Mrs Mary Shepherd, Chief Nurse Mr Anthony Fitzgerald, Chief of Strategy & Delivery

Author(s) Performance and Intelligence Team Quality Team


This report sets out the key quality and performance issues to be noted by the NHS Doncaster Clinical Commissioning Group (NHS Doncaster CCG) Governing Body. The report covers 3 main sections this month:

Provider Performance - main local healthcare providers

Other services commissioned by NHS Doncaster CCG

Items for escalation regarding Local Delivery Plan in year delivery The performance rating, indicated by Red, Amber or Green status, denotes the current month performance and does not reflect the historic trends. This is supported by a detailed appendix (Appendix 1) which highlights performance for NHS Doncaster CCG and all local providers with regards to the main performance indicators. The key areas of change, both positive and negative, to note since the last report are: Doncaster & Bassetlaw Hospitals NHS Foundation Trust (DBHFT)

A case of MRSA was identified in May 2016.

4 ENT patients waiting over 52 weeks at the end of June 2016

NHS England Quality Surveillance Team report on the Cancer of Unknown Primary (CUP) service has been received

Cancer 62 day measures – all measures were met by the Trust again in May 2016 which is the fourth month running.

Diagnostics met target in June 2016 for 3 months running, which is the first time since 2013.

A&E – Performance was 92.8% in July 2016 against the NHS Improvement trajectory of 94%

Rotherham, Doncaster & South Humber NHS Foundation Trust (RDASH)

IAPT Recovery Rate failed to meet target at 44.4%

2

Other Commissioned Services

FCMS Data Validation exercise complete and performance reported from this month

Local Delivery Plans

None applicable

Recommendation(s)

The NHS Doncaster CCG Governing Body is asked to:

Note the key quality performance areas for attention

Impact analysis

Assurance Framework

2.1, 2.2, 2.4

Risk analysis

Risks are captured in the Executive Summary

Equality impact

Neutral


Nil


As identified in the report

Legal implications

Nil


N/A

3

INTRODUCTION This report sets out the key quality and performance issues to be noted by the NHS Doncaster Clinical Commissioning Group (NHS Doncaster CCG) Governing Body using May data unless noted. The report covers 3 main sections this month:

Provider Performance - main local healthcare providers

Other services commissioned by NHS Doncaster CCG

Items for escalation regarding Local Delivery Plan in year delivery

The report is supported by a detailed appendix (Appendix 1) which highlights performance for NHS Doncaster CCG and all local providers with regards to the main performance indicators.

SECTION 1: PROVIDER PERFORMANCE REPORT

The following section of the report details performance for each main local provider, namely DBHFT and RDASH. Performance is across a range of quality and more traditional “performance” measures. As such the report includes performance as a whole for DBHFT and Doncaster sites for RDASH, and does not simply relate to the service provided to NHS Doncaster CCG.

Doncaster & Bassetlaw Hospitals NHS Foundation Trust

Governance

Time Period

May 2016 June 2016 July 2016

Changes to the board

None Applicable None Applicable

New Chair; Suzy Brain England OBE is set to

replace outgoing Chair, Chris Scholey, from 31 December

2016 and will serve a three year term.

Kirsty Edmondson-

Jones has been appointed as Director

of Estates and Facilities.

NHS Improvement Governance Rating

Red – Subject to enforcement action



Financial sustainability risk rating

1 1 1

DBHFT’s internal monitoring against its Turnaround Programme is on-going, at month 2 their plans are on track, although the Trust are aware of the significant scale of their efficiency plans. The CCG have been attending a monthly Turnaround Board which reviews both the quality

4

impact of the programme and any contractual impact, at this point the CCG are satisfied that all the appropriate risks have been identified. Further work is on-going to ensure the CCG and DBHFT wider delivery/transformational plans and the wider Sustainability and Transformation Plan (STP) align.

Mortality

The Trust's rolling 12 month Hospital Standardised Mortality Rate (HSMR) was 94.05 at the end of March, with the rolling 12 month Standardised Hospital Mortality Indicator (SHMI) at 100 at the end of December 2015. As part of a larger audit DBHFT have been identified as having the third lowest 30 day risk adjusted mortality rate for emergency laparotomies.

Contractual actions

2016/17 Contract Queries: no queries issued during July 2016. Performance Notices: zero.

Number of serious incidents reported

(CCG)

Q4 2015/16 - 30 Q1 2016/17 – 22

Please note that the above figures include incidents which may be subsequently de-logged as a SI. There were 26 fewer SIs during Quarter 1 2016/17 than in the same period of 2015/16.

Patient Experience

Time Period

April 2016 May 2016 June 2016

Complaints/concerns Opened

119 124 138

Complaints and concerns have risen slightly again in June 2016 however this rise is mainly due to concerns being raised, rather than formal complaints. While complaints are reducing, there are more concerns being raised. This is consistent with the intention to capture and deal with issues and concerns to prevent escalation to the more formal complaint process. The Patient Experience Team has also improved their entry of issues that were resolved rapidly at the time they were brought to their attention, which contributes to the rate increase. Response times continue to be below the Trust’s expected standard at 34%. Themes and trends are monitored and managed by the Trust with communication and lack of information being passed to patients and relatives as a current focus. Communication complaint reduction is one of the Quality Account objectives for 2016/17 and the findings of this analysis (including key learning) has been shared across care groups to disseminate the themes for local care group and specialty action. In relation to response times clearing historical cases at a greater rate than the rate of new complaints is a key aim of improving the handling and management of complaints. Weekly monitoring and performance reporting arrangements are provided to Care Group leads, so that they can ensure that there are effective systems in place. Supportive interventions from the Patient Experience Team, to help improve processes, are being taken forward with each Care Group Head of Nursing/Midwifery/Therapies and the Clinical Governance Lead in Diagnostic and Pharmacy Care Groups. This method has increased the productivity of the Care Groups and there is a gradual reduction of overdue complaints seen in the weekly reports and complaint tracking reports.

5

Friends & Family Test

Inpatients

A&E

Outpatients

All DBHFT measures remain above the national average except for A&E where response rates were lower than expected in May. Further work is required with the Care Group to improve performance.

Friends & Family test

Antenatal

6

Birth

Postnatal

Workforce

Time

Period

June 2016

The Government has confirmed that a new contract for junior doctors will be imposed from October after junior doctors and medical students voted to reject the deal negotiated with the British Medical Association (BMA). The Health Secretary pledged to impose the terms and conditions negotiated in May in stages, from October this year to October 2017. Locally the Trust are continuing to prepare for implementation on that basis and will appoint a Guardian for Safe Working. Following the Lord Carter Review of workforce and financial plans, care hours per patient day (CHPPD) data is now being collected monthly. CHPPD provides a single consistent way of recording and reporting deployment of staff working on inpatient wards and is calculated by adding the hours of registered nurses to the hours of healthcare support workers, and dividing the total by every 24 hours of inpatient admission (or approximating 24 patient hours by counts of patients at 23:59hrs). To ensure skill mix and care needs are met CHPPD reports split out registered nurses and healthcare support workers. It is still not clear how these figures compare nationally and what is demonstrated locally but it will allow DBHFT to see how CHPPD compare to other Trusts by specialty and ward to inform how improvements to staff deployment and productivity can be made in the future. The initial figures are provided below but the trend over time needs to be built up and analysed.

Site Registered

midwives/nurses Care Staff Overall

7

Bassetlaw 6.0 3.2 9.2

Doncaster Royal Infirmary

3.8 2.9 6.7

Montagu 2.3 2.5 4.7

Trusts 4.2 2.9 7.1

Safety

Time Period Nov 15 Dec 15 Jan 16 Feb 16 Mar 16 Apr 16 May 16 Jun 16

Number of Never Events

(cumulative during financial

year)

1 1 1 2 2 0 0 0

There were no never events in June 2016.

MRSA (cumulative

during financial year)

1 1 1 1 2 0 0 1

DBHFT have identified an MRSA Blood Stream Infection for a resident outside of Doncaster.

C-diff Actual

Trajectory (NHSE cum. target 40)

25 26 27 29 32 0 4 7

32 36 40 44 45 3 6 9

There were 3 cases of C Diff in June 2016 but the Trust is still meeting the cumulative target of 9 or lower. There were no C Diff cases attributable to the Trust during June.

Hospital Acquired Pressure Ulcers

(category 3, 4 and ungradeable,

target of less than 60 in 2016/17)

Q4 2015/16 - 10 Q1 2016/17 – 13

Serious Falls (target of less than 29 during

2016/17)

Q4 2015/16 - 5 Q1 2016/17 – 1

8

Operational Effectiveness

Time Period

Nov 15 Dec 15 Jan 16 Feb 16 Mar 16 Apr 16 May 16 Jun 16

18 week Referral to Treatment Times Incomplete Waits

(target 92%)

92.6% 92.1% 92.3% 92.1% 92.1% 92.9% 93.1% 92.8%

The position for Incomplete pathways in June fell by 0.3% to 92.8% which is compliant with the standard (92% of patients waiting under 18 weeks). Four specialities failed to meet the standard:

General Surgery, 89.8%

General Medicine 91.3%

Urology 89.8%

Trauma and Orthopaedics 91.1%

General Surgery performance has been adversely affected by the lack of junior medical staff at Bassetlaw District General Hospital, which led to a reduction in operating capacity. The service has an action plan in place which includes: - training existing staff - releasing them from other duties - recruitment. General medicine relates to gastroenterology and is due to reduced medical workforce. A review of General Medicine RTT performance is taking place with the service and the CCG in August to further understand the issues and actions to be taken. Urology demand has been raised with Commissioners and alternative pathways are being reviewed to increase internal capacity. Trauma and orthopaedics had workforce issues at consultant level which impacted on performance. A review of T&O RTT performance is taking place with the service and the CCG in September to further understand the issues and actions to be taken.

6 week referral to Diagnostic test

times (target 99%)

Nov 15 Dec 15 Jan 16 Feb 16 Mar 16 Apr 16 May 16 Jun 16

98.8% 96.5% 99.5% 99.7% 98.3% 99.2% 99.5% 99.6%

33 patients in total waited over 6 weeks, all test areas were compliant with the standard with Quarter 1 performance also achieving 99.17%. The service having met the standard for 3 months running is the first time since 2013.

R

R

9

52 Week Waits – Incomplete Pathway

Oct 15

Nov 15

Dec 15

Jan 16

Feb 16

Mar 16

Apr 16

May 16

Jun 16

DCCG 0 0 0 0 0 0 0 0 4

Other 0 0 0 0 0 0 0 0 0

NHSE 0 0 0 0 0 0 1 0 0

There were 4 ENT patients waiting over 52 weeks at the end of June at DBHFT, all of whom were all Doncaster CCG patients. These patients were identified through data validation work on the waiting lists following the implementation of CaMIS. All 4 patients have now been seen and breach reports for each have been produced and shared with Doncaster CCG. Actions have been identified following this to ensure that correct processes are in place to prevent any further breaches.

4 Hour access - total time in the A&E department

(target 95%)

FCMS – Urgent Care Centre (UCC)

Performance contributing to

Total A&E Performance above

Nov 15

Dec 15

Jan 16

Feb 16

Mar 16

Apr 16

May 16

June 16

July 16

94.2% 95.5% 92.1% 92.5% 92.5% 95.1%

93.1%

92.2%

92.8%

100% 100% 100% 100% 100% 100% 100% 100% 100%

DBHFT’s July position improved to 92.8% however remained below the 95% standard of patients being discharged or transferred within 4 hours and also the Q2 94% recovery trajectory set with NHS Improvement. Patient flow processes have been reviewed to improve early discharge and improve flow through the department though there remain some medical staffing difficulties due to the April agency cap rates. The Memorandum of Understanding (MOU) for Working Together Trusts has been signed. A number of initiatives are underway to improve staffing levels including training roles and overseas recruitment. Streaming at DRI increased to 12.7% to unplanned care during July 2016 and a review of the UCC criteria is underway with DCCG. This review will focus on additional presenting symptoms which could potentially be assessed and treated at the UCC rather than be directed to A&E. Improved Trust wide escalation plans for care groups have now been formally approved through appropriate channels. Learning from the perfect week undertaken in June is to be carried forward with actions that are sustainable day to day.

Cancelled Operations

(target <0.8%)

Oct 15 Nov 15

Dec 15 Jan 16

Feb 16 Mar 16

Apr 16

May 16

Jun 16

1.3% 1.3% 2.0% 2.9% 2.1% 1.1% 1.2% 1.2% 1.4%

Cancelled operations (cancelled on the day of operation) rose to 1.4% in June 2016 (1.0% in June 2015). Theatre cancellations were impacted by staff availability. Cancellations due to bed availability remained at 11 across BDGH and DRI.

10

Cancelled Operations-28 Day

Standard

Oct 15 Nov 15

Dec 15

Jan 16

Feb 16 Mar 16

Apr 16

May 16 June 16

0 1 2 5 2 2 0 2 2

There were 2 breaches of the 28 day standard in June where patients have not been offered another appointment for their operation within the 28 days. One patient has a date for surgery in August while the other had their operation in July 2016.

Outpatient DNA rate of total

appointments

9.4% 10.3% 9.5% 7.9% 7.6% 8.2% 8.2% 8.7% 10.1%

Overbooking is taking place in areas of high DNA rates and individual specialty DNA rates have been benchmarked to understand where particular issues require further action.

Two week wait from referral to date first seen: symptomatic

breast patients (target 93%)

Oct 15 Nov 15

Dec 15 Jan 16 Feb 16 Mar 16 Apr 16 May 16

97.4% 94.6% 93.3% 94.9% 97.4% 96.3% 93.4% 95.8%

Two week wait from referral to date first

seen: all urgent cancer referrals

(cancer suspected) (target 93%)

96.4% 95.0% 95.0% 93.5% 96.6% 94.9% 93.1% 93.1%

31 day wait from diagnosis to first

definitive treatment (target 96%)

98.6% 98.2% 99.4% 97.6% 97.6% 98.0% 99.3% 99.4%

31 day wait for subsequent

treatment – surgery (target 94%)

100% 90.0% 100% 100% 100% 100% 100% 100%

31 day wait for subsequent

treatment – anti cancer drug

regimen (target 98%)

100% 100% 100% 100% 100% 100% 100% 100%

31 day wait for subsequent treatment –

Radiotherapy (target 94%)

100% 100% 100% 100% 100% 100% 100% 100%

11

62 day wait for first treatment from

urgent GP referral to treatment (target

85%)

81.5% 81.5% 89.3% 76.3% 85.2% 90.2% 86.6% 89.7%

62 day wait for first treatment from NHS

cancer screening service referral

(target 90%)

93.3% 91.5% 95.8% 82.4% 91.9% 100% 93.3% 100%

Cancer Summary All cancer measures met the respective standards in May 2016, for the fourth month running.

Outliers (Daily averages)

Medicine to Orthopaedics Medicine to S12 Medicine to surgery Medicine to gynaecology

May 2016 June 2016

Most Outliers

Least Outliers

Average Outliers

Most Outliers

Least Outliers

Average Outliers

13 4 8 16 6 10

6 0 4 9 0 2

22 6 15 24 7 13

11 4 8 12 5 8

The number of outliers is being monitored and is raised through appropriate joint Trust and CCG Groups as necessary. The slight rise in outliers is due to some rising bed pressures during June 2016.

12

CQUINs

Local Intelligence Issues

Time Period April 2016

Stroke: Proportion of patients scanned under 1 hour of clock start (target 48%)

42.9%

Stroke: Proportion of patients directly admitted to a stroke unit under 4 hours (target 90%)

69.6%

Stroke: Proportion of eligible patients (according to the RCP guideline minimum threshold) given thrombolysis (target 90%)

100%

Stroke: Proportion of applicable patients receiving a joint health and social care plan on discharge (target 90%)

87.5%

Stroke: Percentage of patients treated by a stroke skilled early supported discharge team (target 40%)

73.6%

Stroke: Percentage of applicable patients who are discharged who were given a named person to contact after discharge (target 95%)

79.2%

Stroke: TIA patients assessed and treated within 24 hours (target 60%)

66.7%

Stroke Summary Performance measures have been refreshed from April to reflect those measures most underperforming. The key pathway remains direct admission to a stroke unit, with April performance levels based on 40 discharges. The key issues are the transfer from Bassetlaw emergency department to DRI, with delays both in diagnosis and also in transport. The new assessment beds on the stroke unit are in

2015/16

Quarter 4 The Quarter 4 evidence from the Trust was due at the end of February 2016. At the time of writing this report, this was not received and the period for provision of the evidence has passed. A summary of the evidence received Q1-3 is due to be discussed at the CCG’s July meeting of the Clinical Quality Review Group.

2016/17

Quarter 1 The quarter 1 evidence was due from the Trust at the end of July 2016. This is yet to be received.

Quarter 2 The quarter 2 evidence is due from the Trust at the end of October 2016.

Quarter 3 The quarter 3 evidence is due from the Trust at the end of January 2017.

Quarter 4 The quarter 4 evidence is due from the Trust at the end of February 2017.

13

operation, with the overall number of stroke beds increased to 49 across the Trust. Further training has been undertaken within the emergency department, to identify the key signs of strokes. In addition, a review is underway to assess pathways for the stroke service out of the hospital to MMH and early supported discharge, to ensure adequate bed capacity is available. Underperformance is raised through contractual meetings between the Trust and CCG. Discussions on specific pathway delays are happening regularly between the Stroke unit, A&E and diagnostics to improve the effectiveness.

Cancer of Unknown Primary (CUP) Peer

Review Visit.

The NHS England Quality Surveillance Team completed an external Peer Review of the CUP service (Primary Diagnostic Clinic to allow GP’s and community services, ambulatory care, emergency receiving areas and inpatient wards to access the service through two week wait referrals to try and facilitate early identification) in early July 2016 with positive feedback provided to DBHFT around the team and service. The reviewers did identify concerns rated as serious in the Peer Review nomenclature: 1. Cover for the Multi-Disciplinary Team from Palliative Care and Oncologist perspective. 2. The need to do a formal audit to ensure all patients are being picked up and also to capture training and education of the CUP pathway and processes 3. CUP Clinical Nurse Specialist (CNS) –the nurse assessing the patient should attend the MDT All of the concerns raised had already been identified by DBHFT and plans are in place to address them. The Lead Cancer Nurse has produced an action plan which will be used to provide assurance to the Trust Board, NHS England and Commissioners. The Positive Feedback included:

Work and commitment with education of GPs resulting in a pilot and CUP CNS

Bereavement support group in response to patient feedback has been a major success

Collocated clinics for CUP, Upper GI and Oncology

GPs being able to refer in to CUP clinic

Passionate about supporting patients – The Aurora Centre being specifically acknowledged

The use of Infoflex (system which can model information and workflow processes across departments) was recognised as excellent practice

Evident that CUP is a very well supported service by the Trust.

The Trust has entered the risks on to the appropriate risk registers and will formally respond to NHS England with an action plan to address the concerns. Previous CUP referral guidance is currently being revised to reflect that some diagnostic tests cannot be accessed directly by GPs. The CUP Clinical Lead will be attending GP target sessions in September to present information around this before updated guidance is circulated to GPs. The CUP pilot is planned to run for 9 months.

14

Rotherham, Doncaster & South Humber NHS Foundation Trust

Governance

Time Period

April 2016 May 2016 June 2016 July 2016

Number of serious incidents reported

11 12 12 7

Monitor Governance Rating

Green Green Green Green

Monitor Financial sustainability risk rating

3 3 3 3

No evident concerns.

Contractual Actions

No contractual actions were undertaken during July 2016.

Patient Experience

Friends and Family Test Mental Health

Performance fell again in May to 77%. Detailed comments for all FFT areas are shared with DCCG’s Patient Experience Manager and the Trust share learning across their service teams. The underperformance for Mental Health and Community has been raised with the Trust and a response will be given at the next RDASH Clinical Quality Review Group.

Friends and Family Test Community

15

The percentage of people recommending community services has been at 76% for the last 3 months. In this time the number of people responding has increased from 85 people in January 2016 to 357 people in May 2016. As above these results will be shared with DCCG’s Patient Experience Manager and the Trust share learning across their service teams

Workforce

Time Period

June 2016

Overview by exception A review of how the safer staffing figures are recorded and reported is being undertaken by RDASH and has been asked to be presented at the next RDASH CQRG meeting.

Safety

Operational Effectiveness

Time Period

Dec 15 Jan 16 Feb 16 Mar 16 Apr 16 May 16 June

16

Improved access to psychological services - the

proportion of people who complete

treatment who are moving to recovery

(Target – 50%)

50.9% 61.6% 57.2% 46.4% 44.1% 46.1% 44.4%

The IAPT recovery rate has not achieved target over the last 4 months. The CCG is arranging a meeting with RDASH to review the current service provision, as patients with different levels of complexity are accessing the service which impacts on reported performance. A number of these patients are being offered an intervention even if they may not achieve recovery against national reporting requirements. These patients may however achieve reliable improvement, as demonstrated by the current score of 67.8% in June 2016 (national average of 65.2% in April).

The recovery performance is shown in the graph below:

Time Period

Sept 15

Oct 15

Nov 15

Dec 15

Jan 16

Feb 16

Mar 16

Apr 16

May 16

June 16

Number of Never Events

0 0 0 0 0 0 0 0 0 0

MRSA (cumulative during financial

year)

0 0 0 0 0 0 0 0 0 0

C-diff Actual

(cumulative during financial year)

4 6 6 6 6 6 6 0 1 1

These cases are attributed to NHS Doncaster CCG and apportioned to RDASH. If RDASH services are involved in the clinical management of the patient the root cause analysis is carried out by the RDASH Infection Prevention and Control Team.

16

Improving Access to Psychological

Therapies (IAPT), cumulative – Access

(Target 4.38% per quarter, 17.5%

annually)

13.3% 14.7% 16.3% 17.4% 1.7% 3.3% 5.1%

IAPT – Reliable Improvement (no

target)

64.9% 66.3% 68.8% 66.1% 65.7% 67.9% 67.8%

Percentage of referrals to IAPT who

have received 1st

treatment within 6 weeks (target 75%)

87.6% 82.8% 86.7% 87.5% 76.6% 82.6% 81.1%

Percentage of referrals to IAPT who

have received 1st

treatment within 18 weeks (target 95%)

99.1% 99.4% 98.9% 99.4% 99.0% 98.7% 99.2%

Adults receiving a 12 month S117 review compliance (Target

95%)

91.6% 91.3% 92.0% 91.6 91.0% 94.5% 93.8%

The Doncaster Borough wide S117 group is currently reviewing the processes around patients with outstanding reviews.

The percentage of older people

requiring non urgent treatment (mental

health) who receive treatment within 6

weeks of assessment (8 week pathway)

(Target 85%)

81.1% 78.4% 78.5% 86.3% 78.4% 77.3% 78.8%

There were 25 patients treated in June who waited over 8 weeks. The Trust has reported that this was mainly due to staff shortages in the Central Team. The team is now fully staffed and addressing the backlog, although referral rates are high. Actions have been taken to address similar problems in the North West Team and the CCG is awaiting a progress report. Some breaches relate to diagnostic waits; this part of the pathway is being discussed as part of the potential reduction in waiting times, as per national guidance, that dementia patients are diagnosed within 6 weeks by 2020.

17

The percentage of new patient waits for

podiatry within 18 weeks incomplete waits (target 95%)

100% 100% 100% 100% 100% 100% 100%

The percentage of patients seen within 18 weeks of referral to Evergreen Falls Prevention Service incomplete waits

(target 95%)

100% 88.8% 100% 100% 100% 100% 100%

The percentage of patients seen within 18 weeks of referral

to Dietician incomplete waits

(target 95%)

98.8% 99.0% 100% 95.7% 95.7% 95.7% 96.1%

There continue to be capacity and demand issues which are highlighted on the DCIS risk register. The number of patients currently waiting has reduced to 51 which include 2 patients waiting over the 18 week target, the longest wait at 22 weeks. There has been temporary funding put in place for a continued locum member of staff and a fixed term member of staff. A capacity report has been completed for commissioners and further work completed for the CCG, relating to managing the GP referrals from Care Homes, although no significant impact was evidenced. Commissioners are fully aware and the service is awaiting a response regarding the future specification. Performance will continue to be monitored via monthly contract monitoring meetings.

Percentage of urgent referrals to CAMHS triaged within 24 hours of receipt

(target 95%)

100% 100% 100% 98.0% 98.5% 99.4% 97.3%

Percentage of urgent referrals to CAMHS assessed within 24

hours of receipt (target 98%)

100% 100% 100% 100% 71.4% 100% 100%

Percentage of assessed CAMHS

patients starting their treatment plan within

8 weeks of referral (target 95%)

100% 85.2% 86.0% 97.0% 84.8% 87.3% 84.8%

The data previously reported for April and May has been refreshed by the Trust. The CCG has requested an explanation for the reasons why the service is failing against this part of the patient’s pathway.

(New local measure) Percentage of

patients classed as an emergency who

are assessed within a maximum of 4 hours

(target =>98%)

N/A N/A N/A N/A 100% 100% 100%

18

CQUINs

2016/17

Quarter 1

The quarter 1 evidence has now been received from the Trust and is currently being reviewed by the Quality Team within the CCG.

Quarter 2

The quarter 2 evidence is due from the Trust at the end of October 2016.

Quarter 3

The quarter 3 evidence is due from the Trust at the end of January 2017.

Quarter 4

The quarter 4 evidence is due from the Trust at the end of February 2017.

19

SECTION 2: OTHER COMMISSIONED SERVICES 2.1 FCMS

FCMS continue to review the quality of their data and are finalising the migration to an improved performance reporting tool. Reporting from the new tool has been reviewed in significant detail with the CCG through a joint and open approach with FCMS. Definitions have been agreed which has provided assurance of the calculation methodology and robustness of the performance data. Work will continue, as per the process with other providers, to continually refine the reporting and update it as the services develop. Regular Quality meetings and Contract meetings with FCMS continue to provide assurance of quality of care and service with no significant issues being raised to date. Positive patient experience results were reported last month and the performance data is provided below following the work done with FCMS as described above. Urgent Care Centre

Nov 15

Dec 15

Jan 16

Feb 16

Mar 16

Apr 16

May 16

June 16

July 16

FCMS – Urgent Care Centre (UCC) Performance against

4 hour A&E target

100% 100% 100% 100% 100% 100% 100% 100% 100%

Of the patients who have been streamed to the Urgent Care Centre by the Front Door Assessment and Signposting Service since October, all patients waited less than 4 hours to be seen in the UCC. Out of Hours

Oct 15 Nov 15 Dec 15 Jan 16 Feb 16 Mar 16 Apr 16 May 16 Jun 16

Telephone clinical assessment - <20 min

(target 95%)

91.22% 93.16% 92.12% 95.70% 97.33% 97.34% 97.89% 98.87% 98.34%

Telephone clinical assessment - <60 min

(target 95%)

85.39% 89.49% 62.03% 79.81% 92.28% 89.59% 97.48% 97.10% 96.50%

Face to face assessment (base) – triaged as emergency in <1 hour (target 95%)

42.86% (3/7)

33.33% (1/3)

50.00% (1/2)

50.00% (1/2)

25.00% (2/8)

50.00% (2/4)

33.33% (2/6)

100.00%

(5/5)

80.00% (4/5)

Face to face assessment (base) –

triaged as urgent in <2 hours (target 95%)

64.44% (58/90)

78.26% (72/92)

62.77% (86/ 137)

68.89% (93/ 135)

90.91% (100/ 110)

74.87% (140/ 187)

87.58% (134/ 153)

84.69% (166/ 196)

88.39% (137/ 155)

20

Face to face assessment (base) –


98.62% 98.48% 97.26% 97.46% 98.61% 97.72% 98.72% 97.67% 97.67%

Face to face assessment (visit) –

triaged as emergency in <1 hour (target 95%)

0.00% (0/2)

55.56 %

(5/9)

33.33% (1/3)

66.67% (2/3)

50.00% (1/2)

40.00% (2/5)

75.00% (3/4)

100.00%

(2/2)

50.00% (2/4)



46.51% (40/86)

69.09% (38/55)

83.64% (46/55)

62.82% (49/78)

63.27% (31/49)

78.87% (56/71)

82.69% (43/52)

78.46% (51/65)

72.00% (36/50)



87.62% 97.54% 91.89

% 92.29% 91.61% 97.45% 97.03% 98.94% 96.61%

The 1 patient requiring a face to face attendance within an hour who breached, chose an appointment outside the hour and was seen within 1 hour 25 mins.

Of the 18 patients not having an attendance within 2 hours, 14 were due to the patients choosing a later appointment time. If these patients had chosen an appointment within the advised timeframe this measure would have met target. The longest wait of the remaining 4 patients was 3 hours and 35 mins due to the demand in the UCC.

For the 2 patients requiring a visit within 1 hour who weren’t seen in time, this was due to the logistics of meeting the timeframe given the distance to travel. The longest wait was 1 hour and 16 mins. For the 14 patients not visited within 2 hours, 5 of those were actually seen within time but not correctly recorded in the system. The remaining patients were not seen in time with the longest wait being just under 4 hours. Work is continuing within the service to ensure the patients requiring a visit are prioritised appropriately, with the vehicles and staffing available. Where there is a delay patients continue to receive a comfort call to advise on progress. Same Day Health Centre

Oct 15 Nov 15 Dec 15 Jan 16 Feb 16 Mar 16 Apr 16 May 16 Jun 16

Face to face appointment – triaged as emergency seen in <1 hour (target 95%)

36.36% (24/66)

28.57% (16/56)

28.57% (18/63)

20.00% (22/ 110)

11.22% (12/ 107)

17.00% (17/ 100)

16.67% (9/54)

39.39% (13/33)

32.00% (8/25)

21

Face to face appointment – triaged as emergency seen in <2 hours (target 95%)

70.37% (95/ 135)

53.42% (86/ 161)

50.30% (83/ 165)

48.17% (92/ 191)

49.21% (94/ 191)

47.19% (109/ 231)

55.17% (112/ 203)

68.54% (122/ 178)

74.09% (143/ 193)

Face to face appointment – triaged as emergency seen in <24 hours (target 95%)

99.85% 100.00

% 99.48% 99.47% 99.59% 99.55% 99.03% 99.57% 99.21%

For the 17 patients who did not have an appointment within 1 hour, the patients chose an appointment outside the advised timeframe. For the 50 patients who did not have an appointment within 2 hours, 40 of those were booked by the patient outside the advised timeframe. If those patients had booked an appointment within the advised timeframe, the performance would have been 94.8%. 10 breaches were due to available capacity in the centre and all patients were seen within 2 and a half hours.

2.2. Yorkshire Ambulance Service (YAS) NHS Doncaster CCG YAS Performance: Original Category Performance

October November December January February March

R1 MTD

72.03% 68.18% 59.13% 68.97% 62.88% 64.47%

R1 YTD 71.05% 70.66% 69.24% 69.21% 68.50% 68.04%

R2 MTD

66.96% 65.54% 64.41% 65.79% 64.01% 64.80%

R2 YTD 67.99% 67.65% 67.22% 67.05% 66.75% 64.48%

Performance during Ambulance Response Programme Pilot

April (21st

– 30

th)

May June July YTD

Red < 8 min 68.5% 66.1% 62.5% 63.2% 61.7%

Amber R < 19 min 86.8% 79.9% 89.4% 58.8% 63.6%

Amber T < 19 min 76.2% 66.5% 66.7% 53.4% 58.7%

Amber F < 19 min 87.0% 73.4% 62.5% 55.7% 64.5%

Green F <60 min 86.2% 76.3% 100% 76.0% 79.2%

Green T <60 min 77.5% 75.9% 78.9% 68.1% 70.3%

Green H <60 min 100% 100% 100% 97.5% 99.3%

Please note that performance standards for the new categories have not yet been confirmed.

Tail of Performance July 2016 Red time

(hh:mm:ss) Amber R time (hh:mm:ss)

Amber T time (hh:mm:ss)

Amber F time (hh:mm:ss)

50% 00:06:02 00:11:10 00:12:58 00:10:19

75% 00:08:26 00:17:29 00:21:40 00:18:36

95% 00:13:35 00:35:15 00:48:03 00:49:49

100% 00:23:26 01:52:31 03:27:47 03:49:43

22

The above table shows that for 75% of patients, the appropriate vehicle for a Red response arrived within 8 minutes 26 seconds compared to the 8 minute target.

For 75% of patients, the appropriate vehicle for an Amber Response arrived within 17 minutes 29 seconds compared to the 19 minute target.

For 75% of patients, the appropriate vehicle for an Amber Transfer arrived within 21 minutes 40 seconds compared to the 19 minute target.

For 75% of patients, the appropriate vehicle for an Amber Face to Face arrived within 18 minutes 36 seconds compared to the 19 minute target.

YAS, NHS England and wider partners continue to review the new Ambulance Response Programme pilot. They will assess the impact on the patients both in terms of quality and performance, the clinical codes within both NHS Pathways and the Advance Medical Priority Dispatch System (AMPDS) to ensure the most appropriate clinical response is made to every call and will see significant changes to the way the service responds to patients. It will also enable decisions on the most appropriate response for patients’ needs. Initial findings suggests the acuity of calls is higher than anticipated so may result in the requirement to move ambulance response vehicles to a higher ratio of transport vehicles.

2.3 Nursing / Care Homes / Domiciliary Care Providers

The information provided within this section is taken up to 31st July 2016. Since the last Governing body meeting there have been 0 new embargoes against admissions / new care packages placed. There has been 1 embargo lifted.

At present there are 2 providers within Doncaster with embargoes in place and 0 providers with restrictions in place.

2.5 Serious Case Reviews / Lesson Learnt Reviews

No new Serious Case Reviews or Lessons Learnt Reviews have been recommended or commissioned since the last Governing Body Report.

SECTION 3: NHS Doncaster CCG Local Delivery Plans- Items to note There were no items of escalation this month.

Indicator Pass Condition Fail Condition Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

TA&E waiting time -Maximum waiting time of 4 hours in the A&E department

(DBHFT)

Equal to or greater

than 95%Less than 95% 92.1% 92.5% 92.5% 95.1% 93.1% 92.2% 92.8%

10405 9976 11545 11365 12632 11834 12165

Less than baseline Greater than 5% 11294 10706 11856 11762 11950 12487 12047

13099 12548 14800 14396 15058 14729 14396

Less than baseline Greater than 5% 13735 13176 14679 13550 13797 13547 14046

7035 6774 7769 7540 7935 7902 8139

N/A N/A 7376 6815 7360 7811 7701 8365 8656

% of patients seen within 4 hours at DRIEqual to or greater

than 95%Less than 92% 87.2% 87.7% 87.6% 93.3% 89.0% 89.2% 90.1%

3370 3202 3776 3825 4020 3932 4026

N/A N/A 3918 3891 4496 3951 4249 4122 4492

% of patients seen within 4 hours (Bassetlaw)Equal to or greater

than 95%Less than 95% 96.4% 96.0% 95.6% 96.3% 96.1% 94.7% 94.9%

T Trolley waits in A&EEqual to or less than

12 Hours

Greater than 12

Hours0 0 0 0 0 0

C Ambulance clinical quality – Category A (Red 1) 8 minute response time YASEqual to or greater

than 75%Less than 71.25% 69.0% 69.6% 68.5%

Ambulance clinical quality – Category A (Red 1) 8 minute response time ENG

C Ambulance clinical quality – Category A (Red 2) 8 minute response time YASEqual to or greater

than 75%Less than 71.25% 72.5% 72.0% 70.2%

Ambulance clinical quality – Category A (Red 2) 8 minute response time ENG

C Ambulance clinical quality - Category A 19 minute transportation time YASEqual to or greater

than 95%Less than 90% 94.7% 94.3% 93.7%

Ambulance clinical quality - Category A 19 minute transportation time ENG

C Ambulance clinical quality – Category A (Red 1) 8 minute response time DONCEqual to or greater

than 75%Less than 71.25% 69.0% 62.9% 64.5%

C Ambulance clinical quality – Category A (Red 2) 8 minute response time DONCEqual to or greater

than 75%Less than 71.25% 65.8% 61.0% 64.8%

Q1Q3

T A&E Attendances (Type1) DBHFT

Baseline

T A&E Attendances (All) DBHFT

Baseline

A&E Attendances (DRI)Baseline

Doncaster CCG 2016/17 Performance Report Q4 Q1 Q2

A&E

Ambulance

A&E Attendances (Bassetlaw)Baseline

Doncaster CCG 2016/17 Performance Report CCG

DBHFT

RDaSH

Misc Delivery Plans

Key: T = Trust Targets

C = CCG related Targets

ND No Data Available

1


Q1Q3Doncaster CCG 2016/17 Performance Report Q4 Q1 Q2


DBHFT

RDaSH

Misc Delivery Plans




C Ambulance clinical quality - Category A 19 minute transportation time DONCEqual to or greater

than 95%Less than 90% 93.6% 94.3% 93.3%

TAll handovers between ambulance and A&E must take place within 15 minutes -

those over 30 minutes0 Greater than 1 239 229 247 75 76

TAll handovers between ambulance and A&E must take place within 15 minutes -

those over 60 minutes0 Greater than 1 40 50 65 11 12

Red Under 8- 8 minute response time DONC TBC TBC 68.5% 66.1% 62.5% 63.2%

Amber R- 19 minute response time DONC TBC TBC 86.8% 79.9% 89.4% 58.8%

Amber T- 19 minute response time DONC TBC TBC 76.2% 66.5% 66.7% 53.4%

Amber F- 19 minute response time DONC TBC TBC 87.0% 73.4% 62.5% 55.7%

Green F- 60 minute response time DONC TBC TBC 86.2% 76.3% 100.0% 76.0%

Green T- 60 minute response time DONC TBC TBC 77.5% 75.9% 78.9% 68.1%

Green H- 60 minute response time DONC TBC TBC 100.0% 100.0% 100.0% 97.5%

Red Under 8- 8 minute response time YAS TBC TBC 73.0% 71.0% 68.1% 66.3%

Amber R- 19 minute response time YAS TBC TBC 83.1% 77.7% 74.7% 71.6%

Amber T- 19 minute response time YAS TBC TBC 76.8% 68.6% 66.4% 60.5%

Amber F- 19 minute response time YAS TBC TBC 86.8% 75.6% 72.2% 66.4%

Green F - 60 minute response time YAS TBC TBC 92.2% 87.4% 85.1% 85.4%

Green T- 60 minute response time YAS TBC TBC 84.2% 79.5% 77.6% 73.9%

Green H- 60 minute response time YAS TBC TBC 99.8% 99.6% 99.7% 99.3%

C All cancer two week waitEqual to or greater

than 93%Less than 88% 93.8% 97.1% 95.2% 93.7% 94.0%

C Two week wait for breast symptoms (where cancer was not initially suspected)Equal to or greater

than 93%Less than 88% 93.9% 98.9% 95.0% 92.1% 97.0%

CPercentage of patients receiving first definitive treatment within one month of a

cancer diagnosis

Equal to or greater

than 96%Less than 91% 96.0% 94.2% 96.0% 93.0% 98.1%

* The new standards are defined at the bottom of the report. The Data provided is prior to signoff via YAS and is subject to change.

Cancer

2




DBHFT

RDaSH

Misc Delivery Plans




C 31-day standard for subsequent cancer treatment - anti cancer drug regimensequal to or greater

than 98%Less than 87% 97.3% 100.0% 97.9% 100.0% 100.0%

C 31-day standard for subsequent cancer treatments- radiotherapyEqual to or greater

than 94%Less than 89% 100.0% 100.0% 97.4% 100.0% 100.0%

C 31-day standard for subsequent cancer treatments- surgeryEqual to or greater

than 94%Less than 89% 85.0% 81.8% 86.4% 88.9% 100.0%

CPercentage of patients receiving first definitive treatment for cancer within two

months (62 days) of an urgent GP referral for suspected cancer

Equal to or greater

than 85%Less than 80% 75.5% 81.1% 83.9% 81.1% 82.8%

CPercentage of patients receiving first definitive treatment for cancer within 62-

days of referral from an NHS Cancer Screening Service

Equal to or greater

than 90%Less than 85% 75.0% 87.5% 100.0% 92.3% 100.0%

CPercentage of patients receiving first definitive treatment for cancer within 62-

days of a consultant decision to upgrade their priority status

Equal to or greater

than 90%Less than 85% 83.3% 88.9% 89.5% 86.4% 70.6%

T All cancer two week wait.Equal to or greater

than 93%Less than 88% 93.5% 96.6% 94.9% 93.1% 93.1%

T Two week wait for breast symptoms (where cancer was not initially suspected)Equal to or greater

than 93%Less than 88% 94.9% 97.4% 96.3% 93.4% 95.8%

TPercentage of patients receiving first definitive treatment within one month of a

cancer diagnosis

Equal to or greater

than 96%Less than 91% 97.6% 97.6% 97.9% 99.3% 99.4%

T 31-day standard for subsequent cancer treatments-anti cancer drug regimensEqual to or greater

than 98%Less than 87% 75.0% 100.0% 100.0% 100.0% 100.0%

T 31-day standard for subsequent cancer treatments-surgeryEqual to or greater

than 94%Less than 89% 100.0% 100.0% 100.0% 100.0% 100.0%

3




DBHFT

RDaSH

Misc Delivery Plans




TPercentage of patients receiving first definitive treatment for cancer within two

months (62 days) of an urgent GP referral for suspected cancer

Equal to or greater

than 85%Less than 82% 76.3% 85.2% 90.2% 86.6% 89.7%

TPercentage of patients receiving first definitive treatment for cancer within 62-

days of referral from an NHS Cancer Screening Service

Equal to or greater

than 90%Less than 85% 82.4% 91.9% 100.0% 93.3% 100.0%

0 0 0 0 0 0

0 Greater than 0 0 0 0 0 0 0

0 0 0 0 0 0

0 Greater than 0 0 0 1 0 0 1

0 0 0 0 0 0

0 Greater than 0 0 0 0 0 0 0

66 73 81 6 13 20

Equal to or less than

46Greater than 46 61 64 72 3 4 10

33 36 40 3 6 9


20Greater than 21 27 29 32 0 4 7

T

Mental Health Measure – Care Programme Approach (CPA) - The proportion of

those patients on Care Programme Approach (CPA) discharged from inpatient

care who are followed up within 7 days (stretch local target)

Equal to or greater

than 95%Less than 90.25% 100% 94.7% 93.8% 100% 100% 100%

14.7% 16.3% 17.4% 1.7% 3.3% 5.1%

T

Mental Health Measure- Improved access to psychological services - The

proportion of people who complete treatment who are moving to recovery

(Target)

Equal to or greater

than 50%Less than 47.50% 61.6% 57.2% 46.4% 44.1% 46.1% 44.4%

41

115

27

230C

5% Reduction in emergency admissions for upper respiratory tract infections by

April 2015


5%Greater than

T Incidence of healthcare associated infection: MRSA bacteraemia

48

C Incidence of healthcare associated infection: MRSA bacteraemia

T Incidence of healthcare associated infection: MRSA bacteraemia

C Emergency admissions for children with lower respiratory tract infections (LRTIs)Equal to or less than

382 per annumGreater than

238

116

131

Mental Health Measure- Improved access to psychological services - The

proportion of people that enter treatment against the level of need in the

general population (the level of prevalence addressed or ‘captured’ by referral

routes)

T Incidence of healthcare associated infection: C. difficile

T

Childrens

Infection Control

Mental Health

C Incidence of healthcare associated infection: C. difficile

15.00%Equal to or greater

than 7.5%Less than 7.125%

4




DBHFT

RDaSH

Misc Delivery Plans




C Mixed Sex Accommodation (MSA) Breaches CCG 0 Greater than 0 0 0 0 0 0 0

T Mixed Sex Accommodation (MSA) Breaches (DBHFT) 0 Greater than 0 0 0 0 0 0 0

T Mixed Sex Accommodation (MSA) Breaches (RDASH) 0 Greater than 0 0 0 0 0 0 0

TCancelled Operations - All patients who operations cancelled for non clinical

reasons to be offered another binding date within 28 days0 Greater than 0 5 2 2 0 2 2

T Stroke: proportion of patients scanned within 4 hours of arrival at hospitalEqual to or greater

than 90%Less than 85.5% 67.3% 62.5% 65.0% 69.6%

T Stroke: proportion of patients scanned within 1 hour of arrival at hospitalEqual to or greater

than 50%Less than 45% 50.0% 41.7% 47.5% 42.9%

TStroke: Proportion of patients scanned within 24 hours of first contact with a

professional

Equal to or greater

than 60%Less than 57% 66.7% 70.0% 81.5% 66.7%

C

Number of 52 week Referral to Treatment Pathways - the number of admitted

pathways greater than 52 weeks for admitted patients whose clocks stopped

during the period on an adjusted basis

0 Greater than 0 0 0 0 0 0

C

Number of 52 week Referral to Treatment Pathways - the number of non-

admitted pathways greater than 52 weeks for non-admitted patients whose

clocks stopped during the period


C

Number of 52 week Referral to Treatment Pathways - the number of incomplete

pathways greater than 52 weeks for patients on incomplete pathways at the end

of the period


Other

Waiting Times

Stroke & TIA

Mixed Sex Accommodation

5




DBHFT

RDaSH

Misc Delivery Plans




T Diagnostic test waiting timesEqual to or greater

than 99%Less than 99% 99.5% 99.7% 98.3% 99.2% 99.5% 99.6%

C Diagnostic test waiting timesEqual to or greater

than 99%Less than 99% 99.5% 99.7% 98.4% 99.2% 99.5%

TThe percentage of incomplete pathways within 18 weeks for patients on

incomplete pathways at the end of the period

Equal to or greater

than 92%Less than 87% 92.3% 92.1% 92.1% 92.9% 93.1% 92.8%

CPercentage of incomplete pathways within 18 weeks for patients on incomplete

pathways at the end of the period

Equal to or greater

than 92%Less than 87% 92.8% 92.7% 92.6% 93.6%

* The new standards for YAS are as followed:

Red – Life-threatening; Time critical life-threatening event needing immediate intervention and/or resuscitation; 8 minute target.

Amber – Emergency; Potentially serious conditions (ABCD problem) that may require rapid assessment, urgent on-scene intervention and/or urgent transport; 19 minute target.

Green – Urgent; Urgent problem (not immediately life-threatening) that needs transport within a clinically appropriate timeframe or a further face-to-face or telephone assessment and management; 60 minute

target.

Further Detail on Amber Codes

Amber R– a patient who does not have an immediately life threatening condition but requires an emergency response. Their condition/problem requires assessment/management on scene and it is likely that they

will require conveyance to hospital. Example – patients having a heart attack (MI) require on scene management by a clinician AND conveyance to an appropriate facility (PPCI).

Amber T – a patient who does not have an immediate life threatening condition but requires an emergency response. Their condition/problem is time dependant on reaching definitive care and therefore a

conveying resource is the most important. Example Stroke (CVA) patients require rapid transport to a hyper-acute stroke unit or other appropriate facility.

Amber F – a patient who does not have an immediate life threatening condition but does require an emergency response. Their condition/problem may well be managed on scene by a clinician and may or may

not require onward referral. Example – hypoglycaemia.

6

Enc E

Corporate Assurance Report – Quarter 1


Meeting date 18 August 2016

Title of paper

Corporate Assurance Report – Quarter 1 2016/17


Mrs Sarah Atkins Whatley, Chief of Corporate Services

Author(s) Mrs Sarah Atkins Whatley, Chief of Corporate Services Corporate Services Team


The key points from this report to which the organisation’s attention is particularly drawn are:

Risk: The Risk Register now holds 47 risks, up from 33 at the end of the last Quarter. The additional risks reflect a more proactive use of the Risk Register to capture emerging risks, and the inclusion of primary care commissioning risks associated with our delegated responsibility for primary medical care commissioning from 1 April 2016.

External Assessments: The last quarter has seen the conclusion of 2015/16 reporting. We have received positive assurance through the final Head of Internal Audit Opinion, the ISA 260 Report to those charged with Governance, and the Independent Auditors Report to Members of the Governing Body which confirmed issue of an unqualified regulatory opinion and opinion on the CCG’s 2015/16 financial statements with no matters arising from the CCG’s use of resources to report for the year.

Committee activity: The Engagement Committee held a development session during the last quarter to develop a shared understanding of the role of the Committee, its future priorities, and to consider how to increase Committee effectiveness. Moving forward, the Committee aims to develop a forward workplan mapped to our strategic plan priorities, focus on key engagement areas for maximum impact, strengthen relationships with our partners on engagement activity, and promote engagement, experience and equality at each stage of the commissioning cycle. The first Executive Committee meeting was held in June 2016 and considered operational matters such as proposals for joint working across areas broader that Doncaster and updates on progress with the RightCare programme. The new Primary Care Commissioning Committee has met 3 times during the Quarter and received updates on the Primary Care Strategy, approved a Primary Care Quality Assurance Strategy, and considered and approved investment proposals for allocating transforming primary care funding and for allocating capital/IT investment.

Governance Structure: Our revised meeting governance structure was implemented from 1 June 2016.

Business Continuity: Business Continuity Week took place in the quarter 1 and we used the opportunity for a live test. Staff team members were stopped going

into our Headquarters on the morning of the test and asked about business continuity. The results from the exercise demonstrate the need for more work on embedding business continuity within the organisation, and work on this will take place in the next 2 quarters.

Information Governance: A new General Data Protection Regulation (GDPR) was adopted across the EU on 27 April 2016 and must be implemented across the EU by 25 May 2018. There are significant changes to the regulation which will impact NHS Doncaster CCG, and a significant programme of work will commence to prepare for the new regulation. Also in the last quarter, the Caldicott Plan, Management Statement and Caldicott Log have been updated, a range of Information Sharing Agreements have been developed to support the Digital Roadmap work, and we have developed a Data Quality Plan and a forward programme of data quality audits for 2016/17.

Organisational Development: We are starting to review our Organisational Development Strategy in 2016/17 to make sure it is fit for purpose with the changing commissioning landscape. We are currently starting the diagnostic stage of the process which will include one to one meetings with key staff and stakeholders and some staff workshops. The findings from this piece of work will be available by October 2016 and will inform the Organisational Development Strategy. The Colleague Engagement Group (CEG) continues to meet bi-monthly and has expanded its membership. Compliance with mandatory & statutory training is improving.

Recommendation(s)

It is recommended that the meeting considers and notes the information provided.

Impact analysis

Assurance Framework

4.1, 5.1, 5.2, 5.3, 5.4, 5.5, 6.1

Risk analysis

Risks are highlighted throughout the report.

Equality impact

Neutral


Sustainability impacts are listed in the report


Nil

Legal implications

Nil


N/A

1

CORPORATE ASSURANCE

REPORT

Quarter 1 2016/17

(1st

April – 30th

June 2016)

2

Contents ______________________________________________________

Section Sub-Section Page Executive Summary

3

Section 1 Risk Management 1.1. Assurance Framework 1.2. Risk Register 1.3. Internal Incident Reporting 1.4. Claims & Legal Issues

4 4 6 7 8

Section 2 External Assessments

9

Section 3 Committee Activity

10

Section 4 Corporate Governance 4.1. Constitution & Establishment 4.2. Governance Structure 4.3. Statutory roles 4.4. Procedural Document Management 4.5. Health & Safety, Fire Safety & Security 4.6. Emergency Resilience & Business Continuity 4.7. Sustainability 4.8. Complaints Management 4.9. Whistleblowing

12 12 12 14 14 14 15 15 15 16

Section 5 Information Governance 5.1. The protection and use of personal confidential data 5.2. Information Governance Toolkit 5.3. Freedom of Information Act Requests 5.4. Data Protection Subject Access Requests 5.5. Information Management & Technology

17 17 17 18 18 19

Section 6 Financial Governance

20

Section 7 Organisational Development & Staffing Governance 7.1. Organisational Development 7.2. Staffing Governance

21 21 22

3

Executive Summary _________________________________________________________ The key points from this report to which the organisation’s attention is particularly drawn are:

Risk: The Risk Register now holds 47 risks, up from 33 at the end of the last Quarter. The additional risks reflect a more proactive use of the Risk Register to capture emerging risks, and the inclusion of primary care commissioning risks associated with our delegated responsibility for primary medical care commissioning from 1 April 2016.

External Assessments: The last quarter has seen the conclusion of 2015/16 reporting. We have received positive assurance through the final Head of Internal Audit Opinion, the ISA 260 Report to those charged with Governance, and the Independent Auditors Report to Members of the Governing Body which confirmed issue of an unqualified regulatory opinion and opinion on the CCG’s 2015/16 financial statements with no matters arising from the CCG’s use of resources to report for the year.

Committee activity: The Engagement Committee held a development session during the last quarter to develop a shared understanding of the role of the Committee, its future priorities, and to consider how to increase Committee effectiveness. Moving forward, the Committee aims to develop a forward workplan mapped to our strategic plan priorities, focus on key engagement areas for maximum impact, strengthen relationships with our partners on engagement activity, and promote engagement, experience and equality at each stage of the commissioning cycle. The first Executive Committee meeting was held in June 2016 and considered operational matters such as proposals for joint working across areas broader that Doncaster and updates on progress with the RightCare programme. The new Primary Care Commissioning Committee has met 3 times during the Quarter and received updates on the Primary Care Strategy, approved a Primary Care Quality Assurance Strategy, and considered and approved investment proposals for allocating transforming primary care funding and for allocating capital/IT investment.

Governance Structure: Our revised meeting governance structure was implemented from 1 June 2016.

Business Continuity: Business Continuity Week took place in the quarter 1 and we used the opportunity for a live test. Staff team members were stopped going into our Headquarters on the morning of the test and asked about business continuity. The results from the exercise demonstrate the need for more work on embedding business continuity within the organisation, and work on this will take place in the next 2 quarters.

Information Governance: A new General Data Protection Regulation (GDPR) was adopted across the EU on 27 April 2016 and must be implemented across the EU by 25 May 2018. There are significant changes to the regulation which will impact NHS Doncaster CCG, and a significant programme of work will commence to prepare for the new regulation. Also in the last quarter, the Caldicott Plan, Management Statement and Caldicott Log have been updated, a range of Information Sharing Agreements have been developed to support the Digital Roadmap work, and we have developed a Data Quality Plan and a forward programme of data quality audits for 2016/17.

Organisational Development: We are starting to review our Organisational Development Strategy in 2016/17 to make sure it is fit for purpose with the changing commissioning landscape. We are currently starting the diagnostic stage of the process which will include one to one meetings with key staff and stakeholders and some staff workshops. The findings from this piece of work will be available by October 2016 and will inform the Organisational Development Strategy. The Colleague Engagement Group (CEG) continues to meet bi-monthly and has expanded its membership. Compliance with mandatory & statutory training is improving.

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Section 1 – Risk Management _________________________________________________________

1.1.

Assurance Framework

Our Assurance Framework captures risks to the achievement of our strategic objectives. It has been refreshed during the last Quarter and the position is presented as at quarter-end. There have been no new risks added to or removed from the Framework and the total number of risks on the Framework at quarter-end therefore stands at 20. Of these risks, three are being treated. Risk 1.4 relating to the challenging financial position for 2016/17, and Risk 2.4 relating to provider performance are at a score of 12 which is above the CCG’s risk toleration threshold. Risk 1.3 on health inequalities remains below the risk toleration threshold but continues to be treated to further strengthen existing controls / assurances.

Risks

2015/16 2016/17

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Total number of risks on the Assurance Framework

22 22 22 20 20

Number of risks in excess of the toleration threshold

3 3 3 2 2

Number of risks in excess of toleration threshold being treated

3 3 3 2 2

Number of risks below the toleration threshold being treated

3 1 1 1 1

Number of new risks added to the Assurance Framework during the Quarter

0 0 0 0 0

Number of risks removed from the Assurance Framework during the Quarter

0 0 0 2 0

The risks being treated as at Quarter-end are:

Ref Risk

description Updates Rating

1.3

Failure to effectively

commission services to

reduce health inequalities, potentially

resulting in a widening of

the inequalities

gap.

This risk remains at a score of 8 (below the risk toleration threshold) but is being treated to strengthen controls and assurances with an action to “work in partnership with the Health & Wellbeing Board to identify inequalities and address these in partnership in line with the Health & Wellbeing Board Strategy”.

In the last Quarter an engagement session with Governing Body members on health inequalities was developed and it was run at the May meeting of the Strategy & Organisational Development Forum.

It has been agreed that a health inequalities plan will be developed focussing on performance data, reducing unwarranted variation in primary care, and seeking to

Medium

5

better understand the health needs of our black, asian and minority ethnic population in Doncaster.

Work is taking place jointly with public health team members over the summer to develop these workstreams into an action plan, which we intend will then be combined with our existing Equality Strategy.

1.4

A change to the national

business rules for CCG

allocations has resulted

in an extremely

challenging financial

position for CCGs in 2016/17 which in

Doncaster will require a significant efficiency

programme, which could affect our

local achievement of financial targets and our system

transformation plans

A change to the national business rules for CCG allocations has resulted in an extremely challenging financial position for CCGs in 2016/17, which we have assessed in Doncaster could affect our local achievement of financial targets and our system transformation plans.

The risk remains at a score of 12 (above the risk toleration threshold) and is being treated with an action plan to “develop and implement an efficiency programme aligned to the Right Care analysis, impact assess this against our transformation plan, and monitor progress throughout the year”.

Based on the national Commissioning for Value packs and tools, four local workstreams have been initiated in the areas of a) Respiratory, b) Endocrine, c) Neurology, and d) Musculoskeletal, and clinical leaders have been identified to these workstreams. We are also focussing on quality and value in prescribing, and July has seen the launch to General Practice of a prescribing gain-share scheme approved by the Primary Care Commissioning Committee. These areas form the basis of our efficiency programme in 2016/17. Progress will be reported to the Governing Body as the workstreams develop.

High

2.4

Failure to performance

manage contracts to ensure that Providers

deliver against local and national performance

targets, potentially resulting in

organisational non-

achievement of required

targets.

This is an ongoing risk which the Governing Body keeps sight of on the Assurance Framework. This risk remains at a score of 12 (above the risk toleration threshold) and it is being treated with an action to “continue to take all contractual and partnership measures available to the CCG to ensure provider performance is brought back on track for key performance targets”.

The Governing Body receives monthly Quality & Performance reports which identify performance areas which are off trajectory. The transformation programmes approved by the Governing Body aim to address the underpinning system issues and support care closer to home. Additional remedial action on performance issues is reported to the Governing Body e.g. in response to the pressures on the NHS system associated with Junior Doctor industrial action and ongoing performance issues nationally in urgent care systems and

High

6

Ambulance Services. The risk is being maintained at its existing score and progress will continue to be reported to Governing Body through the Quality & Performance Report.

1.2.

Risk Register

NHS Doncaster CCG’s Risk Register captures operational organisational risks. Risks scoring 16 or more can be escalated to the Assurance Framework where they could affect achievement of the CCG’s strategic objectives, and risks can also be de-escalated from the Assurance Framework to the Risk Register should risks be mitigated to a lower level or no longer threaten achievement of the CCG’s strategic objectives. As at the end of Quarter 1 the CCG Risk Register held 47 risks, of which 10 were rated as High and all of the risks rated High or above were being treated. The key changes to the Risk Register in the last Quarter comprise the addition of 14 new risks:

New: QS-008 - Failure to effectively commission, quality assure and performance manage a Continuing Healthcare (CHC) system that is safe and effective for patients and represents value for money.

New: FC-016 – The Parliamentary & Health Service Ombudsman may investigate any CCG which has not completed assessment of Previously Un-assessed Periods of Care (PUPoC) cases by March 2017 for maladministration and fine CCGs the total costs for the outstanding cases – financial risk.

New: CS-012 – Acute Trust are not compliant with fire compartmentalisation requirements and a 5 year plan is required to remedy this.

New: CS-013 - On 25 May 2018, the existing Data Protection Directive 95/46/EC (which was implemented in the UK as the Data Protection Act 1998) will be replaced by the new EU General Data Protection Regulation (GDPR). There will be process and cost implications for the organisation which are not quantified at the present time.

New: CS-014 - The implications of the EU Referendum are unclear for the NHS. There is currently a huge body of law that derives from EU law, including 2015 Procurement Regulations. Employment legislation may also be affected.

The Primary Care and Partnership Risk Register had been newly developed following delegation from NHS England for primary medical care commissioning on 1st April 2016, and it contains nine new risks.

RISK REGISTER 2015/16 2016/17

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Risk Type

Commissioning 4 5 4 4 11

Employment 2 1 1 1 1

Environmental 0

Financial 9 8 10 11 12

Governance 6 5 3 3 5

Performance 4 5 6 7 8

Quality 3 3 5 6 9

Reputational 1 1 1 1 1

7

TOTAL 29 28 30 33 47

Risk rating

Extreme

Very High

High 4 4 6 7 10

Medium 24 24 24 26 36

Low 1 1

TOTAL 29 28 30 33 47

Treatment

Treat 12 12 13 14 23

Tolerate 17 16 17 19 24

Terminate

Transfer

TOTAL 29 28 30 33 47

1.3.

Internal Incident

Reporting

The following table shows the number and category of internal incidents reported during the last quarter, and the severity. There have been eight incidents reported in the last Quarter. Five of the incidents were information governance issues; one was an IT system failure, and the remaining four were low-level incidents around information sharing. None of the information governance incidents were reportable to the Information Commissioner. The two facilities / health & safety incidents comprise one incident of verbal abuse to a Continuing Healthcare staff member by a patient (future meetings will be held at CCG Headquarters), and a faulty smoke detector (which was remedied the same day). The patient safety incident relates to a delayed package of fast-track continuing healthcare.

INCIDENT MANAGEMENT 2015/16 2016/17

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Category

Accident / Injury 4

Communication

Confidentiality / Information Governance

1 4 2 5 5

Disruptive or Violent behaviour / Assault

Estates/Facilities/Security/Health & Safety

3 5 1 2

Financial loss

Patient Safety 1

Other

Total 5 7 7 6 8

Impact

1 - Low (No Harm) 1 7 7 6 8

2 - Medium (Minor treatment only)

3

3 - High (Significant, not permanent harm)

1

4 - Very High (Permanent harm /

8

damage)

5 - Extreme (death)

Total 5 7 7 6 8

Reporting

National Patient Safety Agency (NPSA)

0 0 0 0 0

Counter Fraud and Security Management Service SIRS Reporting

0 0 0 0 0

Information Commissioners Office

0 0 0 0 0

Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR)

1 0 0 0 0

Total 1 0 0 0 0

1.4.

Claims & Legal issues

Insurance to the CCG is commissioned from the NHS Litigation Authority (NHSLA). The limitation period during which claims can be made is 3 years from the affected individual becoming aware of the issue. No new claims were received in the last quarter and there are no claims outstanding for the CCG. The CCG has sought legal advice on two matters in the last quarter – the governance of the Previously Unassessed Periods of Care (PUPoC) process, and the primary care contracting process for PMS contract to GMS contract transfers.

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Section 2 – External Assessments _________________________________________________________ NHS Doncaster CCG is subject to a number of external assessments / inspections in order to

provide assurance on the quality of services commissioned and our systems of internal control. The following reports have been received in the last Quarter.

Internal Audit

(Service commissioned

from 360 Assurance)

Final Head of Internal Audit Opinion 2015/16: The final Head of Internal Audit Opinion for 2015/16 was received and noted. The report covered Design & operation of the Governing Body Assurance Framework, arrangements for the management of risk, the outturn of the Internal Audit Plan and follow-up of actions. No risks were identified from the report. Internal Audit Annual Report: A summary of the year’s work. Public Sector Equality Duty (PSED) Report: The audit provided significant assurance of controls. 1 medium risk recommendation was made regarding an update to the Equality Strategy.

External Audit

(Service commissioned from KPMG)

ISA 260 Report to those charged with Governance: concluding that NHS Doncaster CCG has put in place proper arrangements to secure economy, efficiency and effectiveness in the use of resources. There were no significant adjusted or unadjusted audit differences Identified as part of the audit. Independent Auditors Report to Members of the Governing Body: Summarising External Audit’s 2015/16 audit for NHS Doncaster CCG and confirming issue of an unqualified regulatory opinion and opinion on the CCG’s 2015/16 financial statements with no matters arising from the CCG’s use of resources to report for the year ending 31 March 2016. Audit fees: £67,500 for 2016/17.

Other inspections

External inspections of the CCG’s arrangements for Health & Safety, Fire Safety, or Information Governance can take place on an ad hoc basis. No inspections have taken place and no reports are expected.

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Section 3 – Committee Activity _________________________________________________________

Audit Committee

At the meeting held in the last Quarter the Committee considered and noted assurance on:

External Audit year-end audit progress and audit fees for 2016/17 of £67,500.

A range of Internal Audit reports as detailed in Section 2 of this report, including the final Head of Internal Audit Opinion.

A review of the un-audited annual accounts which were completed and submitted on 21 April 2016. The Committee particularly focussed on the summary of financial performance and achievement of all financial targets, the Statement of Comprehensive Net Expenditure, the Statement of Financial Position, the Statement of Changes in Taxpayers Equity and the Statement of Cash Flows.

The Service Auditor Report assurance from all three Shared Service Providers: Shared Business Services Finance & Accounting, Shared Business Services Employment Services (Payroll) and Yorkshire & Humber Commissioning Support.

Corporate Governance assurance including a review of the Assurance Framework Quarter 4 position, and the draft Annual Report and Annual Governance Statement.

Minutes from the Corporate Governance Management Group.

Remuneration Committee

The Remuneration Committee meets as required; no meetings were held in the last Quarter.

Quality & Patient Safety

Committee

At the meeting held in the last Quarter, the Committee discussed the following areas:

Ratification of changes to the terms of reference.

Overview Quality Reports for each of our main providers.

A Medicines Management report focusing on a primary care gain share scheme, prescribing links to the digital roadmap, and the interface between secondary and primary care prescribing.

Oversight of the quality of, and our benchmarked position on, individual placements.

Patient Experience Annual Report.

The 2016/17 Caldicott Work Plan, Management Statement, and Log.

Engagement & Experience Committee

Meetings are now being held monthly instead of quarterly. 2 meetings were held in the last Quarter where the following areas were discussed:

CCG priority areas of engagement focus.

Year-end reports on the Communication, Engagement & Experience Strategy actions: better information and engaged communities, experience of accessible & responsive care, and our equality objectives. The Committee also considered and approved the Statement of Involvement 2015/16 and the Complaints & Patient Experience Annual Report 2015/16.

Partner engagement plans for 2016/17 to coordinate activity and reduce duplication.

Feedback from the CCG’s Health Ambassador Scheme meetings which are held with some of the seldom heard voices in Doncaster.

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A development session was held during the June meeting to develop a shared understanding of the role of the Committee, its future priorities, and to consider how to increase the effectiveness of the Committee. Moving forward, the Committee aims to:

Develop a forward workplan mapped to our strategic plan priorities.

Focus on key engagement areas to gain maximum impact.

Watch out for “blind spots” through feedback from our partners.

Strengthen relationships with our partners on engagement activity.

Promote engagement, experience and equality at each stage of the commissioning cycle.

Executive Committee

The first Executive Committee meeting was held in June 2016, when our new governance structure was enacted. The Committee:

Noted the terms of reference delegated to the Committee by the Governing Body.

Considered proposals for joint working across areas broader that Doncaster.

Recommended a proposal for joint commissioning of Patient Transport Services to the Governing Body.

Considered the financial and organisational implications of a Primary Care Gain Share prescribing scheme, and recommended this to be discussed by the Primary Care Commissioning Committee.

Received a report which evaluated the recent Chair election process.

Received an update on the RightCare programme.

Considered a request from staff for a lease car scheme.

Primary Care Commissioning

Committee

The first formal Primary Care Commissioning Committee was held in April 2016 following delegation of responsibility for primary medical care commissioning from NHS England. Three meetings were held during the Quarter at which the Committee:

Noted the terms of reference delegated by NHS England and populated the list of members with named individuals.

Received updates on the Primary Care Strategy and shaped the development of a specification for the first “pillar” of the strategy – proactive coordinated primary care.

Approved a Primary Care Quality Assurance Strategy.

Considered a primary care stakeholder engagement plan.

Considered and approved investment proposals for allocating transforming primary care funding and for allocating capital/IT investment.

Considered approaches to transforming prescribing, and subsequently approved a primary care gain share prescribing scheme for launch during summer 2016.

Approved a proposal for a phased reduction and re-allocation of PMS premiums, and an approach to PMS uplifts.

Developed a programme of support to practices who could potentially be classed as vulnerable.

Received minutes from the Primary Care Management Group and the Primary Care Provider Engagement Group.

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Section 4 – Corporate Governance _________________________________________________________

4.1.

Constitution and

Establishment

As a Membership organisation comprising 43 Member Practices, NHS Doncaster CCG remains fully authorised by NHS England. There were no Locality Lead elections scheduled during the last Quarter. A vacancy for a Central Locality Lead was put out to expressions of interest, however Central Member Practices requested that the election be deferred pending forthcoming discussions on the future member engagement model. A recommendation has been made to suspend the North East and South West scheduled for July pending this same review of the member engagement model. On 1 April 2016 our new Chair, Dr David Crichton, and our new Chief Officer, Mrs Jackie Pederson, started in post. Miss Anthea Morris moved from the Public & Patient Engagement Lay Member position to the Audit & Governance Lay Member position. Mrs Linda Tully commenced in post as the Lay Member for Primary Care Commissioning, and for 6 months as an interim will also cover the vacant Public & Patient Engagement Lay Member position. The vacancy for the Chief of Strategy & Delivery position has been recruited to, and Mr Anthony Fitzgerald will commence in post in mid-July 2016. Delegated responsibility from NHS England for commissioning primary medical care commenced on 1st April 2016 and a new Primary Care Commissioning Committee met from April 2016 onwards.

4.2.

Governance Structure

Our meeting governance structure is detailed overleaf. Activity flowing through each formal Committee of the Governing Body is captured in Section 3 of this report. Following consultation with Member Practices, we moved to a refreshed meeting governance structure from 1 June 2016. The changes include:

Dividing the responsibilities of the Delivery & Performance Committee between the Governing Body and a new operational Executive Committee

Establishing a Clinical Reference Group to provide strong clinical leadership to commissioning debate and discussion and to facilitate clinical dialogue and leadership across primary, community and secondary care. The group aims to stimulate, challenge and propose innovative solutions to transformation and service/care pathway improvements in order to improve outcomes for patients and will determine, review and agree issues for cases for clinical change.

13

North West Locality

North East Locality

Central Locality

South West Locality

South East Locality

43 Member Practices

Key:

Governing

Body

Incident Management Group

Safeguarding Assurance Group

Medicines Management Group

Strategic Contracting Meetings

(with each of our main providers)

System Resilience

Group

Corporate Governance Management Group

Audit Committee


Quality & Patient Safety Committee


Executive Committee


Committee

Clinical

Reference Group

Primary Care Management Group

Primary Care Provider Engagement Group

Area Prescribing Committee

Team Doncaster Local Strategic Partnership and

underpinning Boards

Local Intelligence Network (LIN)

(for Controlled Drugs)

Patient Participation

Group Network

Health Ambassador Group

Working Together Partnership Board

A Sub Group of a formal Committee (may have delegated authority)

An external / partnership meeting feeding into the organisation (generally via the Minutes)

Strategy & Organisational

Development Forum

XXXXXX

XXXXXX

A formal Committee of the Governing Body with delegated authority

XXXXXX

Underpinned by Clinical Quality Review Groups and Finance,

Performance & Information Groups with each of our

main providers

XXXXXX A CCG-led engagement meeting (non decision-making)

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4.3.

Statutory roles

The Officers fulfilling the key statutory roles required of a CCG remain unchanged and are noted below:

Responsibility Lead

Accountable Officer Chief Officer

Accountable Emergency Officer

Chief Officer

Accounting Officer Chief Finance Officer

Caldicott Guardian Chief Nurse

2 deputies: Deputy Chief Nurse, and Quality & Patient Safety Manager

Safeguarding

Chief Nurse Designated Nurse for Safeguarding Children

Designated Professional for Safeguarding Adults

Research Governance Chief Nurse

Equality and Diversity Executive Lead

Chief of Corporate Services

Whistleblowing Lead Chief of Corporate Services

Senior Information Risk Owner Chief of Corporate Services

Health & Safety “Competent Person”

Head of Health, Safety & Security

Fire Safety “Responsible Person”

Fire Safety “Competent Person”



Security Management Director

Local Security Management Specialist



Claims Officer Chief of Corporate Services

Local Counter Fraud Specialist

360 Assurance

Registration Authority HR Team

Accountable Officer Controlled Drugs

Director of Nursing in the local NHS England Area Team (delegated operationally to the

CCG Head of Medicines Management)

4.4.

Procedural Document

Management

Procedural documents due for review in 2016 are on track. Four procedural documents are due for renewal by the end of the year.

4.5.

Health & Safety, Fire

Safety & Security

Health & Safety:

The Competent Person for Health & Safety has confirmed to the Corporate Governance Management Group that the CCG remains compliant with health & safety legislation.

Premises inspections are continuing and ongoing.

The annual organisational health & safety risk assessment is in date and is next due for review in September 2016.

The annual First Aid risk assessment is in date, has been received by the Corporate Governance Management Group, and is next due for review in January 2017.

Fire:

15

The annual fire risk assessment is in date, and is next due for review in September 2016.

Fire Marshalls are running weekly fire alarm tests. Security:

The Standards for Providers and Commissioners 2016-17: security management have been published in draft and an initial self-assessment has been conducted. Against the draft standard there are 3 areas classed as amber and one classed as red, and an action plan has been put into place to move these towards a green rating. The action plan will be formalised once the standards are published in final format.

4.6.

Emergency Resilience and

Business Continuity

Emergency Preparedness, Resilience & Response: We have received notification of the Emergency Preparedness, Resilience & Response self-assessment requirements for 2016/17 and we are undertaking this assessment across South Yorkshire and Bassetlaw for peer reflection. The Local Health Resilience Partnership (LHRP) has reviewed the shared Risk Register across South Yorkshire & Bassetlaw and included in the updated assessment is Air Quality, Cyber Security and Electrical Blackouts (for 5-7 days). A blackout training exercise is planned for 12 July 2016 and will be attended by a CCG team member. Business Continuity: Business Continuity Week took place in the quarter 1 and we used the opportunity for a live test in order to raise awareness of business continuity. Staff team members were stopped before going into White Rose House and Sovereign House on the morning of the 16 May 2016 and asked about business continuity. This was done as a conversation/discussion with staff, with questions along the lines of: what would you do if you couldn’t gain access to the building, what is your business continuity plan, do you know what NHS Doncaster CCG’s business continuity plan is? The results from the exercise demonstrate the need for more work on embedding business continuity within the organisation, and work on this will take place in the next 2 quarters.

4.7.

Sustainability

We have an action plan for sustainability as part of our CCG Sustainability Strategy. All actions are on track.

4.8.

Complaints management

Below is a summary of complaints data for NHS Doncaster CCG for the last quarter which has been reported to the Health & Social Care Information Centre.

Total Upheld Partially upheld

Not upheld

2015/16 Annual Total

56 6 16 30

Quarter 1 2016/17

15 1 6 7

3 complaints opened in Quarter 4 2015/16 were resolved in Q1 2016/17 1 complaint (currently closed) is awaiting the outcome of the Independent Review 3 complaints opened in Quarter 1 are carried forward to Quarter 2

16

Themes and trends from complaints are reported through the Committee structure of the organisation. Of the 15 complaints received and investigated during the quarter (4 were received as MP letters):

6 complaints related to the Continuing Health Care (CHC) Previously Un-assessed Periods of Care (PUPoC) - the time taken, and the process

5 complaints related to current CHC – relating to the decision-making process and subsequent funding decisions

1 complaint related to the lack of a fast track referral at End of Life

2 complaints related to non-eligibility regarding Individual Funding Requests

1 related to commissioning of a specific MH service. The complaint which was upheld related to PUPoC team and how a specific telephone enquiry was dealt with. The complaints which were partially upheld related to:

CHC PUPoC - flaws in CHC checklists completed several years ago, and patients not being advised of right to appeal/complain in outcome letters/reviews not completed in the time specified, errors in letters.

CHC current - the delay in achieving an outcome and communication with a CHC provider.

4.9.

Whistleblowing

Whistleblowing may relate to financial, employment or clinical care. The CCG has not received one whistleblowing disclosure in the last Quarter relating to staffing and patient safety at a provider organisation. This disclosure was fully investigated, and whilst the allegations were not substantiated, good practice recommendations were made which will be monitored through the routine contractual routes.

Category

2015/16 2016/17

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Whistleblowing disclosures 0 0 0 0 1 0 0 0

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Section 5 – Information Governance _________________________________________________________

5.1.

The protection and use of Personal

Confidential Data

NHS Doncaster CCG continues to operate within the Section 251 exemptions agreed by the national Confidentiality Advisory Group. NHS England has received confirmation of approval from the Secretary of State for Health, through the Confidentiality Advisory Group (CAG), for an extension of commissioning Section 251s until 31 March 2017. This will support the transition from existing temporary arrangements, to a sustainable future model that meets commissioners’ needs and complies with legal and security requirements.

CAG 2-03(a)/2013 Application for transfer of data from the Health and Social Care Information Centre (HSCIC) to commissioning organisation Accredited Safe Havens (ASH).

CAG 7-04(a)/2013 Disclosure of commissioning data sets and GP data for risk stratification purposes to data processors working on behalf of GPs.

CAG 7-07(a)(b)(c)/2013 Application for transfer of data from the HSCIC to commissioning organisation accredited safe havens: inclusion of invoice validation as a purpose within CAG 2-03 (a)/2013.

We have a Data Sharing Contract with the Health & Social Care Information Centre which takes us through to 2017, and Data Sharing Agreements which underpin this contract have been refreshed. A new General Data Protection Regulation (GDPR) was adopted across the EU on 27 April 2016 and must be implemented across the EU by 25 May 2018. There are significant changes to the regulation which will impact NHS Doncaster CCG, and a significant programme of work will commence to prepare for the new regulation.

5.2.

Information Governance

Toolkit

The Information Governance Toolkit is a national toolkit administered by the Health & Social Care Information Centre (HSCIC) which enables us to measure our information governance compliance. Level 2 is the required standard and we achieved this across all standards in 2015/16 by the required deadline of 31st March 2016 with a score of 76% (satisfactory). Our self-assessment was validated by an independent review from the Health & Social Care Information Centre in the last quarter.Our last published CCG assessment is available online via https://www.igt.hscic.gov.uk/reportsnew.aspx. Information Governance activity in the last quarter has included:

The Caldicott Plan, Management Statement and Caldicott Log have been updated.

Any Information Governance incidents have been formally reviewed, including consideration of any reporting required to the Information Commissioner.

Information Sharing Agreements have been developed to support the Digital Roadmap work.

We have developed a Data Quality Plan and a forward programme of data quality audits for 2016/17 has been agreed.

http://links.nhs.mkt5643.com/ctt?kn=15&ms=NTExMjM4ODcS1&r=NTMyMjc2ODAwNTkS1&b=0&j=OTAxMzY3MzEzS0&mt=1&rt=0

http://links.nhs.mkt5643.com/ctt?kn=15&ms=NTExMjM4ODcS1&r=NTMyMjc2ODAwNTkS1&b=0&j=OTAxMzY3MzEzS0&mt=1&rt=0

https://www.igt.hscic.gov.uk/reportsnew.aspx

18

Our Data Protection registration with the Information Commissioner has been renewed – reference Z3624278.

Our Fair Processing Notice has been updated and re-published on our website.

A letter has been sent out from Care Quality Commission (CQC) and the National Data Guardian to all trusts in relation to the CQC carrying out a review of Data Security in the NHS. The National Data Guardian developed new Data Security Standards for the NHS and also social care alongside developing a method of compliance testing. A self-assessment has been completed against the initial standards published and actions developed to ensure compliance.

5.3.

Freedom of Information Act

Requests

The following table shows the number of Freedom of Information Act requests received and the number responded to within the 20 working day timeframe.

Enquirer type

2015/16 2015/16

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Commercial 23 26 21 18 32

Education Establishment 1 5 3 2

Legal

Media 11 9 7 5 7

Member of Public 25 26 18 21 18

MP 2 4 2 1 2

Other NHS 4 6 4 4 3

Public Authority

Solicitors

Staff

Voluntary / Charitable 4 9 8 10 12

Total 70 80 65 62 76

% responded to within 20 working days

100%

100%

100%

100%

100%

Nine Section 21 exemptions were quoted for information accessible by other means, which is linked to our ongoing approach to place more information into the public domain on our website to support transparency. One Section 22 exemption was quoted for information intended for future publication in our Annual Report. Trends in request topics relate to expenditure on specific areas of healthcare, commissioning arrangements, and eligibility criteria.

5.4.

Data Protection Subject Access

Requests

The CCG is required to meet statutory timeframes for responding to Subject Access Requests under the Data Protection Act. The statutory timeframe is 40 days. No subject access requests were received within the last Quarter.

19

5.5.

Information Management &

Technology

A Local Digital Roadmap has been under development in Quarter 1. The purpose of Digital Roadmaps is to plan for paper-free care records at the point of care which will enable health and care professionals access to digital information. Each CCG is responsible for its own plan regarding Digital Care records and NHS Doncaster CCG is working in partnership with Fylde Coast Medical Services (FCMS), Doncaster Children’s Trust, Doncaster Metropolitan Borough Council (DMBC), Rotherham Doncaster and South Humber Foundation Trust (RDaSH) and Doncaster and Bassetlaw Hospitals NHS Foundation Trust (DBHFT). A Doncaster Health and Social Care Interoperability Group has been established, chaired by the Chief Officer, to oversee the planning and implementation of the Local Digital Roadmap. The plan is being aligned to the local Sustainability Transformation Plan, and the first draft was submitted to NHS England on 30th June 2016.

20

Section 6 – Financial Governance _________________________________________________________

Financial procedures and

systems

The Standing Financial Instructions, Standing Orders and Scheme of Delegation are in date, having been updated in March 2016 to mirror our Constitutional changes.

Financial Governance

Losses and Special Payments: No losses or special payments have been reported during the Quarter. Waivers for SFIs: Two new applications to waive the tenders and quotes procedures were made (Storage King and Healthcare Gateway). Concerns were raised by Audit Committee members regarding the rationale for the Storage King exemption, and requested further work on this with reporting to the next meeting. Debtors/Creditors: As at quarter-end there were two outstanding Debtor balances over six months old, and two creditor balances. All are being actively pursued. Declarations of Interest: The NHS Doncaster CCG Declarations of Interests Register was updated throughout the period and includes declarations from all employees. New conflicts of interest guidance was published at the end of the quarter, and the policy will be updated in accordance with this guidance. Disclosure of Gifts and Hospitalities: There have been no gifts or hospitality accepted by the organisation in line with the Standards of Business Conduct & Conflicts of Interest Policy during the Quarter.

Counter Fraud The CCG’s Counter Fraud Specialist (CFS) is commissioned via 360 Assurance. The Audit Committee receives assurance via Counter Fraud reports which cover the areas of contract performance, strategic governance, inform and involve, and prevent and deter. The counter fraud self-review tool (SRT) has been completed in accordance with the newly-published standards and is due to be submitted to NHS Protect in quarter 2. There are new standards and therefore it is expected that an action plan will be required to move us to compliance.

21

Section 7 – Organisational Development & Staffing Governance _________________________________________________________

7.1.

Organisational Development

Organisational Development is our systematic approach to improving organisational effectiveness – one that aligns our strategy, our people and our processes to drive forward our vision and effectively enact our Strategic Plan. Our Organisational Development Strategy is underpinned by an action plan, and in 2015/16 we agreed to focus on the following areas which were reported in the 2015/16 Quarter 4 report:

Developing a shared narrative of our vision and strategy

Exploring the opportunities afforded by delegation for primary care commissioning from NHS England, and developing appropriate governance arrangements in response to any delegation

Reviewing the breadth of our organisational meeting structure to ensure that the structure supports effective communication and maximises clinical added value.

Ensuring our continued cultural competence as an employer, working to identify any potential barriers to employment for equality groups and exploring ways in which we could overcome them.

Developing a more “personalised” or individualised approach to development activities.

We are starting to review our Organisational Development Strategy in 2016/17 to make sure it is fit for purpose with the changing commissioning landscape. We are currently starting the diagnostic stage of the process. We have commissioned Bain Associates to undertake this piece of work which will include one to one meetings with key staff and stakeholders and some staff workshops. The findings from this piece of work will be available by October 2016 and will inform the Organisational Development Strategy. The Colleague Engagement Group (CEG) continues to meet bi-monthly and has expanded its membership to include representatives from the Continuing Healthcare team and a representative for our colleagues in the hosted services based over at 722 Prince of Wales Road in Sheffield. The CCG is committed to the Workforce Race Equality Scheme. Training on cultural awareness and understanding bias has been made available to staff via e-learning packages and the CCGs lead for equality and diversity will be rolling out face to face training in 2016/17. The CCG will publish its annual statement in relation to WRES in July 2016. A training and development programme for 2016/17 has been circulated to all staff covering a wide range of courses including mandatory and statutory training and personal and professional development training courses.

22

7.2.

Staffing

Governance

Governing Body: Our Governing Body continues to comprise 18 members: the Chair, 10 elected Locality Leads (two in each of the five Localities), 3 Lay Members, a Registered Nurse (also the Chief Nurse), a Secondary Care Specialist Doctor, the Accountable Officer (the Chief Officer) and the Chief Finance Officer. Locality Leads: The Locality Lead portfolios are as follows:

Locality Lead

Lead clinical areas Lead corporate areas

Dr Andy Oakford

Unplanned Care

Audit Committee

Delivery & Performance Committee

Dr Jeremy Bradley

Prescribing Remuneration Committee

Quality & Safety Committee

Dr Marco Pieri

Cancer

Musculoskeletal

Dr Niki Seddon

Mental Health Primary Care

Commissioning Committee

Dr Sam Feeney

Community Services



Vacancy

Dr Pat Barbour

Children’s Services

CAMHS

Primary Care Commissioning Committee

Dr Khaimraj Singh

Neurology

Information Technology & Premises


Dr Lindsey Britten

Continuing Healthcare / Individual Placements / End of Life Care

Endocrine including Diabetes

Quality & Safety Committee

Dr Karen Wagstaff

Dementia

Learning Disabilities

Community Nursing

Care Homes

Audit Committee

Chair

Dr David Crichton

North East

Locality

North West Locality

Central Locality

South East Locality

South West Locality

Locality Lead

Dr Andy Oakford

Locality Lead

Dr Jeremy Bradley

Locality Lead

Dr Niki Seddon

Locality Lead

Dr Marco Pieri

Locality Lead

Dr Sam Feeney

Locality Lead

Vacancy

Locality Lead

Dr Pat Barbour

Locality Lead

Dr Khaimraj Singh

Locality Lead

Dr Lindsay Britten

Locality Lead

Dr Karen Wagstaff

23

Lay Members: The Lay Member portfolios are as follows:

Chair of Audit

Committee

Chair of Remuneration Committee

Lay lead for Audit and Governance

Chair of Engagement & Experience Committee

Lay Public and Patient Involvement Champion

Chair of Primary Care Commissioning Committee

Lay lead for primary care commissioning

Chair of Quality & Safety Committee

Lead for Secondary Care, bringing an understanding of patient care in the secondary care setting

Senior Management Team: The directorate leadership portfolios are as follows:

Financial

Strategy

Financial management and control

Financial reporting

Financial governance

Contracting

External Audit

Internal Audit

Counter Fraud

Quality & Safety

Safeguarding children and vulnerable adults

Medicines Management

Serious Incident management

Contractual quality

Clinical governance and assurance

Continuing Healthcare (including Previously Unassessed Periods of Care)

Strategic Plan

Delivery Plan

Commissioning to meet the aspirations of the CCG’s transformation and clinical priority areas

System transformation

Performance management

Business Intelligence & Information Technology

Corporate Governance & Risk

Communication, Engagement and Experience

Equality & Diversity

Emergency Planning

HQ Management

Secretariat and corporate support function

Health, Safety & Security

Commissioning in partnerships

Joint CCG Commissioning

Joint commissioning with the Local Authority


Locality support and development

Primary Care education

Chief Officer

Chief Finance Officer

Chief Nurse

Chief of Strategy & Delivery


Chief of Partnership

Commissioning & Primary Care

Chair

Dr David Crichton

Lay Member: Audit & Governance

Miss Anthea Morris

Lay Member: Patient & Public

Involvement

Mrs Linda Tully

Lay Member: Primary Care

Commissioning

Mrs Linda Tully

Secondary Care Doctor Member

Dr Emyr Wyn Jones

24

Mandatory & Statutory Training: Staff compliance with mandatory & statutory training is monitored on a quarterly basis to ensure to ensure that employees who are non-compliant, or who will become non-compliant in the next three months, are encouraged to complete their training. Compliance reports are routinely shared with the Senior Management Team. The Quarter end position is detailed below alongside a comparison with the previous Quarter, and is generally showing an improving position.

Name of Training Compliance rate

Q4 2016/17 Q1 2016/17

Equality & Diversity 87% 93%

Fire Safety 83.5% 83%

Fraud 67% 88%

Health & Safety incorporating Risk Management

88.5% 93%

Information Governance 79% 81.5%

Moving & Handling 80% 83.5%

Safeguarding Adults 90% 95%

Safeguarding Children & Young People

88.5% 96%

Infection Prevention 89.5% 96%

Induction 100% 100%

Enc F

Chair & Chief Officer Report

1



Title of paper

Chair and Chief Officer Report


Dr David Crichton, Clinical Chair Mrs Jackie Pederson, Chief Officer

Author(s) Mrs Sarah Atkins Whatley, Chief of Corporate Services


The purpose of this report is to update the Governing Body on issues relating to the activity of the CCG of which the Governing Body needs to be aware, but which do not themselves warrant a full Governing Body paper. This month the paper includes updates on the following areas:

Planning update

Strengthening financial and operational performance for 2016/17

RightCare update

Chair election evaluation

Engagement with Member Practices – consultation on future models

Locality meeting feedback

Recommendation(s)

The Governing Body is asked to:

Note the report.

Impact analysis

Assurance Framework

3.2, 5.1, 6.2

Risk analysis

None

Equality impact

Neutral


Nil


Nil

Legal implications

Nil


N/A

2

Chair and Chief Officer Report August 2016

1. Planning update Over the summer period we are continuing to work in partnership on the Sustainability & Transformation Plan (STP), and particularly the finances to support the plan. Key future dates include:

End of August – finance submission.

Beginning of October – final STP submission.

Overarching governance arrangements in place from 1st October 2016 involving all 17 contributing organisations in South Yorkshire and Bassetlaw.

Work continues apace on the local Doncaster Place Plan (DPP), with energy and enthusiasm from all partners. The DPP will connect to the STP, which will ensure a South Yorkshire and Bassetlaw system focus and a local integration focus. The DPP is being developed in partnership in Doncaster with leadership and contribution from all organisations including:

NHS Doncaster CCG

Doncaster & Bassetlaw Hospitals NHS Foundation Trust

Doncaster Children’s Trust

Fylde Coast Medical Services

General Practice

Local Authority (Adult’s, Children’s and Public Health)

Rotherham Doncaster & South Humber NHS Foundation Trust Progress so far has seen agreement on:

The vision for Doncaster and partnership working principles

The wider system vision – building on the CCG system vision

Focussing the DPP on a neighbourhood model delivering integrated health and social care

Testing the neighbourhood model as we implement the new service model for Intermediate Care (phase 1)

Future neighbourhood phasing is in development

Integrated commissioning to commission integrated services from a provider partnership

The partnership ambition is to have a draft DPP available by mid September 2016.

x-apple-data-detectors://embedded-result/1369

3

2. Strengthening financial and operational performance for 2016/17 NHS England, in partnership with NHS Improvement, has unveiled a suite of new measures for providers and commissioners to cut the annual trust deficit, sharpen the direct accountability of trusts and CCGs, and help ensure ongoing financial sustainability for the NHS. Included in the comprehensive set of actions is an extra £1.8 billion allocated to trusts, with the aim of cutting the combined provider deficit, and a two year NHS planning and contracting round for 2017/18 to 2018/19, to be completed by December 2016, and linked to Sustainability & Transformation Plans. As part of the announcement, the 2015/16 performance ratings for CCGs have also been published; NHS Doncaster CCG was assessed as “Good”. 3. RightCare update Four workstreams have been developed in response to the RightCare areas where national data indicates that NHS Doncaster CCG could achieve efficiency savings when benchmarked to comparable CCGs. Neurology: The Neurology workstream has clinical leadership from Governing Body GP, Dr Khaimraj Singh. The main areas of focus have been determined as Parkinson’s, epilepsy, and migraine, looking at A&E attendances and unplanned admissions. Respiratory: The Respiratory workstream has clinical leadership from Primary Care & Long Term Conditions lead GP, Dr Nabeel Alsindi. The main areas of focus have been determined as electives, non-electives, and prescribing. Dashboards of activity per General Practice are being produced. A review of community respiratory services is underway, and our local Acute Trust is undertaking work on Length of Stay. Endocrine: The Endocrine workstream has clinical leadership from Governing Body GP, Dr Lindsey Britten. The main focus is on coordination of care between secondary care and primary care, and prescribing. Musculoskeletal: The Musculoskeletal pathway has clinical leadership from Governing Body GP, Dr Marco Pieri. Our local Acute Trust are planning to review the pathways for musculoskeletal pathways for hip, knee, spinal, shoulder, foot/ankle and wrist/hand. The engagement of our Clinical Reference Group (CRG) in clinically reviewing the impact of any proposed pathway changes and referral criteria will be critical.

http://links.nhs.mkt5643.com/ctt?kn=28&ms=NTE5MzU0NTIS1&r=NTMyMjc2ODAwNTkS1&b=0&j=OTY0MDkxOTk4S0&mt=1&rt=0



4

4. Chair election evaluation Following the election process for a new Chair in late 2015/16, an evaluation of the process has been undertaken. The evaluation was discussed with Governing Body members at the Strategy & Organisational Development Forum held at the beginning of August 2016. The election ran to schedule, and the outcome of the Member vote was rapidly enacted. However some minor changes have been recommended to internal operational processes to support improved transition planning and greater Member engagement moving forwards:

Schedule the Chair election to permit a minimum 1 month handover period.

Publish to the electorate, well in advance, the forward election schedule, including any planned Question & Answer sessions / Hustings.

Offer a range of voting methodologies for prospective Chair candidates, including mixed hardcopy and electronic routes.

Use an external ballot company to administer the vote element of the Chair elections due to the size of the electorate (approximately 240 GPs). Our independent partner, the Local Medical Committee (LMC) will still be requested to support us in running Question & Answer / Hustings sessions in order to provide a range of information on Chair position applicants to our Members. We also hope that the LMC will wish to continue to independently administer our Locality Lead elections for us.

5. Engagement with Member Practices – consultation on future models At the June 2016 Governing Body meeting, members agreed to commence a planned consultation with Member Practices on potential future engagement models in response to feedback through both the CCG 360 Stakeholder Survey and through discussions with Localities. This consultation was launched during July 2016, and runs until 31 August 2016.

Option 1: Current locality model, but with greater clarity of purpose on the role of Locality Leads (5 Localities)

Option 2: Council of Members across Doncaster (in effect, 1 Locality) Option 3: Constituency / MP model (no Localities, no direct member

engagement in clinical commissioning) No matter which option is chosen by Members, there is a commitment to maintain the current level of elected clinical leadership i.e. 10 elected clinical leaders. If Members choose Option 2 or Option 3, then further work will be undertaken to redefine the current role description for Locality Leads and revise the method of election to ensure fair representation of the membership. Any changes are scheduled to be presented back to the Governing Body in September for further debate and recommendation to our Membership for their consideration.

5

The consultation process is set out below:

6. Locality meeting feedback The following common themes were discussed by all Localities in the past month:

The new Chair and Chief Officer made introductory visits to all Localities.

Working together as providers / collaborations in response to the Primary Care Event on 30 June 2016 organised by the CCG in partnership with the national Primary Care Commissioning team.

Cover arrangements for TARGET (protected GP education time); it was announced at the primary care event on 30 June that the CCG would re-allocate

6

funding to provide clinical cover for future TARGET sessions from September 2016.

Locality engagement structures – discussion of potential future models. In addition, individual Localities also covered the following topics:

North East

Locality

Prescribing.

Issues Log.

The scheduled Locality Lead election for the post currently held by Dr Andy Oakford has been postponed at the recommendation of the Governing Body pending the Doncaster-wide discussions about potential future Locality engagement structures.

North West

Locality

Physiotherapy – a new suggested referral model.

Follow-up from a North West Team Timeout held in June 2016 to discuss ways of working together as providers.

Carpal tunnel surgery service and Ophthalmology service from a North West practice commissioned by the CCG.

Central Locality

A vacancy remains for a Central Locality Lead. Recruitment to this role was requested to be deferred earlier in the year by the Locality pending the planned Doncaster-wide discussions about potential future Locality engagement structures.

Moving forward, the Central Locality will now use 1 hour for Commissioning discussions (funded by the CCG as normal) and 1 hour to meet as Providers (not funded by the CCG).

South East

Locality

Prescribing.

Issues Log

South West

Locality

A Team Time Out for Practices as providers was held in place of the Locality meeting (not funded by the CCG).

A 3-month Pharmacy pilot to improve prescribing to the most vulnerable 2% of South West Practice lists is coming to an end and will be evaluated in the coming month.

The scheduled Locality Lead election for the post currently held by Dr Karen Wagstaff has been postponed at the recommendation of the Governing Body pending the Doncaster-wide discussions about potential future Locality engagement structures.

7

7. Recommendations The Governing Body is asked to:

Note the report.

Enc G

Policies for Approval



Title of paper

Standards of Business Conduct & Conflicts of Interest Policy


Sarah Atkins Whatley, Chief of Corporate Services

Author(s) As above


A conflict of interest occurs where an individual’s ability to exercise judgement, or act in a role, is or could be impaired or otherwise influenced by his or her involvement in another role or relationship. Conflicts of interest are inevitable in commissioning, and as a CCG we manage them as part of our day-to-day commissioning activities. Effective handling of conflicts of interest is crucial to give confidence to patients, taxpayers, healthcare providers and Parliament that CCG commissioning decisions are robust, fair and transparent and offer value for money. Failure to manage conflicts of interest could lead to legal challenge and even criminal action in the event of fraud, bribery and corruption. To support CCGs to improve their management of conflicts of interest, revised statutory guidance from NHS England was issued in late June 2016 Managing Conflicts of Interest: Revised Statutory guidance for CCGs which supersedes Managing Conflicts of Interest Statutory Guidance (December 2014). https://www.england.nhs.uk/commissioning/pc-co-comms/coi/ The key changes set out in this latest update of the guidance are:

The recommendation for CCGs to have a minimum of three lay members on the Governing Body, in order to support with conflicts of interest management. We already have three lay members specified in our Constitution, and are currently recruiting to the vacancy for a Lay Member for Public & Patient Engagement.

The introduction of a conflicts of interest guardian in CCGs. The Conflict of Interest Guardian will be expected to receive concerns about conflicts of interest, apply conflict of interest principles, provide independent advice, and seek to minimise risks associated with conflicts. The Lay Member for Audit & Governance has agreed to assume this role.

The requirement for CCGs to include a robust process for managing any breaches within their conflict of interest policy and for anonymised details of the breach to be published on the CCG’s website for the purpose of learning and development.

https://www.england.nhs.uk/commissioning/pc-co-comms/coi/

Strengthened provisions around decision-making when a member of the governing body, or committee or sub-committee is conflicted. There is an expectation that Chairs will prepare for meetings in advance and consider conflicts of interest, that minute takers will record all conflicts and how they were managed in a set format, and that any declared interests will be added to the central register of interests.

Strengthened provisions around the management of gifts and hospitality, including the need for prompt declarations and a publicly accessible register of gifts and hospitality. Any gift under the value of £10 may be accepted and doesn’t have to be declared, as can modest hospitality in line with what the NHS would offer. What cannot be accepted is cash or cash equivalents, gifts/hospitality over the prescribed “£10 gift / modest hospitality” limit by existing or potential providers/suppliers, any hospitality over £25 a head, and any offers of foreign travel & accommodation.

A requirement for CCGs to include an annual audit of conflicts of interest management within their internal audit plans and to include the findings of this audit within their annual end-of-year governance statement. The first quarterly report is due in September 2016. The annual audit by Internal Audit must take place in Quarters 3 or 4 (NHS England will publish a template). The quarterly and annual audits will form part of the CCG Improvement & Assessment Framework.

A requirement for all CCG employees, governing body and committee members, and practice staff with involvement in CCG business, to complete mandatory online conflicts of interest training, which will be provided by NHS England. The online training will be supplemented by a series of face-to-face training sessions for CCG leads in key decision-making roles. There will be three different levels of training depending on the person’s level of influence on CCG decision making.

There have also been some re-definitions within the statutory guidance of what interests are. These are now a) financial, b) non-financial professional, c) non-financial personal, and d) indirect (i.e. through family members / associates). Declarations of conflicts will be required from all CCG employees including staff who are sessional, students, agency, seconded or Consultants, and any General Practice team members engaged in CCG business (e.g. sitting on Committees):

On appointment

6-monthly (this is a new requirement and includes nil returns

At meetings

On changing role Further statutory guidance is expected later in the year to cover new care models and integrated care organisations.

In accordance with the revised statutory guidance and the requirement to self-certify from September 2016 against the revised guidance, the Standards of Business Conduct & Conflicts of Interest Policy has been refreshed. The main changes to the policy are all are in line with and as required by the statutory guidance, and are highlighted in yellow throughout the policy:

Update of legislation throughout the policy and procedure.

Refresh of responsibilities (p.9-10) including new Conflict of Interest Guardian role and reference to Lay Member roles.

Inclusion of new training requirements (p.11-12).

Refresh of conflict of interest principles (p.14).

Reference to publication of registers of interest (p.15).

New national definitions of types of interest (p.16-17).

Listing of the different registers of interest (p.18-19) and retention periods.

Refresh of how we manage conflicts of interests in meetings (p.21-23).

Refresh of management of conflicts during service design and evaluation of bids (p.30-31) and addition of new section on contract management (p.32).

Minor changes to Primary Care conflicts section to reflect delegation for primary medical care commissioning (p.34-35).

Further details on how we manage gifts (p.36).

Further details on how we manage hospitality (p.37-38).

Further details on how we manage sponsorship (p.38-39).

Refresh of how we manage additional staff employment outside the CCG (p.40-42).

Significant revisions to how to raise concerns under the policy, and how breaches will be reviewed and published on the website (p.45-47).

Appendix C – revised Declarations of Interest form in line with national template.

Appendix D – inclusion of new national template for register of interests.

Appendix E – inclusion of new national declarations of interest checklist for chairs alongside corporate templates for coversheets, agendas and minutes, and a conflicts of interest flowchart.

Appendix F – minor changes to Business Case & Procurement template to align to national requirements.

Appendix G – new national template for a register of procurement decisions.

Appendix H – revised Gifts, Hospitality, & Sponsorship form in line with national template.

Appendix I – inclusion of new national template for register of gifts, hospitality & sponsorship.

The next steps to roll out the approved policy throughout the organisation are:

1. Policy approval by Governing Body (August 2016). 2. Highlights of policy changes cascaded to staff in month-end organisational e-

briefing (August) and Staff Brief (September). 3. Launch of new Declarations of Interest Form to staff and member practices,

requiring returns within the month (September 2016). 4. Corporate Governance Manager to populate new declarations of interest and

gifts/hospitality/sponsorship register templates and publish on website (September 2016).

5. Development of training sessions for admin staff responsible for minuting meetings (September 2016).

6. Briefing session at Strategy & Delivery DMT for commissioning managers on changes to business case and procurement conflicts of interest management (October 2016).

7. Development of “Lunchtime Learning” sessions for all staff to further raise awareness of the policy (October 2016).

8. Rollout of the mandatory online training to all staff when it is launched by NHS England (expected during Autumn 2016 with compliance required by 31 January 2017).

Recommendation(s)

It is recommended that the Governing Body:

Notes the changes to the policy in line with the revised statutory guidance

Supports the planned next steps to roll out the changes, and

Approves the revised policy.

Impact analysis

Assurance Framework

5.1, 5.3

Risk analysis

If we do not amend our Standards of Business Conduct & Conflict of Interest Policy to reflect the revised statutory

guidance, we are at risk of adverse reputational impact in terms of the confidence of our population, and legal challenge.

Equality impact

Neutral – national statutory guidance


Nil


Nil – human resource only to administer the new requirements

Legal implications

Statutory guidance


N/A – national statutory guidance

1

STANDARDS OF BUSINESS CONDUCT & CONFLICTS OF INTEREST

POLICY & PROCEDURE

Last Review Date

August 2016

Approving Body

Governing Body

Date of Approval August 2016 Next Review Date August 2019 Review Responsibility


Version

4.0

2

REVISIONS/AMENDMENTS SINCE LAST VERSION (IF APPLICABLE)

Date of Review

Amendment Details

October 2012 Document developed. Approved by Governing Body.

January 2015 Legislative amendments throughout. Approved by Governing Body.

November 2015 Additional reference to the primary care commissioning role and safeguards. Approved by Governing Body.

March 2016 Minor changes made to Appendix F – sponsorship agreements.

June 2016 Minor amendment to Booking Form for TARGET in Appendix F.

August 2016 Full refresh of policy to align to new NHS England statutory guidance 2016 Managing Conflicts of Interest: Revised Statutory guidance for CCGs which supersedes Managing Conflicts of Interest Statutory Guidance (December 2014). Main changes (all are in line with and required by the statutory guidance):

Update of legislation throughout the policy and procedure.

Refresh of responsibilities (p.9-10) including new Conflict of Interest Guardian role and reference to Lay Member roles.

Inclusion of new training requirements (p.11-12).

Refresh of conflict of interest principles (p.14).

Reference to publication of registers of interest (p.15).

New national definitions of types of interest (p.16-17).

Listing of the different registers of interest (p.18-19) and retention periods.

Refresh of how we manage conflicts of interests in meetings (p.21-23).

Refresh of management of conflicts during service design and evaluation of bids (p.30-31) and addition of new section on contract management (p.32).

Minor changes to Primary Care conflicts section to reflect delegation for primary medical care commissioning (p.34-35).

Further details on how we manage gifts (p.36).

Further details on how we manage hospitality (p.37-38).

Further details on how we manage sponsorship (p.38-39).

Refresh of how we manage additional staff employment outside the CCG (p.40-42).

Significant revisions to how to raise concerns under the policy, and how breaches will be reviewed and published on the website (p.45-47).

Appendix C – revised Declarations of Interest form in line with national template.

Appendix D – inclusion of new national template for register of interests.

Appendix E – inclusion of new national declarations of interest checklist for chairs alongside corporate templates for coversheets, agendas and minutes, and a conflicts of interest flowchart.

Appendix F – minor changes to Business Case & Procurement template to align to national requirements.

Appendix G – new national template for a register of procurement decisions.

Appendix H – revised Gifts, Hospitality, & Sponsorship form in line with national template.

Appendix I – inclusion of new national template for register of gifts, hospitality & sponsorship.

3

CONTENTS

Page Definitions 5 Section A – Policy 6 1. Policy Statement, Aims & Objectives

6

2. Legislation & Guidance

7

3. Scope

8

4. Accountabilities & Responsibilities

9

5. Dissemination, Training & Review

11

Section B – Procedure 13 1. Standards of Business Conduct

13

2. Conflicts of Interest 2.1. Legislation 2.2. Conflicts of Interest Principles 2.3. Definitions of conflicts of interest 2.4. Declaring and registering interests 2.5. Managing conflicts of interest which arise during meetings

13 13 14 15 18 21

3. Specific conflicts of interest in procurement

3.1. Legislation 3.2. Commissioning cycle conflict of interest principles 3.3. Register of procurement decisions 3.4. Potential procurement conflict of interest scenarios 3.5. Governance of conflict of interest in procurement 3.6. Conflicts of interest at the different procurement stages 3.7. Declaration, review and management of procurement conflicts of interest

24 24 25 26 27 28 30 32

4. Primary Care conflicts of interest, procurement and contracting

34

5. Gifts, Hospitality & Sponsorship 5.1. Overview 5.2. Gifts 5.3. Hospitality 5.4. Sponsorship

36 36 36 37 38

6. Earned income and outside employment

40

4

7. Provision of professional advice and services

42

8. Preferential treatment in private transactions

43

9. Intellectual Property Rights

43

10. Facilitation Payments and Kickbacks

43

11. Political and Charitable Contributions

44

12. Due Diligence

44

13. Raising concerns and breaches – failure to comply with this policy and procedure

45

Appendices Appendix A The Nolan Principles 48 Appendix B Standards for members of NHS boards and Clinical

Commissioning Group governing bodies in England

49

Appendix C Declarations of Interest Form 53 Appendix D Template for the register of interests 55 Appendix E Declaration of interest checklist for Chairs

Coversheet for papers

Agenda template

Minutes template

Template for secretariat to record interests in meetings

Conflicts of Interest Flowchart

56 58 60 61 64

65

Appendix F Business Case & Procurement Template 66 Appendix G Template for register of procurement decisions 80 Appendix H Gifts, Hospitality & Sponsorship Form 81 Appendix I Template for the register of gifts, hospitality &

sponsorship 83

Appendix J Governance arrangements for commercial sponsorship of TARGET

84

Appendix K Potential Risks – Bribery (Red Flags) 89 Appendix L Chief Officers Statement on Bribery 91

5

DEFINITIONS Term

Definition

Bribery Inducement for an action which is illegal, unethical or a breach of trust. Inducements can take the form of gifts, loans, fees, rewards or other advantages, both given and received.

Commercial sponsorship

For the purpose of this Policy, commercial sponsorship is defined as “Funding by an external company of all or part of the costs of a member of staff [or governing body member], NHS research, staff training, pharmaceuticals, meeting rooms, costs associated with meetings, meals, gifts, hospitality, holidays, hotel and transport costs (including trips abroad), provision of free services, equipment, buildings, or premises.” Commercial Sponsorship – Ethical

Standards for the NHS, November 2000.

Conflict of interest

A conflict of interest occurs where an individual’s ability to exercise judgement, or act in a role, is or could be impaired or otherwise influenced by his or her involvement in another role or relationship.

Corruption This can be broadly defined as the offering or acceptance of inducements, gifts, favours, payment or benefit-in-kind which may influence the action of any person. Corruption does not always result in a loss. The corrupt person may not benefit directly from their deeds; however, they may be unreasonably using their position to give some advantage to another.

Nolan Principles The seven principles of public life or “Nolan Principles” were established in 1995 by the Committee for Standards in Public Life and set out the ways in which holders of public office should behave in discharging their duties.

Third Party In this policy, "third party" means any individual or organisation you come into contact with during the course of your work for the CCG, and includes actual and potential clients, Trusts, suppliers, distributors, business contacts, agents, advisers, and government and public bodies, including their advisors, representatives and officials, politicians and political parties.

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SECTION A – POLICY

1. Policy Statement, Aims & Objectives All members of NHS boards and Clinical Commissioning Group governing bodies should understand and be committed to the practice of good governance and to the legal and regulatory frameworks in which they operate. As individuals they must understand both the extent and limitations of their personal responsibilities. NHS Doncaster CCG adopts a transparent approach to all our activities, which are undertaken in line with the Nolan Principles (Appendix A). All Governing Body members are required to abide by the Standards for members of NHS Boards and CCG governing bodies in England (Professional Standards Authority – November 2012) (Appendix B). By virtue of section 14O of the 2006 NHS Act, as inserted by Section 25 of the Health & Social Care Act 2012, NHS Doncaster CCG is required to make arrangements to manage conflicts and potential conflicts of interest to ensure that decisions made by the CCG will be taken and seen to be taken without any possibility of the influence of external or private interest. Clinical Commissioning Groups (CCGs) manage conflicts of interest as part of their day-to-day activities. This commitment is captured in our Constitution. Effective handling of conflicts of interest is crucial for the maintenance of public trust in the commissioning system. NHS Doncaster CCG’s effective handling of conflicts of interest will serve to give confidence to patients, providers, parliament and taxpayers that our commissioning decisions are robust, fair, transparent, and offer value for money. NHS Doncaster CCG is also committed to collaborative working with partners and stakeholders to improve the health of residents within Doncaster. NHS Doncaster CCG recognises the benefits which multi-agency partnership working can deliver and must ensure that these partnerships are in accordance with the Nolan Principles. This Policy sets out our Standards of Business Conduct, our approach to identifying, managing and recording conflicts of interest that may arise during the course of NHS Doncaster CCG fulfilling its duties, and our management of gifts, hospitality and sponsorship.

To ensure continuous improvement in the management of standards of business conduct and conflicts of interests and to monitor the effectiveness of this policy, NHS Doncaster CCG has the following key performance indicators (KPIs):

No Key Performance Indicator Method of Assessment

1. Maintenance of Probity Registers. Publication of Registers.

2. Reporting of the Probity Registers to the Audit Committee (or its Sub Committees).

Audit Committee minutes.

3. Annual self-certification to NHS England.

CCG Improvement & Assessment Framework.

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No Key Performance Indicator Method of Assessment

4. Internal Audit of conflicts of interest. Internal Audit report to Audit Committee.

2. Legislation & Guidance The following legislation and guidance has been taken into consideration in the development of this policy and procedure:

The Nolan Principles (Appendix A)

The Good Governance Standards for Public Services (2004), Office for Public Management (OPM) and Chartered Institute of Public Finance and Accountancy (CIPFA)

The seven key principles of the NHS Constitution

Equality Act 2010

The UK Corporate Governance Code

Standards for members of NHS Boards and CCG governing bodies in England (Professional Standards Authority – November 2012)

Bribery Act 2010

Fraud Act 2006

HSC 1998/106 which obliges NHS Trusts to put in place arrangements for the protection of intellectual property

NHS Act 2006

Health & Social Care Act 2012

National Health Service (Procurement, Patient Choice and Competition) (No.2) Regulations 2013

Substantive guidance on the Procurement, Patient Choice and Competition Regulations IRG 35/13 (Monitor, December 2013)

Public Contracts Regulations 2015

Code of Conduct: Managing conflicts of interest where GP practices are potential providers of CCG-commissioned services (NHS Commissioning Board, October 2012)

Managing Conflicts of Interest: Revised Statutory guidance for CCGs (June 2016)

Data Protection Act 1998

Standing Orders, Scheme of Delegation and Standing Financial Instructions

Our CCG Constitution The Bribery Act 2010 came into force on 1 July 2011 and this legislation affects the NHS as a whole. It is now an offence under the Bribery Act 2010 to give, promise or offer a bribe, and to request, agree, receive or accept a bribe, either at home or abroad. It also includes bribing of foreign officials. It is also now an offence for an NHS body to fail to prevent bribery by the organisation. A breach of the Act renders offending staff liable to prosecution and imprisonment of up to 10 years and/or a fine. NHS organisations can face an unlimited fine. It is an offence under the Fraud Act 2006 for an employee to fail to disclose information to the organisation to make a gain for themselves or another or to cause

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a loss or expose the organisation to the risk of loss. Additionally, the Act also provides that it is an offence for an employee who occupies a position in which they are expected to safeguard or not act against the financial interests of the organisation, to abuse that position to cause a loss or expose the organisation to the risk of loss. Therefore, where a conflict of interest is not declared for the purposes above, this will be considered serious and should be referred appropriately in accordance with the Fraud Policy and Response Plan. By virtue of HSC 1998/106, NHS Trusts are obliged to put in place arrangements for the protection of intellectual property. Intellectual property is a tangible output of any intellectual activity. It has an owner and it can be bought, sold or licensed and must be adequately protected. It can include inventions, industrial processes, software, data, written work and images, although this list is not exhaustive. The Department of Health published The NHS as an innovative organisation: a Framework and Guidance on the Management of Intellectual Property in the NHS. This Framework and Guidance became operational along with Section 5 of the Health and Social Care Act on 9 September 2002. The Guidance extends the powers of the previous 1998 policy on exploiting intellectual property generated through research and development to include intellectual property generated by all NHS employees in the delivery of health care. Any issues regarding Intellectual Property Rights must be managed in accordance with this framework, guidance and NHS Doncaster CCG’s Intellectual Property Policy. A number of procedural documents are related to this policy and should be read in conjunction as shown below:

Disciplinary Policy

Fraud Policy & Response Plan

Information Governance Framework, Strategy, Policy & Procedure

Intellectual Property Policy

Whistleblowing Policy 3. Scope This policy applies to those members of staff that are directly employed by NHS Doncaster CCG and for whom NHS Doncaster CCG has legal responsibility. For those staff covered by a letter of authority / honorary contract or work experience this policy is also applicable whilst undertaking duties on behalf of NHS Doncaster CCG or working on NHS Doncaster CCG premises and forms part of their arrangements with NHS Doncaster CCG. As part of good employment practice, agency workers are also required to abide by NHS Doncaster CCG policies and procedures, as appropriate, to ensure their health, safety and welfare whilst undertaking work for NHS Doncaster CCG. Those persons subscribed to an NHS standard contract which states that they are regarded as a health service body for the purposes of Section 4 of the National Health Service and Community Care Act 1990 and who in the course of their business act for and on behalf of the NHS Doncaster CCG (e.g. those operating

http://www.dh.gov.uk/assetRoot/04/07/73/07/04077307.pdf

http://www.dh.gov.uk/assetRoot/04/07/73/07/04077307.pdf

http://www.innovations.nhs.uk/pdfs/106HSC.pdf

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under a standard NHS business contract) are required to comply with this policy and the provisions of the Bribery Act. 4. Accountabilities & Responsibilities Overall accountability for standards of business conduct and conflicts of interest within NHS Doncaster CCG lies with the Accountable Officer, who is known as the Chief Officer. The responsibility for standards of business conduct and conflicts of interest is delegated to the following individuals:


(or equivalent)

Has delegated responsibility for:

Establishing the Standards of Business Conduct and Probity systems for the organisation including Declarations of Interest, Gifts and Hospitality, and Sponsorship.

Provision of advice and information relating to declarations and conflicts of interest, gifts, hospitality, sponsorship, and professional advice and services to employees, and how these should be managed.

Ensuring appropriate training is available to staff and associates of the organisation, commensurate with their role within the organisation.

Support the Conflict of Interest Guardian and keep them briefed on conflicts of interest matters and issues arising.



Ensuring this Policy is adhered to from a procurement perspective.

Ensuring adequate procurement records are kept for audit requirements.

Provision of advice and information relating to declarations and conflicts of interest, gifts, hospitality, sponsorship, and professional advice and services to employees.

Corporate Governance

Manager


Maintaining the Probity Register including logging Gifts and Hospitality Forms, Sponsorship Forms and Declaration of Interest Forms in the Register.

Reviewing the Register on a 6-monthly basis and providing reports to the Audit Committee and its Sub Groups as required.

Ensuring that appropriate administrative processes are put into place and promoting these within the organisation.

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Lay Member for Audit &

Governance

Is the organisation’s nominated Conflict of Interest Guardian. The Conflicts of Interest Guardian will, supported by the CCG’s Chief of Corporate Services (or equivalent):

Act as a conduit for GP practice staff, members of the public and healthcare professionals who have any concerns with regards to conflicts of interest.

Be a safe point of contact for employees or workers of the CCG to raise any concerns in relation to this policy.

Support the rigorous application of conflict of interest principles and policies.

Provide independent advice and judgement where there is any doubt about how to apply conflicts of interest policies and principles in an individual situation.

Provide advice on minimising the risks of conflicts of interest.

Lay Members

Lay members play a critical role in CCGs, providing scrutiny, challenge and an independent voice in support of robust and transparent decision-making and management of conflicts of interest.

By statute, CCGs must have at least two lay members. In light of lay members’ expanding role in primary care co-commissioning, NHS Doncaster CCG has increased this requirement within our CCG Constitution to a minimum of three lay members on the governing body, one focussing on audit & governance, one focussing on public & patient engagement and one focussing on primary care commissioning.

Head of Procurement


Providing professional conflicts of interest guidance within NHS Doncaster CCG business case / procurement processes.

Maintaining the procurement and contracts register, and making arrangements to publish this on the CCG website.

Staff

Responsibilities of Staff (including all employees, whether full/part time, agency, bank or volunteers) are:

Ensuring compliance with this policy.

Complying with any relevant professional Codes of Conduct.

Where there is any uncertainty regarding the contents of this Policy and Procedure, confirmation should be sought from the Chief Officer or Conflicts of Interest Guardian.

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5. Dissemination, Training & Review 5.1. Dissemination The effective implementation of this Policy and Procedure will support openness and transparency in decision making. NHS Doncaster CCG will:

Ensure all staff and stakeholders have access to a copy of this Policy and Procedure via the organisation’s website.

Communicate to staff any relevant action to be taken in respect of standards of business conduct or conflicts of interest issues.

Develop policies, procedures and guidelines based on the results of assessments to assist in the implementation of this policy and procedure.

Ensure that relevant training programmes raise and sustain awareness of the importance of identifying and managing standards of business conduct and conflicts of interest.

This Policy & Procedure is located in the General Policy Manual. A set of hardcopy Procedural Document Manuals are held by the Governance Team for business continuity purposes and all procedural documents are available via the organisation’s website. Staff are notified by email of new or updated procedural documents. 5.2. Training

All staff will be offered relevant training commensurate with their duties and responsibilities. Specific training will be offered to all employees, governing body members and members of CCG committees and sub-committees on the management of conflicts of interest. This training will include:

What is a conflict of interest;

Why is conflict of interest management important;

What are the responsibilities of the organisation you work for in relation to conflicts of interest;

What should you do if you have a conflict of interest relating to your role, the work you do or the organisation you work for (who to tell, where it should be recorded, what actions you may need to take and what implications it may have for your role);

How conflicts of interest can be managed;

What to do if you have concerns that a conflict of interest is not being declared or managed appropriately;

What are the potential implications of a breach of the CCG’s rules and policies for managing conflicts of interest.

NHS Doncaster CCG intends to provide this training via NHS England’s online training package for CCG staff, governing body and committee members. This will be required to be completed on an annual basis to raise awareness of the risks of conflicts of interest and to support staff in managing conflicts of interest. Completion rates will be recorded as part of the annual conflicts of interest audit and monitoring

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of mandatory and statutory training. This training will be supplemented with local training where deemed necessary and appropriate. Fraud Awareness Training is mandatory training for all staff every 3 years and includes reference to the broad areas contained in this Policy & Procedure. Our zero-tolerance approach to bribery and corruption will be communicated to all suppliers, contractors and other third parties with whom our CCG has dealings at the outset of a business relationship with them including a requirement for compliance in all contracts with Suppliers. 5.3. Review As part of its development, this policy and its impact on staff, patients and the public has been reviewed in line with NHS Doncaster CCG’s Equality Duties. The purpose of the assessment is to identify and if possible remove any disproportionate adverse impact on employees, patients and the public on the grounds of the protected characteristics under the Equality Act. The Policy & Procedure will be reviewed every three years, and in accordance with the following on an as and when required basis:

Legislatives changes

Good practice guidelines

Case Law

Significant incidents reported

New vulnerabilities identified

Changes to organisational infrastructure

Changes in practice

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SECTION B – PROCEDURE 1. Standards of Business Conduct 1.1. All members of NHS boards and CCG governing bodies should understand

and be committed to the practice of good governance and to the legal and regulatory frameworks in which they operate. As individuals they must understand both the extent and limitations of their personal responsibilities.

1.2. All Governing Body members will abide by the standards for members of NHS

boards and Clinical Commissioning Group governing bodies in England shown at Appendix B. This will be signed upon appointment to the Governing Body.

1.3. Employees, Members, Governing Body, Committee and Sub Committee

members of the Group / Governing Body are at all times required to comply with the Group’s Constitution and be aware of their responsibilities as outlined in it. The Constitution confirms that these individuals should act in good faith and in the interests of the Group and should follow the Seven Principles of Public Life as set out by the Committee on Standards in Public Life (the Nolan Principles) shown at Appendix A.

2. Conflicts of Interest 2.1. Legislation 2.1.1. Section 14O of the 2006 NHS Act, as inserted by Section 25 of the Health &

Social Care Act 2012, requires CCGs as a minimum to:

Maintain appropriate registers of interests.

Publish or make arrangements for the public to access those registers.

Make arrangements requiring the prompt declaration of interests by the persons specified (members and employees) and ensure that these interests are entered into the relevant register.

Make arrangements for managing conflicts and potential conflicts of interest (e.g. developing appropriate policies and procedures).

Have regard to guidance published by NHS England and Monitor in relation to conflicts of interest.

2.1.2. Section 14O is supplemented by the procurement specific requirements set

out in the National Health Service (Procurement, Patient Choice and Competition) (No.2) Regulations 2013). In particular, regulation 6 requires the following:

CCGs must not award a contract for the provision of NHS health care services where conflicts, or potential conflicts, between the interests involved in commissioning such services and the interests involved in providing them affect, or appear to affect, the integrity of the award of that contract; and

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CCGs must keep a record of how it managed any such conflict in relation to NHS commissioning contracts it enters into.

2.2. Conflict of Interest principles 2.2.1. Clinical Commissioning Groups (CCGs) manage conflicts of interest as part of

their day-to-day activities. Effective handling of conflicts of interest is crucial to give confidence to patients, taxpayers, healthcare providers and Parliament that CCG commissioning decisions are robust, fair and transparent and offer value for money. It is essential in order to protect healthcare professionals and maintain public trust in the NHS. Failure to manage conflicts of interest could lead to legal challenge and even criminal action in the event of fraud, bribery and corruption.

2.2.2. Conflicts of interest can arise in many situations, environments and forms of

commissioning, with an increased risk in primary care commissioning, out-of-hours commissioning and involvement with integrated care organisations, as clinical commissioners may here find themselves in a position of being at once commissioner and provider of services. Conflicts of interest can arise throughout the whole commissioning cycle from needs assessment, to procurement exercises, to contract monitoring.

2.2.3. Seeking to eliminate conflicts of interest completely is unlikely to be possible or desirable. It is important for an individual to have a strong interest in a subject or cause in order to understand, promote and take it seriously. This is, in fact, part of the basic rationale for clinically led commissioning. It is, however, important that conflicts of interest are declared and measures are taken to manage them in the right way to protect individuals and the organisation from accusations of conflicts of interest influencing decisions. Failure to acknowledge, identify and address conflicts of interest could result in poor decision making, legal challenge and reputational damage.

2.2.4. The general safeguards that are needed within NHS Doncaster CCG to manage conflicts of interest will vary to some extent, depending on at what stage in the commissioning cycle decisions are being made. The following principles will be integral to our commissioning of all services, including decisions on whether to continue to commission a service, such as by contact extension. To support the management of conflicts of interest, the CCG will:

Do business appropriately: If we get our needs assessments, consultation mechanisms, commissioning strategies and procurement procedures right from the outset, then conflicts of interest become much easier to identify, avoid and/or manage, because the rationale for all decision-making will be clear and transparent and should withstand scrutiny.

Be proactive, not reactive: We will seek to identify and minimise the risk of conflicts of interest at the earliest possible opportunity.

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Be balanced and proportionate: This policy and procedure is intended to be clear and robust, but not overly prescriptive or restrictive. It aims to ensure that decision-making is transparent and fair, but does not constrain people by making it overly complex or cumbersome.

Be transparent: Documenting clearly the approach taken at every stage in the commissioning cycle so that a clear audit trail is evident.

Create an environment and culture where individuals feel supported and confident in declaring relevant information and raising any concerns.

Assume that individuals will seek to act ethically and professionally, but may not always be sensitive to all conflicts of interest. A perception of wrongdoing, impaired judgement or undue influence can be as detrimental as any of them actually occurring. If in doubt, the CCG will assume the existence of a conflict of interest and manage it appropriately rather than ignore it. For a conflict of interest to exist, financial gain is not necessary.

2.2.5. The Chief of Corporate Services is responsible for overseeing the governance

of the general system for managing conflicts of interest within the organisation.

2.2.6. NHS Doncaster CCG will publish the register(s) of interest and register(s) of Gifts and Hospitality, and the Register of Procurement Decisions on the CCG website. In exceptional circumstances, where the public disclosure of information could give rise to a real risk of harm or is prohibited by law, an individual’s name and/or other information may be redacted from the publicly available register(s). Where an individual believes that substantial damage or distress may be caused, to him/herself or somebody else by the publication of information about them, they are entitled to request that the information is not published. Such requests must be made in writing. Decisions not to publish information will be made by the Conflicts of Interest Guardian for the CCG, who will seek appropriate legal advice where required, and the CCG will retain a confidential un-redacted version of the register(s).

2.2.7. All persons who are required to make a declaration of interest(s) or a declaration of gifts or hospitality will be made aware that the register(s) will be published in advance of publication via the CCG Fair Processing Notice that details the identity of the data controller, the purposes for which the registers are held and published, and contact details for the data protection officer. This information will additionally be provided to individuals identified in the registers because they are in a relationship with the person making the declaration.

2.3. Definitions of conflicts of interest 2.3.1. A conflict of interest occurs where an individual’s ability to exercise

judgement, or act in a role, is or could be impaired or otherwise influenced by his or her involvement in another role or relationship. In some circumstances,

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it could be reasonably considered that a conflict exists even when there is no actual conflict. In these cases it is important to still manage these perceived conflicts in order to maintain public trust. (Managing Conflicts of Interest: Revised Statutory Guidance for CCGs (NHS England, June 2016)).

2.3.2. For the purposes of Regulation 6 National Health Service (Procurement, Patient Choice and Competition) (No.2) Regulations 2013), a conflict will arise where an individual’s ability to exercise judgement or act in their role in the commissioning of services is impaired or influenced by their interests in the provision of those services as detailed in Substantive guidance on the Procurement, Patient Choice and Competition Regulations (Monitor, December 2013).

2.3.3. Regulation 6 of the Procurement, Patient Choice and Competition Regulations makes it clear that an interest, from a procurement specific perspective, includes an interest of:

A member of the commissioner;

A member of the governing body of the commissioner;

A member of the commissioner’s committees or sub-committees, or committees or sub-committees of its governing body; or

An employee.

Other interests that might give rise to a conflict include the interests of any individuals or organisations providing commissioning support to the commissioner, such as Commissioning Support services, who may be in a position to influence the decisions reached by the commissioner as a result of their role.

2.3.4. Types of conflicts of interest can include but are not limited to:

Financial interests: This is where an individual may get direct financial benefits from the consequences of a commissioning decision. This could, for example, include being: o A director, including a non-executive director, or senior employee in a

private company or public limited company or other organisation which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations.

o A shareholder (or similar ownership interests), a partner or owner of a private or not-for-profit company, business, partnership or consultancy which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations.

o A management consultant for a provider. o In secondary employment. o In receipt of secondary income from a provider. o In receipt of a grant from a provider. o In receipt of any payments (for example honoraria, one-off payments,

day allowances or travel or subsistence) from a provider. o In receipt of research funding, including grants that may be received by

the individual or any organisation in which they have an interest or role;

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o Having a pension that is funded by a provider (where the value of this might be affected by the success or failure of the provider).

Non-financial professional interests: This is where an individual may obtain a non-financial professional benefit from the consequences of a commissioning decision, such as increasing their professional reputation or status or promoting their professional career. This may, for example, include situations where the individual is:

o An advocate for a particular group of patients. o A GP with special interests e.g. in dermatology, acupuncture. o A member of a particular specialist professional body (although routine

GP membership of the Royal College of General Practitioners (RCGP), British Medical Association (BMA) or a medical defence organisation would not usually by itself amount to an interest which needed to be declared).

o An advisor for the Care Quality Commission (CQC) or the National Institute for Health and Care Excellence (NICE).

o A medical researcher. Additionally, GPs and practice managers, who are members of the governing body or committees of the CCG, should declare details of their roles and responsibilities held within their GP practices.

Non-financial personal interests: This is where an individual may benefit personally in ways which are not directly linked to their professional career and do not give rise to a direct financial benefit. This could include, for example, where the individual is:

o A voluntary sector champion for a provider. o A volunteer for a provider. o A member of a voluntary sector board or has any other position of

authority in or connection with a voluntary sector organisation. o Suffering from a particular condition requiring individually funded

treatment. o A member of a lobby or pressure group with an interest in health.

Indirect interests: This is where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision (as those categories are described above) for example, a:

o Spouse / partner. o Close relative e.g., parent, grandparent, child, grandchild or sibling. o Close friend. o Business partner. A declaration of interest for a “business partner” in a

GP partnership should include all relevant collective interests of the partnership, and all interests of their fellow GP partners (which could be done by cross referring to the separate declarations made by those GP partners, rather than by repeating the same information verbatim).

Whether an interest held by another person gives rise to a conflict of interests will depend upon the nature of the relationship between that person and the individual, and the role of the individual within the CCG.

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The above categories and examples are not exhaustive and the CCG will exercise discretion on a case by case basis, having regard to the principles set out in this policy, in deciding whether any other role, relationship or interest could impair or otherwise influence an individual’s judgement or actions in their role within the CCG. If so, this should be declared and appropriately managed.

2.3.5. When determining whether an interest must be declared, pertinent issues to

bear in mind include:

a perception of wrongdoing, impaired judgment or undue influence can be as detrimental as any of them actually occurring;

if in doubt, it is better to assume the existence of a conflict of interest and manage it appropriately rather than ignore it; and

for a conflict of interest to exist, financial gain is not necessary.

Individuals will also need to consider whether any previous or prospective roles or relationships may give rise to a conflict of interest. A conflict of interest may arise, for example, where a person has an expectation of future work or employment with a provider that is bidding for a contract.

2.4. Declaring and registering interests

Statutory Requirements

2.4.1. As confirmed in our Constitution, we will to maintain one or more registers of interest of:

All CCG employees, including: o All full and part time staff o Any staff on sessional or short term contracts o Any students and trainees (including apprentices) o Agency staff o Seconded staff

In addition, any self-employed consultants or other individuals working for the CCG under a contract for services will be required to make a declaration of interest in accordance with this guidance, as if they were CCG employees.

Members of the governing body: All members of the CCG’s committees, sub-committees/sub-groups, including:

o Co-opted members o Appointed deputies o Any members of committees/groups from other organisations

Where the CCG is participating in a joint committee alongside other CCGs, any interests which are declared by the committee members should be recorded on the register(s) of interest of each participating CCG.

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All members of the CCG (i.e. each Member Practice): This includes each provider of primary medical services which is a member of the CCG under Section 14O (1) of the 2006 Act. Declarations should be made by the following groups:

o GP partners (or where the practice is a company, each director); o Any individual directly involved with the business or decision-

making of the CCG

2.4.2. The Corporate Governance Manager will record an interest in the register as soon as he/she becomes aware of it. We will publish, and make arrangements to ensure that members of the public have access to these registers on request. Interests will remain on the public register for a minimum of 6 months after the interest has expired. In addition, the CCG will retain a private record of historic interests for a minimum of 6 years after the date on which it expired. The CCG’s published register of interests will state that historic interests are retained by the CCG for the specified timeframe, with details of whom to contact to submit a request for this information.

Declaring an Interest 2.4.3. Individuals are required to declare any interest that they have in writing to the

Corporate Governance Manager, as soon as they are aware of it and in any event no later than 28 days after becoming aware. Where an individual is unable to provide a declaration in writing, for example, if a conflict becomes apparent in the course of a meeting, they are required to make an oral declaration before witnesses, and provide a written declaration as soon as possible thereafter.

2.4.4. Conflicts of interests should be declared in accordance with paragraph 2.3.4

and regularly confirmed and updated (including a nil declaration) in the following circumstances:

On appointment in writing: Applicants for any appointment to the CCG or its governing body will be asked to declare any relevant interests. When an appointment is made, a formal declaration of interests will again be made by the successful applicant and recorded accordingly.

6-monthly: We have a system in place to review our register of interests on a six-monthly basis to ensure that the register of interests is accurate and up-to-date. Declarations of interest will be obtained from all relevant individuals every six months, and where there are no interests or changes to declare, a “nil return” will be requested and recorded.

At meetings: As a standing agenda item, all attendees will be asked to verbally declare any interest they have in any agenda item at every governing body, committee, sub-committee or working group meeting before it is discussed or as soon as it becomes apparent. Even if an interest is declared in the register of interests, it should be verbally declared in meetings where matters relating to that interest are discussed. Declarations of interest will be recorded in minutes of meetings.

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On changing roles, responsibilities or circumstances: Where an individual changes role or responsibility within a CCG or its governing body, any change to the individual’s interests should be declared in writing.

Whenever an individual’s role, responsibility or circumstances change in a way that affects the individual’s interests (e.g. where an individual takes on a new role outside the CCG or enters into a new business or relationship), a further declaration should be made to reflect the change in circumstances as soon as possible, and in any event within 28 days. This could involve a conflict of interest ceasing to exist or a new one materialising. It is the responsibility of the individual to make a declaration of interests if their circumstances change as soon as possible, and in any event within 28 days, rather than waiting to be asked.

At specific points during the procurement process: See procurement section (section 3) for further guidance.

2.4.5. Whenever interests are declared, they should be promptly reported (and in any event within 28 days) to the Corporate Governance Manager within the CCG who has designated responsibility for maintaining the register of interests. The Corporate Governance Manager will ensure that the register of interests is updated accordingly. All written declarations should be made using the “Declaration of Interest” form (Appendix C) and should be forwarded to the Corporate Governance Manager for registering. Declarations of no interests are required as well as declaring identified interests.

2.4.6. Where an individual, i.e. an employee, Group Member, member of the Governing Body, or a member of a Committee or a Sub-Committee of the Group or its Governing Body has an interest, or becomes aware of an interest which could lead to a conflict of interests in the event of the Group considering an action or decision in relation to that interest, that must be considered as a potential conflict.

2.4.7. Based on the written Declaration of Interest Form, the Chief Officer will put in writing to the relevant individual any arrangements required for managing any actual or potential conflict arising from the declared interests, taking into account both the materiality and extent of the interest. The arrangements may confirm the following areas:

When an individual should withdraw from a specified activity or meeting, on a temporary or permanent basis.

Monitoring of the specified activity undertaken by the individual, either by a line manager, colleague or other designated individual.

2.4.8. A template for the register of interests is shown at Appendix D.

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2.4.9. On a 6-monthly basis the Corporate Governance Manager will review the registers of interests to ensure that they are accurate and up to date, undertaking any spot-check activity required.

2.5. Managing Conflicts of interests which arise during meetings 2.5.1. The CCG is under a statutory obligation to make arrangements for managing

conflicts of interests, and potential conflicts of interest, in such a way as to ensure that they do not, and do not appear to, affect the integrity of the group’s decision-making.

2.5.2. The chair of a meeting of the CCG’s governing body or any of its committees, sub-committees or groups has ultimate responsibility for deciding whether there is a conflict of interest and for taking the appropriate course of action in order to manage the conflict of interest. In the event that the chair of a meeting has a conflict of interest, the vice chair is responsible for deciding the appropriate course of action in order to manage the conflict of interest. If the vice chair is also conflicted then the remaining non-conflicted voting members of the meeting should agree between themselves how to manage the conflict(s).

2.5.3. It is good practice for the chair, with support of the CCG’s Chief of Corporate

Services or equivalent and, if required, the Conflicts of Interest Guardian, to proactively consider ahead of meetings what conflicts are likely to arise and how they should be managed, including taking steps to ensure that supporting papers for particular agenda items of private sessions/meetings are not sent to conflicted individuals in advance of the meeting where relevant. To support chairs in their role, they will have access to a declaration of interest checklist (Appendix E) prior to meetings, which will include details of any declarations of conflicts which have already been made by members of the group.

2.5.4. The chair should ask at the beginning of each meeting if anyone has any conflicts of interest to declare in relation to the business to be transacted at the meeting. Each member of the group should declare any interests which are relevant to the business of the meeting, whether or not those interests have previously been declared. Any new interests which are declared at a meeting must be included on the CCG’s relevant register of interests to ensure it is up-to-date. Similarly, any new offers of gifts or hospitality (whether accepted or not) which are declared at a meeting must be included on the CCG’s register of gifts and hospitality to ensure it is up-to-date.

2.5.5. It is the responsibility of each individual member of the meeting to declare any relevant interests which they may have. However, should the chair or any other member of the meeting be aware of facts or circumstances which may give rise to a conflict of interests but which have not been declared then they should bring this to the attention of the chair who will decide whether there is a conflict of interest and the appropriate course of action to take in order to manage the conflict of interest.

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2.5.6. When a member of the meeting (including the chair or vice chair) has a conflict of interest in relation to one or more items of business to be transacted at the meeting, the chair (or vice chair or remaining non-conflicted members where relevant as described above) must decide how to manage the conflict. The appropriate course of action will depend on the particular circumstances, but could include one or more of the following:

Chair: Where the chair has a conflict of interest, deciding that the vice chair (or another non-conflicted member of the meeting if the vice chair is also conflicted) should chair all or part of the meeting.

Total exclusion: o Requiring the individual who has a conflict of interest (including the

chair or vice chair if necessary) not to attend the meeting. o Ensuring that the individual concerned does not receive the

supporting papers or minutes of the meeting which relate to the matter(s) which give rise to the conflict.

o Requiring the individual to leave the discussion when the relevant matter(s) are being discussed and when any decisions are being taken in relation to those matter(s). In private meetings, this could include requiring the individual to leave the room and in public meetings to either leave the room or join the audience in the public gallery.

Partial exclusion: Allowing the individual to participate in some or all of the discussion when the relevant matter(s) are being discussed but requiring them to leave the meeting (or, depending on the materiality of the interest and the nature of the decision, remain silent and not participate) when any decisions are being taken in relation to those matter(s). This may be appropriate where, for example, the conflicted individual has important relevant knowledge and experience of the matter(s) under discussion, which it would be of benefit for the meeting to hear, but this will depend on the nature and extent of the interest which has been declared.

Full participation: Noting the interest and ensuring that all attendees are aware of the nature and extent of the interest, but allowing the individual to remain and participate in both the discussion and in any decisions. This is only likely to be the appropriate course of action where it is decided that the interest which has been declared is either immaterial or not relevant to the matter(s) under discussion. Where the individual is deemed to have a material interest, the option of full participation shall not be available.

2.5.7. All decisions, and details of how any conflict of interest issue has been

managed, should be recorded in the minutes of the meeting. It is the responsibility of the Chair to ensure that interests are formally recorded in the minutes. The chair must ensure the following information is recorded in the minutes as a minimum (corporate templates are in place to facilitate this – Appendix E):

who has the interest;

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the nature of the interest and why it gives rise to a conflict, including the magnitude of any interest;

the items on the agenda to which the interest relates;

how the conflict was agreed to be managed; and

evidence that the conflict was managed as intended (for example recording the points during the meeting when particular individuals left or returned to the meeting).

2.5.8. If during the course of a meeting a conflict of interest is established which was

not identified at the commencement of the meeting, the member concerned should notify the Chair of the meeting immediately. If, after a meeting, a member realises that they have contributed to a discussion in which they had an interest, they must notify the Chair of the meeting at the earliest opportunity and, if there is time, the interest will be noted in the minutes. Otherwise it will be raised as a matter arising at the next meeting.

2.5.9. Where more than 50% of the members of a meeting are required to withdraw from a meeting or part of it, owing to the arrangements agreed for the management of conflicts of interests or potential conflicts of interests, the Chair (or Deputy) will determine whether or not the discussion can proceed. In making this decision the Chair will consider whether the meeting is quorate, in accordance with the number and balance of membership set out in the Group’s Standing Orders. Where the meeting is not quorate, owing to the absence of certain members, the discussion will be deferred until such time as a quorum can be convened. Where a quorum cannot be convened from the membership of the meeting, owing to the arrangements for managing conflicts of interest or potential conflicts of interests and which are not covered by the provisions set out in this policy, the Chair shall consult with the Chief Officer on the action to be taken. These arrangements must be recorded in the minutes. The arrangements may include:

Requiring another of the Group’s Committees or Sub-Committees, the Group’s Governing Body or the Governing Body’s Committees or Sub-Committees (as appropriate) which can be quorate to progress the item of business, or if this is not possible,

Inviting on a temporary basis one or more of the following to make up the quorum so that the Group can progress the item of business.

a member of the Group;

an individual appointed by a member practice to act on its behalf in the dealings between it and the Group;

a member of a relevant Health and Wellbeing Board;

a member of a relevant local Healthwatch;

a member of a Governing Body of another Clinical Commissioning Group.

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3. Managing conflicts of interest throughout the commissioning cycle 3.1. Legislation 3.1.1. The NHS Act 2006, the Health and Social Care Act 2012 and associated

regulations set out the statutory rules with which commissioners are required to comply when procuring and contracting for the provision of clinical services. NHS Doncaster CCG will consider these alongside the Public Contract Regulations and, where appropriate, EU procurement rules. Monitor's Substantive guidance on the Procurement, Patient Choice and Competition Regulations advises that the requirements within these create a framework for decision making that will assist commissioners to comply with a range of other relevant legislative requirements. NHS Doncaster CCG will work in accordance with this framework.

3.1.2. The National Health Service (Procurement, Patient Choice and Competition) (No. 2)) Regulations 2013 place requirements on commissioners to ensure that they adhere to good practice in relation to procurement, run a fair, transparent process that does not discriminate against any provider, do not engage in anti-competitive behaviour that is against the interest of patients, and protect the right of patients to make choices about their healthcare. Furthermore the PPCCR places requirements on commissioners to secure high quality, efficient NHS healthcare services that meet the needs of the people who use those services.

3.1.3. The European procurement regime – Public Contracts Regulations 2015 (PCR 2105) incorporate the European Public Contracts Directive into national law, apply to all public contracts over the threshold value, and are enforced through the Courts. Paragraph 24 of PCR 2015 states: “Contracting authorities shall take appropriate measures to effectively prevent, identify and remedy conflicts of interest arising in the conduct of procurement procedures so as to avoid any distortion of competition and to ensure equal treatment of all economic operators”. Conflicts of interest are described as “any situation where relevant staff members have, directly or indirectly, a financial, economic or other personal interest which might be perceived to compromise their impartiality and independence in the context of the procurement procedure”. The PCR 2015 are focussed on ensuring a fair and open selection process for providers. The regulations set out that:

CCGs must not award a contract for the provision of NHS health care services where conflicts, or potential conflicts, between the interests involved in commissioning such services and the interests involved in providing them affect, or appear to affect, the integrity of the award of that contract; and

CCGs must keep a record of how it managed any such conflict in relation to NHS commissioning contracts it has entered into.

3.1.4. Monitor has a statutory duty under section 78 of the Health & Social Care Act

2012 to produce guidance on compliance with any requirements imposed by the regulations and how it intends to exercise the powers conferred on it by these regulations. Monitor’s Substantive guidance on the Procurement,

25

Patient Choice and Competition Regulations is the relevant statutory guidance.

3.2. Commissioning cycle conflict of interest principles 3.2.1. Conflicts of interest need to be managed appropriately throughout the whole

commissioning cycle. At the outset of a commissioning process, the relevant interests of all individuals involved should be identified and clear arrangements put in place to manage any conflicts of interest. This includes consideration as to which stages of the process a conflicted individual should not participate in, and, in some circumstances, whether that individual should be involved in the process at all.

3.2.2. All staff who are in contact with suppliers and contractors (including external

consultants), and in particular those who are authorised to sign Purchase Orders, or place contracts for goods, materials or services, are expected to adhere to relevant professional standards of the kind set out in the Ethical Code of the Chartered Institute of Purchasing and Supply (CIPS) available at http://www.cips.org

3.2.3. Staff should be particularly careful of using, or making public, internal information of a “commercial in-confidence” nature, particularly if its disclosure would prejudice the principle of a purchasing system based on fair competition. This principle applies whether private competitors or other NHS providers are concerned, and whether or not disclosure is prompted by the expectation of personal gain.

3.2.4. Fair and open competition between prospective contractors or suppliers for NHS contracts is a requirement of NHS Standing Orders, the National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013 and the European and UK Procurement Regulations for Works, Services and Supplies. This means that:

No private, public or voluntary organisation or company which may bid for NHS business should be given any advantage over its competitors, such as advance notice of NHS requirements. This applies to all potential contractors, whether or not there is a relationship between them and the NHS employer, such as a long-running series of previous contracts.

Each new contract should be awarded solely on merit, taking into account the requirements of the NHS and the ability of the contractors to fulfil them.

3.2.5. NHS staff should ensure that no special favour is shown to current or former

employees or their close relatives or associates in awarding contracts to private or other businesses run by them or employing them in a senior or relevant managerial capacity. Contracts may be awarded to such businesses where they are won in fair competition against other tenders, but scrupulous care must be taken to ensure that the selection process is conducted impartially, and that staff who are known to have a relevant interest play no part in the selection.

3.2.6. Anyone seeking information in relation to a procurement, or participating in a

procurement, or otherwise engaging with the Group in relation to the potential

http://www.cips.org/

26

provision of services or facilities to the Group, will be required to make a declaration of any relevant conflict / potential conflict of interest.

3.2.7. Anyone contracted to provide services or facilities directly to the Group will be

subject to the same provisions in relation to managing conflicts of interests. This requirement will be set out in the contract for their services.

3.2.8. To ensure a fair, transparent and competitive procurement process, NHS

Doncaster CCG will actively work to identify and manage all conflict(s) of interest during the procurement process. Conflicts of interest within procurement arise when an individual or organisation is in a position to exploit a professional or official capacity, including acquiring information or being involved in processes connected with the procurements, for their personal or business benefit.

3.2.9. The existence of a conflict of interest does not, in itself, indicate that a person or organisation has acted in an unprofessional manner or done something wrong. In some situations conflicts of interest are unavoidable, for example with primary medical care service delivery there is a strong commissioner / provider link. NHS Doncaster CCG will work to ensure all procurement conflicts of interest are identified and managed appropriately. In the event that a potential conflict of interest cannot be managed, NHS Doncaster CCG will review any risks of negative stakeholder perception that a conflict of interest is not being managed and take this into consideration when determining management actions.

3.3. Register of procurement decisions 3.3.1. The Head of Procurement at NHS Doncaster CCG will maintain a register of

procurement decisions which will be updated whenever a procurement decision is taken with information including:

the details of the decision;

who was involved in making the decision (including the name of the CCG clinical lead, the CCG contract manager, the name of the decision making committee and the name of any other individuals with decision-making responsibility);

a summary of any conflicts of interest in relation to the decision and how this was managed by the CCG; and

the award decision taken. 3.3.2. In the interests of transparency, the register of interests and decisions will be

publically available on the CCG website at www.doncasterccg.nhs.uk and available upon request for inspection at our headquarters. Where required by NHS England, the register will form part of the CCG’s annual accounts and will thus be signed off by external auditors. These records will be retained for a period of at least three years from the date of award of the contract.

3.3.3. NHS Doncaster CCG will use the business case / procurement template at Appendix F when drawing up plans to commission services.

http://www.doncasterccg.nhs.uk/

27

3.4. Potential procurement conflict of interest scenarios

3.4.1. To assist with understanding procurement conflicts of interest, and for the purpose of this procedure, they have been categorised as follows and likely scenarios are detailed below:

Conflicts of interest from an NHS Doncaster CCG perspective;

Conflicts of interest from a bidder perspective;

Conflicts of interest arising from horizontal and/or vertical integration.

NHS Doncaster Clinical

Commissioning Group

perspective

From NHS Doncaster CCG’s perspective any of the following scenarios could be considered to be a potential conflict of interest:

An NHS Doncaster CCG commissioner including governing body and committee members involved in the procurement (e.g. project team or evaluator) has a financial interest (e.g. holding shares or options) in a bidder/bidder entity or any employee or officer thereof;

An NHS Doncaster CCG commissioner has a financial or any other personal interest in the outcome of the evaluation process;

An NHS Doncaster CCG commissioner is employed by or providing services to any bidder party;

An NHS Doncaster CCG commissioner is receiving any kind of monetary or non-monetary payment or incentive (including hospitality) from any bidder party or its representatives;

An NHS Doncaster CCG commissioner has any other close relationship (current or historical) with any Bidder Party;

Any party (NHS Doncaster CCG or Bidder) is canvassing, or negotiating with, any person with a view to entering into any of the arrangements outlined above; or

Any party (NHS Doncaster CCG or Bidder) has a close member of family (including unmarried partners) who falls into any of the categories outlined above.

For the purpose of this guidance, an NHS Doncaster CCG commissioner includes any member of staff directly employed by NHS Doncaster CCG, contracted in specifically for the procurement or on an advisory basis including NHS Doncaster CCG Members and Local Medical Committee members. The above list of examples is a non-exhaustive list, and it is NHS Doncaster CCG’s responsibility to ensure that any and all potential conflicts – whether or not of the type listed above – are disclosed in writing and managed appropriately.

Bidder perspective

From a Bidder perspective any of the following scenarios could be considered to be a potential conflict of interest:

A Relevant Organisation is carrying out, or has carried out, any work for NHS Doncaster CCG in the last 12 months (this would cause a concern, for example, if the Relevant Organisation has had access to commercially sensitive information which would give them an unfair advantage over other bidders);

A Relevant Organisation is potentially providing services for more than one prospective Bidder in respect of the Procurement process;

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or

A Relevant Organisation employs or engages, or has employed or engaged, any person currently or formerly employed or engaged by or otherwise connected with NHS Doncaster CCG.

For the purpose of this policy, a Relevant Organisation is considered to include any organisation(s) - including the Bidder, each Bidder Member and any Clinical Services Supplier - or person connected (including employees and advisers) with a response to a Pre-Qualification Questionnaire. The above list of examples is a non-exhaustive list, and it is NHS Doncaster CCG’s responsibility to ensure that any and all potential conflicts – whether or not of the type listed above – are disclosed in writing and managed appropriately.

Horizontal and vertical

integration

Conflicts of interest may also arise where horizontal and/or vertical integration occurs. Vertical integration is where a provider of the primary care service is a secondary care provider into which the service in question may make referrals. Horizontal is where the provider of primary care services has other primary care services in the locality into which the service in question may make referrals. If vertical integration could occur, NHS Doncaster CCG will work with the NHS Commissioning Board (NHS England) to ensure the necessary safeguards are in place and that appropriate approvals are sought.

3.5. Governance of conflicts of interest in procurement 3.5.1. The Head of Procurement has overall responsibility and oversight for

managing all conflicts of interest for the procurement process including those facilitated and managed by external agencies such as Commissioning Support services. As a core principle, all decisions made around managing conflicts of interest will be made independently of those associated or directly involved in the conflicts of interest itself.

3.5.2. All members of the evaluation panel and/or persons who have access to project information shall be asked to declare conflicts of interest and there is a review mechanism for NHS Doncaster CCG to monitor and manage them. The contact point for any clarification or declaration on procurement conflicts of interest will be the Project Lead. The table below details respective roles within the procurement project.

Role Responsibility

Bidders

Declare conflicts of interest as part of the tender process. Potential Bidders will be made aware of their obligation to formally declare any conflicts of interest through the procurement documentation, namely the Memorandum of Information (MOI), Pre Qualification Questionnaire (PQQ) and Invitation to Tender (ITT). The first stage for bidders to

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Role Responsibility

formally declare any conflicts of interest will be at the Pre-Qualification Stage (PQQ). In addition, bidders will be placed under a continuous obligation to declare any conflicts of interest that arise during all stages of the procurement process.

NHS Doncaster

CCG

Create and maintain a central conflicts of interest log to include all identified conflicts of interest and any minutes taken at meetings where conflicts of interest are discussed. Capturing all conflicts of interest in a central database will help ensure accountability and appropriate capture of information.

NHS Doncaster CCG will seek to establish that any and all potential conflicts, whether or not of the type listed earlier in this procedure, are disclosed and recorded. The Project Lead will ensure that all officers involved in the procurement process declare any conflicts of interest and agree to strict confidentiality agreements as early as possible in the procurement process. This will apply to all Project Team staff, advisors and evaluators. All new staff who become involved in the project subsequent to the initial set up will be required to declare all conflicts of interest before being given access to commercially sensitive information. In addition, NHS Doncaster CCG will document all conflicts of interest and mitigation actions e.g. recording minutes at meetings. All NHS Doncaster CCG commissioners will be made aware of the limitations to any future involvement in the procurement (e.g. as a bidder) because of their entry into the procurement process at the CCG.

Project Team

Identify conflicts of interest and make appropriate channels available for all stakeholders to declare conflicts of interest.

Review conflicts of interest, risks associated with them and the impact that they have on the procurement - seeking necessary expert advice (e.g. legal) and involving the NHS England (or equivalent) where required (e.g. Vertical Integration issues).

Project Lead

Ensure all conflicts of interest are managed appropriately.

Make key decisions on any restrictions to be imposed.

Escalate decisions to a relevant Committee of the Governing Body or to the Governing Body where it is deemed appropriate.

NHS England

Provide advice on specific conflicts of interest where required e.g. vertical integration.

All parties

Declare any conflicts of interest that they know may exist.

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3.6. Conflicts of interest at the different procurement stages 3.6.1. Conflicts of interest can occur at any stage during the procurement process

and are most likely to occur during the following three key phases:

Service Design

Evaluation of Bids (PQQ and ITT)

Bidder selection and contract award 3.6.2. The type of conflicts of interest likely to arise during these phases and the

risks associated with each of them are discussed further below. Commissioners must consider each of these areas as appropriate to their commissioning activity.

Service Design

Two key areas of conflict of interest that can occur at this stage of the process are: 1. The service design may be influenced by an individual in such a way

that the resulting requirements favour the deliverability of any one provider in which the individual has a personal or financial interest; and

2. An individual or organisation gains access to affordability, financial costing or performance information which gives them a commercial advantage when bidding for services.

In both of the areas listed above, bidders could gain an unfair advantage over competitors and NHS Doncaster CCG will take these into consideration when deciding upon mitigating actions. If a conflict of interest, as described above, has occurred, then in order to ensure the integrity of the procurement NHS Doncaster CCG will seek to exclude such bidders from continuing in the procurement process. An assessment will be made on a case by case basis with consideration given to whether the conflicted parties made a declaration upfront. The way in which services are designed can either increase or decrease the extent of perceived or actual conflicts of interest. Public involvement supports transparent and credible commissioning decisions. It should happen at every stage of the commissioning cycle from needs assessment, planning and prioritisation to service design, procurement and monitoring. As a CCG, we have legal duties under the Health & Social Care Act 2012 to properly involve patients and the public in our commissioning processes and decisions. Our Engagement & Experience Committee oversees public engagement activity. It is good practice to engage relevant providers, especially clinicians, in confirming that the design of service specifications will meet patient need. This may include providers from the acute, primary, community, and mental health sectors, and may include NHS, third sector and private sector providers. Such engagement, done transparently and fairly, is entirely legal. However, conflicts of interest, as well as challenges to the fairness of the procurement process, can occur if a commissioner engages selectively with only certain providers (be they incumbent or potential new providers) in developing a service

31

specification for a contract for which they may later bid. Any engagement by the CCG will follow the three main principles of procurement law: equal treatment, non-discrimination and transparency. This includes ensuring that the same information is given to all at the same time, and that procedures are transparent. When engaging providers on service design, NHS Doncaster has ultimate responsibility for service design and will make the final decision on any model. As the service design develops, it is good practice to engage with a range of providers on an on-going basis to seek comments on the proposed design. Engagement should help to shape the requirement to meet patient need, but it is important not to gear the requirement in favour of any particular provider(s). If appropriate, the advice of an independent clinical adviser on the design of the service will be secured. NHS Doncaster CCG will seek, as far as possible, to specify the outcomes that we wish to see delivered through a new service, rather than the process by which these outcomes are to be achieved. As well as supporting innovation, this will help to prevent bias towards particular providers in the specification of services. Specifications will be clear and transparent, reflecting the depth of engagement, and set out the basis on which any contract will be awarded.

Evaluation of Bids (PQQ, Competitive

Dialogue and ITT)

As part of a procurement process, it is good practice to ask bidders to declare any conflicts of interest. This allows us as commissioners to ensure that we comply with the principles of equal treatment and transparency. When a bidder declares a conflict (a standard form is in place to support this), the CCG will decide how best to deal with it to ensure that no bidder is treated differently to any other. It will not usually be appropriate to declare such a conflict on the register of procurement decisions, as it may compromise the anonymity of bidders during the procurement process. However, the CCG will retain an internal audit trail of how the conflict or perceived conflict was dealt with to allow the provision of information at a later date if required. NHS Doncaster CCG will ensure that the evaluation process is robust and that it is open, fair and transparent. In addition, the evaluation criteria will be designed to be non-discriminatory to any particular type of bidder. Evaluation processes will be clearly documented in the Pre Qualification Questionnaire (PQQ), Competitive Dialogue and Invitation to Tender (ITT) Evaluation Plans. NHS Doncaster CCG will ensure that all evaluators are free of any conflicts and all evaluators will complete a conflict of interest declaration prior to them receiving any bid material.

Bidder selection and contract

award

Selection of a successful bidder will follow a pre-documented process – any variation from the process will be carefully considered, justifiable and documented again as a variation. NHS Doncaster CCG will ensure that bidders are selected against pre-determined selection criteria and not other preferences. Although existing knowledge of a bidder may be seen to reduce the risk to service delivery when compared to an unknown bidder with little experience, NHS Doncaster CCG will not favour existing bidders over and beyond the defined evaluation criteria.

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Contract management

The management of conflicts of interest applies to all aspects of the commissioning cycle, including contract management. Any contract monitoring meeting needs to consider conflicts of interest as part of the process i.e. the chair of a contract management meeting should invite declarations of interests, record any declared interests in the minutes of the meeting, and manage any conflicts appropriately and in line with this guidance. This equally applies where a contract is held jointly with another organisation such as the Local Authority or with other CCGs under lead commissioner arrangements. Conflicts should be recorded in line with Section 2.5 and Appendix E of this policy. The individuals involved in the monitoring of a contract should not have any direct or indirect financial, professional or personal interest in the incumbent provider or in any other provider that could prevent them, or be perceived to prevent them, from carrying out their role in an impartial, fair and transparent manner. NHS Doncaster CCG team members are required to be mindful of any potential conflicts of interest when they disseminate any contract or performance information/reports on providers, and manage the risks appropriately.

3.7. Declaring, reviewing and managing procurement conflicts of interest 3.7.1. A simple procurement conflict of interest framework is presented below:

The decision tree has the following steps:

Identify the conflict of interest / receive a declaration (the Head of Procurement will disseminate the appropriate procurement declaration form at the appropriate stage of the procurement).

Review the identified/declared conflict of interest and decide whether:

Conflict of

interest

identification /

declaration

Potential Conflict

No Conflict

Actual Conflict

Record

declaration – no

further action

required

Seek clarification

Monitor conflict

Impose

restrictionsSeek clarification

Divestment

Re

vie

w

Imp

ac

t A

ss

es

sm

en

t

Mit

iga

tio

n A

cti

on

Termination

Conflict of

interest

identification /

declaration

Potential Conflict

No Conflict

Actual Conflict

Record

declaration – no

further action

required

Seek clarification

Monitor conflict

Impose


Divestment

Re

vie

w

Imp

ac

t A

ss

es

sm

en

t

Mit

iga

tio

n A

cti

on

Termination

Conflict of

interest

identification /

declaration

Potential Conflict

No Conflict

Actual Conflict

Record

declaration – no

further action

required

Seek clarification

Monitor conflict

Impose


Divestment

Re

vie

w

Imp

ac

t A

ss

es

sm

en

t

Mit

iga

tio

n A

cti

on

Termination

33

o There is an actual conflict of interest (e.g. a bidder may declare that they are currently delivering services under an existing contract and will bid for new services, in which case this would not be seen as a conflict of interest for the procurement);

o A conflict of interest may materialise in the future but it does not currently exist (e.g. a clinical advisor/GP is advising on the service specification and intends to be involved in a bid for the service); or

o A conflict of interest does exist (e.g. a CCG bid evaluator is related to

the bid lead in a bidding organisation).

The impact of any conflict of interest on the procurement (with specific focus on fairness and transparency) needs to be considered to inform actions to be taken. In many cases, NHS Doncaster CCG will need to seek further clarification before making a decision on the line of action.

Various actions can be taken to manage a conflict of interest and these will be particular to the specific conflict of interest and advice from the Head of Procurement and any legal advice as required. Potential actions are:

o Monitor the situation – this may be most appropriate if there is the potential for a known conflict to materialise and it is currently premature to take any action or where it may be too late in the process to implement any corrective action;

o Restrictions may need to be placed on, for example, certain individuals or specific bidders may be restricted from participating in the scheme – restrictions may be time limited;

o Divestment of assets by the conflicted individual. If the conflict of

interest is identified early, NHS Doncaster CCG commissioners may be given the option of either resigning from their CCG role or to divest their financial interest in a bidder organisation; and

o Termination of the procurement may need to be considered where a

material conflict of interest has occurred and has substantially increased the procurement risk – legal advice and Chief Officer or NHS Doncaster CCG Governing Body approval (dependant on the procurement value in line with the CCG’s scheme of delegation) must be sought if this option is to be pursued.

3.7.2. NHS Doncaster CCG will retain the right to exclude any bidder from the

procurement where there is a material conflict of interest and there are no other appropriate mitigating actions which could be adopted. NHS Doncaster CCG will ensure that it is clear that a chosen mitigation action will be effective. Where doubt exists over the effectiveness of a mitigation action, NHS Doncaster CCG will pursue a safer option of implementing restrictions and excluding bidders from the process where required.

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3.7.3. The approach to managing conflicts during the procurement process will be to deal with each conflict on a case-by-case basis, within the parameters set by procurement law. The concerns around conflict of interest will need to be set against ensuring sufficient bidder participation. Each type of conflict of interest will be considered in a fair and transparent manner that can be documented and audited.

3.7.4. Where a Commissioning Support service or any other external agency is

contracted to provide procurement services to NHS Doncaster CCG, the procurement lead will keep the Head of Procurement informed of all conflicts of interest as they arise and the conflicts of interest process contained in this document will apply.

3.7.5. A business case and procurement template (Appendix F) and a register of procurement decisions template (Appendix G) are appended to this policy.

4. Primary Care conflicts of interest, procurement and contracting 4.1. The most obvious area in which conflicts could arise is where NHS Doncaster

CCG commissions (or continues to commission by contract extension) healthcare services, including GP services, in which a member of the CCG has a financial or other interest. This may most often arise in the context of commissioning of primary care, particularly with regard to any delegated or joint arrangements with NHS England, but must also be considered in respect of any commissioning issue where GPs are current or possible providers. NHS Doncaster CCG will use the business case / procurement template at Appendix F when drawing up plans to commission services where this is potentially the case.

4.2. As with any procurement, the register of interests and the register of decisions will be publically available on the CCG website at www.doncasterccg.nhs.uk and available upon request for inspection at our headquarters.

4.3. Decisions relating to the commissioning of primary medical services shall be made by a committee of the CCG’s governing body – the Primary Care Commissioning Committee. This committee will:

Follow the statutory guidance as issued by NHS England.

Be a decision-making Committee.

Be constituted to have a Lay and Executive (non-clinical) majority, including for quorum.

Have a Lay chair and Lay vice chair.

Issue a standing invitation to Healthwatch Doncaster and the Doncaster Health and Wellbeing Board to appoint representatives to attend committee meetings, including, where appropriate, for items where the public is excluded from a particular item or meeting for reasons of confidentiality. These representatives will not form part of the membership of the committee.

As a general rule, meetings of this committee, including the decision-making and the deliberations leading up to the decision, will be held in


35

public unless NHS Doncaster CCG has concluded it is appropriate to exclude the public. Examples of where it may be appropriate to exclude the public include:

o Information about individual patients or other individuals which includes sensitive personal data is to be discussed.

o Commercially confidential information is to be discussed, for example the detailed contents of a provider’s tender submission.

o Information in respect of which a claim to legal professional privilege could be maintained in legal proceedings is to be discussed.

o To allow the meeting to proceed without interruption and disruption.

4.4. In the interest of minimising the risks of conflicts of interest, it is recommended by NHS England that GPs do not have voting rights on the Primary Care Commissioning Committee. The arrangements do not preclude GP participation in strategic discussions on primary care issues, subject to appropriate management of conflicts of interest. They apply to decision-making on procurement issues and the deliberations leading up to the decision.

4.5. Whilst sub-committees or sub-groups of the primary care commissioning committee can be established (e.g. to develop business cases and options appraisals), ultimate decision-making responsibility for the primary medical services functions rests with the Primary Care Commissioning Committee. Sub-groups must submit their minutes to the Primary Care Commissioning Committee, detailing any conflicts and how they have been managed. Standard templates for agendas, minutes and coversheets are appended as part of Appendix E.

4.6. We will seek additional proportionate scrutiny of our decision-making

processes:

Via decision to tender and approval of bidder selection at our public Governing Body meeting for procurements over the value as specified in our published Scheme of Delegation, or for primary care commissioning decisions to tender and approval of bidder selection at our public Primary Care Commissioning Committee.

The Doncaster Health and Wellbeing Board which receives our Strategic Plan detailing our strategic direction.

Via Internal Audits reported to our Audit Committee if such an audit is risk assessed as required.

Via the local Area Team of NHS England on a regular basis at our Review Meetings in their role as assurers of CCG commissioning arrangements.

4.7. We will regularly review our governance structures for managing primary care

conflicts of interest to ensure that they reflect current guidance and are appropriate, particularly in relation to any co-commissioning roles which we propose to undertake. This may include consideration of our governance meeting structure, our internal controls and assurances, and our approach to identifying, declaring and managing conflicts of interest.

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5. Gifts, Hospitality & Sponsorship 5.1. Overview 5.1.1. Courtesy gifts and hospitality must not be given or received in return for

services provided or to obtain or retain business but shall be handled openly and unconditionally as a gesture of esteem and goodwill only. Gifts and hospitality shall always be of symbolic value, appropriate and proportionate in the circumstances, and consistent with local customs and practices. They shall not be made in cash.

5.2. Gifts 5.2.1. A “gift” is defined as any item of cash or goods, or any service, which is

provided for personal benefit, free of charge or at less than its commercial value.

5.2.2. All gifts of any nature offered to CCG staff, governing body and committee members and individuals within GP member practices by suppliers or contractors linked (currently or prospectively) to the CCG’s business should be declined, whatever their value. The person to whom the gifts were offered should also declare the offer within 28 days using the Gifts, Hospitality & Sponsorship Form (Appendix H) and submit the form to the Corporate Governance Manager so the offer which has been declined can be recorded on the register. A template for the register of gifts, hospitality and sponsorship is shown at Appendix I.

5.2.3. Gifts offered from other sources should also be declined and recorded using the Gifts, Hospitality & Sponsorship Form (Appendix H) and the form submitted within 28 days to the Corporate Governance Manager if accepting them might give rise to perceptions of bias or favouritism, and a common sense approach should be adopted as to whether or not this is the case. The only exceptions to the presumption to decline gifts relates to items of little financial value (i.e. less than £10) such as diaries, calendars, stationery and other gifts acquired from meetings, events or conferences, and items such as flowers and small tokens of appreciation from members of the public to staff for work well done. Gifts of this nature do not need to be declared nor recorded on the register.

5.2.4. Any personal gift of cash or cash equivalents (e.g. vouchers, tokens, offers of remuneration to attend meetings whilst in a capacity working for or representing the CCG) must always be declined, whatever their value and whatever their source, and the offer which has been declined must be declared within 28 days using the Gifts, Hospitality & Sponsorship Form (Appendix H) and the form submitted to the Corporate Governance Manager for recording on the register.

5.2.5. There may very occasionally be exceptional circumstances where it would be inappropriate to decline gifts or hospitality, for example where diplomatic

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sensitivities or protocol would be offended, especially where it is customary among certain cultures to make gifts. In such cases, the register entry must fully explain such reasons for accepting the gift. The above clauses do not preclude members of the Governing Body from accepting gifts in excess of that described above if they are acting in an ambassadorial role as a representative of NHS Doncaster CCG but these must still be declared using the form (Appendix H).

5.2.6. A series of small gifts, received from the same or related source, over a 12

month period, with accumulated worth of greater than £25 should be declared and registered.

5.2.7. If a donor leaves a gift with a value of over £10 for an employee in their

absence, then this should be declared by completing the Gifts, Hospitality & Sponsorship Form (Appendix H).

5.2.8. Where members of staff or individuals covered by the scope of this policy have any concern as to the potentially excessive value of a gift offered or the pressure to accept any gift is particularly high, they should seek advice from their Line Manager, the Chief of Corporate Services or the Chief Finance Officer. Staff should at all times be aware that the Code of Conduct for NHS Managers seeks to ensure that the best interests of the public and patients/clients are upheld in decision-making and that decisions are not improperly influenced by gifts or inducements.

5.2.9. Staff and individuals covered by the scope of this policy should exercise their

judgement when accepting gifts on the basis of a personal friendship if they have reason to believe that, under the circumstances, the gift was provided because of the official position of the member of staff and not because of the personal friendship.

5.3. Hospitality 5.3.1. A blanket ban on accepting or providing hospitality is neither practical nor

desirable from a business point of view. However, individuals should be able to demonstrate that the acceptance or provision of hospitality would benefit the NHS or the CCG.

5.3.2. Modest hospitality provided in normal and reasonable circumstances may be acceptable, although it should be on a similar scale to that which the CCG might offer in similar circumstances (e.g. tea, coffee, light refreshments at meetings). A common sense approach should be adopted as to whether hospitality offered is modest or not. Hospitality of this nature does not need to be declared on the Gifts, Hospitality & Sponsorship Form (Appendix H), nor recorded on the register. Offers of hospitality which go beyond modest or of a type that the CCG itself might offer, should be politely refused. A non-exhaustive list of examples includes:

Hospitality of a value of above £25; and

In particular, offers of foreign travel and accommodation.

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5.3.3. Particular caution should be exercised where hospitality (other than tea/coffee at scheduled meetings) is offered by suppliers or contractors linked (currently or prospectively) to the CCG’s business. Offers of this nature can be accepted if they are modest and reasonable but advice should always be sought from the Chief of Corporate Services or the Chief Finance Officer as there may be particular sensitivities, for example if a contract re-tender is imminent. All offers of hospitality from actual or prospective suppliers or contractors (whether or not accepted) should be declared within 28 days on the Gifts, Hospitality & Sponsorship Form (Appendix H) and submitted to the Corporate Governance Manager to be recorded on the register. A template for the register of gifts, hospitality and sponsorship is shown at Appendix I.

5.3.4. There may be some limited and exceptional circumstances where accepting

the types of hospitality referred to in this section may be contemplated. Express prior approval should be sought from the Chief of Corporate Services or the Chief Finance Officer before accepting such offers, and the reasons for acceptance should be recorded in the CCGs register of gifts and hospitality. Hospitality of this nature should be declared within 28 days on the Gifts, Hospitality & Sponsorship Form (Appendix H) and submitted to the Corporate Governance Manager to be recorded on the register, whether accepted or not.

5.3.5. The over-riding principle is whether the hospitality offered / received was such

that it could have, or could be perceived as having, an actual or potential influence on the conduct of the individual receiving the hospitality. In all cases of doubt, advice should be sought from the Chief of Corporate Services or Chief Finance Officer.

5.3.6. If, having accepted corporate hospitality in good faith, employees feel

uncomfortable with the lavishness of the event or the motives of the third party, the subject should be raised with the Chief of Corporate Services or the Chief Finance Officer and a note made of their concern.

5.3.7. The above clauses do not preclude members of the Governing Body from

accepting hospitality in excess of that described above if they are acting in an ambassadorial role as a representative of the organisation but they must still be declared using the Gifts, Hospitality & Sponsorship Form (Appendix H) and recorded on the register.

5.3.8. It is not appropriate for NHS Doncaster CCG or its employees or those

contracted in a commissioning role to provide or accept alcohol within normal working hours as part of hospitality at any time – please see the Alcohol, Drug and Substance Misuse Policy for detail.

5.4. Sponsorship 5.4.1. CCG staff, governing body and committee members, and GP member

practices may be offered commercial sponsorship for courses, conferences, post/project funding, meetings and publications in connection with the activities which they carry out for or on behalf of the CCG or their GP

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practices. All such offers (whether accepted or declined) must be declared so that they can be included on the CCG’s register of interests and advice can be given on whether or not it would be appropriate to accept any such offers. If such offers are reasonably justifiable and otherwise in accordance with this statutory guidance, then they may be accepted.

5.4.2. Offers of commercial sponsorship for courses, conferences and funding of posts must not compromise commissioning or contracting decisions in any way.

5.4.3. Anyone receiving an approach regarding any sponsorship (e.g. for events or

meetings) should request that the details be put in writing. The Gifts, Hospitality & Sponsorship Form (Appendix H) should then be completed and the form submitted to the Corporate Governance Manager. For regular sponsorship i.e. not a one off event, a written Sponsorship Agreement will also be required. All sponsorship, hospitality and gifts received will be recorded into the register maintained for this purpose to ensure probity, openness and transparency.

5.4.4. Sponsors should not have any influence over the content of an event, meeting, seminar, publication or training event. The CCG will not endorse individual companies or their products and the fact of sponsorship does not mean that the CCG endorses a company’s products or services. All data protection legislation applies during dealings with sponsors. Sponsorship which involves the exchange of patient information must be approved by NHS Doncaster CCG’s Caldicott Guardian. No information will be supplied to a company for their commercial gain unless there is a clear benefit to the NHS. As a general rule, information which is not in the public domain will not normally be supplied.

5.4.5. Sponsorship of meetings, management or educational events may be

authorised by the appropriate Chief of Service in consultation with the Chief Finance Officer, provided that the content of the programme, speakers and attendees are independent of the sponsor(s). If separate from the purpose of the meeting, sponsor(s) may use the event for publicity. Sponsor(s) will be acknowledged for their support.

5.4.6. All pharmaceutical companies entering into sponsorship agreements must

comply with the Association of the British Pharmaceutical Industry (ABPI) Code of Practice. Any sponsorship agreements with pharmaceutical companies will require the advice of NHS Doncaster’s Prescribing Lead before authorisation by the Chief Finance Officer. All collaborative partnerships between NHS Doncaster CCG and the pharmaceutical industry charitable sector or non NHS organisations will comply with the following regulations and guidance and as updated:

The Human Medicines Regulations 2012

The Human Medicines (Amendment) Regulations 2013

The Human Medicines (Amendment) (No. 2) Regulations 2013

The Human Medicines (Amendment) Regulations 2014

The Human Medicines (Amendment No. 2) Regulations 2014

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Council Directive 2001/83/EC - The Community Code relating to medicinal products for human use (external link) - Title VIII of this Directive relates to advertising

Council Directive 2004/27/EC – amending Directive 2001/83/EC (external link)

Council Directive 2004/24/EC - The Traditional Herbal Medicinal Products Directive (external link)

Council Directive 84/450/EEC – relating to the approximation of the laws, Regulations and administrative provisions of the Member States concerning Misleading Advertising

Best Practice Guidance on joint working between the NHS and pharmaceutical industry and other commercial organisations

Association of the British Pharmaceutical Industry guidance and best practice

5.4.7. NHS Doncaster CCG participation in a collaborative pharmaceutical

partnership does not in any way infer NHS Doncaster CCG endorsement, or formulary status, for any product. Proposals which link sponsorship to the purchase, volume, or use of any particular product must be refused.

5.4.8. All staff must ensure that they are not placed in a position which risks, or

appears to risk, conflict between their private interests and their duties to the organisation and the NHS. This principle is applicable to all professional codes of conduct, to all NHS staff groups and to all types of company supplying goods and services to the organisation. All staff and Governing Body members involved in the development of a sponsorship agreement must declare any prior interest in terms of previous sponsorship or relationship to any of the individual sponsors in question.

5.4.9. Appendix J details the internal procedure to be followed for instances of Pharmaceutical Sponsorship of TARGET training. It should be read in conjunction with Section 5.4 of this procedure.

6. Earned Income and Outside Employment 6.1. NHS Doncaster CCG will take all reasonable steps to ensure that employees,

committee members, contractors and others engaged under contract are aware of the requirement to inform the CCG if they are employed or engaged in, or wish to be employed or engage in, any employment or consultancy work in addition to their work with the CCG. The purpose of this is to ensure that the CCG is aware of any potential conflict of interest. Examples of work which might conflict with the business of the CCG, including part-time, temporary and fixed term contract work, include:

Employment with another NHS body.

Employment with another organisation which might be in a position to supply goods/services to the CCG.

Directorship of a GP federation.

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Self-employment, including private practice, in a capacity which might conflict with the work of the CCG or which might be in a position to supply goods/services to the CCG.

6.2. NHS Doncaster CCG employees may not, without the written approval of their

relevant Chief of Service, engage in any outside employment (paid or voluntary) whether connected to their NHS employment or not which prevents them from fulfilling their core role with NHS Doncaster CCG. Individuals are required to obtain prior permission to engage in secondary employment, and NHS Doncaster CCG reserves the right to refuse permission where it is believed that a conflict will arise which cannot be effectively managed.

6.3. NHS Doncaster CCG will not unreasonably withhold consent for additional

employment provided that:

It is not undertaken at times when the employee's contract is considered to be in operation;

In the opinion of NHS Doncaster CCG, the additional employment does not have an adverse impact upon their NHS Doncaster CCG contractual duties;

Where the total hours of work exceed, or are likely to exceed, the European Working Time Directive Regulations, the employee signs the appropriate declaration to work additional hours available from the Human Resources department.

6.4. Where NHS Doncaster CCG employment is on the basis of part-time or ad-

hoc hours, the employee shall obtain a single authorisation from their relevant Chief of Service covering the range of their external bank/part-time employment. This will prevent the need for separate authorisation for each period of employment. It will be the relevant NHS Doncaster Chief of Service’s responsibility that any other employment which may be undertaken by the employee is, and continues to be, in accordance with this policy. Chiefs of Service should ensure that copies of all letters of authorisation are placed on the staff file of the individual concerned. The employee concerned must also therefore keep their line manager directly informed of any material changes in outside working practices or working hours.

6.5. Employees are reminded that if they work for a second employer while off sick

or on a ‘staged return’ from their normal place of employment it should be by prior agreement with their line manager, Occupational Health, Human Resources and their GP as appropriate. This arrangement would normally be agreed if it was considered the work would be therapeutic to their recovery. Work undertaken without permission will be considered fraudulent behaviour and investigated in accordance with the Fraud Policy & Response Plan.

6.6. On appointing governing body, committee or sub-committee members and senior staff, NHS Doncaster CCG will consider on a case-by-case basis whether conflicts of interest should exclude individuals from being appointed to the relevant role. In doing so, the CCG will assess the extent and materiality of the interest and the nature of the appointee’s proposed role within the CCG, in particular whether the individual (or any person with whom

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they have a close association could benefit (whether financially or otherwise) from any decision the CCG might make. This will be particularly relevant for governing body, committee and sub-committee appointments, but will also be considered for all employees and especially those operating at senior level. If the interest is related to an area of business significant enough that the individual would be unable to operate effectively and make a full and proper contribution in the proposed role, then that individual will not be appointed to the role.

7. Provision of Professional Advice and Services 7.1. Professional advice and services can be provided across a wide spectrum,

which not only includes clinical/medical services but also a number of the other services/professions found within the NHS such as fire prevention. Professional liability arises where advice or a service is supplied to a third party. A third party, in this context, should mean any organisation, company or individual outside of the local health and social care community or any private sector organisation. This could include the provision of lectures during conferences where a fee is charged.

7.2. Where any employee is requested to support, contribute or assist any private

or non-NHS organisation (other than within the local health and social care community) they should seek the approval of the Chief Finance Officer before doing so.

7.3. Any payment or honorarium offered for doing so within working hours should

be accepted and paid directly to NHS Doncaster CCG and advised to the Chief Finance Officer. It should be noted that not all advice and services are covered by NHS Doncaster CCG’s schemes of insurance through the NHS Litigation Authority (NHSLA). Guidance can be found in the scheme rules on the NHSLA website www.nhsla.com or from the Chief of Corporate Services.

7.4. Where services are being provided for a fee to a third party, then there must

be clear terms and conditions for the supply of all services by the organisation, and this should be contained within standard terms and conditions. Information and guidance regarding terms and conditions for the supply of certain services to non-NHS bodies is available from the NHS Purchasing and Supply Agency. The Chief Finance Officer must review all contract arrangements prior to completion.

7.5. Healthcare organisations often loan equipment to other similar organisations

or patients. It is important to be clear about where responsibility for liability lies, and that there are suitable systems in place for the tracking of loaned equipment. Any such involvement in the private time of the employee should be approved in accordance with 7.1 and 7.2 above.

7.6. As part of their work for NHS Doncaster CCG, an employee may be required

to provide clinical advice within a clinical setting such as undertaking audits of medical records or providing prescribing advice. Where the employee or a

http://www.nhsla.com/

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close associate of the employee is also receiving or has received care from within that clinical setting, then access to their own or a close associate’s personal identifiable information would be considered a conflict of interest. To protect the employee’s confidentiality regarding declaring that they have received care from that clinical setting, this conflict of interest should not be formally declared using the conflict of interest form but should instead be discussed with the Line Manager to identify an alternative route for provision of that element of clinical advice or to access those records. The line manager will escalate any issues that cannot be managed within the team to the Chief Officer for resolution.

8. Preferential Treatment in Private Transactions 8.1. Individual staff must not seek or accept preferential rates or benefits in kind

for private transactions carried out with companies with which they have had, or may have, official dealings on behalf of the organisation. (This does not apply to concessionary agreements negotiated with companies by NHS management, or by recognised staff interests, on behalf of all staff – for example, NHS staff benefits schemes).

9. Intellectual Property Rights 9.1. Intellectual property covers patents, copyright, registered design rights,

unregistered design rights, trade marks, know-how etc. The first three of these are probably the most important within the NHS, encompassing diverse ‘products’ like medical diagnostics, drugs, new procedures, books, manuals, training packages, videos, films, designs and specialist know-how. Products and inventions made by an employee shall be taken to belong to the employer (NHS Doncaster CCG) if they were “made” or “created” in the course of the normal duties of the employee.

9.2. NHS Doncaster will build appropriate specifications and provisions into

contractual arrangements before the work is commissioned, or begins.

9.3. Refer to NHS Doncaster’s Intellectual Property Policy for more detail.

9.4. Other rewards may be given voluntarily to employees who, within the course of their employment, have produced innovative work of outstanding benefit to the NHS, for example through the Health & Social Care Awards.

10. Facilitation Payments and Kickbacks 10.1. A facilitation payment refers to the practice of paying a small sum of money to

a public official (or other person) as a way of ensuring that they perform their duty either more promptly or at all.

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10.2. Facilitation payments are prohibited under the Bribery Act like any other form of bribe. They shall not be given by CCG staff in the UK or any other country.

10.3. Kickbacks are typically payments made in return for a business favour or

advantage. Everyone covered by this policy must avoid any activity that might lead to, or suggest, that a facilitation payment or kickback will be made or accepted.

11. Political & Charitable Contributions 11.1. The CCG does not make any contributions to politicians, political parties or

election campaigns. 11.2. As a responsible member of society, the CCG may make charitable

donations. However, these payments shall not be provided to any organisation upon suggestion of any person of the public or private sector in order to induce that person to perform improperly the function or activities which he or she is expected to perform in good faith, impartially or in a position of trust or to reward that person for the improper performance of such function or activities.

11.3. Any donations and contributions must be ethical and transparent. The

recipient’s identity and planned use of the donation must be clear, and the reason and purpose for the donation must be justifiable and documented. All charitable donations will be publically disclosed.

11.4. Donations to individuals and for-profit organisations and donations paid to

private accounts are incompatible with our ethical standards and are prohibited.

12. Due Diligence 12.1. Due diligence is a key element of corporate good governance and involves

making an assessment of new business partners prior to engaging them in business. Due diligence procedures are in themselves a form of bribery risk assessment and also a means of mitigating that risk. At the outset of any business dealings, all new business partners should be made aware in writing of the organisation's anti-corruption and bribery policies and code of conduct.

12.2. To ensure adequate anti-bribery prevention is integrated into tendering and

contract arrangements, the standard NHS Contract clauses are utilised by NHS Doncaster CCG.

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13. Raising concerns and breaches - Failure to comply with this policy and

procedure Raising and reporting breaches 13.1. It is the duty of every CCG employee, governing body member, committee or

sub-committee member and GP practice member to speak up about genuine concerns in relation to the administration of the CCG’s policy on conflicts of interest management, and to report these concerns. These individuals should not ignore their suspicions or investigate themselves.

Where the reporter is an employee or worker of the CCG, any non-compliance with this policy should be reported straight away to the Conflicts of Interest Guardian on a strictly confidential basis either in writing or by email.

Anyone who is not an employee or worker of the CCG, and who wishes to report a suspected or known breach of the policy, should ensure that they comply with their own organisation’s whistleblowing policy.

Additionally, providers, patients and other third parties can make a complaint to NHS Improvement in relation to a commissioner’s conduct under the Procurement Patient Choice and Competition Regulations.

13.2. All alleged breach notifications will be treated with appropriate confidentiality

at all times in accordance with the CCG’s policies and applicable laws, and the person making such disclosures can expect an appropriate explanation of any decisions taken as a result of any investigation.

Managing breaches 13.3. The process for investigating and managing breaches is:

The breach will be recorded on the register. Breaches may occur at any stage of the commissioning cycle (e.g. needs assessment, strategic planning, service planning and design, procurement, contract management) or there could be a breach in the declaration of interests, or in declaring gifts, hospitality, sponsorship or outside employment. These are the categories within which breaches may be classified.

The alleged breach will be jointly investigated by the Conflict of Interest Guardian and Chief of Corporate Services (providing the Chief of Corporate Services is not conflicted – if they are conflicted, then an alternative Chief of Service will be identified to support the investigation). The Conflicts of Interest Guardian will have access to other CCG policies on raising concerns, counter fraud, or similar. The Conflict of Interest Guardian will make the final decision on whether a breach has occurred.

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The outcome of the investigation will be reported to the Audit Committee. Lessons learned from any identified breaches of this policy and procedure will be reviewed by the Audit Committee.

Breaches of this policy and procedure may result in disciplinary action in accordance with the CCG’s Disciplinary Policy. Serious breaches could potentially result in the termination of employment or position with the CCG.

Statutorily regulated healthcare professionals who work for, or are engaged by the CCG are under professional duties imposed by their relevant regulator to act appropriately with regard to conflicts of interest. The CCG will consider reporting statutorily regulated healthcare professionals to their regulator if they are believed to have acted improperly, so that these concerns can be investigated. The consequences for inappropriate action could include fitness to practise proceedings being brought, and if appropriate, being struck off by their professional regulator as a result.

Where a breach is proved, the Director of the local NHS England Area Team will be informed by the Chief Officer of the CCG.

Anonymised details of breaches will be published on the CCG’s website for the purpose of learning and development.

The Head of Communication & Engagement (or equivalent) will support communication of the breach and any media interest.

Fraud or Bribery 13.4. It is an offence under the Fraud Act 2006 for an employee to fail to disclose

information to the organisation to make a gain for themselves or another or to cause a loss or expose the organisation to the risk of loss. Additionally, the Act also provides that it is an offence for an employee who occupies a position in which they are expected to safeguard or not act against the financial interests of the organisation, to abuse that position to cause a loss or expose the organisation to the risk of loss. Therefore, where a conflict of interest or other activity as covered by this policy and procedure is not declared for the purposes above, this will be considered serious and should be referred appropriately in accordance with the Whistleblowing Policy, or the Fraud Policy and Response Plan.

13.5. This policy should be read in conjunction with the existing Fraud Policy &

Response Plan and/or Whistleblowing Policy. All individuals subject to this policy and procedure are encouraged to raise concerns about any issue or suspicion of malpractice at the earliest possible stage. If you are unsure whether a particular act constitutes bribery or corruption, or if you have any other queries, these should be raised with the Chief Finance Officer or the local Counter Fraud Specialist (CFS).

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13.6. Suspicions of Bribery, Fraud or Corruption should be reported without delay to the Local Counter Fraud Specialist or as outlined in the Fraud Policy & Response Plan. Alternatively reports can be made confidentially to the NHS Fraud & Corruption Reporting Line (FCRL) on 0800 028 40 60 or online at www.reportnhsfraud.nhs.uk

13.7. Potential risks of Bribery (Red Flags) are detailed in Appendix K.

13.8. A Chief Officer’s Statement on Bribery will be placed on the public website. The statement is included as Appendix L.

Implications of breaches 13.9. Failure to comply with the CCG’s policies on conflicts of interest management,

pursuant to NHS England’s statutory guidance, can have serious implications for the CCG and any individuals concerned. If conflicts of interest are not effectively managed, the CCG could face civil challenges to decisions we make, legal challenge from providers that could potentially overturn the award of a contract, lead to damages claims against the CCG, and necessitate a repeat of the procurement process resulting in a delay in developing better services and care for patients, wasting public money, and damaging the CCG’s reputation. In extreme cases, staff and other individuals could face personal civil liability, for example a claim for misfeasance in public office. Failure to manage conflicts of interest could also lead to criminal proceedings including for offences such as fraud, bribery and corruption. This could have implications for CCGs and linked organisations, and the individuals who are engaged by them.

http://www.reportnhsfraud.nhs.uk/

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THE NOLAN PRINCIPLES

THE SEVEN PRINCIPLES OF PUBLIC LIFE

1. Selflessness Holders of public office should take decisions solely in terms of the public interest. They should not do so in order to gain financial or other material benefits for themselves, their family, or their friends. 2. Integrity Holders of public office should not place themselves under any financial or other obligation to outside individuals or organisations that might influence them in the performance of their official duties. 3. Objectivity In carrying out public business, including making public appointments, awarding contracts, or recommending individuals for rewards and benefits, holders of public office should make choices on merit. 4. Accountability Holders of public office are accountable for their decisions and actions to the public and must submit themselves to whatever scrutiny is appropriate to their office. 5. Openness Holders of public office should be as open as possible about all the decisions and actions that they take. They should give reasons for their decisions and restrict information only when the wider public interest clearly demands. 6. Honesty Holders of public office have a duty to declare any private interests relating to their public duties and to take steps to resolve any conflicts arising in a way that protects the public interest. 7. Leadership Holders of public office should promote and support these principles by leadership and example.

APPENDIX A

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STANDARDS FOR MEMBERS OF NHS BOARDS AND CCG GOVERNING BODIES IN ENGLAND (Professional Standards Authority – November 2012)

All members of NHS boards and CCG governing bodies should understand and be committed to the practice of good governance and to the legal and regulatory frameworks in which they operate. As individuals they must understand both the extent and limitations of their personal responsibilities.

To justify the trust placed in me by patients, service users, and the public, I will abide by these Standards at all times when at the service of the NHS. I understand that care, compassion and respect for others are central to quality in healthcare; and that the purpose of the NHS is to improve the health and well-being of patients and service users, supporting them to keep mentally and physically well, to get better when they are ill and, when they cannot fully recover, to stay as well as they can to the end of their lives. I understand that I must act in the interests of patients, service users and the community I serve, and that I must uphold the law and be fair and honest in all my dealings.

Signature:

Print name:

Position:

Date:

APPENDIX B

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Personal behaviour 1. As a Member1 I commit to:

The values of the NHS Constitution

Promoting equality

Promoting human rights in the treatment of patients and service users, their families and carers, the community, colleagues and staff, and in the design and delivery of services for which I am responsible.

2. I will apply the following values in my work and relationships with others:

Responsibility: I will be fully accountable for my work and the decisions that I make, for the work and decisions of the board2, including delegated responsibilities, and for the staff and services for which I am responsible.

Honesty: I will act with honesty in all my actions, transactions, communications, behaviours and decision-making, and will resolve any conflicts arising from personal, professional or financial interests that could influence or be thought to influence my decisions as a board member.

Openness: I will be open about the reasoning, reasons and processes underpinning my actions, transactions, communications, behaviours and decision-making and about any conflicts of interest.

Respect: I will treat patients and service users, their families and carers, the community, colleagues and staff with dignity and respect at all times.

Professionalism: I will take responsibility for ensuring that I have the relevant knowledge and skills to perform as a board member and that I reflect on and identify any gaps in my knowledge and skills, and will participate constructively in appraisal of myself and others. I will adhere to any professional or other codes by which I am bound.

Leadership: I will lead by example in upholding and promoting these Standards, and use them to create a culture in which their values can be adopted by all.

Integrity: I will act consistently and fairly by applying these values in all my actions, transactions, communications, behaviours and decision-making, and always raise concerns if I see harmful behaviour or misconduct by others.

1 The term ‘Member’ is used throughout this document to refer to members of NHS boards and CCG governing bodies in

England.

2 The term ‘board’ is used throughout this document to refer collectively to NHS boards and CCG governing bodies in England.

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Technical competence 3. As a Member, for myself, my organisation, and the NHS, I will seek:

Excellence in clinical care, patient safety, patient experience, and the accessibility of services

To make sound decisions individually and collectively

Long term financial stability and the best value for the benefit of patients, service users and the community.

4. I will do this by:

Always putting the safety of patients and service users, the quality of care and patient experience first, and enabling colleagues to do the same.

Demonstrating the skills, competencies, and judgement necessary to fulfil my role, and engaging in training, learning and continuing professional development.

Having a clear understanding of the business and financial aspects of my organisation’s work and of the business, financial and legal contexts in which it operates.

Making the best use of my expertise and that of my colleagues while working within the limits of my competence and knowledge.

Understanding my role and powers, the legal, regulatory, and accountability frameworks and guidance within which I operate, and the boundaries between the executive and the non-executive.

Working collaboratively and constructively with others, contributing to discussions, challenging decisions, and raising concerns effectively.

Publicly upholding all decisions taken by the board under due process for as long as I am a member of the board.

Thinking strategically and developmentally.

Seeking and using evidence as the basis for decisions and actions.

Understanding the health needs of the population I serve.

Reflecting on personal, board, and organisational performance, and on how my behaviour affects those around me; and supporting colleagues to do the same.

Looking for the impact of decisions on the services we and others provide, on the people who use them, and on staff.

Listening to patients and service users, their families and carers, the community, colleagues, and staff, and making sure people are involved in decisions that affect them.

Communicating clearly, consistently and honestly with patients and service users, their families and carers, the community, colleagues, and staff, and ensuring that messages have been understood.

Respecting patients’ rights to consent, privacy and confidentiality, and access to information, as enshrined in data protection and freedom of information law and guidance.

52

Business practices 5. As a Member, for myself and my organisation, I will seek:

To ensure my organisation is fit to serve its patients and service users, and the community.

To be fair, transparent, measured, and thorough in decision-making and in the management of public money.

To be ready to be held publicly to account for my organisation’s decisions and for its use of public money.

6. I will do this by:

Declaring any personal, professional or financial interests and ensuring that they do not interfere with my actions, transactions, communications, behaviours or decision-making, and removing myself from decision-making when they might be perceived to do so.

Taking responsibility for ensuring that any harmful behaviour, misconduct, or systems weaknesses are addressed and learnt from, and taking action to raise any such concerns that I identify.

Ensuring that effective complaints and whistleblowing procedures are in place and in use.

Condemning any practices that could inhibit or prohibit the reporting of concerns by members of the public, staff, or board members about standards of care or conduct.

Ensuring that patients and service users and their families have clear and accessible information about the choices available to them so that they can make their own decisions.

Being open about the evidence, reasoning and reasons behind decisions about budget, resource, and contract allocation.

Seeking assurance that my organisation’s financial, operational, and risk management frameworks are sound, effective and properly used, and that the values in these Standards are put into action in the design and delivery of services.

Ensuring that my organisation’s contractual and commercial relationships are honest, legal, regularly monitored, and compliant with best practice in the management of public money.

Working in partnership and co-operating with local and national bodies to support the delivery of safe, high quality care.

Ensuring that my organisation’s dealings are made public, unless there is a justifiable and properly documented reason for not doing so.

53

DECLARATION OF INTERESTS FORM FOR CCG MEMBERS AND EMPLOYEES

Name:

Position within or relationship with NHS Doncaster CCG:

Detail of interests held: (please complete all that are applicable, and enter “nil” if you have no interests) Type of interest*: * see reverse of form for details

Description of interest:

If declaring a business or company where an interest lies, please provide the name and address of the business or company. For indirect interests, please provide details of the relationship with the person who has the interest.

Date interest relates to:

Actions to be taken to mitigate risk:

(to be agreed with line manager or a senior CCG manager)

From: To:

The information submitted will be held by the CCG for personnel or other reasons specified on this form and to comply with the organisation’s policies. This information may be held in both manual and electronic form in accordance with the Data Protection Act 1998. Information may be disclosed to third parties in accordance with the Freedom of Information Act 2000, to NHS Protect for the purpose of verification, prevention, detection and prosecution of fraud, and published in registers that the CCG holds.

Declaration:

I confirm that the information provided above is complete and correct. I acknowledge that any changes in these declarations must be notified to the CCG as soon as practicable, and no later than 28 days after the interest arises. I am aware that if I do not make full, accurate and timely declarations then civil, criminal, or internal disciplinary action may result.

I do / do not [delete as applicable] give my consent for this information to be published on registers that the CCG holds. If consent is NOT given, please give reasons:

Signed:

Date:

Signed:

Position: Date:

(Line Manager or Senior CCG Manager)

Please return to: Alison Hague, Corporate Governance Manager, Sovereign House, Heavens Walk, Doncaster, DN4 5HZ or by email to [email protected]

APPENDIX C

mailto:[email protected]

54

Type of interest Description

Financial Interests

This is where an individual may get direct financial benefits from the

consequences of a commissioning decision. This could, for example, include

being:

A director, including a non-executive director, or senior employee in a private company or public limited company or other organisation which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations;

A shareholder (or similar owner interests), a partner or owner of a private or not-for-profit company, business, partnership or consultancy which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations.

A management consultant for a provider;

In secondary employment (see paragraph 56 to 57);

In receipt of secondary income from a provider;

In receipt of a grant from a provider;

In receipt of any payments (for example honoraria, one off payments, day allowances or travel or subsistence) from a provider

In receipt of research funding, including grants that may be received by the individual or any organisation in which they have an interest or role; and

Having a pension that is funded by a provider (where the value of this might be affected by the success or failure of the provider).

Non-Financial Professional

Interests

This is where an individual may obtain a non-financial professional benefit from the consequences of a commissioning decision, such as increasing their professional reputation or status or promoting their professional career. This may, for example, include situations where the individual is:

An advocate for a particular group of patients;

A GP with special interests e.g., in dermatology, acupuncture etc.

A member of a particular specialist professional body (although routine GP membership of the RCGP, BMA or a medical defence organisation would not usually by itself amount to an interest which needed to be declared);

An advisor for Care Quality Commission (CQC) or National Institute for Health and Care Excellence (NICE);

A medical researcher.

Non-Financial Personal Interests

This is where an individual may benefit personally in ways which are not directly linked to their professional career and do not give rise to a direct financial benefit. This could include, for example, where the individual is:

A voluntary sector champion for a provider;

A volunteer for a provider;

A member of a voluntary sector board or has any other position of authority in or connection with a voluntary sector organisation;

Suffering from a particular condition requiring individually funded treatment;

A member of a lobby or pressure groups with an interest in health.

Indirect Interests

This is where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision (as those categories are described above). For example, this should include:

Spouse / partner;

Close relative e.g., parent, grandparent, child, grandchild or sibling;

Close friend;

Business partner.

55

TEMPLATE FOR REGISTER OF INTERESTS

Name

Current position(s)

held i.e. Governing

Body, Member practice,

Employee or Other

(specify)

Declared Interest

(Name of the organisation and nature of

business)

Type of Interest

Is the

interest direct or indirect?

Nature of Interest

Date of Interest Action taken to mitigate risk From To

Fin

an

cia

l In

tere

sts

No

n-F

ina

nc

ial

Pro

fess

ion

al In

tere

sts

No

n-F

ina

nc

ial

Pers

on

al

Inte

rests

APPENDIX D

56

DECLARATION OF INTEREST CHECKLIST FOR CHAIRS

Under the Health and Social Care Act 2012, there is a legal obligation to manage conflicts of interest appropriately. It is essential that declarations of interest and actions arising from the declarations are recorded formally and consistently across all CCG governing body, committee and sub-committee meetings. This checklist has been developed with the intention of providing support in conflicts of interest management to the Chair of the meeting – prior to, during and following the meeting. It does not cover the requirements for declaring interests outside of the committee process.

Timing Checklist for Chairs Responsibility

In advance

of the meeting

1. The agenda to include a standing item on

declaration of interests to enable individuals to raise any issues and/or make a declaration at the meeting.

2. A definition of conflicts of interest should also

be accompanied with each agenda to provide clarity for all recipients.

3. Agenda to be circulated to enable attendees

(including visitors) to identify any interests relating specifically to the agenda items being considered.

4. Members should contact the Chair as soon as

an actual or potential conflict is identified. 5. Chair to review a summary report from

preceding meetings i.e. sub-committee, working group, etc., detailing any conflicts of interest declared and how this was managed.

A template for a summary report to present discussions at preceding meetings is detailed below – the standard organisational coversheet for all Governing Body and Committee papers. 6. A copy of the members’ declared interests is

checked to establish any actual or potential conflicts of interest that may occur during the meeting.

Meeting Chair and

secretariat

Meeting Chair and secretariat


Meeting members

Meeting Chair

Meeting Chair

During the

meeting

7. Check and declare the meeting is quorate and

ensure that this is noted in the minutes of the meeting.

8. Chair requests members to declare any

interests in agenda items – which have not

Meeting Chair

Meeting Chair

APPENDIX E

57

Timing Checklist for Chairs Responsibility

already been declared, including the nature of the conflict.

9. Chair makes a decision as to how to manage

each interest which has been declared, including whether / to what extent the individual member should continue to participate in the meeting, on a case by case basis, and this decision is recorded.

10. As minimum requirement, the following should

be recorded in the minutes of the meeting:

Individual declaring the interest;

At what point the interest was declared;

The nature of the interest;

The Chair’s decision and resulting action taken;

The point during the meeting at which any individuals retired from and returned to the meeting – even if an interest has not been declared.

Visitors in attendance who participate in the meeting must also follow the meeting protocol and declare any interests in a timely manner.

A template for recording any interests during meetings is detailed below. This should be provided to the Corporate Governance Manager following the meeting for recording on the register of interests.


Secretariat

Following

the meeting

11. All new interests declared at the meeting should

be promptly updated onto the declaration of interest form.

12. All new completed declarations of interest should

be transferred onto the register of interests.

Individual(s)

declaring interest(s)

Corporate Governance

Manager

Annexes to Appendix E:

Coversheet for papers (also used to provide a summary report to Committee Chairs of discussions held at sub-

committees and working groups) Agenda template

Minutes template

Template for secretariat to record interests during a meeting

Conflicts of interest flowchart

58

COVERSHEET TEMPLATE FOR PAPERS TO GOVERNING BODY AND COMMITTEES

(also used to provide a summary report to Committee Chairs of discussions held at sub-committees and working groups)

Meeting name [e.g. Governing Body]

Meeting date [e.g. 1st April 2016]

Title of paper

[Enter relevant title]


[Name(s) & Job Title(s)]

Author(s) [Name(s) & Job Title(s)]


Recommendation(s)

59

Impact analysis

Quality impact [Identify any quality impact]

Equality impact

[Identify any equality impact – positive, negative or neutral]


[Identify any sustainability impact – including nil]


[Identify any financial impact – £ cost, £ saving or £ nil]

Legal implications

[Identify any legal impact – including nil]

Management of Conflicts of

Interest

[Include details of any conflicts of interest declared]

[Where declarations have been made, include details of the conflicted individual(s) name, position; the conflict(s) details, and how these have

been managed in preceding meetings]

[Confirm whether the interest is recorded on the register of interests – if not list the agreed course of action]


(internal departments,

clinical, stakeholder & public/patient)

[Identify any prior consultation/engagement] [include engagement with internal departments (e.g. finance, medicines management, contracting,

quality), clinical engagement, stakeholder engagement and public/patient engagement]

Report previously

presented at

[List any other meetings which have discussed the paper, and the outcomes]

Risk analysis

[Identify any risks arising from the paper not otherwise covered in the Executive Summary and how the paper mitigates risks]

Assurance Framework

[List the Assurance Framework risks to which the paper relates]

60

AGENDA TEMPLATE

TITLE OF MEETING

To be held on [Day, Date, Month, Year] at [time] In [venue]

A G E N D A

Ref Item Enclosure Lead

1. Apologies for Absence

2. Declarations of Interest

3. Minutes of the meeting held on [date]

Enc A

4. Matters Arising not on the Agenda

5.

6.

7.

8.

9.

10.


12. Date and Time of Next Meeting [Date, Time, Venue]

61

MINUTES TEMPLATE

Minutes of the [title of Committee / Group] Held on [Day, Date, Month, Year] at [time] to [time]

In [venue] Present: [Name] [Job Title]

[Name] [Job Title] [Name] [Job Title] [Name] [Job Title] [Name] [Job Title] [Name] [Job Title] [Name] [Job Title] [Name] [Job Title] [Name] [Job Title] [Name] [Job Title] [Name] [Job Title] [Name] [Job Title] [Name] [Job Title]

In attendance: [Name] [Job Title]

[Name] [Job Title] [Name] [Job Title] [Name] [Job Title] [Name] [Job Title]

Action 1. Apologies for Absence

No apologies for absence were received. or Apologies for absence were received from:

[Name and job title]

[Name and job title]

2. Declarations of Interest The Chair reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group (CCG). Declarations declared by members of the committee are listed in the CCG’s Register of Interests. The Register is available either via

62

the secretary to the Governing Body or the CCG website at the following link: www.doncasterccg.nhs.uk The meeting was noted as quorate. Declarations of interest from sub committees / working groups: None declared. Declarations of interest from today’s meeting: None declared. or The following declarations of interest were made: Record in the minutes:

who has the interest;

the nature of the interest and why it gives rise to a conflict, including the magnitude of any interest;

the items on the agenda to which the interest relates;

how the conflict was agreed to be managed; and

evidence that the conflict was managed as intended (for example recording the points during the meeting when particular individuals left or returned to the meeting

E.g. With reference to the business to be discussed under agenda item 7 at this meeting, Mr Smith declared that he is a shareholder at xxx Care Ltd. The Chair advised the Committee that Mr Smith would not be included in any discussions on agenda item 5 due to a financial conflict of interest which could potentially lead to financial gain for Mr Smith. The Chair advised that she had discussed the conflict of interest before the meeting and Mr Smith had agreed to remove himself from the room and not be involved in the discussion around agenda item 5. The Chair declared that the meeting would remain quorate.

3. Minutes of the meeting held on [insert date] The minutes of the meeting held on [insert date] were approved as a correct record. or The minutes of the meeting held on [insert date] were approved as a correct record with the following amendments:

[insert amendments]

4. Matters Arising not on the Agenda [Insert title of matter arising raised]


63

[Insert summary of the matters arising discussion]

5. Agenda Item [Note in the minutes at which point conflicted individuals left the meeting] e.g. Mr Smith left the meeting at this point, excluding himself from the discussion regarding xxxxxx.

[Record a summary of the item] NB this can often be taken from the Executive Summary of a paper. [Record any agreed actions and record any recommendations of the Committee/Group] E.g. It was agreed that Mrs A would complete xxxxxx by [date]. E.g. The Committee noted the paper. E.g. The Committee agreed the recommendations in the paper. E.g. The Committee recommended the paper to the [insert name] Committee. NB What an author is seeking from the Committee/Group can often be taken from the covering sheet or conclusion of a paper.

[Note in the minutes at which point conflicted individuals re-joined the meeting] E.g. Mr Smith was brought back into the meeting.

6. Any Other Business [Insert title of business raised] [Insert summary of the discussion of the business]

7. Date and Time of Next Meeting [Date] at [time] in [venue].

64

TEMPLATE FOR SECRETARIAT TO RECORD INTERESTS DURING A MEETING

Meeting Date of Meeting

Chairperson (name)

Secretariat (name)

Name of person declaring interest

Agenda Item

Details of interest declared

Action taken

65

CONFLICT OF INTEREST FLOWCHART

CONFLICT OF INTEREST

IDENTIFIED

On appointment or change in role / responsibilities or circumstances

At meetings At specific points during the

procurement process

Complete Declaration of Interest Form

(update this declaration 6-monthly)

Declare verbally at beginning of the meeting.

Declare verbally during the meeting if conflicts of interest arise which were not

declared at the start of the meeting

Follow detailed policy guidance in

Section 3 of the Standards of Business Conduct & Conflicts of Interest Policy – seek advice from Head of Procurement

Submit to Corporate Governance

Manager (update this declaration 6-monthly)

A register of procurement decisions will be updated with information including:

the details of the decision;

who was involved in making the decision (i.e. governing body or committee members and others with decision-making responsibility); and

a summary of any conflicts of interest in relation to the decision and how these were managed by the CCG.

The Head of Procurement has overall responsibility and oversight for managing all conflicts of interest for the procurement process. As a core principle, all decisions made around managing conflicts of interest will be made independently of those associated or directly involved in the conflicts of interest itself.

Conflicts of interest can occur at any stage during the procurement process and are most likely to occur during the following three key phases: Service Design, Evaluation of Bids (PQQ and ITT), and Bidder Selection & Contract Award.

Where relevant, Chief Officer confirms to individual how the conflict of interest

will be managed

Chair decides how to handle the conflict of interest

Full

participation Partial

exclusion Total

exclusion

Entered onto

Probity Register

Record conflict of interest and management of the conflict during the meeting in the

minutes

Published

on CCG website

Provide summary of conflicts to Corporate Governance Manager

If the issue is a new Conflict of Interest, submit Declaration of Interest Form

66

BUSINESS CASE / PROCUREMENT TEMPLATE

SECTION A

Leads:

1. Lead Clinician(s):

Lead Manager(s):

The problem:

2.

Title of proposed service / development:

3.

The problem you are trying to tackle:

APPENDIX F

67

The solution:

4.

Your proposal: Describe how the proposal delivers good or improved outcomes and value for money. What are the estimated costs and the estimated benefits? How does it reflect the CCG’s commissioning priorities? How does it comply with the CCG’s commissioning obligations?

68

5.

How have you involved the public in the decision to commission this service? Please also estimate the minimum/maximum number of patients the proposal is likely to cover.

6.

What range of health professionals have been involved in designing the proposed service?

7.

What range of potential providers have been involved in considering the proposals?

69

8.

Does the proposal support the priorities in the Doncaster Health and Wellbeing Strategy? Have you needed to involve the Health and Wellbeing Board or other partners?

9.

What are the proposals for monitoring the quality and performance of the service? Please summarise the quality & performance indicators / measurements of the service and whether any of the monitoring data will be published.

Finance & Governance:

10.

Estimated cost of service:

See Appendix 1 - Financial assessment.

70

11.

What procurement route are you recommending and why?

[Where procuring, please also complete Appendix 2 – procurement decisions & contracts awarded.]

12.

What scrutiny will there be of the proposed decisions? How will the CCG make its final commissioning decision in ways that preserve the integrity of the decision-making process and award of any contract?

13.

Would we need to give contractual notice?

71

14.

Assessment of the risks of implementing this proposal

Risk descriptor Controls Consequence x Likelihood =

Score

Mitigation

15.

Have all conflicts and potential conflicts of interests been appropriately declared and entered in registers which are publicly available? Have you recorded how you have managed any conflict or potential conflict?

16.

Additional question when qualifying a provider on a list or framework or pre selection for tender (including but not limited to any qualified provider) or direct award (for services where national tariffs do not apply):

How have you determined a fair price for the service?

72

17. Additional question when qualifying a provider on a list or framework or pre selection for tender (including but not limited to any qualified provider) or direct award (for services where national tariffs do not apply):

How will you ensure that patients are aware of the full range of qualified providers from whom they can choose?

18.

Additional questions for proposed direct awards to GP providers:

a) What steps have been taken to demonstrate that the services to which the contract relates are capable of being provided by only one provider?

b) In what ways does the proposed service go above and beyond what GP practices should be expected to provide under the GP contract?

c) What assurances will there be that a GP practice is providing high-quality services under the GP contract before it has the opportunity to provide any new services?

73

19.

Timeline for new service to commence: Insert just key actions and who is responsible – expand as needed. Allow time for Procurement to draw up a contract. 6 month and annual progress reports should be timetabled from service commencement rather than approval date.

74

SECTION B: Business Case Checklist

Domain Checklist item Y / N / N/A

A strong clinical and professional focus which brings real

added value

Does the proposal fit our published CCG priorities?

Have a range of health professionals been involved in designing the proposal and support the proposal?

Have clinical and quality outcomes been articulated?

Does the proposal demonstrate evidence based clinical effectiveness?

Does the proposal aim to reduce health inequalities (or will it be run as a pilot)?

Meaningful engagement with patients and carers

Have you involved the public in the decision to commission / decommission this service?

Have any linked decommissioning decisions been communicated to the public?

Is formal public consultation is required (major system/service change)?

Is consultation with Overview & Scrutiny required (major system/service change)?

Does the proposal deliver care closer to home?

Does the proposal deliver integrated / coordinated care?

Does the proposal promote choice, including shared decision making?

QIPP – within financial

resources and in line with

national outcome

standards

Does the project represent value for money? i.e. have non-financial and financial costs and benefits been considered together to give an overall view e.g. using a cost per benefit scoring if there is more than one option. Have benchmarked costs been used to determine a reasonable price range for services?

What is the impact on related services? Has the proposal considered and costed (where appropriate) how this proposal will affect other local and nationally commissioned services.

Does the proposal contact evidence of assessment of both financial and non-financial risks, and are they balanced?

Is the proposal affordable? “Pay-back” for set up non-recurrent costs is no more than three years. In terms of affordability it is important that sensitivity analysis is undertaken showing the impact of changing key financial and activity assumptions.

Have the informatics implications been identified and resources agreed?

Does the specification include a minimum data set?

Have the targets relevant for this service been specified, including the information flows?

Is there evidence that resources can be released?

Are costs correctly identified as capital or revenue?

Are costs correctly identified as recurrent and non-recurrent?

Are part year effects and full year effects accounted for correctly?

What is the funding source and how has it been calculated? (If reduction to secondary care contract – state which one).

Has VAT been accounted for correctly?

75

Domain Checklist item Y / N / N/A

Proper constitutional

and governance

arrangements

Does the proposal consider clinical safety, quality and governance?

Have all conflicts and potential conflicts of interest been appropriately declared and entered into registers which are publically available?

Has equality analysis of the proposal been undertaken?

Has a Finance Officer prepared a finance schedule?

Has the Contracting Team advised on the Business Case?

Has the Performance Team has commented on the key performance measures?

Has the IT Team endorsed any additional IT requirements / interoperability requirements?

Has the Medicines Management Team endorsed any additional primary care prescribing costs?

Has a sourcing/procurement route been recommended with documented rationale?

Has documented market analysis been undertaken to support the sourcing/procurement route recommendation?

Collaborative commissioning & partnerships

Does the proposal fit with the Health & Wellbeing Board strategy and priorities?

Can this service be jointly commissioned?

Have there been initial discussions with any existing providers and an assessment made regarding notice periods, unbundling of tariff arrangements etc and if so has this work started?

Are likely provider(s) accredited?

Leadership which can

make a real difference

Does the pathway have the support of and is signed off by a lead CCG Governing Body member?

Will performance monitoring be put in place to enable the CCG to assess the continuing success and affordability of the proposal?

Has an evaluation framework been developed?

76

SECTION C: Approval

Title Signature Date


Chief Nurse

Chief of Strategy & Delivery


Chief of

Partnership Commissioning &

Primary Care

77

Appendix 1 - Financial assessment

Price Activity De-commission Re-commission Variance Current values

1.

2.

3.

4.

Total de-commission

New proposal values

1.

2.

3.

4.

Total re-commission

78

Cost Benefit Summary:

1. Resources that will change 2. Assumptions 3. Volume change in use 4. Value of change

79

Appendix 2 – Procurement decisions and contracts awarded

Ref No

Contract/ Service

title

Procurement description

Existing contract or

new procurement (if existing

include details)

Procurement type – CCG

procurement, collaborative procurement with partners

CCG clinical

lead (Name)

CCG contract manager (Name)

Decision making process

and name of

decision making

committee

Summary of

conflicts of

interest noted

Actions to

mitigate conflicts

of interest

Justification for actions to mitigate conflicts of

interest

Contract awarded (supplier name &

registered address)

Contract value (£) (Total)

and value to

CCG

Comments to note

To the best of my knowledge and belief, the above information is complete and correct. I undertake to update as necessary the information. Signed: On behalf of: Date: Please return to Claire Burns, Head of Procurement, NHS Doncaster CCG, Heavens Walk, Doncaster, DN4 5HZ [email protected]


80

TEMPLATE FOR REGISTER OF PROCUREMENT DECISIONS

AND CONTRACTS AWARDED

Ref No

Contract/ Service

title

Procurement description

Existing contract or

new procurement

(if existing include details)

Procurement type – CCG

procurement, collaborative procurement with partners

CCG clinical

lead

CCG contract manager

Decision making process

and name of

decision making

committee

Summary of

conflicts of

interest declared and how

these were

managed

Contract Award

(supplier name &

registered address)

Contract value (£) (Total)

Contract value to

CCG

APPENDIX G

81

GIFTS, HOSPITALITY AND SPONSORSHIP FORM

This form must be completed in advance of Sponsorship being accepted, and, wherever possible in advance of any acceptance of Gifts (with a value in excess of £10) or Hospitality.

1. Declaree

Name of recipient:

Role:

2. Details of gift / hospitality / sponsorship (please tick relevant box and complete following sections in full)

[ ] Gift

[ ] Hospitality

[ ] Sponsorship

Date of offer:

dd/mm/yyyy

Details of offer:

(please include the reason for the offer, if known)

Estimated value:

£

Supplier / Offerer name, nature of business and address:

(If hospitality is received, please also provide name and address of hospitality venue)

Details of previous offers or acceptances from this Supplier / Offerer:

3. Action taken (please tick relevant box and complete following sections in full)

[ ] Declined

[ ] Accepted

Reason for accepting or declining:

APPENDIX H

82

Other comments:

If accepting, please:

Confirm date of receipt of gift/hospitality/sponsorship.

Provide names of individuals who will benefit from acceptance of offer.

Describe what benefit NHS Doncaster CGG will receive.

Describe any commitment expected from NHS Doncaster CCG or its staff as a result of accepting the offer.

Pharmaceutical Sponsorship ONLY: Confirm that any sponsorship agreements with pharmaceutical companies have been approved by the CCG Head of Medicines Management.

The information submitted will be held by the CCG for personnel or other reasons specified on this form and to comply with the organisation’s policies. This information may be held in both manual and electronic form in accordance with the Data Protection Act 1998. Information may be disclosed to third parties in accordance with the Freedom of Information Act 2000, to NHS Protect for the purpose of verification, prevention, detection and prosecution of fraud, and published in registers that the CCG holds.

3. Declaration

I confirm that the information provided above is complete and correct. I acknowledge that any changes in these declarations must be notified to the CCG as soon as practicable, and no later than 28 days after the interest arises. I am aware that if I do not make full, accurate and timely declarations then civil, criminal, or internal disciplinary action may result.

I do / do not [delete as applicable] give my consent for this information to be published on registers that the CCG holds. If consent is NOT given, please give reasons:

Signed:

Date:

4. Approval – details of officer reviewing and approving the declaration

Signed:

Date:

Position: Chief Finance Officer Date:

Please return to: Alison Hague, Corporate Governance Manager, Sovereign House, Heavens Walk, Doncaster, DN4 5HZ or by email to [email protected]


83

TEMPLATE FOR GIFTS, HOSPITALITY & SPONSORSHIP REGISTER

Name Position Date of

offer

Declined or

accepted

Date of receipt (if

applicable)

Details of gift / hospitality / sponsorship

Estimated value

Supplier / Offerer Name and Nature of

business

Reason for Accepting or

Declining

APPENDIX I

84

GOVERNANCE ARRANGEMENTS FOR COMMERCIAL SPONSORSHIP OF TARGET

1. Introduction 1.1. This appendix details the governance arrangements and agreements needing to

be in place for NHS Doncaster CCG’s clinical education programme, TARGET, to accept commercial sponsorship in relation to educational events it organises. They are an appendix to, and should be read in conjunction with, NHS Doncaster CCG’s Standards of Business Conduct & Declarations of Interest Policy.

1.2. These arrangements are in response to Best Practice Guidance on joint working

between the NHS and Pharmaceutical Industry and other relevant commercial organisations (2008). They are appropriate for the sponsorship of TARGET events alone.

1.3. Commercial Sponsorship Ethical Standards for the NHS requires that NHS

bodies have formal arrangements, with clear policy statements, codes of practice in working with sponsors, and codes of conduct for the Boards, Professional Executive members and staff. These arrangements need to be in line with standing orders and standing financial instructions.

2. CCG staff 2.1 All sponsorship arrangements will be subject to prior written agreement between

authorised officers and prospective sponsors in line with Standards of Business Conduct & Conflicts of Interest Policy. Any sponsorship agreements with pharmaceutical companies will require prior approval by NHS Doncaster’s Prescribing Lead. All agreements must be authorised by the Chief Finance Officer.

2.2. Where cumulative sponsorship agreements with a pharmaceutical company will

exceed £6,000 in 12 months, confirmation from the Chief Finance Officer and the Chief Nurse for NHS Doncaster CGG will be required to ensure that they comply with the protocols.

2.3 All members and officers of the CCG who are taking part in sponsored projects

must comply with the CCG’s and their own professional codes of conduct. 2.4 Training events which rely heavily on the use of sponsored materials should

promote good practice agreed by the CCG. Service Level agreements with training agencies must include a clause which requires the approval of the CCG for the use of commercially sponsored materials.

APPENDIX J

85

2.5 Projects which involve the use of clinical guidelines or protocols prepared by sponsors should only be agreed following advice from professional advisors at NHS Doncaster CCG.

2.6 All staff or Governing Body members involved in the development of a

sponsorship agreement must declare any prior interest in terms of previous sponsorship or relationship to any of the individual sponsors in question.

2.7 When arranging events that are being sponsored, NHS Doncaster CCG will

inform parties involved that meetings/ events are supported by Commercial Sponsors.

2.8 Any proposed collaboration should be without prejudice to any of NHS Doncaster

CCG’s standing financial instructions and standing orders and within the spirit and letter of the Department of Health guidance and relevant codes of practice.

2.9 All agreements should be transparent, open to discussion and be a matter of

public record. No agreements will be entered into with organisations whose business or functions could be deemed to be unethical by the CCG, its staff or the public.

3. Sponsors 3.1 All sponsorship arrangements will be subject to prior written agreement between

authorised officers and prospective sponsors. 3.2 All pharmaceutical companies entering into sponsorship agreements must

comply with the Association of the British Pharmaceutical Industry (ABPI) code of practice.

3.2 Sponsors should not advertise NHS Doncaster CCG participation as an

endorsement to their product, packages or company without the specific written permission of NHS Doncaster CCG.

3.3 Sponsors should be informed that any sponsorship arrangement will have no

effect on purchasing decisions with NHS Doncaster CCG. 3.4 Sponsors will NOT be allowed to represent products directly related to the

educational content of the event. 3.6. Payment for sponsoring the session must be received a maximum of 14 days

from the date of the session, and failure to pay will result in cancellation of future dates.

86

3.6 Changes to allocated sessions must be completed with NHS Doncaster CCG approval at least a month prior to the session. Any unapproved alternate sponsor will be asked to leave the venue with no reimbursement to the original sponsor. Abuse of swapping sessions will lead to a sponsor having future sessions revoked.

3.7 Sponsors will be able to use a standard display stand and have a maximum of 2

attending representatives at the venue (to include private and public reception areas surrounding the room). A breach of this will lead to the sponsor being asked to leave.

3.8 Sponsors’ displays must be set up ahead of the educational session with sponsor

representatives attending the display ahead of the education session and at coffee. Representatives must leave the room at all other times.

3.9 Display materials must comply with the Association of the British Pharmaceutical

Industry (ABPI) code of practice. 3.10 Clinical and professional decisions must always be in the best interests of the

patients and the service. No sponsorship agreements are acceptable that may compromise clinical or professional judgement.

4. Levels of Sponsorship 4.1 The cost of TARGET sponsorship will be dependent on the nature of the

meeting:

£600 per sponsor per GP TARGET session

£300 per sponsor per TARGET session for pharmacists and dentists

£150 per sponsor per TARGET session for nurses and optometrists 4.2 The numbers of sponsors per session will be regulated, with maximum numbers

of sponsors to be:

6 sponsors per GP session for 16 sessions each year

4 sponsors per nurse session for 16 sessions each year

4 sponsors per pharmacy session for up to 4 sessions each year

4 sponsors per dental session for up to 4 sessions each year

4 sponsors per optometry session for up to 4 sessions each year

87

GP EDUCATION (TARGET) Sponsorship Booking Form

Preferred number of sessions (maximum 10 per year) at £600 per session

Company

Contact Name

Address

Mobile

Email

Head Office details

(Please supply the address and contact details including a telephone number)

Please note all correspondence will need to be on your company headed paper

See attached agreement details on the next page.

88

By signing this agreement you agree:

To make a contribution to Primary Care educational events as agreed with NHS Doncaster CCG. In return NHS Doncaster CCG will allow you to set up and attend a stand at the Meeting. A maximum of 2 representatives will be permitted per stand and no products which relate directly to the educational content may be displayed.

Sessions can only be booked per quarter (3 months) in advance.

Only 1 invoice will be generated per stand, any division of payment within your own or with another company will need to be dealt with by the representatives internally.

Payment will be by BACS only.

You will comply with all legal and ABPI code of practice requirements in relation to any activities you carry out at the Meeting.

You represent that you have the authority and right to enter into this letter agreement.

Neither NHS Doncaster CCG nor you will through the operation of this agreement seek improperly to influence prescribing behaviour, the outcome of clinical trials or any healthcare professional or other government official with the intent to obtain or retain business for any improper purpose.

This letter may only be amended by a further written agreement which specifically refers to this letter and which is signed on behalf of both parties.

Late cancellations (less than 14 days) will be charged the full amount.

14 days prior to the event a confirmatory e-mail will be sent, at this point an invoice will be raised.

Any non-compliant Representatives/Sponsors will be excluded from attending further events.

This form will need to be manually signed not by electronic signature.

Name

Signature

Date

89

POTENTIAL BRIBERY RISKS (“RED FLAGS”) The following is a list of possible scenarios which may raise concerns under the Bribery Act 2010 and associated legislation. The list is not intended to be exhaustive and is for illustrative purposes only. If you encounter any of these issues while working for us, you must report them promptly to your Line Manager or to the Senior Compliance Officer or using the procedure set out in our Whistleblowing Policy:

you become aware or suspect that a colleague or third party engages in, or has been accused of engaging in, improper business practices;

you learn or suspect that a colleague or third party has a reputation for paying bribes, or requiring that bribes are paid to them;

a colleague or third party asks for a commission or fee payment before committing to sign up to a contract with us, or carrying out a government function or process for us;

a colleague or third party requests payment in cash and/or refuses to sign a formal commission or fee agreement, or to provide an invoice or receipt for a payment made;

a colleague or third party requests that payment is made to a country or geographic location different from where the colleague or third party resides or conducts business;

a colleague or third party requests that payment or other benefit is provided to a person other than the expected recipient, or to a person other than the expected provider of goods and services (unless part of an open and transparent contractual arrangement such as subcontracting or factoring);

a third party requests an unexpected additional fee or commission to "facilitate" a service;

a third party requests lavish entertainment or gifts before commencing or continuing contractual negotiations or provision of services;

a third party requests that a payment is made to "overlook" potential legal violations;

a colleague or third party requests that you provide employment or some other advantage to a friend or relative;

you receive an invoice from a colleague or third party that appears to be non-standard or customised;

a colleague or third party insists on the use of side letters or refuses to put terms agreed in writing;

APPENDIX K

90

you notice that we have been invoiced for a commission or fee payment that appears large given the service stated to have been provided;

a colleague or third party requests or requires the use of an agent, intermediary, consultant, distributor or supplier that is not typically used by or known to us;

you are offered an unusually generous gift or offered lavish hospitality by a third party;

you are asked to conceal the receipt of provision of hospitality or any other form of benefit or payment;

a colleague or third party exerts pressure for payments to be made urgently or ahead of schedule;

colleague or third party conducts private meetings with public contractors or companies hoping to tender for contracts;

a colleague or third party never takes time off even if ill, or holidays, or insists on dealing with specific contractors him/herself;

a colleague or third party makes unexpected or illogical decisions accepting projects or contracts;

a colleague or third party abuses or ignores normal decision processes or delegated powers in specific cases;

a colleague or third party agrees contracts not favourable to the organisation either with terms or time period;

a colleague or third party demonstrates an unexplained preference for certain contractors during a tendering period;

a colleague or third party seeks to avoid independent checks on tendering or contracting processes;

a colleague or third party requests that normal tendering/contracting procedure is bypassed;

a colleague or third party reports missing documents or records regarding meetings or decisions.

91

CHIEF OFFICERS STATEMENT ON BRIBERY NHS Doncaster CCG is committed to applying the highest standards of ethical conduct and integrity in its business activities in the UK and overseas. Every member of staff and individual acting on our behalf is responsible for maintaining our reputation and for conducting our business honestly and professionally. Bribery and corruption would have a detrimental impact on our business by undermining good governance. We benefit from carrying out our functions in a transparent and ethical way and helping to ensure that there is honest, open and fair competition in NHS. Where there is a level playing field, we can lead by example and deliver excellent services to our patients. Transparent, fair conduct helps to foster deeper relationships of trust between the CCG and our partners, which is vital for our reputation and future growth. We do not tolerate any form of bribery, whether direct or indirect, by, or of, our staff, agents or consultants or any persons or entities acting for it or on our behalf. The board and senior management are committed to implementing and enforcing effective systems throughout the CCG to prevent, monitor and eliminate bribery, in accordance with the Bribery Act 2010. Key policies are already in use across our component organisations that outline the position on preventing and prohibiting bribery, details can also be found on our CCG intranet. The provisions of these updated policies apply to all staff, as well as agency workers, consultants and contractors. We expect all our staff and other individuals acting for the CCG to familiarise themselves and comply with this policy with immediate effect. A bribe is a financial advantage or other reward that is offered to, given to, or received by an individual or company (whether directly or indirectly) to induce or influence that individual or company to perform public or corporate functions or duties improperly. All staff and associated individuals acting for or on behalf our CCG partners are strictly prohibited from making, soliciting or receiving any bribes or unauthorised payments. As part of our anti-bribery measures, we are committed to transparent, proportionate, reasonable and bona fide hospitality and promotional expenditure. Such expenditure must be authorised in advance, in accordance with the procedures set out in this policy. A breach of this policy by any member of staff or associated person will be treated as grounds for disciplinary action and where appropriate, referral to professional bodies or criminal investigation. All staff and associated individuals acting for or on behalf the organisation should note that bribery is a criminal offence that may result in up to 10 years' imprisonment and/or an unlimited fine for the individual and potentially an unlimited fine for us.

APPENDIX L

92

We will not conduct business with service providers, agents or representatives that do not support the organisation's anti-bribery objectives. We reserve the right to terminate contractual arrangements with any third parties acting for, or on behalf of our organisations with immediate effect where there is evidence that they have committed acts of bribery. The success of the organisation's anti-bribery measures depends on us all playing our part in helping to detect and eradicate bribery. Therefore, all staff and associated persons are encouraged to report any suspected bribery in accordance with the procedures set out in either local Whistleblowing arrangements and/or Fraud Policy & Response Plans. We will support any individuals who make such a report, provided that it is made in good faith. Mrs Jackie Pederson Chief Officer NHS Doncaster CCG 1st April 2016

Enc H

Items to Note

1



Title of paper

2016/17 Finance Report June 2016 (Month 3) Executive Summary


Hayley Tingle Chief Finance Officer

Author(s) Tracy Wyatt

Deputy Chief Finance Officer

Purpose of Paper – Executive Summary

This report sets out the financial position as at the end of June 2016. At this early stage in the year the CCG is forecasting to achieve all of its financial targets for 2016/17. The report also outlines:

The key risk areas identified in 2016/17

A summary of the CCG Efficiency Savings plan for 2016/17 (Appendix 2)

A summary of the CCG’s Resource Allocation (Appendix 3)

A summary of the CCG’s Reserve position (Appendix 4)

2

Recommendation(s)

Members are asked to receive the report and note the financial position.

Impact analysis

Assurance Framework

1.2, 1.4, 2.4, 3.1, 3.2, 6.2

Risk analysis

The CCG has identified a number of risks as part of the Financial planning for 2016/17. These include:

Prescribing and High Cost Drugs Expenditure

Over performance against the main acute contracts

Individual Placements

Non delivery of parts of the Efficiency Savings programme

A small contingency fund which equates to 0.5% of the CCG’s allocation has been set aside to mitigate against these risks as required by the business rules. It will not be possible to flex investment reserves due to the national ring fencing of the 1% headroom and therefore should the contingency fund not be sufficient the CCG will have to increase efficiencies, seek to risk share with other organisations or seek additional support from NHS England.

Equality impact

None Identified


Nil


Highlighted within the Report

Legal implications

None identified


N/A

3

NHS DONCASTER CCG 2016/17 FINANCE REPORT MONTH 3 – JUNE 2016 1. Introduction

This report provides the final financial position for NHS Doncaster CCG for 2016/17 as at the end of June (Month 3). At this early stage in the year, the CCG is forecasting to achieve all of its financial targets for 2016/17. 2. Current Position The year to date position reflects a surplus of £1,936k which is consistent with the year to date target of £1,931k. The annual target is a surplus of £7,722 which the CCG is forecasting to achieve at this early stage in the year. Limited information is available from providers yet but as information starts to come through the position will be updated. The year to date and forecast position is summarised in the Operating Cost Statement included at Appendix 1. 3. Key Messages and Risks

The largest financial risks identified as part of the Financial Planning process were Prescribing and High Cost Drugs. Work to address the variations in both outcomes and costs will be taken forward as part of the Primary Care Strategy, specifically the medicine optimisation work. A prior approval process has been initiated with the Acute Trust and implemented from 1st April 2016; this will address any non-compliance with both NICE guidance and correct charging through the PbR tariff mechanism. Other risks identified include the over performance on acute contracts, increased Individual placements ( including Continuing Healthcare , Specialist Placement and Section 117 packages) and the non-delivery of parts of the efficiency savings. If the efficiency savings fail to deliver there will be increased pressure on the CCGs statutory duty to breakeven. An additional risk has arisen in year in relation to the nationally agreed rates for Funded Nursing Care (FNC) which will cause an additional cost pressure of approximately £600k. The rate has increased by 39% from £112 per week to £156.25 per week following a national review. The CCG has no choice but to implement this rate for FNC patients, however it may also impact on the locally agreed care home rates. The CCG is currently in discussion with the Local Authority to work this through but it may potentially increase costs by a further £200k. To help manage and offset these risks a small contingency fund of £2.2m has been established. This equates to 0.5% of the CCG’s allocation and is in line with planning guidance. If this is insufficient the following actions would need to be considered;

4

Seeking further efficiencies and decommissioning opportunities

Risk sharing with other CCGs

Seeking repayable financial assistance from other NHS organisations.

Seeking further support from NHS England In previous years flexing of investment funds have supported mitigation to manage unexpected risks however this is not an option for 2016/17. 4. Efficiency Savings Programme

All contract values negotiated with providers are net of efficiency saving targets where appropriate. A summary of the high level efficiency plans are shown in Appendix 2, the targets are phased to assume delivery in the latter half of the year therefore savings will be reported from Q3. However, progress in relation to the Right Care work streams including prescribing will be reported each month to outline any risks to delivery as they arise. 5. 1% Non Recurrent Headroom The CCG has set aside £4.8m, (1% of the CCG’s recurrent allocation) as per the business rules for non -recurrent investment. However, the CCG is required to ring-fence this funding to provide funds to insulate the wider health economy from financial risk. If evidence emerges that the risks are being effectively mitigated it is anticipated that this will be released for use. 6. Further Allocations Additional allocations were received in Month 3 for STH’s Vanguard £175k, Eating Disorders Funding £173k, Colposcopy services transfer from NHSE, £76k, and £27k for minor non NHS services transferred from specialised services. 7. Capital Resource

The CCG has not received any capital funding in 2016/17. 8. Other Key Financial Targets Overleaf is a summary table outlining the other key financial targets for the CCG, the current performance and the forecast. There are no areas of concern that require highlighting.

5

Key Duty Target Actual Forecast

BPPC

95% + invoices paid within 30 days (NHS)

96.33% 98%

95% + invoices paid within 30 days (non NHS)

98.80% 98%

95% + invoice values paid within 30 days (NHS)

99.84% 98%

95% + invoice values paid within 30 days (Non NHS)

99.02% 98%

Cash Drawdown

1.25% of monthly drawdown remaining at period end

0.00% 1.25%

Running Costs

Maintain spend within annual target of £6,806k, YTD £1,567k

£1,346k £6,806k

Key Red High risk - significant risk of target not being achieved

Amber Medium Risk - some issues around current performance, actions in place

Green Low risk - target being achieved, no areas of concern

9. Better Care Fund The Section 75 Framework Agreement with Doncaster Council is due to be signed by 30th June 2016. The overall plan has been agreed and submitted to NHS England and the fund remains broadly the same as last year at £23,907k. The governance structure surrounding the BCF has been reviewed and more detailed monitoring will take place in 2016/17. The Quarter 1 report to NHSE will be submitted in August and an update will then be given to the Governing Body. 11. Conclusion and Recommendations Members are asked to: Receive and note the Finance Report for June 2016 (Month 3).

NHS DONCASTER CLINICAL COMMISSIONING GROUP Appendix 1

2016/17 FINANCE REPORT JUNE 2016

Recurrent

Budget

£000s

Non Rec

Budget

£000s

Total

Budget

£000s

Recurrent

Budget

£000s

Non Rec

Budget

£000s

Total

Budget

£000s

Forecast

Outturn

£000s

Variance

(Under)/ Over

£000s

Total

Budget

£000s

YTD Actual

£000s

Variance

(Under)/

Over

£000s

Baseline Allocation -479,863 -9,722 -489,585 -479,863 -9,722 -489,585 0 -489,585

Running Cost Allowance -6,806 0 -6,806 -6,806 0 -6,806 0 -6,806

Initial Allocation -486,669 -9,722 -496,391 -486,669 -9,722 -496,391 0 -496,391

In year changes

Vanguard Q1 Sheffield Teaching Hospitals 0 -175 -175 -175

Q1 Eating Disorder Service 0 -173 -173 -173

PYE Transfer of One Health July-March 2017 0 -22 -22 -22

PYE Transfer of Claremont July-March 2017 0 -5 -5 -5

Colposcopy Contract transfer from NHS England -67 -67 -67

0

TOTAL ALLOCATIONS -486,669 -9,722 -496,391 -486,736 -10,097 -496,833 0 -496,833 -122,805 -122,805 0

Acute Contracts - DBHFT 186,060 907 186,967 185,940 907 186,847 186,847 0 46,712 46,712 0

Acute Contracts - Other NHS 35,728 81 35,809 35,921 429 36,350 36,350 0 8,364 8,357 -7

Acute Contracts - Other Providers Non NHS 4,267 0 4,267 4,253 28 4,281 4,276 -5 1,066 1,061 -5

Acute Contracts - Urgent Care 2,608 0 2,608 5,773 0 5,773 5,773 0 1,443 1,442 -1

Acute - Non Contract Activity 5,773 0 5,773 2,608 0 2,608 2,608 0 652 653 1

Total Acute Services 234,436 988 235,424 234,495 1,364 235,859 235,854 -5 58,237 58,225 -12

Mental Health Contracts - RDaSH FT 34,104 610 34,714 34,175 539 34,714 34,714 0 8,661 8,632 -29

Mental Health Contracts - Other NHS 347 0 347 348 0 348 348 0 87 87 0

Mental Health Contracts - Other Providers 15,704 0 15,704 15,733 0 15,733 15,656 -77 3,933 4,077 144

Mental Health - Non Contract Activity 29 0 29 29 0 29 0 -29 7 0 -7

Total Mental Health Services 50,184 610 50,794 50,285 539 50,824 50,718 -106 12,688 12,796 108

Community Contracts - RDaSH FT 30,945 82 31,027 30,963 82 31,045 31,045 0 7,761 7,762 1

Community Contracts - Other NHS 366 0 366 366 0 366 366 0 91 91 0

Community Contracts - Other Providers 10,650 0 10,650 10,603 0 10,603 10,641 38 2,651 2,585 -66

Total Community Services 41,961 82 42,043 41,932 82 42,014 42,052 38 10,503 10,438 -65

Prescribing 61,738 0 61,738 61,738 0 61,738 61,738 0 16,216 16,216 0

Oxygen Services 573 0 573 573 0 573 573 0 143 143 0

Other Primary Care Services 2,030 1,559 3,589 3,656 0 3,656 3,662 6 914 906 -8

GPIT 800 0 800 800 0 800 800 0 165 165 0

Medical Recommendations 0 0 0 0 0 0 0 0 0 0 0

Delegated Co-Commissioning 41,348 41,348 41,348 0 41,348 41,348 0 10,051 10,051 0

Primary Care Services 106,489 1,559 108,048 108,115 0 108,115 108,121 6 27,489 27,481 -8

Continuing Healthcare 34,146 1,117 35,263 34,146 1,116 35,262 35,327 65 9,652 9,832 180

Continuing Healthcare Services 34,146 1,117 35,263 34,146 1,116 35,262 35,327 65 9,652 9,832 180

Medicines Management 507 0 507 507 0 507 507 0 127 136 9

Safeguarding 39 0 39 39 0 39 39 0 10 10 0

Mental Health Assessments 60 60 0 0 0 0 0 0 0 0

NHS Property Services Recharge 2,404 0 2,404 2,404 0 2,404 2,404 0 601 601 0

Corporate non running costs 3,010 0 3,010 2,950 0 2,950 2,950 0 738 747 9

Chief Pharmacist 87 0 87 87 0 87 87 22 21 -1

Admin & Business Support 896 0 896 896 0 896 896 0 80 81 1

Contract Management 413 0 413 413 0 413 413 0 110 119 9

Finance 792 0 792 792 0 792 792 0 201 176 -25

Corporate Costs & Services 397 0 397 397 0 397 397 0 99 82 -17

Human Resources 82 0 82 82 0 82 82 0 20 15 -5

Health & Safety 20 0 20 20 0 20 20 0 5 5 0

Patient & Public Involvement 186 0 186 186 0 186 186 0 46 39 -7

Communications & PR 5 0 5 5 0 5 5 0 1 3 2

Performance 823 0 823 823 0 823 823 0 206 201 -5

Quality Assurance 614 0 614 614 0 614 614 0 153 120 -33

Primary Care Support 208 0 208 208 0 208 208 0 52 32 -20

Strategy & Development 962 -171 790 962 -171 790 790 0 198 136 -62

Governing Body 1,493 0 1,493 1,493 0 1,493 1,493 0 373 319 -54

Corporate Running Costs 6,978 -171 6,806 6,977 -171 6,806 6,806 0 1,566 1,349 -217

Total Corporate Costs 9,988 -171 9,816 9,927 -171 9,756 9,756 0 2,304 2,096 -208

1% Non Recurrent Headroom Reserve 4,799 4,799 4,799 4,799 4,799 0 0 0 0

Contingency Reserve 0.5% 2,482 0 2,482 2,482 0 2,482 2,482 0 0 0 0

Investments 0 0 0 0 0 0 0 0 0 0 0

Total Reserves 2,482 4,799 7,281 2,482 4,799 7,281 7,281 0 0 0 0

TOTAL APPLICATION OF FUNDS 479,686 8,983 488,669 481,383 7,728 489,111 489,110 -1 120,873 120,868 -5

SURPLUS 1% REQUIREMENT* 7,722 7,722 0 -7,722 1,931 0 -1,931

OPERATING COST STATEMENT

Opening Budget YEAR TO DATEFORECAST

NHS DONCASTER CLINICAL COMMISSIONING GROUP APPENDIX 2

Savings / Efficiency Programme 2016/17

Programme Area Project 2016/17 Target Risk

Right Care incl prescribing Endocrine, respiratory, MSK and Neurological Medium

Other Schemes Review of Procedures with Low Clinical value Medium

Other schemes as part of Working Together and STP Medium

2016/17 TOTAL 8,882

Note: Risk assessed on the basis of management experience

There is not a specific target for each right care stream but the overall potential savings per the Right Care reports is £22m, based on achieving

the same performance as the best 5 similar CCG's. To achieve the same as the 10 similar CCG's that are in our 'cluster' there is potential

savings of £13.7m. The CCG has assumed that there will be a lead in time to understand the right care data and implement any pathway changes

but that a minimum of 25% could be achieved.

Other areas are being developed as part of the Working Together and STP work streams.


SUMMARY OF RESOURCE ALLOCATIONS AS AT MONTH 3 JUNE 2016

Recurrent Non Recurrent Total

£000's £000's £000's

Recurrent Baseline -438,097 -438,097

Primary Care Delegation -41,766 -41,766

Non Recurrent Surplus from prior years -9,722 -9,722

Running Cost Allowance -6,806 -6,806

Total Resources Available at Plan Stage -486,669 -9,722 -496,391

Adjustments to the Resource Limit:

Month 01 April

No adjustments 0 0 0

0 0 0

Month 02 May

No adjustments 0 0 0

0 0 0

Month 03 June

Vanguard Q1 Sheffield Teaching Hospitals 0 -175 -175

Q1 Eating Disorder Service 0 -173 -173

PYE Transfer of One Health July-March 2017 0 -22 -22

PYE Transfer of Claremont July-March 2017 0 -5 -5

Colposcopy Contract transfer from NHS England -67 0 -67

-67 -375 -442

Revised Resources available as at Month 3 June 2016 -486,736 -10,097 -496,833


SUMMARY OF RESERVES AS AT MONTH 3 JUNE 2016

RESERVES Recurrent Non Total

Recurrent

£000's £000's £000's

RISK RESERVES AND CONTINGENCIES

1% Non Recurrent Headroom

Initial Plan 0 4,799 4,799

Budget Transfers

No transfers as at Month 3 - funding uncommitted and ringfenced as per 0

NHSE Guidance 0

0

0

0

0

0

0

0

0

0

0

0

0 4,799 4,799

0.5% Contingency

Initial Plan 2,482 0 2,482

Budget Transfers

No transfers as at Month 3

2,482 0 2,482

2,482 4,799 7,281

Cross Check to Operating Cost Statement 2,482 4,799 7,281

Enc I

Receipt of Minutes from Committees

1

Minutes of the Primary Care Commissioning Committee Held on Thursday 16th June 2016 commencing at 3.30pm

In the Boardroom, Sovereign House Present:

Mrs Linda Tully – Lay Member (Chair) Miss Anthea Morris – Lay Member and Vice Chair of the Primary Care Commissioning Committee Mrs Jackie Pederson – Chief Officer Mrs Hayley Tingle – Chief Finance Officer Mrs Laura Sherburn – Chief of Partnerships Commissioning and Primary Care Dr Pat Barbour – Locality Lead, South East Locality Dr Niki Seddon – Locality Lead, North West Locality Dr Nabeel Alsindi – Clinical Lead for Primary Care and Long Term Conditions Mrs Suzannah Cookson – Head of Quality Designated Nurse for Safeguarding & Looked after Children Mrs Carolyn Ogle – Primary Care Contract Manager, NHS England

In attendance:

Mrs Jayne Satterthwaite – PA (Taking Minutes) Mr Ian Carpenter, Head of Communications & Engagement

ACTION

1. Welcome and Introductions Mrs Tully welcomed everyone to the Primary Care Commissioning Committee meeting. There were 0 members of the public in attendance at the meeting.


Dr Rupert Suckling – Director of Public Health

Dr Dean Eggitt – Medical Secretary, Doncaster Local Medical Committee

Mrs Debbie Hilditch – Healthwatch Doncaster Representative

3. Declarations of Interest Mrs Tully reminded members of their obligation to declare any interest

2

they may have on any issues arising at the meeting which might conflict with the business of NHS Doncaster CCG. Declarations declared by members of the Committee are listed in the CCG’s Register of Interest, (available either via Mrs Satterthwaite, or the CCG website http://www.doncasterccg.nhs.uk/about-us/who-are-we/ Declarations from today’s meeting: Item 7 Prescribing Gain Share Scheme. Dr Seddon, Dr Barbour and Dr Alsindi declared an interest in respect of Item 7, Prescribing Gain Share Scheme. Mrs Tully advised that they could remain in the room and participate in the discussion however they could not take part in the decision.

4. Minutes of the Previous Meeting held on 24th May 2016 The minutes of the meeting held on 24th May 2016 were agreed as an accurate record subject to the following amendments: Page 1, In attendance – Add Mr Andrew Russell – Deputy Chief Nurse.

5. Matters Arising PMS Contract Uplift 2016/17 Mrs Tingle confirmed that she had spoken with Mrs Miller regarding the reason for the deduction of the Dementia DES from the figures. Separate payments were made in respect of the Dementia DES which ceased on 31st March 2016. With Effect from 1st April 2016, the Dementia monies became part of the core contracts which resulted in an increased uplift. Mrs Tingle agreed to circulate the information relating to the affected practices to the Committee.

Mrs Tingle

6. National Primary Care Transformation Fund (Capital Infrastructure & IT) - Update Mrs Sherburn provided the following update to the Committee:

The further guidance from NHS England regarding the National Estates and Technology Transformation Fund (ETTF) bids has been reviewed.

Our review of the North Somerset CCG’s approach to prioritisation, to compare and contrast with ours, did not result in changes to our approach being made.

NHS Doncaster CCG has been unable to source external clinical

http://www.doncasterccg.nhs.uk/about-us/who-are-we/


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input so far, however the search will continue.

We continue to work with and advise practices regarding the submission of their bids and Dr Alsindi has also provided a screen shot of the portal to assist practices.

The deadline for practices to submit bids to the CCG is 17th June 2016 and the panel will convene the following week to prioritise them for upload onto the NHS England portal. It was considered more appropriate that Mrs Ogle does not attend the panel.

The Primary Care Commissioning Committee noted the report.

7. Prescribing Gain Share Scheme 2016 – 2017 Mrs Tingle explained that NHS Doncaster CCG is facing a significant financial challenge in 2016-17. There are areas of prescribing where the Doncaster spend is relatively more than comparable CCGs for similar clinical outcomes. Analysis by the national NHS RightCare Team has identified some key pathway areas where improving the quality of the prescribing could also achieve savings. As a result the Finance Team was asked to devise an appropriate scheme to suit all. The overall aim of the scheme is to facilitate cost effectiveness of prescribing, whilst maintaining the quality of prescribing in general practice across Doncaster, with a particular focus on areas where the CCG is an outlier against its peers. It is the CCG’s intention to introduce this scheme to general practice in July, via a dedicated briefing event to enable all practices to understand the aims, objectives and expectations around delivery. Implementation will begin in August. Mrs Tingle presented the following options for discussion: Option 1 Do Nothing. Prescribing costs will continue to overspend and the CCG will continue to be an outlier having higher than national and cluster average expenditure. There is a risk that the CCG may not achieve its statutory financial targets. Option 2 To qualify for payment, Practices have to achieve the following targets based on expenditure per weighted list size in addition to the overall CCG expenditure on the relevant RightCare area having a minimum of 5% reduction in expenditure relating to the items identified. The maximum incentive scheme payment for each practice will be £1.25 per patient calculated using April 2016 practice list size. Payments to individual Practices will only be applicable if the CCG expenditure for the relevant RightCare area has reduced by a minimum of 5% on the baseline expenditure. Option 3 To qualify for payment, Practices have to reduce expenditure against

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the indicative budget. Payments to Practices will be based on a gain share basis with Practices receiving 20% of any prescribing savings made against the items identified. All options pose an element of risk however Option 3 is the least risky from a CCG financial perspective, as there is only a pay-out if there is a certain percentage saved, at an individual practice level. As targets for savings will be tiered according on the distance away the practice is from the CCG average, this attempt to mitigate the penalising of better performing practices. However this option does essentially imply that we are rewarding practices who historically have been higher spenders/poorer prescribers; as they stand to gain just as much as practices who have performed well. Mrs Cookson queried if the practices who have performed well had already received gains however Mrs Tingle confirmed this was not the case. Dr Barbour raised concerns that quality of care may deteriorate and that this had not been addressed. Practices may also deem the 20% saving as unfair and practices may be more willing to engage if it was a 50/50 arrangement. Dr Barbour also stated that she considered that all three options were not ideal and that perhaps a complete rethink was needed. Mrs Tully urged the committee to be aware of the potential for conflict of interest and reminded GP members that they could not be part of the decision process. She assured them there had been clinical involvement from the onset via Dr Bradley as clinical lead for prescribing. The Committee approved Option 3 and for it to be introduced to general practices for consultation in July 2016.

8. Proposed Merger Mrs Sherburn informed the Committee that she had received a letter from Oakwood Surgery formally requesting that NHS Doncaster CCG and NHS England give consideration to a request for a potential merger of the Oakwood Surgery, Cantley and the Mayflower Surgery, Bawtry on or around 1 July 2017 and for the two organisations to guide the practices through the formal process. Mrs Ogle stated that NHS England will meet with the practices to discuss the process for the merger. The Committee noted the contents of the letter.

9. Quality Assurance Framework & Quality Dashboard - Progress Update Mrs Cookson advised the Committee that the Quality & Safety Committee had approved the Quality Assurance Framework. The IT Resource Team is in the process of populating the Quality Dashboard. The Committee noted the update.

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10. Vulnerable Practice Support Programme Update Mrs Sherburn informed the Committee that NHS Doncaster CCG had formally written to the 8 practices which had been identified as requiring potential support under the Vulnerable Practices Support Programme, on 3rd June 2016. The letter advised practices that NHS England would require confirmation of their acceptance of support by 24th June 2016. NHS England is currently tendering for providers of the support package after which we will have a better idea of what the support offer to practices entails. The Committee noted the update.

11. Receipt of Minutes The following draft minutes were received and noted by the Primary Care Commissioning Committee:

Primary Care Delivery Group – Draft minutes of the meeting held on 20th May 2016 and the Primary Care Work Plan 2016.

Provide Engagement Group – Draft minutes of the meeting held on 13th May 2016.

13. Any Other Business There was no other business discussed.

14. Date and Time of Next Meeting To be confirmed.

15. It was resolved 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 1960.

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Minutes of the Primary Care Commissioning Committee Held on Thursday 14th July 2016 commencing at 12.30pm

In the Boardroom, Sovereign House Present:

Miss Anthea Morris – Lay Member and Vice Chair of the Primary Care Commissioning Committee (Chair) Mrs Laura Sherburn – Chief of Partnerships Commissioning and Primary Care Dr Pat Barbour – Locality Lead, South East Locality Dr Niki Seddon – Locality Lead, North West Locality Dr Nabeel Alsindi – Clinical Lead for Primary Care and Long Term Conditions Mrs Suzannah Cookson – Head of Quality Designated Nurse for Safeguarding & Looked after Children Mrs Carolyn Ogle – Primary Care Contract Manager, NHS England

In attendance:

Mrs Jayne Satterthwaite – PA (Taking Minutes)

ACTION

1. Welcome and Introductions Miss Morris welcomed everyone to the Primary Care Commissioning Committee meeting. Miss Morris explained that the meeting was not quorate due to the number of apologies received however the agenda items were updates and were for noting only by the Committee. For future reference, confirmation has been received from Mrs Atkins Whatley, Chief of Corporate Services, that quoracy can be achieved if members Skype (subject to confidentiality) or telephone into the meetings and they are able to participate in the discussions. There were no members of the public in attendance at the meeting however three NHS Doncaster CCG staff members observed the meeting.


Mrs Linda Tully – Lay Member

Mrs Jackie Pederson – Chief Officer

Mrs Hayley Tingle – Chief Finance Officer

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Dr Rupert Suckling – Director of Public Health

Dr Dean Eggitt – Medical Secretary, Doncaster Local Medical Committee

Mrs Debbie Hilditch – Healthwatch Doncaster Representative

Mr Ian Carpenter, Head of Communications & Engagement

3. Declarations of Interest Miss Morris reminded members of their obligation to declare any interest they may have on any issues arising at the meeting which might conflict with the business of NHS Doncaster CCG. Declarations declared by members of the Committee are listed in the CCG’s Register of Interest, (available either via Mrs Satterthwaite, or the CCG website http://www.doncasterccg.nhs.uk/about-us/who-are-we/ Declarations from today’s meeting: There were no declarations of interest made for any of the agenda items or any additional declarations of interest than those previously registered.

4. Minutes of the Previous Meeting held on 16th June 2016 Miss Morris explained that the minutes of the meeting held on 16th June 2016 could not be agreed as an accurate record as today’s meeting was not quorate. The following amendments were suggested: Page 1, Minutes heading, amend to read ‘Thursday 16th June 2016 commencing at 3.30pm’. Page 2, Matters arising, Lines 3 and 4, amend to read ‘Dementia DES’. Page 3, National Primary Care Transformation Fund (Capital Infrastructure & IT) – Update, Bullet Point 5, amend to read, ‘It was considered more appropriate that Mrs Ogle does not attend the panel’. Page 4, Prescribing Gain Share Scheme 2016 -2017, Paragraph 3, Line 4, amend to read, ‘Dr Barbour raised concerns that quality of care may deteriorate and that this had not been addressed. Practices may also deem the 20% saving as unfair and practices may be more willing to engage if it was a 50/50 arrangement. Dr Barbour also stated that she considered that all three options were not ideal and that perhaps a complete rethink was needed however Mrs Tully believed that, as there had been clinical involvement in the work up of the scheme to date, Dr Barbour’s clinical advisor role in the Committee was to comment on the content of the three options and not request a



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redesign. Mrs Tingle advised that a number of possibilities were looked at but we need to be making material savings. If not other areas will be targeted. The scheme has been designed in line with NICE guidelines and RightCare identified areas. It was stated that Dr Bradley had also been involved with the design of the scheme. The minutes will be amended and presented at the next meeting for approval.

5. Matters Arising Prescribing Gain Share Scheme 2016 – 2017 Mrs Sherburn reported that Option 3 was presented to GPs at a recent TARGET session where they were asked to sign up to the option or not and decisions are awaited. The perception was that it was better received than anticipated and the fact that the option may not suit everyone was strengthened. Dr Barbour queried if the deadline date of 1st August 2016 could be extended to give Locality Leads more time to address this in their Locality meetings. Mrs Sherburn stated that this was not possible but practices may commence work on it if they wish and an email will be circulated to GPs as a gentle reminder. Dr Seddon requested that the Medicines Management Team become involved and offered their support and also offered her support alongside them.

Dr Seddon

6. National Primary Care Transformation Fund (Capital Infrastructure & IT) - Update Mrs Sherburn reported that the Primary Care Estates and Technology Transformation Fund (ETTF) has been set up to consider proposals from general practice in support of the expansion and strengthening of primary care, including infrastructure. These proposals must also link to the CCG Estates Strategy, Digital Roadmap, Strategic Plan and the delivery of priorities from the emerging Sustainability and Transformation Plan. In May 2016, the Primary Care Commissioning Committee approved the prioritisation methodology to be used for this purpose and delegated the authority for assessing, prioritising and submitting the bids to a panel comprised of:

- Chief of Partnerships & Primary Care - Head of Procurement - Deputy Chief Finance Officer - Head of Health Informatics - Senior Primary Care Officer

The Primary Care Commissioning Committee also agreed that clinical input should be sought, whilst avoiding conflict of interest. GP input from outside Doncaster was sought but not found therefore the panel was joined by Dr Emyr Jones, a NHS Doncaster CCG Governing Body

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member with a previous background as acute Trust medical director. Also joining the panel was the Strategic Estates Advisor from Community Health Partnerships (CHP), to help provide objectivity and expert knowledge where needed. Conflicts of interest were checked at the beginning of the panel and it was agreed there were no material conflicts. However in recognition that the Head of Informatics could be seen as biased towards any bids for Digital Roadmap funding put forward by the CCG, it was agreed that he would not input into the scoring of the bids. The panel met on 23rd June and assessed 36 bids. 28 were scored and submitted to the portal (8 were for technology, 20 were for premises). 8 bids did not meet the initial threshold criteria for scoring and therefore were not scored and not submitted to the portal. The relevant lead organisations for these bids have been informed. Throughout July, NHS England will be assessing the bids that have been submitted on the portal, and by the end of the month, it is anticipated that the CCGs will be informed as to: a) Which practices have been approved to take to the due diligence

stage of the Estates and Technology Transformation Fund, and which have not

b) The process to follow for the practices who have not qualified for

funding via this programme, and require their premises and IT requirements to be met via an alternative funding route. No details are as yet available about this alternative route/process however the CCG understands it is being clarified during July.

Mrs Ogle informed the Committee that the timescales had moved and that the ‘first cut’ would be the end of July, the Regional panel will sit on 1st August and the National panel on 11th August after which results will be communicated. Mrs Ogle stated that the detail regarding Core Capital is unclear at this stage. Dr Seddon questioned if it was possible that Doncaster may not receive anything and Mrs Ogle confirmed that this could be a possibility however stated that practices should be encouraged to continue with aspirational bids. The Primary Care Commissioning Committee noted the report.

7. Future of Primary Care in Doncaster Event 30th June 2016 – Feedback Mrs Sherburn informed the Committee that the Primary Care event which was held on 30th June was divided into two sections. Section 1 focussed specifically on Commissioning. Section 2 was facilitated by Dr Mike Smith from Primary Care Commissioning who gave an

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informative speech on the benefits and drawbacks of Federations and irrespective of how small a Federation may be Dr Smith considered them to be worth embarking upon. There has been no further feedback from Primary Care Commissioning since the event. Primary Care Commissioning offered to put together a proposal and flexible offer to deliver what would be useful for Federations to NHS Doncaster CCG. Mrs Sherburn will inform the Committee when something tangible has been received. It was reported that the Practice Managers who had attended the event considered it valuable for them to be present. The Committee noted the update.

8. Taking forward the Primary Care Strategic Model – next steps Mrs Sherburn informed the Committee that the first of the 4 Pillars in the Strategic Model relating to the Pro-active Care specification has been launched. The population profile is due shortly and Mr Chris Empson, Support Manager – Performance will incorporate it into the Risk Ratification Tool. The Public Health practice information will also be incorporated at a later date. Mr Empson will be invited to present the Risk Stratification Tool to a future Primary Care Commissioning Committee meeting. Dr Barbour reported that she had recently attended a Commissioning event and observed a presentation given by a company who has a Risk Stratification Tool for purchase. It can be used for as many patients as you wish and is able to indicate via an IPhone or IPAD the top 5 patients within a practice who are most likely to go into unplanned care thereby giving GPs the opportunity to intervene and avoid an unplanned admission. Dr Barbour and Mrs Sherburn agreed to discuss this further outside of the meeting. It is proposed to hold ‘drop in’ sessions to prepare practices in readiness to deliver in October 2016. An Extra ordinary Primary Care Commissioning Committee will be held on 22nd September where recommendations will be put in place. It is hoped that the payment schedule will be approved at the next Committee meeting. Miss Morris asked that clarification should be sought from Mrs Tingle, Chief Finance Officer that the Committee has the authority to approve the payment schedule within the Standing Financial Instructions. It will be necessary to establish how the remaining 3 Pillars are taken forward, each will move at differing paces and specifications will be required for each one. Dr Alsindi commented that we need to ascertain how Governing Body GPs will be involved and Task & Finish Groups may be an option to work on various specifications.

Dr Barbour/ Mrs

Sherburn

Mrs Sherburn

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9. PMS Contract Update

Mrs Sherburn reported that all PMS contracts had now been signed. The Committee congratulated Mrs Sherburn on this.

10. Quality Assurance Framework & Quality Dashboard - Progress Update Mrs Cookson advised the Committee that Mr Empson has populated the indicators on the Quality Dashboard which was presented at the Primary Care Delivery Group meeting on 17th June 2016. It will also be presented to a future Primary Care Commissioning Committee meeting when a more even spread of data has been received. Dr Barbour requested that the Quality Dashboard be circulated to Governing Body GPs. Miss Morris suggested that a deadline for presentation of the report be established. Mrs Cookson stated that Mr Empson is also working on a Primary Care Web tool and Dr Barbour highlighted that practices are not aware of this. Dr Alsindi informed the Committee that he is working on a Primary Care Website which will assist practices in locating different information and the Web Tool could be added. Mrs Cookson agreed to circulate the practice profiles, Public Health tool and the practice Web Tool. Mrs Ogle stated that practices should have been provided with their Logon Details. Mrs Cookson informed the Committee that a Primary Care Quality Nurse has been appointed and will commence in post in August. An anonymous whistle blow has been received. The practice has been visited however no evidence has been found to substantiate. The Committee noted the update.

Mrs Cookson

Mrs Cookson

11. Receipt of Minutes The following draft minutes were received and noted by the Primary Care Commissioning Committee:

Primary Care Delivery Group – Draft minutes of the meeting held on 17th June 2016 and the Primary Care Work Plan 2016.

Provide Engagement Group – Draft minutes of the meeting held on 24th June 2016.


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There was no other business discussed.

13. Date and Time of Next Meeting Thursday 11th August 2016 at 12.30pm

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Executive Committee Held on Wednesday 6 July 2016 commencing at 20m

In Dr David Crichton’s Office, Sovereign House, Heavens Walk, Doncaster, DN4 5HZ

Present: Dr David Crichton – Chairman

Mrs Jackie Pederson – Chief Officer Mrs Sarah Atkins Whatley – Chief of Corporate Services Mrs Laura Sherburn – Chief of Partnerships Commissioning

Mrs Ailsa Leighton – Deputy Chief of Strategy – Urgent Care Mrs Hayley Tingle – Chief Finance Officer

Mr Andrew Russell, Deputy Chief Nurse

In attendance: Mrs Jayne Satterthwaite – PA to Chair and Chief Officer (taking

minutes) Mrs Lisa Devanney – HR Manager Mrs Alison Hague – Corporate Governance Manager (Item 5) Mrs Jo Forrestall - Head of Strategy and Delivery-Community Services (Item 8)

ACTION 1. Apologies

Apologies were received from:

Mrs Mary Shepherd, Chief Nurse

Mr Ian Carpenter – Communications and Engagement Manager

2. Declarations of Interest Dr Crichton declared a Conflict of Interest in respect of Item 8, Dietetics discussion paper. The Committee agreed that, as the item was for discussion and agreement that Mrs Forrestall explore the option of one community base service Dr Crichton remain and participate in the discussions. Mrs Tingle stated that she intended to raise the contract variation in respect of the provision of cover for future TARGET sessions under Any other Business therefore Dr Crichton declared a Conflict of Interest in this item and would be excluded from the discussion.

3. Action Summary from the Formal Senior Management Team Meeting held on 8 June 2016

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The Action Summary from the Formal Senior Management team meeting held on 8 June 2016 was agreed as a correct record subject to the following amendment: Page 8, Line 2 - Amend to read ‘6th and 13th July’.

4. Matters Arising Terms of Reference Mrs Sherburn confirmed that she had informed the practice which had expressed a concern at the absence of clinical input, that the Executive Committee will only make business and corporate decisions when a thorough process has taken place and that the Clinical Reference Group (CRG) and the Governing Body will make clinical decisions and the CRG will make recommendations to the Executive Committee on clinical issues. Network Business Cases Mrs Leighton confirmed that the Executive Committee comments regarding addressing the short timescales given for approval of business cases by CCGs have been given to the Working Together Programme Senior Management Team (WT SMT). Patient Transport Services Mrs Tingle confirmed that a Business Case will be produced. Prescribing Gain Share Scheme Mrs Tingle confirmed that the Prescribing Gain Share Scheme had been presented to the Primary Care Commissioning Committee and the Committee had made a decision to progress with the offer to General Practice. QIPP/RightCare Mrs Leighton stated that RightCare will be discussed in the Rotherham, Doncaster and South Humber NHS Foundation Trust (RDaSH) and Doncaster and Bassetlaw Hospitals NHS Foundation Trust (DBHFT) Finance, Performance and Intelligence Group (FPIG) meetings and suggested that the RightCare Area Leads attend an Informal Senior Management Team meeting to discuss progress so far. Mrs Pederson commented that it also be discussed in a future Strategy and Organisational Development Forum meeting. Lease Cars Mrs Devanney stated that she had consulted with the wider HR team regarding the Lease Car scheme. It is not without

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complications particularly when staff members leave the organisation and careful wording within employment contracts would be needed. It was agreed that Mrs Devanney contact Complete Solutions to visit NHS Doncaster CCG to present the information to all CCG staff. Prescription Prescribing Authority (PPA) Mrs Tingle confirmed that she had spoken with Mrs Shepherd regarding the methodology for setting PPA budgets.

Mrs Devanney

5. Risk Register Options Proposal Mrs Hague informed the Executive Committee that, as at the beginning of Quarter 1, NHS Doncaster CCG holds 5 Risk Registers - Corporate Services, Finance and Contracting, Quality and Safety, Strategy and Delivery. One additional risk register has been developed following Primary Care Delegation from 1st April 2016, Primary Care and Partnerships. A full review was undertaken by the Chief of Corporate Services and the Corporate Governance Manager at the beginning of Quarter 1 and the following options were identified as a way forward which will remove duplication and ensure that the risk register is up to date and all emerging risks are identified promptly:

Option 1 - Do nothing however this will result in no consistency in registers, duplications on registers, no updates by teams and no real ownership of registers.

Option 2 – Have a combined risk register managed by the Corporate Governance Manager and the risk register will be presented to the appropriate Committees on a quarterly basis.

Option 3 – Keep registers as they are and risk registers go to the appropriate Committee on a quarterly basis.

Mrs Hague will continue to meet with the Chief of Corporate Services, Chief of Strategy & Delivery, Chief Finance Officer, Chief Nurse and Chief of Partnership Commissioning and Primary Care to review and update the risk register which will then be aligned to the Assurance Framework. Mrs Sherburn queried which Committees will receive the Risk Registers. Mrs Atkins Whatley stated that they will go to the Audit Committee and the Primary Care Commissioning Committee. The Governing Body will receive them via the Assurance Framework. Risks associated with Continuing Healthcare and Previous Unassessed Periods of Care (PUPoC) will be incorporated in the Assurance Framework and Risk Register respectively.

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The Executive Committee approved Option 2.

6. Proposed changes to the Hosted Health & Safety service. Mrs Atkins Whatley explained that the South Yorkshire and Bassetlaw CCGs are all party to a shared Health & Safety Service which is hosted by NHS Doncaster CCG. The service commenced on 1 December 2015 when the team transferred to NHS Doncaster CCG from Yorkshire & Humber Commissioning Support. The service is covered by a Memorandum of Understanding signed by all parties. The service currently comprises the following elements: Competent Person for health and safety Competent Person for Fire Safety Accredited Local Security Management Specialist (LSMS) Waste Management lead and advice / Dangerous Goods

Safety Advisor Expert advice on health and safety management including

external on-site contractor management processes Advice, support and provision of health and safety mandatory

and enhanced training such as health & safety, fire, security, and manual handling

On-site inspections and audits Support and advice on Health and Safety Executive matters

and reviews External incident reporting and management (e.g. RIDDOR) Support for development and review of policies associated

with the service Facilities Management liaison with NHS Property Services The service which transferred comprised of 3 staff - Head of Health, Safety & Security (1 wte), Competent Person, Health & Safety Manager (0.8 wte) and Support Officer (1wte) (vacant). Following discussions with service liaison leads across the 5 participating CCGs, it was agreed not to replace the Support Officer post when the previous incumbent left the organisation. The current Head of Service for Health, Safety & Security has been recruited to the Assistant Chief Officer role within NHS Rotherham CCG. To enable the service delivery to continue for the South Yorkshire & Bassetlaw CCGs and to realise further savings the following proposal has been developed.

For the current Head of Service to continue to lead the strategic development and management of the service across the South Yorkshire & Bassetlaw CCGs, utilising up to 4 hours a week of time from the Assistant Chief Officer role. This would provide service resilience and strategic leadership to the service.

For the service host to change from NHS Doncaster CCG to

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NHS Rotherham CCG including a possible TUPE of the existing Band 5 role.

To offer more hours to the current 0.8wte Band 5 to 1wte Band 5 to provide further resilience.

For the service to reduce from the current “enhanced” service to a health, safety & security compliance service.

For the South Yorkshire & Bassetlaw CCGs to realise a cost saving.

Further to this proposal it has also been recommended that there is a formal resilience agreement between the two CCGs for the following areas:

Governance

Emergency Planning, Response and Resilience (EPRR)

Business Continuity Management (BCM) If accepted, the Chief of Corporate Services at NHS Doncaster CCG and the Assistant Chief Officer at NHS Rotherham CCG would provide urgent cover for each other, if required, from 1st August 2016. The Executive Committee agreed the proposal for the new Health & Safety service model and the changes in hosting the new service and noted the resilience arrangements.

7. Proposed Changes to the Hosted CHC PUPoC – Options Mr Russell updated the Executive Committee that an option paper has been prepared relating to the Previous Unassessed Periods of Care (PUPoC) hosted service. Currently NHS Doncaster CCG hosts the service for 12 CCGs for PUPoC and five CCGs for appeals team and clinical leadership. A Memorandum of Understanding exists across the 12 CCGs which states how we work together and the responsibilities for any staffing changes within the team. The following options have been suggested:

To continue the current service across the 12 CCGs.

Consider a more discreet footprint.

Each CCG hosts its own PUPoC service. Risks have been identified for staff members. There are currently 18.5wte staff on permanent contracts and there is a number of staff who are on temporary contracts however as some of these contracts have been extended over time, those staff now have employment rights in cases of redundancies. NHS Doncaster CCG Lay Representatives have been informed and Mrs Pederson recently held discussions with both Mrs Alison Knowles, Locality Director – NHS England North (Yorkshire & the Humber) and Mrs Margaret Kitching, Chief Nurse North, NHS

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England. Mrs Shepherd is attending the South Yorkshire and Bassetlaw Chief Officer meeting on 11th July to discuss the option paper and Mrs Tingle has briefed all Chief Finance Officers in the Chief Finance Officer meeting on 1st July 2016. The option paper will also be discussed in the next Continuing Healthcare Delivery Group meeting and the August Strategy & Organisational Development Forum. NHS England has given a deadline of September 2016 for the completion of all PUPoC cases and NHS Doncaster CCG will remain under pressure to complete. The Executive Committee noted the update.

8. Dietetics discussion paper Mrs Forrestall attended the Executive Committee meeting to present a paper regarding the current Dietetics service. Dietetic services in Doncaster are currently provided by Doncaster and Bassetlaw Hospitals NHS Foundation Trust (DBHFT) and Rotherham, Doncaster and South Humber NHS Foundation Trust RDaSH, which is a result of part of the resource being transferred under Transfer of Undertakings (Protection of Employment) (TUPE) from the acute trust to RDaSH in April 2012. Referral criteria for the services have not been defined by NHS Doncaster CCG nor are there specifications in place, and as a result there is no clear distinction between the two services. The RDaSH service manages the dietetic need of patients within their services, however over time, it appears the service also manages housebound patients and care home residents. The DBHFT service manages all other outpatients, both adults and children, as well as managing their own inpatients in need of dietetic support. It seems to have evolved to become more specialist and as commissioners we need to decide whether this is what we require. There is not a single entry route for referrers to support appropriate triage. Both services manage the same conditions however there is variance in terms of criteria, management approach and follow up. The two services do work together on some conditions, primarily diabetes; however in other areas there is overlap in provision and the services are largely independent of one another. Along with the increasing referrals, there is an increase in the cost associated with the prescribing of nutritional products. Both DBHFT and RDaSH manage the ordering and issuing of nutritional supplements for their own inpatient wards, however there seems to be limited management of prescribing in the

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community. Care homes are increasingly using sip feeds for emerging nutritional difficulties, making direct requests for prescriptions to primary care. In addition to this there is currently a large number of patients receiving enteral feeds via home delivery from an external company however this is currently under procurement via DBHFT. The company provides expert training and specialist care for patients leaving hospital and being cared for in the community as part of the service offer at no additional cost. The outcome of the procurement could also mean that this element of current provision is no longer available, putting extra pressure on the system. The proposed approach is to explore the option of one community based service which holds a centralised budget for consumables. Transferring the responsibility for prescribing nutritional products from Primary Care to the centralised service, could result in the improved management of dietetic products in the community. Mrs Forrestall stated that she would also reissue advice and guidance to Care Homes in relation to weight loss and enriched diets. GP practices will be contacted to request that any referrals include a Malnutrition Universal Screening Tool (MUST) score and other reasons for weight loss are explored prior to referring to the dietetic service. Mrs Pederson suggested that the Medicines Management Team need to be fully involved in the development of any future model of care. Mrs Pederson also suggested that the proposed model be presented to the Clinical Reference Group in the first instance then a Business Case to the Executive Committee for approval and that updates be provided to the Executive Committee. Mrs Forrestall highlighted that, at present, a clinical GP lead has not been identified for support and consultation. Dr Crichton suggested that Mrs Forrestall consult with either Dr Bradley or Dr Alsindi and stated that he would speak with Dr Bradley in the first instance. The Executive Committee agreed the exploration of options.

Mrs Forrestall Dr Crichton

9. Domestic Abuse Strategy Mr Russell stated that he had previously circulated the Domestic Abuse Strategy to the Executive Committee for information and comments and queried if, as a CCG, we wished to give a formal response on the strategy. Mr Russell explained that strategy has been completed with a multi-agency approach, led by the Local Authority, and is a consistent method in response to violence. The document has also been presented at a TARGET session. The Executive Committee agreed that an official response be provided that NHS Doncaster CCG is supportive of the strategy

Mr Russell

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and will continue to participate and support as necessary.

10. Joint Commissioning Co-ordination Committee Meeting Mrs Pederson informed the Executive Committee that the Joint Commissioning Co-ordination Committee is a newly formed group with colleagues from NHS Doncaster CCG and the Local Authority. The Committee will be instrumental in creating solutions on how joint commissioning will be achieved, investment to release resources particularly regarding the current Intermediate Care Plan and the approval of future Business Cases. Mrs Pederson highlighted that it will be essential that the Committee be mindful of Conflict of Interests going forward and Mrs Atkins Whatley offered to attend the meeting should her knowledge and expertise be required. The Executive Committee noted the update.

11. Bring Forward Agenda Mrs Pederson suggested to the Executive Committee that it may be useful to create Bring Forward Agendas for both the Strategy & Organisational Development Forum and Governing Body future meetings for discussion/agreement at this meeting. The Committee agreed that this would prove beneficial. The Committee agreed the following: Strategy & Organisational Development Forum July 2016

Sustainability & Transformation Plan and Place Based Plan. (Mrs Pederson)

Care Home Strategy. (Mr Boldy)

Locality Model discussion and Workshop. (Dr Crichton) August 2016

Children’s Services (Surgery and Anaesthesia). (Mrs Sherburn)

Previous Unassessed Periods of Care (PUPoC Options Appraisal. (Mr Russell)

September 2016

GP 5 Year Forward View. (Mrs Sherburn)

Doncaster Place Based Plan. Mrs Pederson)

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October 2016

Efficiency Plan progress. (Mrs Tingle/Mrs Leighton)

Prevention Strategy. (Mr Joseph) November 2016

2017/18 Planning session. (Mr Fitzgerald) Feedback on Organisational Development will also be scheduled once dates are confirmed. Governing Body July 2016

Hyper Acute Stroke Unit Option Appraisal. (Mrs Sherburn).

Chemotherapy Delivery Model – Case for Change. (Mrs Sherburn)

Local Digital Roadmap. (Mr Clayton)

Patient Transport Service. (Mrs Ayres) August 2016

Children’s Services (Surgery and Anaesthesia). (Mrs Sherburn)

12. Any Other Business TARGET Mrs Tingle reported that an agreement has been reached with General Practice regarding the provision and funding of cover for TARGET sessions. A number of options were discussed and procurement requirements considered. It was then suggested that a contract variation will be made regarding the existing contract with Fylde Coastal Medical Service (FCMS) who will provide cover. The Executive Committee agreed that contract variation be made for a period of 1year + 1year + 1year. Mrs Tingle agreed to start contractual discussions with FCMS colleagues. Minutes for noting by the Executive Committee The Executive Committee agreed that the minutes from the System Resilience Group and the RDaSH/DBHFT Strategic Contracting meetings be presented to the Committee for noting in the future.

Mrs Tingle Mrs Tingle Mrs Satterthwaite

13. Date and Time of Next Meeting Wednesday 3 August 2016 at 10am, Dr Crichton’s Office, Sovereign House

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