GOVERNING BODY MEETING – PUBLIC SESSION · 2019-11-20 · GOVERNING BODY MEETING – PUBLIC...

GOVERNING BODY MEETING – PUBLIC SESSION

Agenda for the meeting to be held on Tuesday 26 November 2019 from 10:00hrs, Conference Room, Southgate House, Devizes

Item Number Item Lead Format Timings

GOV/19/11/01 Welcome and apologies for absence CHAIR VERBAL

10:00 10 mins

GOV/19/11/02 Questions/Comments from the Public CHAIR To be tabled

GOV/19/11/03

Declarations of Interest Members are reminded of their obligation to declare any interest they may have on any issues arising at the meeting which might conflict with the business of the Wiltshire Clinical Commissioning Group (CCG). (This includes any relevant interests previously declared on the Register of Interests)

CHAIR VERBAL

GOV/19/11/04 Approval of the Minutes of the Wiltshire Governing Body Meeting in Public held on 24 September 2019

CHAIR ENC

GOV/19/11/05 Matters Arising CHAIR VERBAL

GOV/19/11/06 Action Tracker CHAIR ENC

GOV/19/11/07 Chair’s Report CHAIR VERBAL 10:10 5 mins

GOV/19/11/08 BSW Chief Executives Report and Wiltshire Chief Operating Officer Report

Tracey Cox / Ted Wilson PRESENTATION 10:15

10 mins

GOV/19/11/09 Register of Sealing’s - none CHAIR VERBAL 10:25 -

ITEM FOR DECISION

None

ITEMS FOR DISCUSSION

GOV/19/11/10 BSW Performance and Finance Report and Wiltshire CCG Integrated Performance Quality Report

Ted Wilson / Caroline Gregory PRESENTATION 10:25

20 mins

GOV/19/11/11 Wiltshire Winter Plan – Additonal Capacity 2019/20 Update Ted Wilson PRESENTATION 10:45

15 mins

GOV/19/11/12 Audit Committees in Common Update Peter Lucas ENC 11:00 5 mins

GOV/19/11/13 BSW Quality, Performance and Assurance Committee Update Gill May VERBAL 11:05

5 mins

GOV/19/11/14 Health and Wellbeing Board Meeting Draft Minutes – 26 September 2019 Ted Wilson ENC 11:10

5 mins

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ITEMS TO NOTE

GOV/19/11/15 Memorandum of Understanding for Collaborative Working Between Public Health and Wiltshire CCG

Hayley Mortimer, Public Health ENC 11:15

-

GOV/19/11/16 Review of Register of Interests CHAIR ENC 11:15 -

GOV/19/11/17 Any Other Business ALL VERBAL 11:15 -

Date of next Governing Body Meeting in Public: Wednesday 11 December 2019, 17:00hrs at Hilton, Swindon

The Public version of the CCGs Register of Declarations of Interests can be found on our website here: http://www.wiltshireccg.nhs.uk/governance

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http://www.wiltshireccg.nhs.uk/governance

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DRAFT MINUTES OF WILTSHIRE CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BODY MEETING IN PUBLIC

HELD ON TUESDAY 24 SEPTEMBER 2019, 10.00HRS AT SOUTHGATE HOUSE, DEVIZES

Voting Members Present: Dr Richard Sandford-Hill RSH Clinical Chair of Wiltshire CCG Tracey Cox TC BSW Chief Executive Caroline Gregory CG BSW Chief Financial Officer Christine Reid CR Vice Chair, Lay Member, Patient and Public Involvement Peter Lucas PL Lay Member for Audit and Governance Julian Kirby JK Lay Member Dr Mark Smithies MS Secondary Care Doctor Gill May GM BSW Director of Nursing and Quality / Registered Nurse Dr Toby Davies TD GP, Chair of Sarum Dr Catrinel Wright CW GP, Chair of West Dr Andrew Girdher AG GP, Chair of North and East Wiltshire (NEW)

In Attendance: Jo Cullen JC Director of Primary Care and Urgent Care Ted Wilson TW Director of Community and Joint Commissioning Julie-Anne Wales JAW Interim Head of Corporate Planning and Governance Dr Helen Osborn HO Medical Advisor Tamsin May TM BSW Deputy Director of Communications and Engagement Sharon Woolley SW Board Administrator Helen Scott HS Transformation Business Manager Primary Care (for item 12)

Apologies: Linda Prosser LP Interim Deputy Chief Executive (Wiltshire) Tracy Daszkiewicz TDas Director of Public Health and Public Protection Lucy Baker LB Acting Commissioning Director (Maternity, Children and Mental

Health) Group Director (Sarum) Andrew Mintram AM Healthwatch Wiltshire Mark Harris MH Chief Operating Officer

ITEM NUMBER

ACTION

GOV/19/09/01 Welcome and apologies for absence RSH welcomed all to the meeting. Apologies were noted as above.

GOV/19/09/02 Questions/Comments from the Public Four questions had been received from Don Harper, Secretary, National Pensioners Convention Wessex Region. RSH read out the following.

We have seen reports that some CCGs have stopped commissioning certain treatments/ operations such as hernia, cataracts, knee/ hip replacement on the grounds that they have low clinical value. Yet none of these treatments is so classified by the National Institute of Health and Care Excellent (NICE). In our view NICE is the body with the highest expertise to determine what treatments/ interventions have low clinical value.

GOV/19/11/04

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We would therefore like to know: 1. Has the CCG stopped commissioning/ have you decided to stop commissioning in future any of those or other treatments on such basis although they are not considered of low clinical value by NICE? If so, which one(s)? Last year, NHS England launched its Evidence-Based Interventions Programme aimed at preventing avoidable harm to patients, avoiding unnecessary operations, and freeing up clinical time by only offering interventions that are evidence-based and appropriate. The Evidence-Based Interventions programme guidance was developed in partnership with the Academy of Medical Royal Colleges, NHS Clinical Commissioners, the National Institute for Health and Care Excellence (NICE), NHS England and Improvement, Royal Colleges, specialist societies, Clinical Commissioning Groups, providers, patients and the public. The guidance came into effect April 2019 and included 17 interventions - four that should not be routinely offered to patients unless there are exceptional circumstances and 13 interventions that should only be offered to patients when certain clinical criteria are met. Wiltshire CCG complies with these guidelines and monitors progress against them in line with the guidance produced by NHS England. The interventions are: • Intervention for snoring • Dilatation and curettage for heavy

menstrual bleeding • Knee arthroscopy with

osteoarthritis • Injection for nonspecific low back

pain without sciatica • Breast reduction • Removal of benign skin lesions • Grommets for glue ear in children • Tonsillectomy for recurrent

tonsillitis • Haemorrhoid surgery

• Hysterectomy for heavy menstrual bleeding

• Chalazia removal • Shoulder decompression • Carpal tunnel syndrome release • Dupuytren’s contracture release • Ganglion excision • Trigger finger release • Varicose vein surgery.

We had already developed policies for many of these, detailing the clinical criteria that need to be met for the procedure. There is more information on the treatments and services we do and don’t fund on our website www.wiltshireccg.nhs.uk/what-we-do-and-dont-fund We have not stopped commissioning treatments for cataracts, hernias or hip replacements. For hernias we have a triage process that considers whether the procedure can be performed under local anaesthetic which helps reduce waiting times for patients. For all orthopaedic referrals we have commissioned an intermediate orthopaedic service which allows a greater range of interventions to be considered prior to surgery where this is appropriate. 2. Does the CCG Board agree that commissioning policy on specific treatments should comply fully with current NICE guidance? We agree that we should fully implement NICE Technology Assessments for medicines and comply with both the Low Value medicines programme and the Evidence Based Intervention programme.

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Clinical guidance issued by NICE is not mandatory for CCGs but in most circumstances we fully support the adoption of NICE guidance. However, sometimes we have to take difficult decisions in order to maintain our statutory obligation to remain within our budgetary allocation and ensure that the population health needs are appropriately and fairly provided for. 3. If not, why not? N/A 4. What other factors does the CCG Board consider, in addition to NICE guidance, when formulating commissioning policy? Commissioning policy and decisions are formed using best practice evidence and benchmarking information which highlights where we may have opportunities to improve how services are delivered. For Clinical Commissioning Groups this includes the NHS England Right Care Programme and Elective Transformation Programme. For providers this includes the Getting It Right First Time Programme. These programmes are based on reducing unwarranted clinical variation. A written response would also be sent to Don Harper following the meeting.

GOV/19/09/03 Declarations of Interests Members were reminded of their obligation to declare any interest they may have on any issues arising at the meeting which might conflict with the business of the Wiltshire Clinical Commissioning Group (CCG). (This included any relevant interests previously declared on the Register of Interests) There were none declared. The meeting was quorate.

GOV/19/09/04 Approval of the Minutes of the Governing Body Meeting in Public held on 23 July 2019 The minutes of the meeting held on 23 July 2019 were approved as an accurate record.

GOV/19/09/05 Matters Arising There were no matters raised.

GOV/19/09/06 Action Tracker The action tracker was reviewed and updated. GOV/19/01/15 - JC advised that this related to an issue with one practice and a discrepancy in the Information Governance advice they had received concerning data sharing. GM advised that a meeting focussing on data sharing was to be held with the Local Medical Committee. GM and JC would continue to work on this and would bring an update to the November meeting. ONGOING GOV/19/07/15 - TW advised that the Diabetes Programme Board meeting had been rescheduled to early October. The Respect Form was to go through national modifications, which may result in it not being available until February. TW would bring an update when appropriate (February 2020). ONGOING

GM / JC

GOV/19/09/07 Chair’s Report On behalf of the Board and CCG staff, RSH wished to thank MS for his support and commitment to the CCG over the years, in particular support to the Quality team and the valued secondary care input into matters. MS would be leaving the

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CCG today. LP would be leaving the CCG on 2 October 2019 after being with the CCG for two years. RSH noted that LP had led the organisation well ensuring it was in a good position, helping to maintain the CCGs overall rating of ‘good’. A vote concerning the proposed merger of BaNES, Swindon and Wiltshire (BSW) CCGs had been conducted with BSW practices 4 to 14 September 2019. Practices across Wiltshire and the wider footprint had been in overwhelming support and agreed the pursuit of the merger. This would be further ratified by each Governing Body at the BSW Governing Bodies in Common meeting being held on 25 September 2019.

GOV/19/09/08

Deputy Chief Executives Report TC wished to echo the thanks to MS who had been a vital supporter and advocate for the CCG. TC talked through the report, as prepared by LP, and highlighted the following: • Transition to new BSW structure – Alison Kingscott and Sheridan Flavin

had been appointed as the Directors of Workforce and Organisation Development on an interim, job share basis. TW would commence as the Acting Locality Director for Wiltshire from 1 October 2019. Hunter Executive were supporting the recruitment of the Locality Director roles for Swindon and Wiltshire.

• Merger consultation – The practice vote ended on 17 September, showing support for merging BSW CCGs. Wiltshire had a turnout of 83%, with 67% voting yes towards the merger. BaNES CCG had a turnout of 75% with 89% voting in favour, and Swindon CCG had a turnout of 70% with 87% voting yes. TC was aware of some reservations about the merger across the patch and would ensure more engagement work was undertaken with practices and Primary Care Networks (PCNs) to demonstrate the benefits of creating one CCG. The application was to be submitted to NHS England by 30 September 2019. A regional panel meeting would be held on 9 October, at which an initial verbal outcome would be given.

• A BSW wide PCN engagement event was to be held on 1 October 2019 with leads, the support offer from the CCGs would be discussed. Quarterly meetings would be held going forward.

• The draft BSW Sustainability Transformation Partnership (STP) Long Term Plan was to be submitted by 27 September 2019, with the final to be submitted by 1 November 2019. The final plan, detailing the aspirations of the system would be brought to the October Governing Body meeting.

• An independent Chair of the BSW STP was to be appointed; this was an expectation of the move to an Integrated Care System. The role would be advertised soon. Panel nominations had been requested from the STP Sponsoring Board. There would be wider stakeholder involvement in the process.

GOV/19/09/09 Register of Sealing There were no sealings to record.

ITEMS FOR DECISION GOV/19/09/10 Governing Body Sub Committee Item for Approval:

The Governing Body were asked to approve the following item:

a) Wiltshire CCG Risk Register JAW advised that a new process for managing risks was to be implemented across the BSW, which would include a Risk Management Panel and introducing a risk appetite. Further detail would be brought to the October Governing Body meeting.

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The top risk referred to the ambulance response times for South Western Ambulance Service Trust (SWAST). GM advised that SWAST has requested that each CCG note a call stacking risk upon their own risk registers to ensure it was recognised. All risks would be further reviewed by the Risk Panel. A number of risks were a key priority of the Long Term Plan and would be a focus for service commissioning and integrating services. Risks relating to winter pressures were expected.

The Risk Register was approved by the Governing Body.

ITEMS FOR DISCUSSION GOV/19/09/11 Winter Plan 2019/20 Update

JC talked through the slides regarding the first draft of the BSW System Sustainability (Winter 2019/20) Plan. Wiltshire’s focus was the South Wiltshire system as the lead for the South Wilshire A&E Local Delivery Board. This would feed into the Swindon and B&NES systems. Key lines of enquiries had been identified against each of the five domains to provide assurance to the Board and wider system that action, plans and schemes were in place. Links had been formed with health and social care providers where needed. The lessons learnt from 2018/19 had been incorporated into the 2019/20 plan. As part of SFT’s operation - the fifth option could be to further reduce delayed transfers of care (DTOC) figure, but capacity within the system was needed to ensure patients could be moved. TW advised that capacity reviews had indicated that pathways one and two had capacity gaps and were creating blockages affecting the flow through the system. It was a challenging position to work from, particularly over winter. The joint challenge with Wiltshire Council was to improve the process to ensure the system could cope with pressure points. A range of other ‘contingency’ initiatives were in place, but the realisation of their impact was unknown, it may be a few months later. Other initiatives were being looked at to build resilience and reduce impact. Wiltshire Council had received an additional £1.8m to support winter pressures. They were focussing on pathway three as their biggest challenge. Additional domiciliary care and care home capacity would be bought, which would also benefit pathways one and two. The Council had commissioned an additional 30 beds across the system and 800 hours of bridging/reablement domiciliary capacity. A Trusted Assessment and Trusted Assessor pilot for SFT was expected to commence in November. A rollout to the north and west of the county would be raised at the Wiltshire Integration Board. JK felt that the capacity was there in the wider system if non-clinical and non-medical options were considered. (10.55hrs – HS joined the meeting) AG raised the issue concerning frontline staff flu vaccinations that were to be recorded as part of domain five external events. Guidance in place meant that GP’s and nurses could not vaccinate members of their own practice staff due to occupational health reasons. ACTION: GOV/19/09/11 - Discussion to be taken outside of the meeting concerning the national guidance issued to practice staff regarding flu vaccinations to own practice staff. Communications to be shared with practices with clear guidance.

JC / GM

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TM reported that the BSW winter communications plan was to be draft by the end of the week. TC advised that the Long Term Plan expects the system to implement a rapid/crisis response of two hours as part of out of hospital care. BSW providers were not in a position to provide this; a cost would be associated with delivery of this. A £4.5bn investment was to bring a new service model and increased capacity. Opening more intermediate care beds was to be a last resort. Upskilling community services would help towards reducing the workforce challenge. JK advised that in Bath, Age UK Wiltshire provide a Home from Hospital service to aid patients and GP, a redeployment of non-clinical support.

GOV/19/09/12 Primary Care Transformation JC advised that HS was a Practice Manager seconded into the CCG to support the primary care transformation programme. The slides updated the Board on the commissioned transformation work undertaken by McKinsey’s, the programmes achievements, next steps and embedding the legacy. HS talked through the lessons learnt from the transformation work and shared a number of case studies of schemes implemented by PCN’s. These success stories needed to be widely shared to encourage other PCN development and schemes. The CCG were particularly interested in the work undertaken by the North Wiltshire Border PCN to design a workforce model based upon population health analytics, as a potential link to the proposed BSW transformation project. Feedback from PCNs regarding the primary care transformation programme was shared with members, along with feedback from patients on their primary care experience. JC talked through the national context and the seven domains. Wiltshire had progressed well against the domains and was now in a good position to move forward. A BSW ‘Academy’ support offer to PCNs was being developed which would encourage integrated working and a quality improvement approach. A primary care transformation team would be established, which would keep the momentum going, utilising existing skills within the team and networks. A maturity matrix was to be completed with BSW PCNs to establish their status. A handbook of all the gathered information, learning, case studies and tools over the programme had been created and was available to share with PCNs. An event for Wiltshire PCNs was being held on 8 October to celebrate the programme achievements. A suggestion was made that items from the event could be videoed to share with B&NES and Swindon PCN’s for information. ACTION: GOV/19/09/12 – Communications Team to consider the feasibility of recording elements of the Wiltshire Primary Care Celebratory event to share with B&NES and Swindon PCN’s.

TM

GOV/19/09/13 Board Assurance - No Deal EU Exit JAW presented the paper to the Board which demonstrated that sufficient assurance was being provided regarding BSW preparations made across the BSW for a no deal EU exit. This had also been submitted to the regional EU Exit Team. JAW was undertaking the BSW Senior Responsible Officer EU Exit role. The paper highlighted two concerns where the assurance rating was amber – concurrent incident management capacity and risks within the domiciliary care

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and care home sectors. A BSW workshop was being planned for 11 October 2019, which would also involve a number of key local stakeholders, and would test the escalation plans and look at how additional incidents would be managed. Louise Cadle, Head of Emergency Preparedness, Resilience and Response (EPRR) was to join BSW on 30 September 2019. Members reported that there had not been any major concerns raised by the public concerning the EU exit, but any concerns would be shared. The key message to share was that stockpiling of medication was not required. Communications was to be shared with community pharmacists concerning the supply of medication and replacements. The role the Prescription Ordering Direct services could play in medicine management during the exit with patients was also to be considered. Representative from the Local Pharmaceutical Committee (LPC) were to attend the October workshop. ACTION: GOV/19/09/13 - Communications to be shared with community pharmacists with key messages regarding the supply of medication.

JC / JAW / TM

GOV/19/09/14 Wiltshire Obesity Strategy TW talked through the paper which provided an update on the outcomes from the current Strategy and proposal for a legacy programme. This work was led by Wiltshire Council, in partnership with the CCG and Public Health. The legacy programme proposal from the Obesity Strategy Implementation Group to the Board (and also presented to the Health and Wellbeing Board) was to revise the focus to create a narrower and stronger remit and a wider system approach. The Board noted the outcomes to date since the strategy was published in 2016, and the proposed Wiltshire legacy programme. MS queried what was being delivered through the legacy programme to encourage walking, cycling and use of public transport as part of the environment priority. TW would pick this up with the Council and circulate information to the Board in due course. ACTION: GOV/19/09/14 - Walking, cycling and the use of public transport to be considered as part of the legacy programme. TW to take back to Wiltshire Council.

TW

GOV/19/09/15

Audit Committees in Common Update The approved minutes from the Wiltshire CCG Audit Committee meeting held on 9 July 2019 were circulated with the meeting papers and noted. PL reported that the first BSW Audit Committees in Common meeting had been held on 17 September 2019. A common workplan was in place and audit reports aligned across the BSW where possible. Committees reviewed the proposed risk management process and recommended it for Governing Body approval. This would be presented to the October meeting.

GOV/19/09/16 BSW Quality, Performance and Assurance Committee Update GM reported that due governance had been applied at the first joint BSW meeting of the Quality, Performance and Assurance meeting held on 19 September 2019. The minutes from the last individual CCG’s quality committee meetings had been signed off and would be shared with Board members. A review of the new terms of reference had been the main focus. Representatives from each CCG had now been agreed. Paul Byrnes, the Lay

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Member for Swindon CCG was appointed as the Chair of the Committee for the next six months. The BSW quality and performance dashboard had been reviewed; this would also be brought to Governing Body meetings going forward.

GOV/19/09/17 Health and Wellbeing Board Meeting Draft Minutes – 25 July 2019 The draft minutes from the Health and Wellbeing Board meeting held 25 July 2019 were noted.

GOV/19/09/18 Any Other Business

There was none.

The meeting concluded at 12.00hrs

Date of next Governing Body Meeting in Public: Wednesday 25 September 2019, 18:00hrs at Hilton, Swindon

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ITEM PAPER TITLE / AGENDA REFERENCEACTION PERSON

RESPONSIBLEUPDATE TO BE

PROVIDEDUPDATE STATUS

GOV/19/01/15 Improved Access Update DMcA to investigate the information governance barriers impacting upon the delivery of Improved Access and those on the End of Life and palliative care pathway.

DMcA / SP CG / GM / Steve Mapleston / JC

01/03/2019 May-19 July-19 Sep-

19 Nov-19

Update 26/3/19 - DMcA advised that the CCG would be further engaging with primary care to resolve the access to information issues for patient identifiable and non-patient identifiable data. To date there had not been successful communication with practices concerning the sharing of information and some guidance was conflicting. This had been discussed at the Information Governance Group meeting held in March. The data sharing agreement was to be reviewed. SP as the CCGs SIRO would request clarification of definitive advice through the IG Group and report back to the Governing Body. Update 28/05/19: DMcA advised that this concerned a number of practices and the sharing of non-patient identifiable information. Assurance had been given that this would not be a breach of confidentiality, but further assurance was required. DMcA and SP were to meet with the group to answer their questions and concerns. (Dependent on timescales, this action may transfer to the new Chief Financial Officer and Director of Nursing). Update 23/07/19: GM advised that this was a wider issue than just for Wiltshire. Steve Mapleston (SCCG) was developing a sharing agreement and looking into the outcome of any potential sharing breaches. Update 28/08/2019: Project currently being scope across B&NES Swindon and Wiltshire (BSW) to enable relevant IG to be in place at care homes to enable NHS Mail and GP Clinical systems access. Target for 15% BSW Care Homes to be live with NHSmail by 31 March 2020.

DPIA (Data protection impact assessment) created for BSW to enable the sharing of information via the new national NHS GP Connect platform, working closely with NHSE Digital to enable this. Data sharing agreement also currently being drafted in conjunction with the GPs Practice Data Protection Officer.

Wider piece of work underway to procure a BSW wide interoperability platform that will support future needs such a shared care plans and feed into wider national /regional systems.Update 24/09/19: JC advised that this related to an issue with one practice and a discrepancy in the IG advice they had received concerning data sharing. GM advised that a meeting focussing on data sharing was to be held with the Local Medical Committee. GM and JC would continue to work on this and would bring an update to the November meeting.

ONGOING

GOV/19/07/15

Wiltshire End of Life Strategy - RESPECT Form

TW to ensure new RESPECT form is transferable from secondary care and primary care.

Ted Wilson 01/09/2019 Feb-20

Update 19/08/19: Respect will form an agenda item at the next End of life programme board. Board is due to take place on 27 September. An update will be given on the development of Respect and wider considerations around implementation including transferability. Update 24/09/19: TW advised that the Programme Board meeting had been rescheduled to early October. The Respect Form was to go through national modifications, which may result in it not being available until February. TW would bring an update when appropriate.

ONGOING

GOV/19/09/11

Winter Plan 2019/20 Discussion to be taken outside of the meeting concerning the national guidance issued to practice staff regarding flu vaccinations to own practice staff. Communications to be shared with practices with clear guidance.

JC / GM Nov-19 ONGOING

GOV/19/09/12

Primary Care Transformation - Celebration Event 08/10/19

Communications Team to consider the feasibility of recording elements of the Wiltshire Primary Care Celebratory event to share with B&NES and Swindon PCN’s. TM Oct-19

Update 11/10/19: Unfortunately this was not feasible within the timeframe. Information about the project will be sent out to members in electronic format instead.

CLOSED

GOV/19/09/13Board Assurance - No Deal EU Exit Communications to be shared with community pharmacists

with key messages regarding the supply of medication. JC / JAW / TM Nov-19 ONGOING

GOV/19/09/14

Wiltshire Obesity Strategy Walking, cycling and the use of public transport to be considered as part of the legacy programme. TW to take back to Wiltshire Council.

TW Nov-19

Update 30/09/19: Note from Public Health circulated by SW concerning the refresh of the core strategy and its associated policies and programmes. CLOSED

Governing Body Meeting in Public - 23 July 2019

WILTSHIRE CCG GOVERNING BODY IN PUBLIC ACTION TRACKER - APRIL 2019 - MARCH 2020

Governing Body Meeting in Public - 22 January 2019

Governing Body Meeting in Public - 24 September 2019

19/11/2019

GOV/19/11/06

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Working together: NHS Bath and North East Somerset Clinical Commissioning Group NHS Swindon Clinical Commissioning Group NHS Wiltshire Clinical Commissioning Group

BSW Performance Report October 2019

GOV/19/11/10

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BaNES, Swindon and Wiltshire Commissioning Alliance

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WCCG - Performance Summary Workstream Performance Measure Period Perf. Rating Page

Planned Care

RTT Incompletes - % waiting less than 18 weeks Aug 19 87.9% 4-8 RTT Waitlist difference to plan Aug 19 +3,288 4-8 RTT 52 Week Waits Aug 19 0 9

Diagnostics - % waiting less than 6 weeks Aug 19 96.1% 10-13

Cancer – Referral to Treatment within 62 days Aug 19 78.9% 14-18

Urgent Care A&E 4-Hour Target Aug 19 95.0% 19-21

Stranded Patients Reported Separately

Ambulance & NHS111/IUC N/A 22

Mental Health

Dementia Diagnosis Rate Aug 19 65.6% 23 Improving Access to Psychological Therapies (IAPT) Various 23 Early Intervention in Psychosis (EIP) – treated < 2 wks of referral Jul 19 75.0% 23 Out of Area Admissions May 19 70 24

Local Authority

DToC Aug 19 3.7% 27-31 Care Home Placements Jul 19 N/A 32 Reablement Jul 19 N/A 33

Community Wiltshire Health and Care Aug 19 N/A 34 Swindon Community Health Services Aug 19 N/A 35 Virgin Care Aug 19 N/A 36

RAGs: Above national standard = Green, below standard but above local plan = Amber, below local plan = Red

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BSW Performance Summary Workstream Performance Measure Period Perf. Rating Page

Planned Care







Mental Health


Local Authority




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NHS Constitutional Targets

Referral to Treatment Incompletes (RTT) Target = 92.0% 92% of patients still waiting for non-urgent consultant led treatment at the end of the reporting period should have been waiting no more than 18 weeks.

Cancer 62 Day Referral to Treatment Target = 85.0% 85% of patients beginning their first definitive treatment for cancer within the reporting period should have been waiting no more than 62 days from receipt of an urgent GP referral for suspected cancer.

Diagnostic Waiting Times (DM01) Target = 99.0% 99% of patients still waiting for a diagnostic test at the end of the reporting period should have been waiting no more than 6 weeks.

A&E 4 Hour Target = 95.0% 95% of patients attending A&E should be admitted, transferred or discharged within four hours.

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Referral to Treatment (RTT)

GWH = 79.9%

SFT = 92.6%

RUH = 85.4%

BSW: The waitlist continues to increase with just over 1000 patients added in August - 5775 over plan. The specialties with the biggest increases compared to March are T&O, ENT and Dermatology. The waitlist for admitted treatment has reduced by approx 400 from July. RUH: increasing referrals in ENT are significant factors in the increasing waiting list; the Trust is focusing on increasing outpatient capacity in ENT to manage demand. Gastro performance continues to be challenging, particularly for 52ww breaches. GWH: GWH is actively seeking options to increase activity over Q2 and Q3 to ensure delivery of a stable waiting list by the end of the year. SFT: Planned care remains below plan, mainly in first outpatients (-3%). In-Month waiting list increases seen in Urology, Ophthalmology and Cardiology. with Gastro outsourcing arrangement now commissioned by Trust.

RAGs: Above constitution = Green, below constitution but above local plan = Amber, below local plan = Red

BSW = 86.3% (England = 81.3%) Waitlist = 61,262 (Plan 55,487)

Aug ’19

Provider Waitlists as at Aug 19

Jun-19 Jul-19 Aug-19<18 weeks 52634 52601 52845

Wait List 59954 60256 61262Performance 87.8% 87.3% 86.3%

<18 weeks 10868 11034 11250Wait List 12181 12471 12790

Performance 89.2% 88.5% 88.0%<18 weeks 12597 12509 12260

Wait List 15095 15059 15084Performance 83.5% 83.1% 81.3%

<18 weeks 29169 29058 29335Wait List 32678 32726 33388

Performance 89.3% 88.8% 87.9%

BSW

BaNES

Swindon

Wiltshire

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RTT Waiting List - BSW

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RTT Provider Detail Lead: Mark Harris

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B: Requires Improvement IAF Domain: Better Care Rating:

Working to Improve

Provider Performance Detail Narrative

GWH

79.9% Aug 19 (Down 2.3%) Below National Target of 92% Below Local Plan Target of 83.8% Main Areas of Concern: T&O – 1108 breaches (71.6%) ENT – 557 breaches (75.1%) Gynae – 447 breaches (74.5%) Gastro – biggest deterioration in performance in month

The Key specialities driving the deterioration against trajectory YTD are ENT (+585), Oral Surgery (+277), T&O (+269), Gynaecology (+228) and Dermatology (. ENT: Long term sick leave, maternity leave, consultant vacancies and lack of anaesthetic cover have all been contributing factors to deterioration in performance. Further non-admitted WLIs were planned for in Sept. A second attempt to recruit a substantive consultant commenced in Sept, with interim plans to recruit a locum. Proactive Hold File and PIFU review and validation is now embedded, which will release OPD capacity. There are also plans for Audiology to provide further support, releasing more consultant time. T&O: Issues have included a lack of anaesthetic cover, cancellations on the day, reduction of bed base due to NEL pressures, and a locum consultant vacancy. 4 joint lists with Health Care Business Solutions (weekend lists) due to commence at the end of Oct. This was delayed while contractual and governance arrangements were finalised. A locum consultant has now been appointed to support with RTT recovery plans. This post will be covering Trauma, releasing consultants for elective work. Building work and ward reconfiguration is also being investigated to boost capacity. Gynae: Increased referrals and long term sickness remain a risk. The job plan for the obstetrician vacancy has been reviewed and now includes 2 additional gynae clinics per week from Sept. Consultant on long-term S/L is due to return in Oct. Currently 2 Registrar vacancies which 1 commencing in post in August. Interviews planned for Nov for new substantive consultant post.

RUH

85.4% Aug 19 (Down 0.6%) Below National Target of 92% Below Local Plan Target of 88.3% Main Areas of Concern: Gastro – 650 breaches (73.7%) ENT – 514 breaches (77.7%) Dermatology – 330 breaches (75.1%) Cardiology – 261 breaches (86.3%)

The Trust waiting list increased to 24,256 (+813 compared to July) to remain above plan. The key waiting list growth is in ENT (+372) and Cardiology (+125). ENT: increasing demand has contributed to the 19% increase in the waiting list. The Trust is focusing on increasing outpatient capacity through WLIs to bring the waiting list down. Dermatology: the tele-dermatology pilot continues but referrals to the service are increasing, particularly for 2ww referrals. Additional locum capacity is supporting the service for one week per month. A review of roles and processes is underway with a view to creating a one-stop super clinic model. (Continued overleaf)

S: Requires Improvement W: Good

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RTT Provider Detail Lead: Mark Harris

8

Working to Improve Provider Performance Detail Narrative RUH (Continued)

85.4% Aug 19 (Down 0.6%) Below National Target of 92% Below Local Plan Target of 88.3% Main Areas of Concern: Gastro – 650 breaches (73.7%) ENT – 514 breaches (77.7%) Dermatology – 330 breaches (75.1%) Cardiology – 261 breaches (86.3%)

Cardiology: the waiting list increased in August but additional sessions were undertaken over one week in September which reviewed around 100 patients. A further week is planned for October, with a similar impact expected. The phased return of a consultant from long-term absence will increase outpatient activity. A focus on clinic letter delays is expected to improve the validation process and therefore improve performance. Gastro: the backlog of patients waiting >18 weeks is reducing and performance improved in month. A second locum took up post in August to support improvement. A joint working group with CCGs is reviewing 40 week waiters, with options for patients in community settings being considered. A Clinical Summit to discuss demand management has been arranged and outsourcing options are being explored. All patients are being called prior to appointments to ensure attendance and maximise capacity. The 52 week wait position continues to be impacted, as noted on the 52ww page.

SFT

92.6% Aug 19 (Up 0.2%) Above National Target of 92% Above Local Plan Target of 92% Main Areas of Concern: Dermatology – 254 breaches (62.0%)

SFT have achieved the 92% standard for August 2019 Gastro: Outsourcing activity commissioned by Trust to support diagnostics, cancer targets, routine backlog and screening recall activity. Some of the T&O waiting list increase is connected to Wiltshire Health & Care intermediate orthopaedic service now reporting clock starts under the new pathway as a new reporting activity.

Independent Providers by Exception

BMI Ridgeway = 87.4% Aug 19 (Performance for BSW patients only) Main Areas of Concern: T&O – 44 breaches (81.7%) Ophthalmology–44 breaches (66.7%)

B: Requires Improvement IAF Domain: Better Care Rating:

S: Requires Improvement W: Good

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Referral to Treatment – 52 Week Waits

9

Working to Improve Provider Performance Detail Narrative GWH Zero 52 Week Waits for August 2019 National target achieved for GWH 52 week waits for year to date 19/20

RUH 12 for August 2019 10 Gastroenterology 2 Dermatology

As noted last month, high numbers of patients waiting over 40 weeks in Gastro were expected to impact on performance. These impacts were not planned for in the Trust’s trajectory, so performance is now worse than the initial planned trajectory of 3. Locum support has increased capacity and RUH staff are also providing additional capacity where possible. Commissioners are working with RUH via the RTT Performance Delivery Group to manage the issue. The Trust has been asked to provide details on patients waiting over 40 weeks without confirmed dates so that potential breach numbers can be identified. For other specialties, the breaches are attributable to process errors. Patients waiting over 40 weeks have a clinical harm review and 52 week breaches are subject to RCAs. Clinical harm reviews completed in the year to date have not identified any harm for patients.

SFT Zero 52 Week Waits for August 2019

National target achieved for SFT 52 week waits for year to date 19/20

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3

Diagnostics

GWH = 93.0%

SFT = 99.6%

RUH = 94.5%

BSW = 95.0% (England = 95.7%) BSW: Diagnostic breaches have increased by 138 in August leading to a deterioration in performance of -1.2% compared to July. The biggest increase in breaches was for MRI scans (+97) largely at the RUH. Echos continue to have the largest number of breaches (280 out of 803 in total – 35%) and the downward trend in breaches has begun to reverse for the first time this year. RUH: MRI breaches increased significantly due to Cardiac capacity and the impact of machine replacement. Proposals for further mobile scanning on site is under consideration. Echos breaches remain high. GWH: Performance deteriorated in August due to an increase in Echos breaches. Endoscopy delivery becomes a risk in October due to limited take up of additional lists (WLI). SFT: Breach numbers mostly relate to Endoscopy, but are relatively minor, with the 99% target being achieved.


Aug ‘19

Jun-19 Jul-19 Aug-19<6 weeks 16566 16679 15216Wait List 17328 17344 16019

Performance 95.6% 96.2% 95.0%<6 weeks 3691 3681 3476Wait List 3866 3825 3701



Performance 96.2% 96.8% 96.1%

BaNES

Swindon

Wiltshire

BSW

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Diagnostics

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Diagnostic Provider Detail Lead: Mark Harris

12

IAF Domain: Better Care Rating:

Working to Improve Provider Performance Detail Narrative

GWH 93.0% Aug 2019 (Down 1.2%) Below National Target of 99% Below Local Plan Target of 95.0% Main Areas of Concern: Echocardiography: 186 breaches Sleep Studies: 75 breaches Peripheral Neurophys: 53 breaches

Endoscopy delivery becomes a risk in October due to limited take up of additional lists (WLI). 18 week support are continuing to provide cover. GWH are exploring extended options to address the deficit with the clinical teams. Sleep Services - Additional in week activity has commenced (15 patients per week), with weekend activity due to start 12/10. Neuro- physiology concerns over capacity and recovery options – securing support from other surrounding trusts has not been possible due to their resource issues. USC Management are actively working with a private provider to exploring options for additional capacity and a potential external candidate visiting the Trust on 14/10. Within September Cardiology have continued their DM01 recovery utilising an enhanced rate of pay for additional work – Recruitment plans have not delivered as expected and further staff have left. Options to secure delivery are being reviewed against the financial position of the trust.

RUH

94.5% Aug 19 (Down 1.9%) Below National Target of 99% Below Local Plan Target of 98.3% Main Areas of Concern: MRI: 197 breaches (+134) Echos: 120 breaches (+3) Sleep Studies: 80 breaches (+28)

MRI: the significant increase in breaches was due to Cardiac capacity and the impact of the MRI replacement programme, which is expected to continue over the coming months. The options being considered include outsourcing – although this will not manage the full range of complexity of tests required – and a second mobile MRI van on site to accommodate the more complex imaging. A mitigation plan for the MRI replacement programme is being revised to enable sign off of the proposed actions. Echos: breach numbers were stable in August, following July’s improvement, as the focus continues to be on specific specialist Echos (DSE and TOE) capacity and plain Echos capacity. Weekend Agency support has been approved but suitable staff have not been identified; alternative staffing options are being considered. Internal requests for Echos are being reviewed and external demand will be managed through the Referral Assessment Service. Sleep Studies: Sleep Studies breaches continued following changes to administrative processes allowed some referrals to not appear to the team. The process has been fixed to avoid repeat and additional equipment has been procured and overtime agreed to facilitate a reduction of the backlog. • (Continued overleaf)

B: Requires Improvement S: Requires Improvement W: Good

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Diagnostic Provider Detail Lead: Mark Harris

13


Working to Improve Provider Performance Detail Narrative SFT

99.6% Aug 19 (Up 0.9%) Above National Target of 99% Above Local Plan Target of 99%

SFT have achieved the 99% standard for August 2019

• Previous workforce constraints affecting endoscopy and colonoscopy capacity have been addressed through outsourcing.

Independent Providers by Exception

None to report for August 2019


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3

62-Day Cancer

GWH = 86.0%

SFT = 80.5%

RUH = 86.6%

BSW = 81.9% (England 78.5%) BSW performance has improved by 0.7% for August with 186 out of 227 treatments across BSW taking place within 62 days of referral. Q1 performance is 82.7% with the following tumour sites failing to achieve the 85% standard: Gynae (75.0%); Haem (77.1%); Lower GI (67.5%); Lung (76.6%); Upper GI (75%); Urology (68.3%) RUH: performance was above the target for the first time in 2019/20 at 86.6%. Improvements in Urology and Lower GI diagnostic pathways have supported improvements. Swindon Providers: GWH achieved the 62 Day standard for August 2019; OUH performance improved by 1.7% to 70.9%. SFT: Achieved 80.5% with non-achievement mostly impacted by urology and capacity issues across Salisbury and Southampton.


August ‘19

Jun-19 Jul-19 Aug-19<62 day 155 246 186>62 day 187 303 227

Performance 82.9% 81.2% 81.9%<62 day 28 57 43>62 day 35 68 51



Performance 81.9% 81.9% 78.9%

BaNES

Swindon

Wiltshire

BSW

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3

62-Day Cancer

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3

All Cancer Wait Time Standards - BSW

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62-Day Cancer Detail Lead: Mark Harris

17


Working to Improve Provider Performance Detail Narrative GWH 86.0% Aug 19 (Up 2.7%)

Above National Target of 85% Above Aug Local Plan of 85.5%

GWH achieved the standard for August 2019

RUH 86.6% Aug 19 (+4.5%) Above National Target of 85% Above Aug Local Plan of 81.2% Main Areas of Concern: Urology (4.5 breaches) Lower GI (4 breaches)

RUH exceeded the 85% target for the first time in 2019/20 in August. Breaches were recorded in all tumour sites except Gynaecology. Breaches were lower in the most challenged tumour sites of Urology and Colorectal. The Trust continues to target the longest waiting patients. Urology: Continued focus on reducing the length of diagnostic pathways has contributed to this improvement, with particular improvement in MRI prostate capacity. Lower GI: The Colorectal straight-to-test pathway is also supporting improvement as a Nurse Practitioner is triaging patients and, where appropriate, referring directly to diagnostics. 60 patients have been contacted so far.

SFT 80.5% Aug 19 (Down 1.6%) Below National Target of 85% Below Aug Local Plan of 83.3% Main Areas of Concern: Urology

There were 16 breaches overall: 1 Haem; 3 Head & Neck; 1 Lung; 2 Other; 1 Breast, 1 Lower GI, and 7 for Urology. Therefore, performance was mostly impacted by Urology. Lack of capacity was the main breach reason, with issues at both Salisbury and Southampton.

OUH 70.9% Aug 19 (Up 1.7%) Below National Target of 85% Main Areas of Concern:

• Diagnostics Improvement Project: 7 days and 2WW patient prioritising to reduce waiting times; designing a ‘true cancer patient’ list part of a PDSA trial.

• Urology Improvement: Looking to introduce one stop clinics for both Haematuria and Prostate. • Working with Oncology to increase consultant clinic capacity, creating parallel clinics to see both

Consultant Urologist and Oncologist – same day. • Inflo-Flex: system manager appointed, programme of work agreed for improving and functions to

support improved PTL management, MDT reporting and escalation. • All services have action plans/performance improvement trajectories in place. • Expectation is that performance will improve from October onwards.


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Other Cancer Detail Lead: Mark Harris

18


Working to Improve Provider Performance Detail Narrative GWH 2 Week Waits

682 out of 788 patients were seen within two weeks of referral 106 breaches in total (51 breaches over the accepted standard) - reasons as follows: 67 Outpatient Capacity Inadequate 23 Patient Choice 7 Administrative Delay 5 Other reason 4 Clinic Cancellation 31 Day Subsequent Surgery 2 breaches in total - both at GWH due to inadequate elective capacity (1 x Skin; 1 x Gynae)

RUH 2 Week Wait Breast Symptomatic Performance fell in month with 6 breaching patients. Patient choice delays contributed to the below-target performance. All other targets were met in August.

SFT SFT have achieved all of the cancer wait times standards for August 19 except 62 Day GP Referral to 1st Treatment. See previous slide for main concerns around 62 Day performance.


Performance standard Standard Jun-19 Jul-19 Aug-19Cancer - 2 week wait 93% 90.3% 85.8% 93.2%Cancer - Breast symptomatic 2 week wait 93% 80.6% 96.0% 84.2%Cancer - 31 Day 1st Treatment 96% 96.2% 98.5% 97.7%Cancer - Subsequent Surgery 94% 96.8% 100.0% 95.5%Cancer - Subsequent Drug 98% 100.0% 100.0% 100.0%Cancer - Subsequent Radiotherapy 94% 100.0% 100.0% 98.6%Cancer - 62 Day GP referral 85% 82.2% 82.1% 86.6%Cancer - 62 Day Screening 90% 100.0% 100.0% 100.0%

Performance Standard Standard Jun-19 Jul-19 Aug-19

Cancer - 2 week wait 93% 87.8% 94.3% 86.6%

Cancer - Breast Symptomatic 2 week wait 93% 96.1% 98.0% 97.0%

Cancer - 31 Day 1st Treatment 96% 96.2% 98.0% 100.0%

Cancer - 31 Day Subsequent Surgery 94% 100.0% 100.0% 90.5%

Cancer - 31 Day Subsequent Drug 98% 100.0% 100.0% 100.0%

Cancer - 31 Day Subsequent Radiotherapy 94% N/A N/A N/A

Cancer - 62 Day GP Referral 85% 90.2% 83.3% 96.0%

Cancer - 62 Day Screening 90% 98.1% 100.0% 100.0%

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3

A&E 4-hour

GWH = 84.8%

SFT = 95.0%

RUH = 81.2%

BSW = 85.2% (England = 86.3%) BSW performance remained the same at 85.6% in August. Whilst RUH and GWH saw a drop in performance this was mitigated by improvement at SFT to 95% - on target. RUH: performance continues below the local plan target. Pre-hospital urgent care pathways, internal pathways and back door flow remain the priorities for the A&EDB. GWH: performance has deteriorated by 2.0% in August and remains under the local plan target. GWH supported by NHS Improvement are focusing on improvement of the Front Door (ED & assessment areas). SFT: South Wiltshire System (incl .Dorset and West Hampshire) Improvement Programme in place with weekly System Improvement Delivery Group focusing on key work streams. 95% target achieved in August.

Aug ‘19

Type 1 (A&E) Only Provider Footprint


Jun-19 Jul-19 Aug-1913643 14429 1389317297 18785 1805778.9% 76.8% 76.9%

4459 4700 44676035 6768 6479

73.9% 69.4% 68.9%5425 5597 54077006 7262 7249

77.4% 77.1% 74.6%3759 4132 40194256 4755 4329

88.3% 86.9% 92.8%

Jun-19 Jul-19 Aug-19<4 hour 25513 26798 25129

Total Atts 29310 31455 29482Performance 87.0% 85.2% 85.2%

<4 hour 9018 9643 8850Total Atts 10637 11835 10900

Performance 84.8% 81.5% 81.2%<4 hour 11685 12156 11168

Total Atts 13376 14009 13167Performance 87.4% 86.8% 84.8%

<4 hour 5577 5921 5923Total Atts 6074 6544 6233

Performance 91.8% 90.5% 95.0%

RUH

GWH

SFT

BSW

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A&E Provider Detail

20



GWH Lead: Dasa Miklosovicova

84.8% Aug 19 (Acute Trust Footprint) Target = 95% GWH Aug Plan = 89.2% 0 x 12 hour DTA breaches Sept Provisional = 82.0% GWH Sept Plan = 87.0%

• GWH supported by NHS Improvement focuses on improvement of the Front Door (ED & assessment areas): the 6A Audit was repeated in early October to assess management of emergency admissions- the formal evaluation report is pending

• Ambulatory Care and Triage (ACAT): • A weekly dashboard for ACAT has been developed showing the number of admissions, transfers,

discharges and LoS, development of more complex KPIs (e.g. time to junior review, time to consultant review, number of diagnostic requests) underway;

• Relationship with ED and inpatient wards: criteria for early discharge being developed to inform ED and inpatient wards when ambulatory care can support early discharge;

• Weekend opening: discussions on-going as part of the Way Forward Programme. Also awaiting results of 6As audit held recently to determine benefit;

• Consultant Connect: ambulatory care have been part of the trial since it started. Not all GPs use the system however so it is not at present a true reflection of the volume of calls/outcomes;

• Workforce review: recruitment for 1 WTE advanced care practitioner (ACP) under way to ensure workforce sustainability for current opening hours. Business case to increase the ACP establishment to support weekend opening/ additional pathways via ambulatory care being developed;

• Improvement of standard of referrals to ACU: development of checklist for the ambulatory care team to ensure robust information is received from a referrer. Examples of quality referrals are shared with GPs


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A&E Provider Detail

21


Working to Improve Provider Performance Detail Narrative RUH Lead: James Child-Evans /Corinne Edwards

81.2% Aug-19 (Acute Trust Footprint) Target = 95% RUH Aug Plan = 85.0% 0 x 12 hour DTA breaches

• Challenges remain with demand, as well as flow, as a result of the number of delayed transfers of care and increasing +21 day length of stay patient numbers

• LGA-led DToC peer review across B&NES and Wiltshire took place w/c 23rd September with high level findings and opportunities for improvement shared at the BaNES A&EDB in September. A full report with the detailed findings is expected to be received before the end of October

• Discharge PTL ward rounds held weekly on a Tuesday with medical support and community partner involvement

• Draft revised pre-hospital guidance, for the management of older people with an apparent head injury on a direct oral anti-coag, has been developed by the RUH ED consultants which has been shared with SWASFT for their input

• Demand and capacity modelling work is underway as part of winter planning to understand the impact of winter initiatives on reducing LoS and the impact on bedded capacity

• A BSW winter risk summit has been arranged for 25th October to understand our collective readiness for winter and our ability to cope with further increases in demand for all partners on top of the current poor DToC and LoS position across the 3 acutes and community hospitals


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A&E Provider Detail

22


Working to Improve Provider Performance Detail Narrative SFT Lead: Emma Smith / Jo Cullen

95.0% - Aug 19 (Acute Trust Footprint) Target = 95% SFT Aug Plan = % 0 x 12 hour DTA breaches

• South System Integration Delivery group continuing to meet virtually on a weekly basis; focusing heavily on delivery of key workstreams, impact on demand and capacity modelling and focus on resilience plans ahead of Winter to maintain ED and LOS performance

• Revised SOP for escalation gold call process agreed and signed in September LDB • Awaiting outcomes of recent local audit on mental health presentations in ED • HIU business case has now been approved for Wiltshire, with impact expected in Q4 to reduce

the number of HIUs presenting at ED


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3

SWAST SWAST saw an improvement in performance for both category 1 response standards in August resulting in both achieving target. For BSW, activity levels are 3.1% above contract for August and 6.2% above contract year to date. The proportions of Ambulance Incident Outcomes are shown opposite for BSW. ‘See and Convey to A&E’ outcome has increased by 1.2% in August whilst ‘Hear and Treat’ has fallen 2% in the same month. IUC For BSW, the number of calls answered within 60 seconds has deteriorated for August and remains below target, however the integrated hub continues to allow a higher proportion of calls to be assessed by a clinician – well above the 50% target. The proportion of calls for which an ambulance is dispatched remains below the 10% threshold for August, but calls referred to ED are over the 5% target at 6.6%.

NHS111/Integrated Urgent Care Hub August Performance - BSW

Activity and Data Field Expressed as Indicative Target 7 day total Month to Date Green Amber Red

Answered within 60 seconds % 95% 75.8% 74.6% >95% >92% < 92%Number of calls assessed by a Clinician % 50% 67.3% 67.8% >50% >30% < 30%Number of Ambulance dispatches % 10% 9.6% 9.6% <10% <11% >11%Number of Recommended to attend A&E % 5% 7.3% 6.6% < 5% <7% >7%Average time to call answer (format hh:mm:ss) hh:mm:ss 00:01:06 00:01:12Average time to clinical encounter (format hh:mm:ss) hh:mm:ss 01:10:29 01:06:06

RAG Rating

SWAST Incidents Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20Contract 11,293 10,230 10,654 10,573 10,931 10,635 10,405 10,895 11,105 12,100 11,397 10,564 11,116Actuals 11,784 11,165 11,432 11,063 11,684 10,969Variance 4.3% 9.1% 7.3% 4.6% 6.9% 3.1%Response Times Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19Cat 1 Mean 6.6 7.1 6.7 6.9 7.2 6.7Cat 1 90th Percentile 12.2 13.8 12.0 13.0 13.7 12.7

BSW

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BSW CCGs Mental Health


Dementia Diagnosis Jun-19 Jul-19 Aug-19Plan 65.1% 65.3% 65.4%Actual 63.6% 63.7% 63.6%Plan 63.7% 64.0% 64.4%Actual 63.6% 63.4% 63.1%Plan 61.6% 62.2% 62.8%Actual 58.5% 58.2% 57.9%Plan 66.7% 66.7% 66.7%Actual 65.3% 65.6% 65.6%

IAPT Roll-out (Access) 18/19 Q3 18/19 Q4 19/20 Q1 IAPT Recovery 18/19 Q3 18/19 Q4 19/20 Q1Plan 5.60% 5.70% 5.76% Plan 52.1% 52.3% 52.1%Actual 5.49% 5.90% 5.34% Actual 50.7% 52.4% 51.8%Plan 4.40% 4.75% 4.75% Plan 57.0% 57.1% 50.0%Actual 5.10% 4.92% 4.61% Actual 52.9% 54.3% 55.0%Plan 7.80% 7.80% 6.90% Plan 51.1% 51.1% 52.1%Actual 6.59% 6.72% 6.22% Actual 47.4% 49.4% 52.0%Plan 4.80% 4.77% 5.51% Plan 50.2% 50.4% 53.1%Actual 5.01% 5.81% 5.13% Actual 51.3% 53.0% 51.0%

IAPT <6 Week Waits 18/19 Q3 18/19 Q4 19/20 Q1 Early Intervention Psychosis <2Wks 18/19 Q4 19/20 M3 19/20 M4Plan 90.7% 90.6% 89.4% Plan 70.2% 61.0% 61.0%Actual 95.3% 96.3% 95.4% Actual 87.5% 81.8% 80.0%Plan 75.6% 75.5% 75.2% Plan 58.8% 56.0% 56.0%Actual 95.8% 95.6% 93.0% Actual 91.7% N/A 50.0%Plan 99.0% 99.0% 99.1% Plan 55.6% 63.6% 63.6%Actual 97.6% 98.2% 98.0% Actual 100.0% 100.0% 100.0%Plan 90.6% 90.8% 90.0% Plan 85.7% 65.2% 65.2%Actual 92.9% 95.5% 95.0% Actual 71.4% 71.4% 75.0%

E.A.S.1

National standard = 66.7%

E.A.3National standard18/19 Q3 = 4.61%18/19 Q4 = 4.75%19/20 Q1 = 4.94%19/20 Q2 = 5.13%19/20 Q3 = 5.31%19/20 Q4 = 5.5%Main Provider = AWP

E.A.S.2

National standard = 50%

Main Provider = AWP

E.H.1 a


Main Provider = AWP

E.H.4


Main Provider = AWPSwindon

Wilts

BSW

BaNES

Swindon

Wilts

BSW

BaNES

Swindon

Wilts

BaNES

BSW

Swindon

Wilts

BSW

BaNES

Swindon

Wilts

BSW

BaNES

Drop in RTT in Swindon EI team in June and July has returned to 80% in August and may be linked to low level of referral i.e. zero referrals taken on by team would result in 0% RTT achievement. To be discussed at CQPM. Dementia Diagnosis Work to share best practice and drive improvements ongoing through BSW DDR TFG. IAPT Access in BaNES related to lack of investment in workforce to meet expansion. BaNES commissioner leading on plan to address.

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BSW CCGs Mental Health (2)


CYPMH Access 18/19Q3 18/19Q4 19/20Q1Plan 1,661 1,661 2,527Actual 4,435 3,205Plan 235 235 417Actual 625 595Plan 373 373 850Actual 2,085 930Plan 1,053 1,053 1,260Actual 1,725 1,680

CYP Eating Disorders Routine Access 18/19Q3 18/19Q4 19/20 Q1 CYP Eating Disorders Urgent Access 18/19Q3 18/19Q4 19/20 Q1Plan 91.7% 93.9% 94.4% Plan 100.0% 100.0% 87.3%Actual 90.2% 91.2% 91.7% Actual 87.0% 83.3% 84.0%Plan 80.0% 90.9% 90.9% Plan 100.0% 100.0% 81.0%Actual 87.5% 89.7% 90.9% Actual 76.5% 72.2% 64.3%Plan 100.0% 100.0% 100.0% Plan 100.0% 100.0% 100.0%Actual * * 92.6% Actual * * 100.0%Plan 93.3% 94.0% 94.0% Plan 100.0% 100.0% 91.3%Actual 91.3% 91.8% 91.8% Actual 93.1% 90.0% 90.0%

SMI Health Checks 18/19Q3 18/19Q4 19/20 Q1 Out of Area Admissions Mar-19 Apr-19 May-19Plan 19.0%Actual 13.6% 19.9% 17.9%Plan 20.0%Actual 19.5% 21.3% 20.0%Plan 15.0%Actual 12.1% 21.0% 17.5%Plan 20.0%Actual 11.9% 18.8% 17.2%

Swindon

Wilts

BaNES

BSW

BaNES

E.H.9

National standard = 34% Diagnosed with MH ConditionReceiving NHS Community Care

Main Provider = Oxford P'ship

E.H.10

National standard by 2020/21 = 95% <4Wks

Main Provider = Oxford P'ship* = Low suppressed number

E.H.11

National standard by 2020/21 = 95% <1Wk

Main Provider = Oxford P'ship* = Low suppressed number

Swindon

Wilts

BSW

BaNES

Swindon

Wilts

BSW

135 120

35 50

220

100Actual

Actual

Actual

E.H.13


E.H.12

National standardis count of OBDsTarget is zero by 2021

ActualBSW

BaNES

Swindon

Wilts

BSW

BaNES

Swindon

Wilts

50

65 20

35 50

70

Out of Area Admissions actively monitored on weekly basis. Bed pressures and Trust moving into Opel 4 for some time in Q1/Q2had effect on OOA BD’s SMI Health checks continue to prove a challenge. LES in place Banes & Swindon, 10 point plan for improvement following Wilts approach to DDR improvements implemented in Wilts. This area forms part of BSW THRIVE work stream to redress the balance between physical and mental health and improve outcomes CYP Eating Disorders Access. Numbers involved are very low and percentages skewed by DNA’s and patient choice. Monitored and discussed at regular CQPM with provider

No Adults & Children split available

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Mental Health Detail Lead: George Ruddle/Lucy Baker

26


Working to Improve Measure Performance Detail Narrative Dementia Diagnosis

AWP Swindon Deterioration of 0.3% from July 19 to 57.9%. Swindon CCG now ranks 10th against our 10 peer CCGs.

Since December 2018, the following actions have been undertaken:

Reviewing AWP processes Reviewing performance and liaising with GP practices Reviewing against Gloucestershire CCG Reviewing SCCG Pharmacy review of dementia prescribing against diagnoses (ongoing) Participating in DDR BSW STP Task & Finish Group (ongoing) Dementia Coding element to be included in Older Person’s LES - drafted and under review Paper presented at Swindon CCG EMT with recommendations for next steps Confirmation that current Swindon primary care pressures have impacted upon specific GP

practices, resulting in further deterioration in DDR. Current planned actions: • Identification of Dementia Lead GP for Swindon to promote GP engagement • SCCG pharmacy screening of dementia prescriptions to resume on a monthly basis. • BSW dedicated B5 DDR resource • Proposal on a page to NHSE regarding use of small amount of non-recurrent NHSE funding to

provide temporary dedicated dementia worker to work with specific practices, winning hearts and minds, reversing the downward trend and smoothing the pathway for BSW resource and LES.

• SWSCN Dementia GP Lead to engage with Swindon GPs to win hearts and minds, (when current primary care pressures ease)

• The trajectory for Swindon and BSW has been revised to show that the downward trend will be reversed by March 2020, achieving >60% DDR, with work to embed processes and achieve and sustaining national standard of 67.6% during the following year.


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Mental Health Detail Lead: George Ruddle/Lucy Baker

27


Working to Improve Provider Performance Detail Narrative Dementia Diagnosis

Bath and North East Somerset CCG achieved 63.1% in August, slight decline from 63.6% in June and below the plan target of 64.4%

• Continue to engage in DDR TFG. • Working with GPs monitoring and suggesting improvements to build on

gradually increasing performance since April.

Dementia Diagnosis

Wiltshire The August rate was 65.6%, the same rate as reported in July; Target is 66.7%.

• Work continues on delivery of Improvement plans to facilitate achievement of targets.

• Engaging with commissioning colleagues in BaNES & Wilts to share best practice and drive improvement.


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3

Average number of people delayed per day per 100,000 population (DTOC)

Swindon = 6.8

Wiltshire = 16.1 B&NES = 18.5

BSW = 14.4 BSW performance deteriorated to 14.4 people delayed per day per 100,000 population in August. Swindon saw a reduced rate compared to June but B&NES and Wiltshire both saw increases. BSW performance is significantly above the national and regional averages for NHS-attributable delays. Swindon’s rate remains significantly better than the national and regional averages. Social-care attributable delays continue to be among the lowest in the region. The improvement on May was driven by reductions in delays at GWH. Wiltshire saw improvements for some breach reasons, such as people awaiting social care assessments, residential home placements, housing and due to patient choice, but the overall rate was affected by increases for people awaiting funding decisions at Wiltshire Health & Care, home care at RUH, nursing home placements at SFT, further non-acute NHS care at GWH and community equipment. B&NES’ increase was driven by increased delays for people awaiting home care at RUH, Virgin Care and AWP and by nursing home placement delays at RUH and AWP. Plans for internal brokerage service will support improvement over the winter. There were reduced delays for people awaiting social care assessments, further non-acute care and residential home placements across providers. Across BSW, the most common reason for delays was awaiting home care packages, which accounted for 39% of all delays in August.

Aug ‘19

Note: RAG ratings are based on a combination of variance to the national and regional averages and each HWB’s BCF plans. Similar values for each area may lead to different RAG ratings due to the specific plans and plan targets in place in each area. Changes in national and regional figures may also lead to similar values generating different RAG ratings month on month. STP performance isn’t RAG rated as BCF plans are set at HWB level only.

Local authority Mar-

19 Apr-19 May-19 Jun-19 Jul-19 Aug-19

BSW

NHS 8.1 8.5 10.7 11.6 9.1 9.3 Social Care 3.4 3.8 3.4 3.8 4.2 4.7

Joint 0.6 0.2 0.2 0.1 0.2 0.5 Total 12.1 12.5 14.3 15.6 13.5 14.4

B&NES

NHS 10.8 8.5 10.0 12.6 11.9 12.9 Social Care 4.0 6.3 4.5 4.6 5.3 5.1

Joint 0.0 0.1 0.0 0.1 0.4 0.5 Total 14.9 15.0 14.5 17.3 17.6 18.5

Swindon

NHS 7.6 8.2 13.0 9.4 6.1 5.4 Social Care 1.2 0.6 1.4 1.4 1.0 1.3

Joint 0.5 0.1 0.2 0.0 0.0 0.0 Total 9.2 9.0 14.6 10.9 7.1 6.8

Wiltshire

NHS 7.3 8.7 10.0 12.2 9.3 9.5 Social Care 4.2 4.2 3.9 4.6 5.2 5.9

Joint 0.9 0.2 0.2 0.2 0.2 0.7 Total 12.3 13.1 14.1 17.0 14.7 16.1

12.1

12.5

14.3

15.6

13.5

14.4

02468

1012141618

Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19

BSW Performance Trend

BSW SW avg Eng avg

9.3

4.7

7.3

4.3

1.6

6.6

3.3

1.0

0 2 4 6 8 10

NHS

SC

Joint

Benchmarking: delays by responsible organisation

BSW SW avg Eng avg

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3

Delayed Transfers of Care as a percentage of Occupied Beds

GWH = 5.7%

SFT = 3.7%

RUH = 6.1%

BSW = 5.5% BSW performance moved further away from the 3.5 target at 5.5% in August. All providers saw an increased rate, although SFT remain close to the target. GWH’s improved rate was supported by reduced delayed days for people awaiting social-care assessments, residential home placements and nursing home placements in Swindon and Wiltshire. In addition, delays for out-of-area patients reduced slightly but they still account for 24% of Trust-total delayed days. The increased rate at RUH was due to increases in delayed days for people awaiting home care packages and nursing home placements across B&NES, Wiltshire, South Glos and Somerset. There were reduced patient choice delays in Wiltshire to offset some of the increases. SFT’s increased rate was largely due to an increase in delayed days for people awaiting nursing home placements for Wiltshire residents. 46% of delayed days at SFT were for Dorset and Hampshire residents. AWP’s rate increased as there were increased delays due to housing in Swindon and Wiltshire and due to home care packages and nursing home placements in B&NES. These increases were offset by reduced delayed days for people awaiting further non-acute NHS care and residential placements.

Aug ‘19

Note: the BSW figure is a proxy for BSW performance, as it aggregates the delayed days and OBDs for the providers. The AWP figures relate to B&NES, Swindon, and Wiltshire patients at AWP only. OBDs are based on the latest national quarterly publication (and will be retrospectively updated once the latest quarter is published); Trust reporting may show different percentage performance therefore.

AWP = 12.5%


Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 BSW Delayed days (DTOC) 2,667 2,338 2,952 2,969 2,595 2,808

Occupied bed days (OBD) 51,702 49,314 50,958 49,314 50,958 50,958 DTOCs as % of OBDs 5.2% 4.7% 5.8% 6.0% 5.1% 5.5%

RUH Delayed days (DTOC) 976 862 1,010 1,033 991 1,151 Occupied bed days (OBD) 19,127 18,360 18,972 18,360 18,972 18,972

DTOCs as % of OBDs 5.1% 4.7% 5.3% 5.6% 5.2% 6.1% GWH Delayed days (DTOC) 1,015 985 1,482 1,521 1,079 1022

Occupied bed days (OBD) 18,073 17,370 17,949 17,370 17,949 17,949 DTOCs as % of OBDs 5.6% 5.7% 8.3% 8.8% 6.0% 5.7%

SFT Delayed days (DTOC) 493 406 318 285 396 462 Occupied bed days (OBD) 13,113 12,240 12,648 12,240 12,648 12,648

DTOCs as % of OBDs 3.8% 3.3% 2.5% 2.3% 3.1% 3.7% AWP Delayed days (DTOC) 183 85 142 130 129 173

Occupied bed days (OBD) 1,389 1,344 1,389 1,344 1,389 1389 DTOCs as % of OBDs 13.2% 6.3% 10.2% 9.7% 9.3% 12.5%

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DTOC Provider Detail

30



GWH Lead: Dasa Miklosovicova

Aug ’19 GWH DTOC rate (local calculation) = 5.7% of OBD Target = 3.5% Aug ‘19 Average number of people delayed per day: Swindon UA = 11.6 (target 15.0) GWH = 33.0 Latest Weekly Data (8th Sept Snapshot) GWH DTOC rate: 3.5% of OBD

• Swindon system has signed up to deliver 40% reduction in number of patients with length of stay over 21 days in 2019/20. The outline of the Length of Stay (LOS) Reduction Delivery Plan was submitted to NHS England at the end of April. The risk rating for DToC for the CCG remains Green.

• GWH focus on management of complex patient discharges - getting an accurate daily

list of ‘complex’ patients who are at risk of delays to their discharges and using this list as the definitive version when working with partners to help to deliver at least 20 partner discharges every day.

• GWH launched electronic recording of predicted discharge medically safe (PDMS) dates and accurate recording of delays (using ECIST F- codes) on the patient flow tracking system NerveCentre to ensure accuracy for partners when selecting appropriate care requirements for patients.

• Providing learning from last winter, it has been recognised that more capacity, service

as well as staffing, will be required in reablement services in the winter to support patient flow from the acute hospital following discharge. SBC will recruit 4 additional reablement staff and 2 additional D2A social workers to work in GWH. There is also plan to recruit additional social worker capacity for the older people pathway and front door as well as active case manager for older people. Additional staff for equipment store will be recruited to support the winter period. Additional nursing home beds with OT support will be open from Nov-19 throughout the winter.

• Monitoring performance against target of 3.5% for the percentage of DToC cases

against occupancy is continuing internally on a weekly basis. • Progress with the DTOC action plan continues to be monitored by the monthly AEDB.


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31


Working to Improve Provider Performance Detail Narrative RUH Lead: James Child-Evans /Corinne Edwards

Aug 19 RUH DTOC rate = 6.1% of OBD Target = 3.5% Latest Weekly Data (26th September Snapshot) DTOC rate: 7.2% of OBD Aug ’19 Average number of people delayed per day: B&NES = 28.4 (target 17.9); RUH = 37.1

• LGA-led DToC peer review across B&NES and Wiltshire took place w/c 23rd September with high level findings and opportunities for improvement shared at the BaNES A&EDB in September. A full report with the detailed findings is expected to be received before the end of October

• Discharge PTL ward rounds held weekly on a Tuesday with medical support and community partner involvement

• A BSW winter risk summit has been arranged for 25th October to understand our collective readiness for winter and our ability to cope with further increases in demand for all partners on top of the current poor DToC and LoS position across the 3 acutes and community hospitals

SFT Lead: Emma Smith / Jo Cullen

Aug ‘19 SFT DTOC rate = 3.7% of OBD Target = 3.5% Aug ’19 Average number of people delayed per day: Wiltshire UA = 63.0 (target 41.2) SFT = 14.9 Wiltshire DToC days increased by 178, (+10%) in Aug-19 to 1,953. This equates to an average 67 patients per day.

• South Wiltshire System (incl. Dorset and West Hampshire) Improvement Programme in place with weekly System Improvement Delivery Group focussing on key workstreams – primary care / prevention / rapid response; in hospital, and discharge – reporting to LDB

• Demand and capacity work completed and updated for Oct LDB • Review of Pathway 3 complete and business case signed off for each scheme • Wiltshire council implementing 30 Discharge to Assess beds across Wiltshire (10 facing each

acute), to enable individuals to move to a care home prior to care act assessment being completed

• Bridging / reablement domiciliary capacity; Block hours to be purchased from private market and allocated for use to each acute. Aim to provide support while long-term decisions are made at home

• Trusted assessor for South Wiltshire expected to be live from Dec


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32



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3

Permanent admissions to care homes per 100,000 population (65+)

Swindon = 24.8

Wiltshire = 34.0

B&NES = 57.2

BSW = 36.8 The rate of permanent admissions across BSW increased in July as B&NES and Wiltshire saw increased rates of admission, although there was a reduction in Swindon. In B&NES and Wiltshire increases were seen in both residential and nursing home admissions, while Swindon saw a reduction in each category. Actual residential admissions across BSW were above the 18/19 average but nursing admissions held at the 18/19 average. At BSW level, 64% of admissions were into residential homes. Overall performance remains better than the national and regional 2017/18 averages. Updated benchmarking for 2018/19 is not expected to be available until the November report. Swindon’s rate continues significantly better than national and regional averages. B&NES is working with social work teams to help them understand how their data inputs affect reporting for this measure, so that only relevant admissions are counted. In Wiltshire, permanent admissions to care homes are higher in the first quarter of 2019/20 than 2018/19 levels as the Council works with clients who have complex needs and substantial packages of care to ensure they are getting the best care possible and this is resulting in some people changing to placements.

Jul ‘19

Note: this measure is part of the Adult Social Care Outcomes Framework (ASCOF). 2017/18 national and regional results are included in the chart to the left. As this benchmarking isn’t available in year, it is provided for context but it’s not suitable to use to RAG rate in-month performance. 2018/19 data will be available in Oct 2019. Lags in data entry mean that data reported in previous months may be updated retrospectively. Population figures have been updated for 2019/20 from the BCF planning template

Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 BSW Residential 20.1 19.6 23.6 25.3 18.1 23.6

Nursing 9.8 11.5 11.0 14.3 11.5 13.2 Total 29.9 31.1 34.6 39.6 29.7 36.8

B&NES Residential 28.0 28.0 40.8 21.8 24.5 35.4 Nursing 16.8 11.2 24.5 27.2 16.3 21.8

Total 44.9 39.3 65.3 49.0 40.8 57.2 Swindon Residential 20.4 17.5 22.0 30.3 16.5 13.8

Nursing 5.8 14.6 8.3 13.8 13.8 11.0 Total 26.2 32.0 30.3 44.0 30.3 24.8

Wiltshire Residential 17.3 17.3 18.4 24.8 16.5 23.0 Nursing 8.7 10.6 7.3 10.1 9.2 11.0

Total 26.0 27.9 25.7 34.9 25.7 34.0

0

10

20

30

40

50

Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19

BSW Trend

Residential NursingEng 2017/18 avg SW 2017/18 avg

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1,287 1,289 1,236 1,252 1,256 1,263

0200400600800

1,0001,2001,400

Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19

BSW Trend

Residential Nursing

3

People permanently placed in care homes per 100,000 population (65+)

Swindon = 1,307

Wiltshire = 1,178

B&NES = 1,470

BSW STP = 1,263 The rate of people in care homes at month end across BSW increased slightly compared to June but is lower than in most months in 2018/19. This is due in part to population figures being updated to reflect the figures used in the 2019/20 Better Care Fund planning template. In terms of actual number of people placed, nursing placements in July are lower than the 2018/19 average. Residential placements are above the 2018/19 average. However, given the reduction in people placed in nursing care, it would be expected that the residential care figure would increase. In B&NES the actual number of people placed reduced for both nursing and residential homes. Swindon and Wiltshire saw small increases in residential home placements and nursing home placements saw a slightly higher increase although, as noted above, these compare well to the 2018/19 averages for each locality. At the end of July, 37% of over 65s permanently placed in care homes across BSW were in nursing home placements, which is on a decreasing trend over the past year. This measure is a snapshot at month end and figures may be updated retrospectively where client records are updated after reports are run.

Jul ‘19

Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 BSW Residential 802 801 767 785 792 792

Nursing 486 488 468 467 464 471 Total 1,287 1,289 1,236 1,252 1,256 1,263

B&NES Residential 732 732 724 724 724 719 Nursing 721 754 754 754 754 751

Total 1,453 1,486 1,478 1,478 1,478 1,470 Swindon Residential 886 868 801 809 828 831

Nursing 519 504 476 471 468 476 Total 1,404 1,372 1,277 1,280 1,296 1,307

Wiltshire Residential 798 802 771 797 803 804 Nursing 394 391 369 368 365 374

Total 1,192 1,193 1,140 1,166 1,168 1,178

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3

Community – Wiltshire Health & Care

DToC LoS

Community Teams

MIU

RTT

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3

Swindon Community Health Services

Community Ward Length of Stay SCHS have two wards in the Swindon Intermediate Care Centre (SwICC). Stroke patients are included in Forest data. The target for Forest ward is 36 days or under, for Orchard 21 Days or under.

Delayed Discharges of Care Delayed Transfer of Care (DTOCs) days in SwICC stood at 105 in September.

RTT rules are currently only applicable to the Dermatology service. One patient seen in September had been waiting 18 weeks.

Swindon Community Health Services currently look after 17087 patients (excluding SwICC inpatients).

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3

Community – Virgin Care (B&NES)

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3

WCCG - Performance Summary Workstream Performance Measure Period Perf. Rating Page

Planned Care







Mental Health


Local Authority




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Working together: NHS Bath and North East Somerset Clinical Commissioning Group NHS Swindon Clinical Commissioning Group NHS Wiltshire Clinical Commissioning Group

Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Groups Financial Position Month 6 2019/20 Caroline Gregory, Chief Financial Officer

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BSW overview position • At month 6 the 3 CCGs are continuing to report breakeven against the combined £1.3bn

resource allocation

– In month additional allocations have been received for • central bids e.g. mental health/perinatal transformation, diabetes transformation • LTP funds for ageing well • National commitments for freestyle libra glucose monitoring

• All CCGs are experiencing pressures against delegated primary care – either as a result of the impact of changes to indemnity funding or from practice resilience issues.

– These pressures have been moved into the main reported position from risk

– No additional central funding support is available

• Work continues with local STP providers to identify in year settlements to provide certainty to financial positions in order to reduce risk from variation. The supported provided to partners reduces the in year flexibility to offset other emergent risks in the commissioning portfolio.

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BSW overview position • Running costs are being prepared on a shared basis – an exercise to understand the

anticipated year end position is being undertaken.

• Residual risks are still identified across the CCGs, outside of those reported to NHSE due to the lack of certainty around them. The CCGs are working on a combined basis where possible to mitigate these.

• M7 has identified further pressures to the overall position linked to prescribing (national issues with script recognition by Lloyds pharmacy) and increased CHC placement costs.

• The following slides show:

– BSW finance scorecard at M6

– BSW combined I&E & net risk position at M6

– SLAM variances against plans month 5

– BSW activity positions by main points of delivery at month 5

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Key financial metrics

Target Forecast RAG Target Forecast RAGRevenue expenditure not to exceed allocations 1,335,698 1,335,698 G 663,164 663,164 GCapital expenditure not to exceed allocations 0 0 G 0 0 GAdministration costs not to exceed the allocation 19,881 19,162 G 9,200 8,773 GBetter paayment practice code % of NHS invoices paid within target (value) 95% 99.6% G 95% 99.6% GBetter paayment practice code % of NHS invoices paid within target (number) 95% 99.5% G 95% 99.5% GBetter paayment practice code % of non NHS invoices paid within target (value) 95% 99.2% G 95% 99.2% GBetter paayment practice code % of non NHS invoices paid within target (number) 95% 95.0% G 95% 94.8% GOperate within cash resources G GQIPP % achieved 85% 93% G 85% 93% GDelivery of cumulative surplus 25,682 25,682 G 25,682 25,682 GDelivery of in year surplus requirement 0 0 G 0 0 G

Full year / £'000s YTD / £'000s

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BSW I&E performance

Budget Variance BaNES Swindon WiltshireAcute 656.65 1.76 1.07 0.69 -0.01Mental health 112.00 0.85 0.22 0.25 0.38Community Health Services (ISFE) 124.88 0.24 0.05 0.00 0.19Continuing Care Services (ISFE) 66.06 1.77 0.18 0.34 1.25Primary Care Services (ISFE) 41.14 -0.59 -0.10 -0.16 -0.33Prescribing 125.65 2.32 0.19 0.53 1.60Primary Care Co-Commissioning (ISFE) 121.00 2.06 -0.16 0.95 1.27Other Programme Services (ISFE) 63.95 -8.26 -1.45 -2.46 -4.35Total programme 1,311.33 0.15 0.00 0.15 0.00Running costs 19.32 -0.15 0.00 -0.15 0.00TOTAL CCG NET EXPENDITURE 1,330.64 0.00 0.00 0.00 0.00Resource limit -1,330.64IN YEAR (UNDERSPEND) / DEFICIT 0.00

Variance by CCG / £'m£'mExpenditure area

BaNES Swindon Wiltshire TotalRisks identified 1.22 1.53 2.42 5.17Less mitigations 0.08 -1.55 -2.49 -3.96Shortfall / (excess) of mitigations 1.30 -0.02 -0.07 1.21

Net risks and mitigations CCG / £'m

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SLAM Activity variance against plan across BSW

Positions are based on the variance between the actual activity up to Month 5 and contractual plan agreed for 2019/20. Data Includes: GWH- Swindon & Wiltshire CCG RUH- BaNES & Wiltshire CCG SFT- Wiltshire CCG

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BSW Planned Care Demand

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Interpreting the bubble charts

Referrals down Activity above plan

Would expect waiting list to be reducing

Referrals up Activity above plan

Suggests capacity is partly mitigating waiting list growth but under pressure

Referrals down Activity below plan

Suggests capacity has decreased

Referrals up Activity below plan

Would expect waiting list to be increasing as suggests capacity does

not meet plan

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Data Includes: GWH- Swindon & Wiltshire CCG RUH- BaNES & Wiltshire CCG SFT- Wiltshire CCG

BSW Elective activity trends

At Month 6 YTD, Daycase admissions have increased across BSW by 6.9% compared to 2018/2019. This reduces to 3.5% once the planned growth is included. The majority of growth is seen within the Gastroenterology specialty at SFT and GWH.

At Month 6 YTD, Elective admissions have decreased across BSW by -10.4% compared to 2018/2019. This reduces to -9.5% once the planned growth is included. The majority of the underperformance can be seen in the Trauma & Orthopaedics specialty at GWH & SFT.

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BSW Outpatient activity trends

At Month 6 YTD, Outpatient First attendances have decreased across BSW by -0.3% compared to 2018/2019. This reduces to -4.0% once the planned growth is included. The majority of underperformance is seen in the Physiotherapy, Dermatology and Urology specialties.

At Month 6 YTD, Outpatient Follow Up attendances have increased across BSW by 0.2% compared to 2018/2019. This reduces to -2.9% once the planned growth is included. The majority of underperformance is seen in the Gastroenterology, Dermatology and Physiotherapy specialties.

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BSW Unplanned Care activity trends

At Month 5 YTD, Emergency admissions have increased across BSW by 2.5% compared to 2018/2019, however incorporating funded growth this reduces to an underperformance of -3% against plan. Most of the underperformance is attributable to the maternity specialties (Obstetrics, Well Babies, Midwife Episode), with Cardiology and Gastroenterology also contributing. The Average length of stay remains relatively stable across all providers with a drop at SFT. The reduction in length of stay at SFT is particularly seen in Super Stranded Spells. All providers are not meeting the national 40% expected reduction. At Month 5 YTD, A&E (excluding SWIC) attendances have increased across BSW by 6.7% compared to 2018/2019. April was a particularly high month at 4.5% above expected levels across BSW (including growth). This has reduced to 1.4% at M5 YTD.

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Working Together: NHS Bath and North East Somerset Clinical Commissioning Group NHS Swindon Clinical Commissioning Group NHS Wiltshire Clinical Commissioning Group Page 1 of 10

BSW Audit Committees in Common Tuesday 17 September 2019, 10.00hrs

Conference Room, Southgate House, Devizes

Minutes taken by Sharon Woolley, Wiltshire CCG

Final Ratified Minutes

Voting Members in Attendance Name Job title Organisation Peter Lucas PL Lay Member, Audit and Governance

and Chair of the Wiltshire and BaNES CCGs Audit Committees (Convenor)

BCCG and WCCG

Maggie Arnold MA Registered Nurse BCCG and SCCG Ian James IJ Lay Member and Audit Committee

Chair for Swindon CCG SCCG

Bill Fishlock BF Lay Member SCCG Christine Reid (from 10.10hrs)

CR Lay Member, Patient and Public Involvement

WCCG

Dr Mark Smithies MS Secondary Care Doctor WCCG Dr Catrinel Wright CW GP, Chair of West WCCG

In Attendance: Name Job title Organisation Caroline Gregory CG BSW Chief Financial Officer BSW Matthew Hawkins (from 10.55hrs)

MH Deputy Financial Officer SCCG

Julie-Anne Wales JAW Head of Corporate Governance and Planning

BCCG and WCCG

Sharon Woolley SW Board Administrator WCCG Melanie Alflatt MAf TIAA Craig Sullivan CS PWC Julie Masci JM Grant Thornton Peter Barber PB Grant Thornton Duncan Laird DL KPMG Rob Andrews RA KPMG

Apologies received Name Job title Organisation Julian Kirby JK Lay Member WCCG Jennie Carroll JC GP Representative SCCG Febin Basheer FB GP Representative SCCG

GOV/19/11/12

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NHS BaNES, Swindon and Wiltshire Clinical Commissioning Groups Page 2 of 10

Katie Hall KH Lay Member (Quality) BCCG Suzannah Power SP Lay Member (Patient and Public

involvement) BCCG

Tracey Cox TC BSW CEO BSW Were each of the meetings quorate? Yes No x

01 Introductions and Apologies PL took the role as convenor for this first meeting of the BaNES, Swindon and Wiltshire (BSW)

CCG’s Audit Committee in Common. Although meeting in common, they remain as three separate committees with their own terms of reference. Introductions of committee members took place. It was noted that MA had now also taken on the role as Registered Nurse for BaNES CCG as well as for Swindon. The BaNES CCG Audit Committee was not quorate, but comments and approval had been sought ahead of the meeting from KH and SP in accordance with the CCG’s Standing Orders. PL had received a response from KH and SP and would incorporate this into the relevant items.

02 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 BSW CCGs. Declarations declared by members of the Audit Committees are listed in each of the CCG’s Register of Interests. The Register is available either via the CCG’s Governance team or the CCG’s website via the following links: BaNES CCG – https://www.bathandnortheastsomersetccg.nhs.uk/documents/policies-and-governance/register-of-interests-2 Swindon CCG – http://www.swindonccg.nhs.uk/about-us/governance-and-compliance Wiltshire CCG - http://www.wiltshireccg.nhs.uk/governance PL advised that as convenor of the meeting, he had reviewed all three registers of interests ahead of the meeting to note any conflicts that may arise. There were no declarations of interests made at the meeting.

03 Approval of Minutes of the Previous Meetings 3.1 BaNES CCG Audit Committee – 17 July 2019

PL and KH confirmed they were an accurate record of the meeting and there were no matters arising. (SP had not been in attendance). The minutes of the meeting held on 17 July 2019 were approved as accurate record of the meeting.

3.2 Swindon CCG Audit Committee – 9 May and 23 May 2019 IJ took this item. IJ and BF agreed there were no points to raise in either set of minutes and they were an accurate record.

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https://www.bathandnortheastsomersetccg.nhs.uk/documents/policies-and-governance/register-of-interests-2

https://www.bathandnortheastsomersetccg.nhs.uk/documents/policies-and-governance/register-of-interests-2

http://www.swindonccg.nhs.uk/about-us/governance-and-compliance

http://www.wiltshireccg.nhs.uk/governance


The minutes of the meetings held on 9 May and 23 May 2019 were approved as accurate records of the meetings. (10.10hrs – CR joined the meeting)

3.2 Wiltshire CCG Audit Committee – 9 July 2019 PL, CR, MS and CW agreed there were no points to raise from the minutes. A correction to page 27 was to be made to the spelling ‘Steve Mapleston’. The minutes of the meeting held on 9 July 2019 were approved as accurate record of the meeting with this suggested amendment.

04 Action Trackers 4.1 BaNES CCG

The action tracker for B&NES CCG was reviewed with the following updates noted: • 5/12/18 – JAW advised that the HR team were reviewing and aligning polices where

possible, including the Whistleblowing Policy (now referred to as the Freedom to Speak Up Policy). CLOSED

• 17/07/19 - MAf advised that this referred to an adjustment to be made to the post training feedback form. MAf would ensure the amendment was made. CLOSED

• 17/07/19 - RA advised that chasing overdue actions earlier had brought some success and responses. Remaining actions would be updated via the internal audit reviews. CLOSED

• 17/07/19 - CG had investigated the NEPT issue – this was due to a change in criteria of accessing patient transport, not the service model. Service leads were now dealing with this issue. CLOSED

It was agreed to continue the approach of noting ‘themes to watch’.

4.2 Swindon CCG

IJ took this item. The action tracker for Swindon CCG was reviewed with the following updates noted: • 09/05/19 - MAf advised this would be revisited with JAW once the BSW Risk Register was

in place. Consideration would be given to a counter fraud specific risk for the register. CLOSED

• 09/05/19 – Leadership change and operational risk controls and impact would continue to be monitored by the Risk Panel. CLOSED

4.3 Wiltshire CCG

The action tracker for Wiltshire CCG was reviewed with the following updates noted: • AAC/19/07/04.1 - Arrangements for the security management service would be

harmonised where possible following the merger to one CCG. This would be noted on the BSW Audit Committees in Common action tracker to revisit in November. CLOSED

• AAC/19/07/08 - Revised Acceptable Use of IT policy to be circulated to Wiltshire Audit Committee members for reference. CLOSED

• AAC/19/07/14b - IT support was a BSW wide piece of work, looking at the model of support to all three CCGs from the CSU. One workshop had been held to date between the CCGs and CSU service leads, with another planned. Discussions were being aligned with other areas of work. The business case was in development, to be finalised by the end of October in readiness for submission to NHS England/Improvement (NHSE/I) for approval. CG advised that two options were being considered, of continuing with the existing CSU support but revising the service model, or transferring staff to bring the service in-house. Consultation with staff would take place through January and February, to bring the revised model online from 1 April 2020.

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Members raised concerns over the viability of the CSU going forward. CG advised that during the initial discussions with the CSU the issue of viability was not recognised. NHSE/I were aware of the discussions and advised that viability was not a concern for the CCGs, they were assured by the process we were following concerning service changes. PL queried if sufficient capacity would be in place if the service and staff were brought in house. Swindon CCG had already brought services in and now had a good IT team in place. The skills, experience and performance within each CCG was also being looked at. Good cyber security was in place in Swindon, there was now an opportunity to improve this across BaNES and Wiltshire. SP had expressed her concerns ahead of the meeting over the lack of focus on digital, data security and protection and technology standards. The committee agreed that this would be an area added to the ‘themes to watch’. This would be noted on the BSW Audit Committees in Common action tracker to revisit in November. CLOSED

05 Audit Committee in Common Work Plan Actions 5.1 Work plans from each Audit Committee had been aligned to

create the work plan for September 2019 to May 2020 to provide assurance to members of the committee’s focus areas and the proposed reporting schedule. A number of amendments were discussed and would be incorporated into the work plan. A request was made for the dates for the April and May Audit Committee meetings to be confirmed as soon as possible. The format for the April and May meetings was to be considered as these were predominately used to review and approve the draft and final Annual Report and Accounts. KH had raised this ahead of the meeting, and perhaps the need for three separate meetings to be held for that focus item for each individual CCG. JAW advised that each Governing Body was being asked to delegate its authority for the sign off of the Annual Report and Accounts to each of their Audit Committees. This was already in place in Swindon. It was also noted that as of the 1 April 2020, the new BSW CCG would be in place and current Lay Members may not form part of the new Board. A request for existing Lay Members to continue for a short while may be required to enable sign off. JAW would look at the options for this to ensure each remained quorate. It was noted that the completion of the annual Audit Committee Self-Assessment Checklists was undertaken differently within each CCG. A review of those completed last year would be undertaken to standardise the approach. These would be added to the work plan for March.

Action 5–01: Work plan to be amended by SW with suggested changes noted at the meeting. Action 5-02: April and May Audit Committee meeting dates to be set. Action: 5-03: JAW to consider extended involvement of existing Lay Members / Committee Members to enable the sign off of each CCGs Annual Report and Accounts. Action: 5-04: Lay Members to review last year’s Audit Committee Self-Assessment Checklists for each CCG to consider the approach for completing next years.

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06 Final Annual Audit Letter 2018/19 - Swindon CCG Actions JM advised that there had been a delay in noting the final

audit letter for Swindon CCG due to the cancelled Audit Committee meeting in July. It was brought to this meeting as a formality to record it had been reviewed and noted. Swindon CCG’s Governing Body had already been sighted on the letter and given its approval. JM had been confirmed as the appointed Grant Thornton auditor to cover external audit for the BSW. An audit manager was to be confirmed. Reports would be consolidated where possible.

07 External Audit Progress Reports Actions 7.1, 7.2, 7.3 & 7.4

BaNES CCG, Swindon CCG, Wiltshire CCG and Mental Health Investment Standard Review JM reported that the audit of the 2018/19 financial statements was now complete and annual letters had been sent. The review of the Mental Health Investment Standard was underway to conclude by the end of September. This was the first year for this review, which was looking at the mental health investments made by each CCG during 2017/18 and 2018/19 to calculate the change. It was not known if this review would be required annually. (10.55hrs – MH joined the meeting)

08 Internal Audit Progress Report and Recommendation Tracker

Actions

8.1 BaNES CCG and Wiltshire CCG RA advised that scoping for upcoming audits was complete and dates being discussed. This was also being aligned to PwC audits where possible. Strong progression would be made on delivering against the B&NES and Wiltshire plans to ensure audit reports were available to bring to the November meeting. CR had concerns regarding the number of audit reviews to complete for Wiltshire before the end of March. 12 March 2020 would be the last meeting of each CCGs Audit Committees before the new organisation was formed. Audit reports could not carry across to the new organisation. DL and RA assured members that KPMG were on course to complete the reviews as scheduled. A technical update for reference was included from page seven for Committee information.

8.2 Swindon CCG CS referred Members to page 86 of the pack to review the progress against the 2019/20 plan. A number of audits had

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been delayed following changes within PwC. Review scope had been aligned where there were common areas with KPMG. Scoping interviews were underway and terms of reference being finalised. Appendix A reviewed the implementation of recommendations and the progress made against outstanding actions. CS advised that an Integrating Organisations event was to be held next week as part of the PwC NHS Non Executive Programme. Details would be shared.

Action: 8.2: CS to share PwC event programme with BSW Lay Members.

09 Counter Fraud Actions 9.1 BSW Counter Fraud Progress Report

Although a BSW report, an update regarding each CCG was included within the document. MAf referred to work underway regarding the pre-employment check review for Wiltshire CCG. This concerned interim agency staff. It had been found that pre-employment checks were not carried out by the agency supplying the staff, which raised a due diligence issue for the CCG. Overall the report confirmed that each CCG was in a good position. TIAA had good support and presence within each CCG. Members were happy with the report format, but it was noted that perhaps too much information had been included in this first BSW report, but TIAA had wished to ensure all members were sighted initially.

9.2 Continuing Healthcare Personal Health Budgets (Swindon CCG) MH was in attendance to present the paper as prepared by Tracy Wray. MH talked through the background of the review and assessment of the cases as identified in the Personal Health Budget (PHB) Review carried out by TIAA. It was expected that all individuals would be transferred over to the in-house PHB Choices system by November 2019. All payments would be made via the CCG direct to a nominal budget for the individual to draw down. New individuals were now being added to this new system. Implementing the PHB Choices system had brought a significant amount of learning that would be valuable to share across the BSW. It also worked closely with the care track system. The system was scalable and allowed individuals to access via the telephone and computer. Wiltshire CCG was now signed up to use the system. The new system involved direct work with the individuals and their families. The staff resource to support this going forward would need consideration. Although the report only concerned the 12 cases identified

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in the review, these carried a huge financial and reputational risk due to the link to PHBs, which was an area scrutinised by the public. This review had brought an opportunity to ensure a robust system was put into place. An increase in the numbers of PHBs was expected across the patch and a robust BSW approach was needed. Targets had been set in the Long Term Plan. MAf advised that TIAA had completed a benchmarking activity against PHBs and had created reference material concerning risks to consider, and the ‘do’s and don’ts’. This learning would be shared with Committee Members. RA confirmed that internal audits of PHBs across B&NES and Wiltshire CCGs were to be undertaken.

Action: 9.2: MAf to share the learning from the TIAA PHB benchmarking exercise to all committee members.

10 Aligning Risk Management Systems and Processes for BSW

Actions

The risk management systems across the BSW were to be aligned to establish a consistent approach and risk appetite. The BSW Governance Teams had identified the best practice areas from each CCG to bring them together into one system and process.

10.1 BSW Risk Management Strategy 2019/2022 The strategy set out the risk appetite against each different type of risk. Page 149 indicated the level of risk tolerated, bringing a more explicit approach and concept. MAf supported the process. There was a need to add a reference to the CQC and HealthWatch on page 144, and ensure there was a link with Quality Impact Assessments.

Action: 10.1: Add reference to the CQC and HealthWatch, and ensure there was a link with Quality Impact Assessments.

10.2 BSW Risk Register – proposed format The proposed format for a combined BSW Risk register had been included with the papers. The operation of the register was to be tested.

10.3 Terms of Reference for Risk Panel Swindon CCG already had a Risk Panel established; this approach was to be implemented at a BSW level to bring a greater risk focus and implement a consistent approach. Registers would be reviewed by the Panel to then undergo further scrutiny at the Audit Committees before recommending adoption by each Governing Body. The draft terms of reference for the panel was included from page 170 of the pack. This structure would still ensure that high risk issues could be escalated at speed through the Executives and the incident management process. The process would be flexible when needed, but not lose the management of the risks in our system. The Executives were in full support of this new process to

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ensure a more rigorous risk management system was in place. The Risk Panel membership would be largely Executives. It was suggested that Locality Directors to be added to the Membership. The inclusion of a Lay Member was discussed, but agreed that this external scrutiny was needed at the Audit Committee. Staff could be called to attend the Panel or the Audit Committee when required to provide further information regarding their risks. Those risks scoring less than eight would not appear on the risk register, there would be a focus on the higher risks.

Action: 10.3: JAW to make suggested amendments to the Risk Panel Terms of Reference.

10.4 BSW Board Assurance Framework (BAF) 2019/20 The BAF currently used by BaNES CCG was a recommended format by the Internal Auditors; this had been adopted as the new BSW BAF. It linked the BSW strategic objectives to risks of delivery. A BSW and STP operating plan had been produced for 2019-20, so a number of priorities did not only relate to CCGs. The CCGs had shared responsibility of delivery of these. The BAF noted largely those for the CCG to deliver and that would be of interest to the Board, and the biggest risks associated with delivery. Members were in support of the new BAF format. This would now be embedded across the BSW, with an operational BAF to be presented to the November Committee meeting. RA advised that feedback against the process had been given ahead of the meeting. KPMG were in support of the format, noting that it would develop as the format was implemented.

PL noted that the aligning of Risk Management Systems and Processes for BSW had support from KH and SP. The BaNES, Swindon and Wiltshire Audit Committees approved the establishment of the BSW Risk Panel, with the suggested membership amendments. The BaNES, Swindon and Wiltshire Audit Committees recommended the BSW Risk Management Strategy, the new format BSW Risk Register and new format BSW Board Assurance Framework to the BaNES, Swindon and Wiltshire Governing Bodies for approval and adoption.

11 Review of Risk Registers Actions 11.1, 11.2 and 11.3

B&NES CCG, Swindon CCG and Wiltshire CCG JAW presented the current risk registers for BaNES, Swindon and Wiltshire CCGs. It was noted that the BaNES CCG register required

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updating, which would bring a change in a number of scores and remove some risks from the top 10. There were a number of similar risks noted upon each register, but also some locality specific risks. The Risk Panel would bring value to sharing these risks and considering mitigations, and would ensure that all risks were regularly updated. Members favoured the risk map and trends elements from the current registers, to take forward into the new BSW Risk Register format. The BaNES, Swindon and Wiltshire Audit Committees approved the top ten risks and recommended them BaNES, Swindon and Wiltshire Governing Bodies for approval.

12 Proposed Audit Committee in Common Meeting Dates Thursday 14 November 2019

Thursday 9 January 2020 Thursday 12 March 2020 10.00 – 12.30hrs Jenner House, Chippenham Apologies from IJ for the November meeting were noted. PL would take the role as convenor for that meeting in the absence of IJ. April and May 2020 meeting dates would be confirmed by SW.

13 Any Other Business Actions 13.1 BSW Audit Committees in Common Feedback

PL welcomed feedback from Members concerning the format of this first Committee meeting in common. Members agreed the meeting format had worked well and reports were as required. JAW raised the issue of hard copy papers, and the need for some Members to move to paperless. It was agreed that printed copies for those who require them will be provided until April.

Date, time and location of next meeting Thursday 14 November 2019

10.00 – 12.30hrs Bevan Room, Jenner House, Chippenham

Meeting closed at 11:50hrs.

Signed as a true record and as approved by the BSW Audit Committees in Common at its meeting on 14 November 2019.

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Name: Peter Lucas

Role: Convenor (Lay Member, Audit and Governance and Chair of the Wiltshire and BaNES CCGs Audit Committees)

Signature:

Date:

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HEALTH AND WELLBEING BOARD

MINUTES OF THE HEALTH AND WELLBEING BOARD MEETING HELD ON 26 SEPTEMBER 2019 AT KENNET COMMITTEE ROOM.

Present:

Dr Richard Sandford-Hill (Co-Chair), Dr Andrew Girdher, Angus Macpherson, Cllr Laura Mayes, Tracy Daszkiewicz, Ian Jeary, Rob Jefferson, Alison Ryan, Andy Hyett and Nerissa Vaughan

Also Present:

Ted Wilson, Lucy Baker, Martin Davis, Helen Jones, James Corrigan, Jo Cullen, Steve Maddern, Richard Crompton and Tracy Cox.

65 Chairman's Welcome

The Chairman welcomed all to the meeting.

66 Apologies for Absence

Apologies were received from Cllr Philip Whitehead, Cllr Ben Anderson, Cllr Gordon King, Cllr Pauline Church, Gareth Bryant, Kier Pritchard, Linda Prosser, Nicola Hazle, Terence Herbert, Carlton Brand, Kevin McNamara, Toby Davies and Suzanne Tewkesbury.

James Scott was substituted by Alison Ryan and Cara Charles-Barks was substituted by Andy Hyett.

67 Minutes

The minutes of the previous meeting held on 25 July 2019, previously circulated, were considered.

Resolved

To approve the minutes as correct.

68 Declarations of Interest

There were no declarations of interest.

GOV/19/11/14

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69 Public Participation There were no questions from the public. The Board received a statement from Vincent Mobey whose wife, Maggie, had been diagnosed with Parkinson’s disease in 2016. Vincent highlighted a service gap in specialist Parkinson’s nurse provision for North Wiltshire patients which had been vital in influencing the proposal to enhance Parkinson’s nurse provision in the GWH Community Neurology Team; and support the next steps to agree the recommended way forward and commission enhanced service with the support of Parkinson’s UK as detailed in the report.

70 Chairman's Announcement The Chairman made the following announcement:

#EPIC Talk - Sir Al Aynsley-Green #EPIC Talks invite you to join Sir Al Aynsley-Green on 26 September 2019 17:30 pm - 19:00 pm as he confronts and explores the reality of childhood in one of the most unequal societies in the developed world. A must-read for those engaged in children’s services, policy and parenting in the UK. Sir Al confronts the obstacles and attitudes faced by young people today with tact, honesty and compassion, to offer his vision of a society in which each and every child is valued.

The Board noted its gratitude to Linda Prosser for all she had done for the Health and Wellbeing Board and wished her luck with the rest of her career.

71 Support for those living with Parkinson's

Ted Wilson gave an update on nursing and other support for those living with Parkinson’s disease. Matters raised during the presentation included existing specialist Parkinson’s provision in Wiltshire; a service gap for North Wiltshire patients and options to enhance the service to deliver greater equity of access. In answer to a question raised by the Board it was noted that there are expected challenges in recruiting for the specialist nurse roles required. There is, however, general training offered nationally and many people are known to move from one specialist role to another, for example physiotherapists.

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The Board noted its gratitude to Vincent Mobey for highlighting this issue and playing such an active role in developing the proposals to enhance Parkinson’s provision in North Wiltshire. The Board also extended its gratitude to Jerry Wickham, who was heavily involved in beginning the process with Ted Wilson and Vincent Mobey. Resolved 1. To note the proposals to enhance Parkinson’s nurse provision in the

GWH Community Neurology Team 2. To support the next steps to agree the recommended way forward and

commission enhanced service with the support of Parkinson’s UK.

72 Maternity Consultation Lucy Baker gave an update on the progress with the consultation on maternity services, noting that the consultation had been completed and the findings had been subject to rigorous academic analysis with an independent panel looking at recommendations. A decision-making case will be put to the October BSW STP meeting and the outcome will be shared at a future Health and Wellbeing Board meeting Resolved To note the progress of the consultation on maternity services.

73 Ofsted Report Martin Davis presented a report on the findings of the recent Ofsted inspection of Wiltshire Council. Matters raised during the presentation included the impact of leaders on social work practice with children and families; the experiences and progress of children who need help and protection; the experience and progress of children in care and care leavers; the Council’s overall effectiveness and what it needs to improve going forward. In answer to a question raised by the Board it was noted that Wiltshire Council had recognised the need to raise awareness of private fostering in the local community before the Ofsted report’s recommendation. It has worked specifically with GPs and practices to raise awareness but there is an acceptance that more needs to be done in regard to engagement with schools. The Board congratulated the service for the work they had put in to achieve a “Good” judgement from Ofsted’s inspection of Wiltshire Council.

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Resolved To note the findings of the recent Ofsted inspection of Wiltshire Council.

74 Children's Community Health Services Lucy Baker, Tracy Daszkiewicz and Helen Jones gave a presentation on progress made delivering the contract for children’s community health services. Matters raised during the presentation included quality and performance data across the whole service; overviews of each individual service within the contract and performance issues currently being managed. In answer to a question raised by the Board it was noted that the children had not been receiving their initial health assessments in a timely manner for some time now. There are several reasons for this delay in assessment and a designated review board had been established with membership from Virgin Care, commissioning representation and Wiltshire Council as well as social care colleagues to find solutions. The Board raised its concerns over capacity within the service. It was noted that there were skill shortages in some areas but that by January 2020 the service all positions in the Community Paediatric Team and Community Therapy Team would be filled. The Looked After Children team is also fully recruited. It was noted that following the release of the latest staff satisfaction survey in October 2019, further work will be required to consolidate any improvements in performance or to address areas of concern. In response to a question from the Chairman it was noted that Virgin Care’s contract would up in 2021 and the parties were nearly at a point in which it could inform the Board on whether its contract would be extended. Resolved To note the summary provided.

75 Child and Adolescent Mental Health Services Transformation Lucy Baker gave an update on the local plan and delegate sign off to the chair in consultation with the Families and Children’s Transformation Board. Matters raised during the presentation included the key achievements over the past 12 months; the funding of services and the key priorities for 2019-20 and beyond. It was noted that a recent Healthwatch Wiltshire study found that there was a great deal of frustration amongst young people regarding Child and Adolescent

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Mental Health Services (CAMHS). However, many of these frustrations had been addressed in the report. It was noted that plan aims to recommission a ‘mental health early intervention service’, to include talking therapies, that offers greater equality of access and which targets young people at high risk of developing mental health disorders. In response to a question from the Board it was noted that the transition from child and adolescent to adult mental health service continued to be a challenge for the service. There are early discussions being had about how the transition for 16-25-year olds can be improved and the development of a whole life pathway Similarly joint work plans, for example for those with eating disorders, were needed. It was suggested that a further update on CAMHS be provided in six months’ time with further information on benchmarking against other areas and historically – covering aspects such as rates of self-harm. Resolved 1. Note the progress to date on the implementation of the CCG local

transformation plan for children and young people’s mental health and wellbeing.

2. Review and support future proposals identified in this paper and in the draft refresh of the transformation plan.

3. Delegate sign off to the HWB Chairs following consultation with the Families and Children’s Transformation Board and finalisation of the 2019 refresh.

76 Mental Health Crisis Care Concordat

Lucy Baker and Angus Mcpherson presented a report on the implementation of the concordat in Wiltshire and across the BSW STP. Matters raised during the presentation included: nobody under s136 had been placed in custody in the last two years; development of Health Based Places of Safety ; the Bluebell Health Based Place of Safety evaluation; rotas for s12 doctors; BaNES & Wiltshire Crisis Accommodation and successful funding bids. Lucy Baker undertook to circulate to the Board the options appraisal on Health Based Places of Safety. In answer to a question raised by the Board it was noted that there were challenges in the way those with learning difficulties and autism had been treated. There would be a whole review of the LD/ ASD pathway which would focus on prevention work and what the service can provide in crisis situations.

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It was noted that there is an imbalance in the number of crisis patients the Wiltshire and B&NES area takes from Bristol and the surrounding areas than vice versa and work needs to be done to address this. Resolved To note the Mental Health Crisis Care Concordat update.

77 Better Care Plan 2019/20 Helen Jones, Ted Wilson and James Corrigan presented a report on the Better Care Plan 2019/20 and the latest information on the performance of existing initiatives. Matters raised during the presentation included the absence of NHS England at the meeting indicating a lack of concern with the proposals; the co-produced model for the Better Care Plan 2019/20 and the Better Care Submission 2019/20. It was noted that while new priorities are in development, an existing programme of schemes funded by the Better Care Plan continues to be implemented with the objectives of contributing to NHS England’s high-impact changes and to the specific performance objectives. Resolved To agree the Better Care Plan Submission for 2019/20 and agree its submission to NHS England.

78 Initial Winter Plan Jo Cullen gave a presentation on the initial winter plan 2019/20. Matters raised during the presentation included: the services covered; assurance and signoff deadlines; lessons learnt in 2018/19; the additional social care winter capacity; that GWH and RUH perspectives are fed in alongside SFT. In answer to a question raised by the Board it was noted that engagement has begun with relevant teams and services and the initial winter plan 2019/20 proposals are based on a confidence in these to quickly and efficiently change to the new social care bedding capacity. Resolved To note the initial winter plan for 2019/20.

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79 Joint Health and Wellbeing Strategy Tracy Daszkiewicz presented a report on the new Joint Health and Wellbeing Strategy. Matters raised during the presentation included its background and purpose; amendments and comments for future discussion. Resolved To note the consultation feedback at Appendix 1 and approves the JHWS at Appendix 2 for publication.

80 Obesity Strategy Steve Maddern presented a report on the obesity strategy. Matters raised during the presentation included its background; the strategic priority areas; strategic target outcomes and future plans. It was noted that there is a healthy weight and diabetes conference on the 07 November 2019. Resolved 1. To note the positive outcomes that have been achieved since the

strategy was published in 2016. 2. To approve the proposal for a legacy programme to support Wiltshire

residents to achieve and maintain a healthy weight.

81 Sexual Health Strategy Steve Maddern presented a report on the sexual health and blood borne virus strategy. Matters raised during the presentation included its background; Wiltshire Sexual Health and Blood Borne Virus Strategy 2017-20; strategic oversight; sexual health strategy outcomes; key priorities and options going forward. In answer to a question raised by the Board it was noted that late diagnosis for those living with HIV is at times due to a stigma. It was noted that sexual health should be managed within the military but it is understood this isn’t fully supported at times. The strategy seeks to provide some support and recognise that some military personnel may prefer to come to public practices than those provided by the military. It was also noted that teenage pregnancy levels remained low. There many factors that have driven this including more effective contraception and changes

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in local policy. However there had been a recent rise in terminations and repeat terminations which was a concern. Resolved To note and acknowledge the Sexual Health and Blood Borne Virus strategy implementation update and agree the way forward post-strategy based on the recommendations in this paper.

82 Wiltshire Safeguarding Adults Board Annual Report 2018/19 Richard Crompton presented the WSAB annual report and priorities for 2019/20. Matters raised during the presentation included the outcome of the 2019 Safeguarding Adults Review regarding Adult E; the work done by WSAB in 2018/19 and its strategy for 2019-2021. With respect to adult E it was noted that commissioners need to consider a continued role for care providers while LD patients are in hospital; commissioners need to look at the way in which advocacy services are provided to residents when they attend acute hospitals out of the area and the RUH reiterated its apology for what had happened in this case. In answer to a question raised by the Board it was noted that every healthcare professional needs to understand more about mental health and not just leave that area of work to specialists. The Board noted that it was impressed with level of debate and engagement with partners and service providers at Wiltshire Safeguarding Adults Board meetings. Resolved 1. Notes the outcome of the 2019 Safeguarding Adults Review relating to

Adult E and acts to ensure that this learning has an impact on the work of its member agencies.

2. Notes the work done by WSAB in 2018/2019 and commits the necessary partnership resources to ensure that the WSAB’s three-year strategy for 2019-2021 can be delivered effectively.

3. Continues to support the work of the Board to safeguard vulnerable adults in Wiltshire.

83 Date of Next Meeting

The date of the next meeting will take place on Thursday 28th November 2019 at 9.00am.

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84 Urgent Items It was noted that James Scott, Chief Executive of Royal United Hospitals Bath NHS Foundation Trust, was to retire and would not at the April 2020 meeting of the Board. It was also noted that Clinical Commissioning Groups (CCGs) had engaged with partners about the forthcoming merger. The CCG will be submitting a formal merger request effective from April next year.

(Duration of meeting: 9.00am – 11.30am)

The Officer who has produced these minutes is Craig Player, of Democratic & Members’ Services, direct line 01225 713191, e-mail [email protected]

Press enquiries to Communications, direct line (01225) 713114/713115

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Paper Summary Sheet

Presented to: Governing Body - Public Date of Meeting: 26 November 2019 For: To Note

Agenda Reference: GOV/19/11/15

Title: Public Health Wiltshire Council and NHS Wiltshire CCG Memorandum of Understanding

Executive summary: This paper details the updated Memorandum of Understanding (MoU) for the collaborative working arrangements between Public Health Wiltshire Council and NHS Wiltshire CCG to enable delivery of statutory public health responsibilities arising from the Health and Social Care Act 2012. There has been an MoU between Public Health Wiltshire Council and NHS Wiltshire CCG since 2013 and this is the updated MoU for 2019-2022. This MoU describes the framework of collaborative working arrangements between NHS Wiltshire CCG and Public Health Wiltshire Council. It agrees a three year ‘core offer’ for public health advice from Public Health (PH) to the CCG which clearly defines outputs. It is important to note that PH support will be provided mainly through the Local Authority PH team but there may also be support available from Public Health England (PHE) and the PH teams at NHS England. No charges will be made between organisations for the collaborative working arrangements described in this document. The core offer agreed through the original MOU has not been altered.

Recommendations: The Governing Body is asked to note the updated MOU between NHS Wiltshire and Public Health Wiltshire.

Previously considered by:

Since Public Health was moved into the local authority there has been an MoU that highlights the agreed areas of support and collaborative work that will take place between the NHS Wiltshire CCG and Public Health Wiltshire. This is the updated version for 2019 - 2022

Author(s): Ted Wilson Tracy Daszkiewicz

Sponsoring Director / Clinical Lead/ Lay Member:

Ted Wilson

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Risk and Assurance: Not Applicable Financial / Resource Implications: Not Applicable

Legal, Policy and Regulatory Requirements:

Not Applicable

Communications and Engagement: Not Applicable

Equality & Diversity Assessment:

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Memorandum of Understanding

Public Health Wiltshire Council and NHS Wiltshire Clinical Commissioning Group

A memorandum of understanding for the collaborative working

arrangements between Public Health Wiltshire Council and NHS Wiltshire CCG to enable delivery of public health responsibilities arising from the

Health and Social Care Act 2012.

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THIS MEMORANDUM is made for the period 1st November 2019 1st November 2022 PARTIES: The parties to this Memorandum are: (1) NHS Wiltshire Clinical Commissioning Group (CCG) and (2) Public Health Wiltshire Council 1. PURPOSE

1.1 This Memorandum of Understanding (MoU) describes the framework of collaborative working arrangements

between NHS Wiltshire CCG and Public Health Wiltshire Council. 1.2 It agrees a three year ‘core offer’ for public health advice from Public Health (PH) to the CCG which clearly defines

outputs. It is important to note that PH support will be provided mainly through the Local Authority PH team but there may also be support available from Public Health England (PHE) and the PH teams at NHS England.

1.3 No charges will be made between organisations for the collaborative working arrangements described in this

document.

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2. BACKGROUND 2.1 Public Health was a part of the NHS from 1974 until 2012. During this time specialist public health staff assumed

the lead for the three major responsibilities on behalf of the NHS and local communities:

Population healthcare – working in collaboration to ensure health services deliver high quality health care best meeting the needs of the local population and maximizing health outcomes.

Health protection - preventing the spread of communicable diseases, coordinating the response to major

incidents, and provision and assurance of screening programmes.

Health improvement - addressing lifestyle factors and the wider determinants of health to reduce inequalities and improve population health.

2.2 Good population health outcomes, including reducing health inequalities, rely not only on health protection and health improvement, but on the quality and accessibility of healthcare services provided by the NHS.

2.3 The delivery of these responsibilities is supported in Wiltshire by a skilled and qualified Public Health team, which

provides high quality specialist public health advice and analysis on the health needs of the population and the impact of ill-health and service delivery on the health of the local population.

2.4 With the implementation of the Health and Social Care Act (HSCA) 2012, primary responsibility for improving health

and coordinating local efforts to protect the public’s health and wellbeing was transferred at local level to Local

Authorities with some public health responsibilities and resources passed at the national level to Public Health

England. Responsibility for strategic planning and commissioning of NHS services was transferred to NHS England

nationally and locally to CCGs.

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2.5 Under the Health and Social Care Act 2012 CCGs have a specific duty to seek public health advice, and local authorities have a duty to provide this advice to CCGs in order to deliver improvement in the quality of services, reducing inequalities and promoting integration of services at the local level.

2.6 These duties and their importance for maintaining and improving the health of the populations served by Public

Health Wiltshire Council and NHS Wiltshire CCG therefore indicate the need to develop and maintain a framework for this relationship.

3. Principles of Collaboration

3.1 NHS Wiltshire CCG and Wiltshire Council agree to adopt the following principles during the period of this MoU.

Collaborate and co-operate: Both organisations will do their best to work in the spirit of positive collaboration, mutual support and shared objectives.

Accountability: Both organisations will accept their responsibility for delivering on the agreement in this MoU.

Openness: NHS Wiltshire CCG and Wiltshire Council will communicate openly about major concerns, issues or opportunities relating to the collaboration outlined in this MoU.

Development: NHS Wiltshire CCG and Wiltshire Council will share information, experience and skills to share best practice and develop effective working practices to identify innovative solutions, eliminate duplication and reduce cost.

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4. Accountability and governance 4.1 The Director of Public Health and the Chief Operating Officer of Wiltshire CCG will meet annually to review the

success of the relationships and work as outlined in the framework. 4.2 A formal report on the work undertaken as part of this MoU will be prepared collaboratively by the responsible

consultant in public health annually and sent to the senior management teams in the CCG and the council.

5. Scope 5.1 The framework sets out the scope of the service that Wiltshire Public Health will provide to the NHS Wiltshire CCG,

and the reciprocal responsibilities of the CCG.

This MoU covers the 3 domains of Public Health:

Population healthcare

Health protection

Health improvement

5.2 The MoU covers the period from 1st September 2019 until 1st September 2022 subject to local needs and national guidance for this period.

5.3 Regulations prescribe that advice can only be given by appropriately skilled public health specialists. This

includes accredited specialists (i.e. Director of Public Health, Public Health Consultants) and wider intelligence and analytical resources.

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6. Population Healthcare 6.1 The Health and Social Care Act 2012 established CCGs as the main local commissioners of NHS services and

gave them a duty to continuously improve the effectiveness, safety and quality of services. 6.2 Department of Health guidance indicates that support for specific NHS commissioning functions should be

obtained from an appropriately skilled local public health specialist team. The functions required of CCGs include domains where significant public health science skills are required to perform competently.

Wiltshire Public Health will provide Public Health information and analysis to support strategic planning through:

Wiltshire Public Health will provide Public Health information and expertise to support the prioritisation and allocation of resources and expertise on clinical effectiveness to support commissioning through:

NHS Wiltshire CCG will support strategic planning through:

Overseeing the production and development of Wiltshire’s Health and Wellbeing Joint Strategic Need Assessment (HWJSNA), which the CCG can use to inform commissioning plans.

Advising the CCG on prioritisation processes, governance and best practice.

Considering Public Health data, including health inequality data, in planning.

Producing JSNAs for CCG localities and JSNAs for Community Areas to inform commissioning plans.

Supporting commissioners to identify areas for disinvestment through use of the CCG budgeting reports and economic appraisals.

Contributing data and intelligence to the production of the suite of JSNAs.

Producing information and intelligence products for developing Primary Care

Advising CCG and PCN on prioritisation processes and

Contributing data and intelligence to the production of products for

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Networks (PCNs) to inform their role on reducing health inequalities and identifying local population needs.

evidence based prevention practice.

PCNs and highlighting areas for future work with PCNs.

Providing health needs assessments for particular conditions/disease groups, where they have been identified as a priority through the JSNA.

Assisting the CCG in critical appraisal of the evidence to aid appropriate response to individual funding requests

Contributing data and intelligence on a range of topics for example: In the reduction of unwanted teenage pregnancies through the sharing of the local teenage conception and abortion data on an annual and quarterly basis.

Providing ad-hoc advice on methodologies to develop and analyse data and achieve data quality.

Providing public health specialist advice on: The clinical and cost effectiveness of interventions and medicines, and the development of evidence based care pathways

Supporting the strategic understanding through the sharing of in-hospital mortality data and intelligence on a quarterly basis for Wiltshire patients and the three acute trusts delivering services to the population of Wiltshire

Supporting commissioning practice towards the reduction of local health inequalities and the specific needs of vulnerable and marginalised groups

Providing public health specialist advice on service specifications and quality indicators.

Working with Public Health on the continued development and delivery of the Health and Wellbeing Strategy.

Supporting GPs to collect and utilise improved inequalities data.

Identifying and assess population impact of implementing NICE guidance/guidelines.

Incorporating the JSNA and Joint Health and Wellbeing Strategy into NHS commissioning plans.

Highlighting any inequalities/vulnerable groups within the Health Profiles (within the constraints of the data available).

Giving advice on monitoring and evaluation frameworks.

Reviewing how commissioning plans have contributed to the delivery of the Health and Wellbeing Strategy and sharing this review with the Health & Wellbeing Board.

Carrying out health equity audits and Providing specialist public health Considering how to incorporate

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providing advice on health impact assessments.

advice on relevant aspects of modelling/capacity planning.

specialist public health advice into decision making processes, in order that public health skills and expertise can inform key commissioning decisions.

Supporting the monitoring of commissioning criteria related to sustainable development presented by service providers.

Providing support for engagement with public and partners through objective analysis, to provide the impartiality necessary to communicate and defend difficult decisions to the public.

Using information on effectiveness, cost effectiveness and acceptability to inform policy decisions on commissioning of services in order to maximise health gains and to reduce health inequalities. Working in partnership with providers and research partners to develop the evidence base for important innovations.

Support the development of the clinical policies and IFR panel work programme through attendance at STP Clinical Policies Working Group and Wiltshire IFR panel to ensure a population health approach is maintained.

Providing specialist public health advice to the work programme to ensure clinical effectiveness, cost effectives and equality of care is maintained.

Pro-actively engage public health in the ongoing work of clinical policy development and IFR.

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7 Health Protection

7.1 The Health and Social Care Act 2012 is supported by regulations which give Wiltshire’s Director of Public Health a series of responsibilities in respect of health protection. These include local strategic leadership for public health protection including preventing and responding to outbreaks of communicable disease, planning for and mitigating the effects of public health incidents and environmental hazards, consulting with local infection, prevention and control leads and receive regular assurance in regarding to NHS resilience’

7.2 The Health and Social Care Act 2012 designates CCGs as Category 2 responders under the Civil Contingencies Act 2004, and bestows on them a duty to co-operate with other responders and to share information both in the planning for and response to major incidents. These duties are intended to ensure that CCGs are properly prepared to deal with emergencies. The Secretary of State retains emergency powers to direct any NHS body to extend or cease functions, and is likely to discharge these through NHS England.

Wiltshire Public Health will implement robust integrated emergency management and health protection principles to ensure that:

NHS Wiltshire CCG will:

Local threats and hazards likely to impact on the health of the local population are identified and mitigated. This will include:

Working as a key member of the Local

Resilience Forum and the Local Health

Resilience Partnership to develop the

Community Risk Register and subsequent

registers of locally accepted risks.

Working collaboratively with specific sites

within Wiltshire that may pose risks to the

health of local populations.

Fulfill their duties as a Category 2 responder under the Civil Contingencies Act 2004 by co-operating with other local responders and sharing information as necessary, especially under major incident conditions.

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Local strategic plans are in place for responding to the full range of principle risks identified in the Community Risk Register.

Adopt, ratify and maintain a suite of appropriate plans policies and procedures to enable the CCG to implement an appropriate response to local to incidents.

Public Health staff are appropriately trained or have access to externally provided or accredited training to be able to expedite specific roles and responsibilities during the response to major incidents or communicable disease outbreaks.

Participate in single or multi-agency exercises when requested to do so. This may include six monthly communication cascade tests, annual table top exercise participation and triennial live exercise participation.

The Public Health capacity and skills are in place to co-ordinate the response to emergencies, through strategic and tactical command and control arrangements.

Ensure that staff required to respond to a major incident are familiar with Strategic (Gold) and Tactical (Silver) multi-agency command centres and procedures.

Plans are adequately tested and exercised. This will require participation in health led or multi-agency exercises, of which some will be coordinated by the LRF.

Respond to and commit appropriate primary care resources required to respond to a public health incidents such as communicable disease outbreaks, major or mass casualty incidents.

Debriefing for real incidents is undertaken and that learning points are captured and incorporated into future training requirements and plan revisions.

Ensure that providers of commissioned services have robust business continuity plans in place as part of established contracting and commissioning processes.

The CCG has access to relevant Emergency Planning Resilience and Response (EPRR) expertise, relevant plans, policies and operating procedures and is provided an opportunity to be involved in any exercises.

Ensure that constituent practices themselves have business continuity plans in place to cover action in the event of the most likely business continuity incidents.

Timely and adequate advice is available to the clinical community on health protection and infection control issues. This will include the provision of Public Health support for Scientific and Technical Advice Cells (STAC) if activated.

Work collaboratively with Public Health on Medicines Management matters to effectively manage outbreaks; produce patient group directives; provide appropriate advice on the storage and distribution of drugs; and provide appropriate advice on new antigens.

The provision of programme management, surveillance and public health intelligence relating to childhood and adult vaccination and immunisation campaigns that protect the health of local populations. This will include feedback

Use Public Health information to support immunisation and screening programmes, working together to reach high coverage.

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and reporting to CCGs especially where potential risks to public health are identified due to inadequate coverage as part of the public health assurance process to inform discussion with NHS England as the commissioners for the service.

Work is undertaken collaboratively with Wiltshire CCG on Medicines Management matters to effectively manage outbreaks; produce patient group directives; provide appropriate advice on the storage and distribution of drugs; work on antimicrobial drug resistance and provide appropriate advice on new antigens.

Supporting, reviewing and challenging delivery of key public health funded and NHS delivered services such as screening programmes.

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8 Health Improvement 8.1 The Health and Social Care Act gave Wiltshire Council a statutory duty to improve the health of the population

from April 2013. Wiltshire CCG also has duties to secure continuous improvement and reduce inequalities in the outcomes achieved by health services. This requires action along the entire care pathway from prevention through primary, secondary, and tertiary care to community health and social care. Wiltshire Council and Wiltshire CCG therefore have a joint interest in health improvement.

Wiltshire Public Health will: NHS Wiltshire CCG will:

In conjunction with other partners, regularly refresh the strategy and action plans for improving health and reducing health inequalities, mental health and wellbeing, obesity, smoking, alcohol and falls and seek CCG input into these.

Contribute to the strategy and action plans for improving health and reducing health inequalities and lifestyle issues.

Work within Wiltshire Council to embed ownership and leadership of health improvement.

Encourage constituent practices to maximise their contribution to disease prevention – for example by taking every opportunity to address smoking, alcohol, obesity in their patients and by optimising management of long term conditions.

Support the embedding of public health and wellbeing initiatives into all frontline services (e.g. NHS, Local Authority and Voluntary Sector) towards improving outcomes and reducing demand on treatment services.

Ensure primary and secondary prevention is incorporated within commissioning plans.

Facilitate partnership working between the CCG, local partners and residents to integrate and optimise local efforts for health improvement and disease prevention.

Commission to reduce health inequalities and inequities in access to services. Support and contribute to locally driven public health campaigns.

9 Communications

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9.1 Communications plans and media relations, such as press releases in relation to operational services, will

continue to be drafted by the communications team that currently supports them and be released by the relevant officer. Controversial issues will be shared between NHS Wiltshire CCG’s and W iltshire Council’s communication teams to ensure a consistent line is taken.

10 Quality of the service 10.1 Wiltshire Council will ensure that an appropriately skilled Public Health workforce will be maintained and supported

to allow delivery of the technical and leadership skills required of the service. This will include ensuring the agreed public health resource is not diminished without agreement from NHS Wiltshire CCG.

10.2 The Director of Public Health , and Public Health consultants, will be registered with the Faculty of Public

Health (FPH) for continuing professional development.

11 Finance

11.1 Financial provision for Public Health in the Local Authority will be made under Section 31 of the LGA 2003 and

will carry conditions about how it may be used. The intention is for the grant to be spent on activities whose main or primary purpose is to impact positively on the health and wellbeing of local populations, with the aim of reducing health inequalities in local communities in accordance with the criteria published at (link to be inserted)

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12 Reconciliation of disagreement

12.1 Any disagreements will normally be resolved amicably at the working level. If this is not possible, senior

managers at either organisation should seek to settle any issue. The escalation route, if necessary, is to the Director Public Health and the NHS Wiltshire Clinical Commissioning Group Chief Operating Officer . If still unresolved, the matter should be referred to the Corporate Director of Wiltshire Council with the responsibility for public health and the Chair of NHS Wiltshire CCG, with the option of considering the use of external facilitation or arbitration.

13 Review of Memorandum of Understanding

13.1 This MoU will be reviewed on an annual basis in January each year. The review will include an update on the

programme of work. Proposed review date-

Signatories

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Date: 05.11.19 Date 05.11.19

Director Public Health Acting CCG Chief Operating Officer Wiltshire Council Wiltshire Clinical Commissioning

Group

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Presented to: Governing Body - Public Date of Meeting: 26 November 2019 For: To Note

Agenda Reference: GOV/19/11/16 Title: Register of Declarations of Interests

Executive summary:

NHS England guidance requires that the CCG has a public register of declarations of interests, which lists the interests of those employed staff who make decisions on behalf of the CCG, as well as individuals who are not CCG employees but input to CCG decisions. This register must be refreshed on at least an annual basis. To ensure the Register is up to date, a monthly process is in place to capture declarations of interest from any new employees and refresh declarations with existing employees. Declarations are also requested at committee meetings. Any declarations of interest are presented on the attached public register, a version of which is also published on the CCG website and updated as further declarations are received throughout the year. The Register is presented to the Governing Body three times a year and is proactively used by committee Chairs to identify potential conflicts of interests prior to meetings.

Recommendations: To note the content of the Register.

Previously considered by:

The Standards of Business Conduct Policy detailing the arrangements for management of declarations of interests was approved by the Audit & Assurance Committee in September 2017.

Author(s): Susannah Long, Governance & Risk Manager Sponsoring Director / Clinical Lead/ Lay Member:

Julie-Anne Wales, Head of Corporate Governance & Planning

Risk and Assurance: The Register is a risk management tool and subject to internal audit. Financial / Resource Implications: None

Legal, Policy and Regulatory Requirements:

Information collected and published in line with NHS England ‘Managing Conflicts of Interest: Revised Statutory Guidance for CCGs 2017’

Communications and Engagement: The Register is a public document which will be published on the CCG website.

Equality & Diversity Assessment:

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Date Received Last Name First Name Title Position within, or relationships with, the CCG Interests to Declare Description of Interest From To Financial

Interests

Non-Financial professional

interests

Non-Financial personal interests

Indirect Interests Source

Consented to

publication

Internal / External /

Seconded InComments / Mitigation Public /

Private

04-May-18 Allen Martin Dr Sarum South Locality Lead No DoI Yes Internal Public10-Jun-19 Baker Lucy Mrs Acting Director of Acute Commissioning Yes Spouse works for GWH 2002 Ongoing Yes DoI Yes Internal Public17-Jun-19 Barber Peter Mr External Auditor No DoI Yes External Public01-Feb-19 Batley Rees Mr Head of Internal Audit Yes A number of NHS and CCG clients Yes DoI Yes External Public

01-Feb-19 Batley Rees Mr Head of Internal Audit Yes Trustee of Headway Bristol Brain Injury Association Limited 01/01/2018 Ongoing Yes DoI Yes External Public

04-Feb-19 Bayliss Donna Ms Quality Manager Yes Spouse wheelchair technician Wiltshire Health and Care 01/03/2018 ongoing Yes DoI Yes Internal Public27-Feb-19 Bickerstaffe Ed Mr Triaging Optometrist (RMC) Yes Optom for Haine & Smith 01/06/2018 Ongoing Yes DoI Yes Internal Public04-Jun-19 Blackburn Kathryn Ms Public Health Consultant, WC No DoI Yes External Public28-Nov-17 Borrelli Paul Dr Member of Clinical Governance Team Yes GP in Wiltshire Yes DoI Yes Internal Public14-May-19 Brown Alison Dr GP Clinical Lead - Dementia Yes GP Partner Castle Practice 5/13/19 Ongoing Yes DoI Yes Internal Public14-May-19 Brown Alison Dr GP Clinical Lead - Dementia Yes PCN and Solstice Health member 01/01/2019 Ongoing Yes DoI Yes Internal Public13-May-19 Burns Timothy Mr Commissioning Manager No DoI Yes Internal Public

18-Oct-19 Cadle Louise Mrs Head of Emergency Preparedness Response and Resistance No DoI Yes Internal Public

06-Jun-19 Champness Kaithleen Ms Children's Commissioning Manager YesNephew has complex health needs and sits under a range of children's community healthcare services (contract managed by me).

ongoing Yes DoI Yes Internal Any complaints/funding requests/incident reports specific to his case will not be handled by me.

Public

19-Aug-19 Clarke Samantha Ms Digital Project Manger No DoI Yes Internal Public20-Mar-19 Cobb Hayley Ms Local Counter Fraud Specialist TIAA Limited Yes Work with various CCGs and Trusts Feb 2016 Ongoing Yes DoI Yes External Public24-May-19 Collins Steven Mr Chief Accountant No DoI Yes Internal Public

28-Mar-19 Cooper Sonya Mrs MASH specialist Nurse practitioner/Adult safeguarding Yes Provision of Private aesthetic treatments (botox and fillers 18/03/2019 Ongoing Yes DoI Yes Internal Discussed with line manager Public

02-Sep-19 Corke Alison Dr Exceptions Committee Member Yes Spouse ENT surgeon at SDH 1997 Ongoing Yes DoI Yes Internal Leave meeting when considering any cases asso Public06-Sep-19 Corke Alison Dr Exceptions Committee Member Yes GP partner wiltshire 2010 Ongoing Yes DoI Yes Internal Leave room when my patient being discussed Public

11-Apr-19 Cox Tracey Ms Chief Executive BSW Yes Member of the NHS Clinical Commissioners (SW Board representative) Sept 2018 Ongoing Yes DoI Yes Internal Public

03-Apr-19 Cullen Joanne Mrs Director Primary & Urgent Care Group Director West No DoI Yes Internal Public

20-Jun-19 Cusack Carole Ms Director of Primary Care, Wessex LMC's No DoI Yes External Public06-Aug-19 Daszkiewicz Tracy Ms Director of Public Health Partner Organisation No DoI Yes External Public

15-Jan-19 Davies Toby Dr Board GP Yes Daughter works for CF Consultants applying for CCG tender 02/01/2019 08/01/2019 Yes DoI Yes Internal Public

15-Jan-19 Davies Toby Dr Board GP Yes Partner at Castle Practice 1994 ongoing Yes DoI Yes Internal Public15-Jan-19 Davies Toby Dr Board GP Yes Practice part of GP Alliance 2018 ongoing Yes DoI Yes Internal Public02-Jul-19 Davies Lucy Dr Locality Lead and Clinical Director Sarum North Yes GP at Castle practice 2012 ongoing Yes DoI Yes Internal Public02-Jul-19 Davies Lucy Dr Locality Lead and Clinical Director Sarum North Yes Clinical Director Primary Care Network 1/7/19 ongoing Yes DoI Yes Internal Public12-Jun-19 Dawe Fiona Dr Locality lead Sarum West Yes Sarum West PCN Clinical Director 1/5/19 ongoing Yes DoI Yes Internal Remove myself from meeting if felt appropriate Public01-Apr-19 Dudgeon John Mr Associate Director Information No DoI Yes Internal Public

08-Jul-19 Dunne James Mr Associate Director Safeguarding, CHC and Specialist Placements No DoI Yes Internal Public

20-Feb-19 Fairfield Hilary Mrs Project Manger Primary Care Training Hub Yes Treasurer of Crosspoint (Westbury) drop‐in food centre Sept 2013 Ongoing Yes DoI Yes Internal Public20-Feb-19 Fairfield Hilary Mrs Project Manger Primary Care Training Hub Yes Ex employee of Motor Neurone Disease Association Mar 2006 Dec 2018 Yes DoI Yes Internal Public07-Aug-19 Finlay Fiona Ms Designated Doctor for Safeguarding No DoI Yes Internal Public

07-Jan-19 Foley David Mr TIAA Limited - External provider of local counter fraud services No DoI Yes External Public

12-Apr-19 Fox Nadine Ms Head of Medicines Management No DoI Yes Internal Public25-Mar-19 Fry Harriet Mrs Urgent Care Project Manager No DoI Yes Internal Public06-Aug-19 Girdher Andrew Dr Chair of NEW, Governing Body Member Yes GP Box Surgery 2010 Ongoing Yes DoI Yes Internal Public06-Aug-19 Girdher Andrew Dr Chair of NEW, Governing Body Member Yes Part of Wiltshire GP Alliance 2018 Ongoing Yes DoI Yes Internal Public06-Aug-19 Girdher Andrew Dr Chair of NEW, Governing Body Member Yes Medvivo and BEMs 2018 Ongoing Yes DoI Yes Internal Public06-Aug-19 Girdher Andrew Dr Chair of NEW, Governing Body Member Yes Wife nurse practitioner 2007 Ongoing Yes DoI Yes Internal Public08-Feb-19 Goddard Alex Mrs Deputy Head of Medicines Management Yes Son, is bank employee for D&M Gompels Parmacy 43446 Ongoing Yes DoI Yes Internal Line manage aware (NF and JoC) Public12-Jun-19 Gonsalves Ravindra Dr NEW Clinical Executive GP Yes GP Partner Newcourt Surgery 01/04/2010 ongoing Yes DoI Yes Internal Public12-Jun-19 Gonsalves Ravindra Dr NEW Clinical Executive GP Yes GP Alliance 2018 ongoing Yes DoI Yes Internal Public

04-Apr-19 Goodwin Neal Mr Associate Director (Interim) Community and Joint Commissioning No DoI Yes Internal Public

24-Jun-19 Gregory Caroline Mrs BSW Chief Financial Officer No DoI Yes Internal Public

02-Oct-19 Grimmer Kim Mrs Practice Lead Nurse Yes Spouse is GP Partner at Hathaway Medical Practice 01/11/2018 Ongoing Yes DoI Yes Internal Declare in meetings and recline from discussions as necessary Public

02-Oct-19 Grimmer Kim Mrs Practice Lead Nurse Yes Former Employee of Hathaway Medical Practice 01/07/2018 01/11/2018 Yes DoI Yes Internal Public12-Jul-19 Harbour Vikki Ms CHS Contractor No DoI Yes External Public

10-May-19 Harris Mark Mr Chief Operating Officer/Director of Acute Commissioning No DoI Yes Internal Public

23-Aug-19 Harris Danielle Mrs Senior Business Information Manager Yes Mother (Sarah Cooke) works for Wiltshire CCG 01/07/2018 Ongoing Yes DoI Yes Internal Public02-May-19 Higgins Emma Mrs Quality Lead No DoI Yes Internal Public03-Apr-19 Hobson Rachel Ms Formulary Pharmacist No DoI Yes Internal Public01-Apr-19 House Amber Mrs Manager Referral Support Service No DoI Yes Internal Public24-May-19 Hughes Sandra Ms Business Manager CHC No DoI Yes Internal Public05-Jun-19 Hughes Nita Mrs Interim Head of CHC and Specialist Placements Yes Director CHC Direct Ltd providing services for WCCG 01/08/2018 ongoing Yes DoI Yes External Public05-Jun-19 Hughes Nita Mrs Interim Head of CHC and Specialist Placements Yes Director Crismate Consulting Ltd 01/01/2019 ongoing Yes DoI Yes External Public

05-Jun-19 Hughes Nita Mrs Interim Head of CHC and Specialist Placements Yes Director CHC Direct Ltd providing services for CSU and STP 2014 ongoing Yes DoI Yes External Public

Date of interest

Declaration of Interest Register 2019 - 20

Type of interest

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Date of interest


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26-Jun-19 James Sarah Mrs Programme Director for Transition BSW Yes Branch Treasurer Healthcare Financial Management Association SW 2009 ongoing Yes DoI Yes Internal Public

02-Aug-19 James Terry Mrs Commissioning Manager Cancer Lead Yes Patient receiving treatment from local acute trust Dec 18 ongoing Yes DoI Yes Internal Oversight by line manager of work undertak Public01-Apr-19 Acting Head of Acute Commissioning No DoI Internal Public

08-May-19 Jimenez Moreno Pablo Mr Medicines Management Pharmacist Yes Locum Community Pharmacist at several companies such as Morrison's & Lloyds Sep-12 Ongoing Yes DoI Yes Internal Public

08-Jan-19 Jones Lauraine Ms Commissioning Manager No DoI Yes Internal Public08-Mar-19 Kamal Nazmul Dr Ad Hoc GP Consultant Yes GP Partner at Millstream 01/01/2018 ongoing Yes DoI Yes Internal Public08-Mar-19 Kamal Nazmul Dr Ad Hoc GP Consultant Yes Directorship Ardens 01/12/2014 ongoing Yes DoI Yes Internal Public08-Mar-19 Kamal Nazmul Dr Ad Hoc GP Consultant Yes Directorship Wilcodoc 01/05/2008 ongoing Yes DoI Yes Internal Public08-Mar-19 Kamal Nazmul Dr Ad Hoc GP Consultant Yes GP Partner at 3 CMP 01/04/2017 ongoing Yes DoI Yes Internal Public23-Jul-19 King Timothy Dr MSK Clinical Chair Yes GP Federation 2015 Ongoing Yes DoI Yes Internal Public23-Jul-19 King Timothy Dr MSK Clinical Chair Yes Partner at Mere Practice 2010 Ongoing Yes DoI Yes Internal Public

23-Jul-19 King Timothy Dr MSK Clinical Chair Yes Employed to perform Carpal Tunnel and Vasectomy Surgery 2010 Ongoing Yes DoI Yes Internal Public

03-May-19 Kinlin Lindsay Dr Bank Contract Yes Chair of Design and Change Management Group 01/04/2018 Ongoing Yes Yes DoI Yes Internal Public03-May-19 Kinlin Lindsay Dr Bank Contract Yes MAP Assessor for RCGP 2013 Ongoing Yes DoI Yes Internal Public03-May-19 Kinlin Lindsay Dr Bank Contract Yes GP Orchard Surgery 01/04/2018 Ongoing Yes Yes DoI Yes Internal Public03-May-19 Kinlin Lindsay Dr Bank Contract Yes Director of Wiltshire GP Alliance Ltd 01/06/2019 Ongoing Yes Yes DoI Yes Internal Resigned role at Sarum GP Exec 1/5/19 Public03-May-19 Kinlin Lindsay Dr Bank Contract Yes IA Director Wiltshire Health & Care 01/10/2018 Ongoing Yes Yes DoI Yes Internal Resigned role at Sarum GP Exec 1/5/19 Public18-Oct-19 Kirby Julian Mr Lay Member Yes CEO Age UK Wiltshire 2014 ongoing Yes DoI Yes Internal Will withdraw from any adverse situations Public15-Feb-19 Laird Duncan Mr Internal Audit Manager Yes A number of NHS and CCG clients Yes DoI Yes External Public01-Apr-19 Long Susannah Mrs Governance and Risk Manager No DoI Yes Internal Public

02-Apr-19 Loveys Ian Mr Financial Accountant Yes Own shares in Glaxo SmithKline valued at more than £5,000 Ongoing Yes DoI Yes Internal Public

02-Apr-19 Loveys Ian Mr Financial Accountant Yes Own shares in a number of investment and unit trusts Ongoing Yes DoI Yes Internal Public02-Apr-19 Loveys Ian Mr Financial Accountant Yes Parents own shares in investment trusts / units trusts Ongoing Yes DoI Yes Internal Public17-May-19 Lucas Peter Mr Vice Chair, Audit Chair and Lay member Yes Audit Chair and Lay member of B&NES CCG 01/04/2019 ongoing Yes DoI Yes Internal Public01-May-19 Lynch Donna Ms Finance Manager Community and Mental Health No DoI Yes Internal Public05-Nov-19 Mandair Jagjit Mr Digital Transformation Manager No DoI Yes Internal Public01-Apr-19 Massey Hannah Miss Service Redesign Lead No DoI Yes Internal Public

Matthews Robert Internal Public26-Sep-19 Matthews-Oliver Abigail Ms Blueteq/High Cost Drugs Pharmacist No DoI Yes Internal Public24-Jun-19 May Gill Mrs Director of Nursing and Quality No DoI Yes Internal Public

McBride Eve Dr Internal Public03-Jul-19 Measham John Mr Interim Deputy Chief Finance Officer No DoI Yes Internal Public

16-Jul-19 Mellers Caroline Ms BSW Thrive Board Member, Workstream Lead Yes Founder of community internet company (connection in crisis) not yet trading Feb 2019 Ongoing Yes DoI Yes External Public

19-Jun-19 Millin Nicola Mrs Director of Strategy and Transformation No DoI Yes Internal Public

26-Mar-19 Mintram Andrew Mr Healthwatch Wiltshire, Local Leadership Board Member No DoI Yes External Public

18-Oct-19 Mitchell Andrew Mr HR Business Partner SCWCSU No DoI Yes External Public07-May-19 Moore Denise Mrs GPFU Lead No DoI Yes Internal Public21-Jun-19 Murray Jane Ms Designated Nurse Safeguarding Children No DoI Yes Internal Public

10-May-19 Osborn Helen Dr GP Medical Adviser, Child Safeguarding lead and Chair of Exceptions Yes GP Courtyard Surgery 01/04/2013 Ongoing Yes Yes DoI Yes Internal Public

10-May-19 Osborn Helen Dr GP Medical Adviser, Child Safeguarding lead and Chair of Exceptions Yes GP Sarum / WEST Group 2016 Ongoing Yes Yes DoI Yes Internal Public

10-May-19 Osborn Helen Dr GP Medical Adviser, Child Safeguarding lead and Chair of Exceptions Yes GP Alliance 2018 Ongoing Yes Yes DoI Yes Internal Public

15-Oct-19 Osborn Jonathan Dr Co Chair Bradford-on-Avon and Melksham locality, Clinical Director Yes GP Partner at Gifford surgery, Melksham Sept 2017 Ongoing Yes DoI Yes Internal Public

15-Oct-19 Osborn Jonathan Dr Co Chair Bradford-on-Avon and Melksham locality, Clinical Director Yes Practice is a member of Wiltshire GP Alliance 2018 Ongoing Yes DoI Yes Internal Declare Public

15-Oct-19 Osborn Jonathan Dr Co Chair Bradford-on-Avon and Melksham locality, Clinical Director Yes Wife is a consultant physician at RUH in Bath Jan 2014 Ongoing Yes DoI Yes Internal Declare Public

15-Oct-19 Osborn Jonathan Dr Co Chair Bradford-on-Avon and Melksham locality, Clinical Director Yes Non executive Director of Devon Health Limited 2014 Ongoing Yes DoI Yes Internal Declare Public

15-Oct-19 Osborn Jonathan Dr Co Chair Bradford-on-Avon and Melksham locality, Clinical Director Yes Clinical Director of Melksham and BoA PCN 2019 Ongoing Yes DoI Yes Internal Declare Public

15-Oct-19 Osborn Jonathan Dr Co Chair Bradford-on-Avon and Melksham locality, Clinical Director Yes Member of Council of College of Medicine 2016 Ongoing Yes DoI Yes Internal Declare Public

15-Oct-19 Osborn Jonathan Dr Co Chair Bradford-on-Avon and Melksham locality, Clinical Director Yes Examiner for Institute of Directors (CDir peer review stage) 2016 Ongoing Yes DoI Yes Internal Is in the process of being wound up. Public

15-Aug-19 Perkins Stephen Mr Interim Deputy Chief Finance Officer Yes Provision of consultancy advice to primary care 7/19 ongoing Yes DoI Yes Internal Public10-May-19 Pettit John Dr NEW Executive GP Board Member Yes PCN joint clinical director NW Boarder 15/05/2019 ongoing Yes DoI Yes Internal Declare at relevant meetings Public

06-Jun-19 Pike Catherine Mrs Care Home Senior Pharmacy Technician Yes Work on a freelance basis delivering training to care workers in Health and Social care 2008 ongoing Yes DoI Yes Internal Public

06-Jun-19 Pike Catherine Mrs Care Home Senior Pharmacy Technician Yes Own training business in H&S case 2015 Suspended '18 Yes DoI Yes Internal Public25-Sep-18 Plumb Stacey Ms Interim Healthwatch Manager, Help & Care No DoI Yes External Public

20-May-19 Pope Caroline Ms Care Home Lead Paramacist, Meds op in care homes No DoI Yes Internal Public

12-May-19 Rehman Muhammad Dr GP for BCAP formulary, Diabetes Board. GP Exe Board WEST Yes GP Whitehorse Health Centre, Westbury 01/08/2019 ongoing Yes DoI Yes Internal Public

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Date of interest


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07-May-19 Reid Christine Mrs Lay Member PPI Yes MHA Associate AWP 1989 ongoing Yes DoI Yes Internal CCG Aware Public07-May-19 Reid Christine Mrs Lay Member PPI Yes Trustee Warrington Homes, Corsham 2015 ongoing Yes DoI Yes Internal CCG Aware Public

07-Oct-19 Rendell Edward Dr Locality Sarum South Representative (GP Exec) Yes Wife employed by Wiltshire Council Educational Psychologist 2015 ongoing Yes DoI Yes Internal Public

07-Oct-19 Rendell Edward Dr Locality Sarum South Representative (GP Exec) Yes Locum GP in local practices Jun-19 ongoing Yes DoI Yes Internal Public07-Oct-19 Rendell Edward Dr Locality Sarum South Representative (GP Exec) Yes GP Appraiser 2018 ongoing Yes DoI Yes Internal Public07-Oct-19 Rendell Edward Dr Locality Sarum South Representative (GP Exec) Yes Specialist Advisor for the CQC Jun-19 ongoing Yes DoI Yes Internal Public01-May-19 Richards Jenna Ms Communications and Engagement Manager No DoI Yes Internal Public03-Apr-19 Ross Tracey Miss Deputy Director of Primary Care No DoI Yes Internal Public

15-Aug-19 Ruddle Georgina Dr Acting Associate Director of Mental Health and TCP Yes Private therapy work with privately referred patients 01/07/2015 Ongoing Yes DoI Yes Internal Public

04-Jul-19 Sandford-Hill Richard Dr Chair Wiltshire CCG Yes GP Partner Market Lavington Surgery 1994 Ongoing Yes DoI Yes Internal Public04-Jul-19 Sandford-Hill Richard Dr Chair Wiltshire CCG Yes Devizes PCN 01/07/2019 Ongoing Yes DoI Yes Internal Public04-Sep-18 Scott Baroness Jane Other. Leader of Wiltshire Council No DoI Yes External Public12-Jul-19 Seymour Lyn Ms CHS Contractor No DoI Yes External Public03-Sep-19 Shallis Susan Ms Mental Health Commissioner No DoI Yes Internal Public

Shaw Elizabeth Dr Internal Public01-May-19 Shepherd Emily Ms Quality Lead No DoI Yes Internal Public

03-May-19 Smith Emma Ms Interim Head of Urgent Care Yes Sister in Law (Liz Smith) works for Wiltshire Health and Care as Diabetes Dietician Jul-13 Ongoing Yes DoI Yes Internal Public

03-May-19 Smith Emma Ms Interim Head of Urgent Care Yes Mother (Sue Smith) works for GWH FT as bank admin for outpatients Feb-16 Ongoing Yes DoI Yes Internal Public

04-Nov-19 Stanley Victoria Ms Primary Care Commissioning Manager Yes Member of Devizes Guardians (non-political) 14/01/2019 Ongoing Yes DoI Yes Internal Public28-Mar-19 Taubman Rachel Dr Diabetes Programme Board Yes Director of Primes Federation ongoing Yes DoI Yes Internal Unknown as the federation is inactive Public08-May-19 Timmins Connie Ms Quality Manager and IPC Lead No DoI Yes Internal Public11-Feb-19 Travers Paul Mr Security Management Specialist No DoI Yes External Public17-May-19 Wales Julie-Anne Mrs Head of Governance No DoI Yes Internal Public04-Jul-18 Commissioning Manager and End of Life Lead No DoI Internal Public10-May-19 Watson Shelley Ms Senior Commissioning Manager No DoI Yes Internal Public16-May-19 Weir Madison Mrs Project Manager Quality Yes Partner works in NHS ongoing Yes DoI Yes Internal Public03-Sep-19 Whybray Katie Ms External Auditor No DoI Yes External Public28-Aug-19 Whysall Kath Ms GP Forward View Lead No DoI Yes Internal Public12-Jun-18 Williamson Joanna Ms Commissioning Manager No DoI Yes Internal Public01-Apr-19 Wilson David Mr Director of Community and Joint Commissioning No DoI Yes Internal Public

11-Feb-19 Windebank-Brooks Ashley Mr Quality Lead Yes Partner employed by local NHS trust 01/02/2019 ongoing Yes DoI Yes Internal Any serious incidents would be lead by another Quality Lead Public

11-Feb-19 Windebank-Brooks Ashley Mr Quality Lead Yes Mother is employed in senior role for Firland Nursing Home 01/02/2019 ongoing Yes DoI Yes Internal Emma Higgins is care home lead and would be responsible for taking any SI forward Public

20-May-19 Woods Anne Dr NEW Clinical Executive Yes Old School Surgery Great Bedwyn 01/04/2016 ongoing Yes DoI Yes Internal Public20-May-19 Woods Anne Dr NEW Clinical Executive Yes Joint CD East Kennet Partnership 02/05/2019 ongoing Yes DoI Yes Internal Public01-Apr-19 Woolley Sharon Mrs Board Administrator Yes Director of Specialist Electrical Contractors Ltd 01/08/2016 Ongoing Yes DoI Yes Internal Line Manager aware Public

30-Aug-19 Worswick Louise Mrs Macmillan Evaluation & Commissioning Project Manager No DoI Yes Internal Public

21-May-19 Wright Catrinel Dr Chair, WEST Wiltshire; GP Executive Yes GPwSI in Dermatology with CSP 06/02/2018 31/03/2020 Yes DoI Yes Internal Should not have access to contract negotiations between CCG and CSP Public

21-May-19 Wright Catrinel Dr Chair, WEST Wiltshire; GP Executive Yes GP Partner Lovemead Practice, Trowbridge 02/12/2017 Ongoing Yes DoI Yes Internal Public02-Sep-19 Wright Jenny Mrs Health Protection Specialist WCC No DoI Yes External Public03-Apr-19 Yeo Simon Mr Estates Advisor Yes Spouse is ward sister at RUH 1997 Ongoing Yes DoI Yes Internal Line Manager aware Public03-Apr-19 Yeo Simon Mr Estates Advisor Yes Son doing work experience with Arcadis 02/09/2019 06/09/2019 Yes DoI Yes Internal Line Manager aware Public

As at 11 November 2019

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