Meeting of the West Suffolk CCG Governing Body 1200 hrs on ... · 1/25/2017 · To receive a...

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Meeting of the West Suffolk CCG Governing Body to be held from 0915–1200 hrs on Wednesday 25 January 2017 at

The Edmund Room (formerly known as the Lecture Room), St Edmundsbury Cathedral, Bury St Edmunds, Suffolk

AGENDA

The Governing Body will be available to meet with members of the public from 0900 – 0915

GENERAL BUSINESS 1. Apologies for Absence Dr Christopher Browning 2. Declarations of Interest

To declare any interests specific to agenda items Declarations made by members of the Governing Body are listed in the CCG’s Register of Interests. The Register is available via contact with the CCG’s Corporate Governance officer or at the CCG website via the following link: http://www.westsuffolkccg.nhs.uk/wp-content/uploads/2013/01/17-01-WSCCG-Published-Register-latest.pdf

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3. Minutes of the previous West Suffolk CCG Governing Body

meeting. To approve as a correct record Minutes of the West Suffolk CCG Governing Body meeting held on 30 November 2016

Dr Christopher Browning

4. Matters Arising and Action Log Dr Christopher Browning 5. General Update

To receive a verbal report from the Chief Officer Ed Garratt

PATIENT AND PUBLIC ENGAGEMENT 6. Community Engagement Group Minutes

To receive and endorse minutes of the Community Engagement Group meeting held on 22 December 2016

David Taylor Report No:

WSCCG17-01 CLINICAL AND SERVICE DEVELOPMENT 7. Patient Story 8. Diabetes Service and Future Strategy

To receive and note a report from the Associate GP Lead for Diabetes

Dr Jon Ferdinand Report No:

WSCCG17-02

http://www.westsuffolkccg.nhs.uk/wp-content/uploads/2013/01/17-01-WSCCG-Published-Register-latest.pdf

http://www.westsuffolkccg.nhs.uk/wp-content/uploads/2013/01/17-01-WSCCG-Published-Register-latest.pdf

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9. In Vitro Fertilisation (IVF) Services To receive and note a report from the Chief Nursing Officer

Barbara McLean Report No:

WSCCG17-03 10. Marginalised and Vulnerable Adults (MVA) Service

To receive and endorse a report from the Chief Redesign Officer Richard Watson

Report No: WSCCG17-04

11. Procurement Update: Summary of Activity 2016/17

To receive and note a report from the Chief Contracts Officer Jan Thomas

Report No: WSCCG 17-05

FINANCE, PERFORMANCE AND SCRUTINY 12. Integrated Performance Report - Are the CCGs finances,

performance and quality on track? To receive and note a report from the Chief Finance Officer, the Chief Nursing Officer, the Chief Redesign Officer and Chief Contracts Officer.

Barbara McLean/ Lesley MacLeod/ Richard Watson/

Jan Thomas Report No:

WSCCG 17-06 GOVERNANCE AND CORPORATE BUSINESS 13. Terms of Reference – Financial Performance Committee

To receive and approve a report from the Chief Corporate Services Officer

Amanda Lyes Report No:

WSCCG 17-07 14. Terms of Reference – Clinical Scrutiny Committee

To receive and approve a report from the Chief Corporate Services Officer


WSCCG 17-08 15. Freedom of Information

To receive and note a report from the Chief Corporate Services Officer Amanda Lyes

Report No: WSCCG 17-09

16. Governing Body Assurance Framework

To receive and endorse a report from the Chief Corporate Services Officer


WSCCG 17-10 17. Minutes of Meetings:

To receive a report from the Lay Member for Governance seeking the endorsement of minutes and decisons of West Suffolk CCG Sub Committees, those being;

a) Audit Committee

The unconfirmed minutes of a meeting held on 6 December 2016. b) Finance and Performance Committee

The confirmed minutes of meetings held on 16 November and 21 December 2016

c) Clinical Scrutiny Committee

The unconfirmed minutes of a meeting held on 14 December 2016 d) CCG Collaborative Group

The unconfirmed minutes of a meeting held on 22 December 2016

Bill Banks Report No:

WSCCG17-11

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e) NHS England-West Suffolk CCG Joint Commissioning Committee Unconfirmed minutes from a meeting held on 30 November 2016

f) Commissioning Governance Committee

Decision from a meeting held on 21 December 2016 18. Any Other Business 19. Date and Time of future Governing Body meetings

0915 - 1200 Wednesday 29 March 2017, The Edmund Room, St Edmundsbury Cathedral, Angel Hill, Bury St Edmunds, IP33 1LS

Questions from the public – Maximum 15 minutes

Please note questions should relate to the items under discussion and must be a question rather than statement. Where individuals deviate from this requirement they will be asked to stop and will not be invited to take any further part in the meeting.

Exclusion of the Press and Public

The Governing Body is recommended to exclude representatives of the press, and other members of the

public, from the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest; Section 1(2), Public Bodies (Admission to

Meetings) Act 1960.

Governing Body GP Member Simon Arthur Partner in Medical Practice where a partner of the practice is an Executive Member of Suffolk GP Federation

Medical partnership has contract with Suffolk Community Healthcare to provide GP services to Gastonbury Court

Lay Member for Governance and Vice Chair CCG Bill Banks Nil

Governing Body Practice Manager Member Kevin Bernard Practice Manager Botesdale Health Centre. Health Centre is member of the Suffolk GP Federation

Company Secretary and shareholder in Botesdale Rural Services Ltd trading as Botesdale Pharmacy

CCG Chair Christopher Browning PMS Provider, Practice Partner Long Melford

Chair, Hartest Parish Council

Wife is consultant geriatrician at West Suffolk Hospital

Lay Member for Patient and Public Involvement Jo Finn Previous Chief Executive of West Suffolk Hospital NHS Trust

Ex-husband was Consultant Obstetrician and Gynaecologist

Patient under care of neurologists and rheumatalogists at West Suffolk Hospital

Chief Officer Ed Garratt Chief Officer for Ipswich and East Suffolk CCG

Governing Body GP Member Andrew Hassan Nil

Secondary Care Doctor Crawford Jamieson Consultant in Gastroenterology at Ipswich Hospital

CBG lead for Gastroenterology, general and vascular surgery

Wife is consultant in Medicine for the Elderly at Ipswich Hospital

Governing Body Practice Manager Member Peter Knights Partner Mount Farm Surgery

Mount Farm Surgery is a member of Suffolk GP Federation

Chief Corporate Services Officer Amanda Lyes Chief Corporate Services Officer for Ipswich and East Suffolk CCG

Interim Chief Finance Officer Lesley MacLeod Interim Chief Finance Officer for Ipswich and East Suffolk CCG

Director of Public Solutions Ltd

Chief Nursing Officer Barbara McLean Owner/Director of Allington Healthcare Ltd. Allington own Beckfield House Residential Home, Lincolnshire

Husband is Executive Chairman of the following group of operating businesses who will trade as Cumbric Care Group:

Byron Court Care Home Ltd

Mother Redcaps Care Home Ltd

Barrisle Care Home Ltd

Rivington Park Care Home Ltd

Blair House Care Come Ltd

Victoria Care Home (Burnley) Ltd

Newco Southport Ltd

Husband is Chair and Director of Allington Healthcare Ltd, offering residential services for the elderly and those suffering from

dementia

Husband is Chair and Director of Horizon 2918 Ltd providing care and support to young people

Husband is Managing Director of Mclean and Mclean Consultants Ltd specialist healthcare advisory serv

Husband is a shareholder of Clearwater Care Ltd, a learning disability service provider.

Husband is a non-executive director of East of England Ambulance Service Trust

Governing Body GP Member Bahram Talebpour Nil

Chair of Community Engagement Partnership David Taylor Trustee of Charity Avenues East

Chief Contracts Officer Jan Thomas Chief Contracts Officer for Ipswich and East Suffolk CCG

Chief Operating Officer Kate Vaughton Nil

Governing Body GP Member Firas Watfeh Local Medical Committee member

Works for Care UK and GP+

Chief Redesign Officer Richard Watson Chief Redesign Officer for Ipswich and East Suffolk CCG

West Suffolk CCG Governing Body and Sub Committee Members

Title First Name Last Name Declared Interest

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Minutes of meeting of the West Suffolk CCG Governing Body held in public on

Wednesday 30 November 2016 in the Lecture Room, St Edmundsbury Cathedral, Bury St. Edmunds, Suffolk

PRESENT: Dr Christopher Browning CCG Chair Dr Simon Arthur GP Member Bill Banks Lay Member for Governance Kevin Bernard Member Jo Finn Lay Member for Patient and Public Engagement Ed Garratt Chief Officer Dr Andrew Hassan GP Member Dr Crawford Jamieson Secondary Care Doctor Peter Knights Member Amanda Lyes Chief Corporate Services Officer Lesley MacLeod Interim Chief Finance Officer Barbara McLean Chief Nursing Officer Dr Bahram Talebpour GP Member Jan Thomas Chief Contracts Officer Kate Vaughton Chief Operating Officer Dr Firas Watfeh GP Member Richard Watson Chief Redesign Officer IN ATTENDANCE: David Kanka Assistant Director of Public Health Gabrielle Irwin Head of Clinical Quality and Patient Experience Jo Mael Corporate and Governance Officer Andrea Wedgewood Patient Story

16/101 WELCOME AND APOLOGIES FOR ABSENCE

The CCG Chair welcomed everyone to the meeting and apologies for absence were noted from: Dr Abdul Razaq Director of Public Health David Taylor Chair: Clinical Engagement Group

16/102 DECLARATIONS OF INTEREST

No declarations of interest, other than those already published, were received.

16/103 MINUTES OF PREVIOUS MEETING

The minutes of the meeting held on 28 September 2016 were approved as a correct record.

16/104 MATTERS ARISING AND ACTION LOG

There were no matters arising and the action log was reviewed and updated.

16/105 GENERAL UPDATE

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The Chief Officer reported that;

The CCG’s Infection Control Team had been ‘runner up’ for an East of England Health and Care Clinical Quality Award.

The CCG had received national recognition from the Health Service Journal l awards in respect of its ‘Connect’ initiative.

The contracts team were currently negotiating two year contracts with providers which were required to be finalised by 23 December 2016. The CCG was also negotiating the East of England Ambulance Service contract on behalf of 19 CCG’s.

The Sustainability and Transformation Plan had been published on 17 November 2016.

14 GP practices had recently committed to development of a Single Partnership.

Dr Simon Arthur and the Chief Redesign Officer had recently visited Holland to see a nursing/neighbourhood care model. Following discussion by the Health and Wellbeing Board development of a pilot in Suffolk was to be encouraged, with the Board expected to receive a proposal for the pilot in January 2017.

The Governing Body noted the Chief Officer’s verbal update.

16/106 CHAIR/CHIEF OFFICER ACTION – 02-2016 (BUSINESS CASE FOR

INTEGRATED COMMUNITY HEALTH AND CARE SERVICES INCLUDING INTEGRATED URGENT CARE SERVICE

The Governing Body was in receipt of a Chair/Chief Officer Action in respect of the business case for integrated community health and care services including integrated urgent care service. The current community services, NHS 111 and GP out of hours contracts are due to expire in October 2017 which provides an opportunity for the West Suffolk and Ipswich and East Suffolk CCGs to deliver the integrated health and care review recommendations of procuring a dynamic all age inclusive 24/7 out of hospital care model. The Chair and Chief Officer had approved; 1) That the contract value for the proposed models of care be kept at the same

levels as paid to the current providers of community services, 111 and GP out of hours in 2016/17 for the duration of the proposed contracts.

2) The preferred procurement arrangement of a mixed approach consisting of;

Procurement of community services through a Most Capable Provider process, local to Ipswich and East Suffolk and West Suffolk, with an alliance partnership of providers to be concluded by the end of November 2016 enabling a decision to be made by the Governing Body to proceed further or revert to open market tender.

Tendering the integrated urgent care service (111, GP out of hours and the CCC) across Ipswich and East Suffolk, West Suffolk and North East Essex (111 and GP out of hours only).

The Governing Body endorsed the reported Chair and Chief Officer Action – 02/2016.

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16/107 APPOINTMENT OF EXTERNAL AUDITORS

The Local Audit and Accountability Act 2014 had brought significant change to the local public audit regime in England by replacing centralised arrangements for appointing external auditors to health service bodies (clinical commissioning groups and NHS trusts) with a system that allowed each body to make its own appointment and directly manage the resulting contract and relationship. The CCG had established an auditor panel, a ‘sub-set’ of the audit committee, in early 2016. The role of the auditor panel was to advise on the selection, appointment and removal of external auditors and on maintaining an independent relationship with them. The auditor panel was an advisory body. Responsibility for the actual procurement and appointment of the auditors remained with the CCG’s Governing Body. The appointment of external auditors was to be made by 31/12/16 for the 2017/18 financial year. The appointment could be for longer than a year but there must be a new appointment process at least once every five years. An auditor could be reappointed for further terms and must be eligible for appointment in line with Financial Reporting Council (FRC) requirements. The CCG was required to publish a notice within 28 days of appointing the external auditor stating that the appointment had been made; who the auditor was and how long the appointment was for. The notice must also summarise the advice given by the auditor panel and reasons for not following the advice if that was the case. The notice must be published on the CCG’s website. Work undertaken by the Joint Auditor Panel prior to making its recommendation was detailed in Section 2 of the report, the outcome of which was that the auditor panel was recommending the Governing Body approve the appointment of the CCG’s existing external auditors, Ernst & Young, through the use of a single tender action/tender waiver. The Governing Body subsequently approved the appointment of Ernst & Young as the CCG’s auditors, for a three year period commencing with the 2017/18 accounts audit, at the proposed fixed price which was an overall net reduction on the price previously paid by the CCG.

16/108 INTEGRATED PERFORMANCE REPORT

The Governing Body was in receipt of the Integrated Performance Report, which

provided members with a summary of performance against national targets, contractual targets, clinical quality and patient safety issues, financial performance and acute activity, together with detailing work being carried out by the redesign team. The Chief Finance Officer reported that the format of the report had been revised and now contained an executive summary with accompanying detailed information attached as appendices. The CCG also now had a well-established Finance and Performance Committee which, along with the Governing Body, Executive and Clinical Scrutiny Committee, was scrutinising the CCG’s finances on a monthly basis. Clinical Quality and Patient Safety Key points highlighted included;

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Harm free care falls – community services had reported high levels of falls recently and detailed analysis work was underway.

As could be seen from the report, it had not been felt appropriate to report pressure ulcer information in a RAG rated format.

In relation to C.Difficile cases, the Chief Nursing Officer advised that post infection reviews were carried out for all cases and work plans developed. Difficulties validating data following introduction of West Suffolk Hospital’s new e-care software had resulted in manual and joint working with the hospital in order to gain assurance. Having noted a decline in Friends and Family Tests in relation to maternity services during September 2016, it was explained that low numbers of tests received could impact on the outcome and there had recently been difficulties obtaining information from the wards. Having identified from the report that seven care homes had been rated as ‘inadequate’ following Care Quality Commission inspections, it was questioned whether the CCG was content with the subsequent responses from those homes. It was explained that responses from the homes were key and it would be important to see movement from monitoring. It was expected that, going forward, there would be more ‘good’ inspections as those giving cause for concern had been prioritised for early inspection. Financial and Performance Delivery The Chief Finance Officer reported that at month seven the CCG was £1.6m off plan with a key variance continuing to be QIPP delivery. QIPP delivery to date was £10.5m against a target of £14m. Actions to address the financial position and deliver a balanced position in-year, included seeking reimbursement of underspend on the continuing healthcare risk pool and the renegotiation of contracts at all levels. Other actions were to review prescribing opportunities from the use of Scriptswitch, seek reimbursement from West Suffolk Hospital’s guaranteed income contract in respect of underperformance and work with the hospital to drive down A&E inefficiencies. The guaranteed income contract with West Suffolk Hospital was currently under re-negotiation for 2017/18. It was felt that whilst the contract had been positive for both commissioner and provider as it minimised risk for both sides, there was a need to address underperformance and have the ability to reconcile data each month. A key message for 2017/18 was the need to have a more joined up approach to demand management. Having questioned the QIPP delivery position, it was explained that the current position was £800k improved on that reported due to the timing of production of the report. Having reported that Addenbrookes had recently agreed a STF fund the Chief Contracts Officer agreed to provide the CCG’s Executive with further information at a forthcoming meeting. The Finance Team was currently in the process of drawing together financial plans for 2017/18-2018/19. The need to build in resilience to address any shortfall was emphasized.

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The achievement of only £100k of Quality Premium from a potential £1.2m was disappointing. The need to increase focus for 2017/18 had been recognized and it was anticipated that the CCG’s Executive would receive a detailed report for review within the next few weeks. Redesign

The Sustainability and Transformation Plan (STP) had now been published.

Marginalised Vulnerable Adult (MVA) and Learning Disability service – following consultation, the CCG was now working with the County Council to develop a proposal for a revised service model.

Connect work had restarted and was integral to the Alliance work post December constructive dialogue decision. There was aspiration that all connect localities would be in place by October 2017.

Discharge to Assess – Glastonbury Court was now fully operational bringing an additional 20 community beds to support discharges from West Suffolk Hospital.

Early Intervention Team – there was agreement in principle by West Suffolk Hospital to review the coding of admission prevention activity currently coded as an admission.

Musculo-skeletal (MSK) single point of access had been approved for launch.

A task force incorporating membership from West Suffolk Hospital, the CCG, Suffolk County Council and Suffolk Community Healthcare had been established for a six week period to better understand A&E flow during winter.

The Chief Redesign Officer advised that, as previously mentioned, he had recently been to Holland to gain information on its nursing/neighbourhood care model. The team providing care had been self-managing with nurses taking more of the social care role and teams retaining their client base. Feedback on the model of care had been positive and an outline case for a pilot here was being developed for presentation to the CCG’s Governing Body and Health and Wellbeing Board in January 2017. Contractual Performance Key points highlighted included;

West Suffolk NHS Foundation Trust – the hospital had achieved a ‘good’ rating following its recent Care Quality Commission inspection. There continued to be issues associated with implementation of the Trust’s new e-care system. A&E performance and diagnostic waits were areas of concern and although referral to treatment performance had improved it was based on incomplete data.

The hospital’s poor performance in relation of cancer waits was highlighted and it was explained that a ‘deep dive’ review was due to take place within the next month

Addenbrookes – A&E performance remained challenging and at 90% was below the 95% requirement. Referral to treatment performance was of concern with focus on those patients waiting longer than 52 weeks.

Norfolk and Suffolk NHS Foundation Trust (NSFT) – the Care Quality Commission had upgraded the Trust to ‘requires improvement’. Performance had improved in those areas subject to a remedial action plan and the Trust was now more open and transparent.

East of England Ambulance Trust (EEAST) – a remedial action plan had

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now been agreed by EEAST and the CCG consortium. The service had increased activity on red ambulance demand which was affecting performance. There was a need to facilitate transformation in order to sustain the service going forward.

All CCGs within the consortium had provided additional transformation funding to EEAST in 2016/2017 and that additional funding would not be available going forward. Handover delays were improving. At an operational level the Trust was keen to assist the A&E Delivery Board and had agreed to place two HALOs at the door of A&E for the next few weeks to mitigate risk. West Suffolk Hospital was not an outlier in respect of handover delays across the area of the 19 CCG consortium.

The Governing Body noted the content of the report.

16/109 PATIENT STORY

The Governing Body noted the accompanying report in respect of transforming care. Andrea Wedgewood and Gabrielle Irwin, Head of Clinical Quality and Patient Experience were welcomed to the meeting. Andrea informed the Governing Body of both her and her family’s experiences as users of services for patients with autistic spectrum disorder. Andrea explained that although she had felt awkward, vulnerable and different as a child, she had not received a personal diagnosis until her son was diagnosed in 2002. Services had been difficult to access at that time and there had been no interaction or joined up working between services. By the time her second son needed to access services in 2010 multi-disciplinary teams (MDTs) were in existence. The experience had been much improved with MDTs having a more person centred approach and all professionals working together for the benefit of the individual. There was however a lack of continuity of services when individuals reached certain ages. The need for continued support and joined up working was emphasized. The need for GPs to appreciate the difficulties experienced by such patients and the courage required to seek assistance was highlighted. It was suggested that stepping into the shoes of a patient with autism for a day might be a good training aid. The Governing Body thanked Andrea for her informative story and the Chief Redesign Officer reported that he would welcome talking to Andrea outside of the meeting to gain further information of her experiences.

16/110 COMMUNITY ENGAGEMENT GROUP (CEG) MINUTES

In the absence of the Chair of the Community Engagement Group (CEG), the Lay

Member for Patient and Public Engagement presented the minutes of the Group’s last meeting, which had been held on 27 October 2016 in Mildenhall. Key points highlighted included;

A joint workshop with Patient Participation Groups was being planned for the New Year.

Members of both West Suffolk CCG and Ipswich and East Suffolk CCG’s

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engagement groups had met with Healthwatch Suffolk to discuss engagement going forward.

The CEG had received an update on the Sustainability and Transformation Plan from the Chief Redesign Office, together with a financial update on the current financial position of the CCG.

A CEG recruitment plan was approved.

A member of the CEG was carrying out work to develop a transport partnership to improve access for Haverhill residents to West Suffolk Hospital.

The Chief Officer advised that the CEG might like to make contact with Ipswich and East Suffolk CCG’s Lay Member for Patient and Public Involvement who was launching co-production work. The Governing Body noted the key items of discussion.

16/111 OPERATIONAL PLANNING 2017/2019

NHS England’s planning guidance differed to that of previous years in several key

ways:

Firstly, all plans were required to show how Sustainability and Transformation Plans would be put into operation within a local CCG area

Secondly, all plans were to demonstrate how they would implement the Five Year Forward View

Thirdly, all plans were to be for a two (rather than one) year period, with contracts being for the same period.

Finally, plans had to be submitted by 23 December 2016 (previously March).

The Governing Body was in receipt of a report which sought approval of the core content of the Operational Plan as set out within the report, together with providing the Finance and Performance Committee, at its meeting to be held on 21 December 2016, with delegated authority to approve submission of the plan. The need for control totals to be achieved in order to avoid special measures was emphasized. CCGs were expected to deliver a minimum cumulative 1% surplus in 2017/18 and 2018/19. CCGs must plan for investment of 1% non-recurrent spend of which 0.5% must be uncommitted (held as risk reserve) and 0.5% could be available for CCGs to spend non-recurrently to support transformation implied by Sustainability and Transformation Plan. CCGs must hold a 0.5% contingency and management costs ceilings could not be exceeded. There remained a requirement to focus on investment in mental health services to ensure parity with other areas of investment Key aspects of the CCG’s plan were identified within Section 2 of the report. The Governing Body noted the national requirements for operational plans 2017/19 and delegated responsibility for approval and submission of the Plan to the CCG’s Finance and Performance Committee at its meeting to be held on 21 December 2016.

16/112 SUSTAINABILITY AND TRANSFORMATION PLAN (STP)

The Governing Body was in receipt of a report from the Chief Redesign Officer

which provided an update on the recently published Sustainability and Transformation Plan (STP). All health and care organisations within the Suffolk and North East Essex health

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and care system had been working together since March 2016 to develop a shared vision, priorities for action and to explore benefits of partnership working through the production of the STP. It had become clear that there were benefits for the CCG’s population from aligned goals and actions, and the sharing of knowledge and skills. The report provided detail of the plan’s development which included financial, together with communication and engagement information. The next steps, as set out within the report, were;

To recruit a Programme Director and Independent Chair

For the STP intent to be part of the operational planning and contracting processes for the NHS to agree two year contracts covering 2017-18 and 2018-19.

For communication and engagement plans to be further developed and implemented.

To establish a project management office to support organisations in mobilising the projects they had committed to deliver.

It was explained that the STP was a direction of travel and not a detailed five year plan. Much of the plan built on work that was already underway. Whilst the Lay Member for Patient and Public Engagement reported that locally patients were concerned that they might lose their hospital, it was explained there was a firm commitment to continue with three hospitals whilst developing community models of care and pathways. The development of patient centred pathways would determine where services were best placed. Having questioned whether the movement of services would result in the movement of funding, it was explained that the East and West Alliances would need to explore and determine specifications. The emphasis was on alignment and collaborative working and not reform. Since publication of the report a STP programme director had now been appointed and it was anticipated that governance would be one of the first challenges going forward together with workforce. The Governing Body noted the content of the report.

16/113 WINTER PLAN

The Governing Body was in receipt of a report which provided an update on the

agreed Winter Plan for 2016/17 for West Suffolk. The Winter Plan had been developed in collaboration with the West Suffolk ‘system’ and set out a whole system approach to seasonal planning and arrangements for delivery for winter 2016/17. Based on lessons learned over recent years, and in particular, from winter 2014/15 & 2015/16 , the aim of the plan was to demonstrate the system would ensure the delivery of safe and high quality services to the population during potential periods of pressure. The complete Winter Plan was appended to the report and the Governing Body was being asked to consider it prior to recommending its approval by the A&E Delivery Board in December 2016. Key points highlighted included;

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The ambulatory emergency are service would be open over the Christmas period to diagnose and treat patients within 12 hours.

The early intervention team had been further enhanced in advance of winter.

As previously mentioned the A&E task force would be focussing on internal flow prior to presentation of a report to the A&E Delivery Board.

Whilst welcoming the plan, the need to mitigate any increased demand after the Christmas period was highlighted. Strengths of the plan included the early intervention team and ambulatory care, with risks being flow and recovery. The Governing Body noted the Winter Plan as appended to the report and recommended that the A&E Delivery Board approve the Plan at its meeting to be held in December 2016

16/114 PROCUREMENT UPDATE: SUMMARY OF ACTIVITY 2016/17

The Governing Body was updated on the procurements completed since the last

procurement update and those currently in progress and planned for 2016/17. Key points included; Peri Diagnostic Dementia Services - NHS West Suffolk CCG was working with NHS Ipswich & East Suffolk CCG and Suffolk County Council to determine the future shape of Peri Diagnostic Dementia Services; the procurement had been undertaken as a restricted procedure and was due to start on the 1 April 2017. The award decision was to be presented to Governing Body for ratification in November 2016. Integrated Urgent Care (OOH / 111) - procurement commenced in October 2016 and was running jointly with West Suffolk CCG and North East Essex CCG as part of the Sustainability and Transformation Plan (STP). Community Services (Constructive Dialogue) - although technically not currently a tender process there was a period of negotiation and assurance which would mirror elements of a single tender action and most capable provider process. The Governing Body noted the content of the report.

16/115 PRIMARY CARE COMMISSIONING – MODEL 3 – FULL DELEGATION

The Governing Body was in receipt of a report which updated on the outcome of a

due diligence process undertaken in respect of fully delegated primary medical care commissioning and sought approval to apply for fully delegated commissioning following the outcome of the Membership vote. The Governing Body was reminded that the CCG had been invited, by NHS England, to consider whether it wished to move to Model 3 in April 2017 or remain within the current joint commissioning arrangements (Model 2). The deadline for CCGs to apply was 5 December 2016. Following a Governing Body proposal in July 2016, the CCG had undertaken a thorough and robust process of due diligence. Areas identified for due diligence had been scrutinised robustly, including a detailed breakdown of the financial implications associated with model 3, clarification of some key areas and a better understanding of the level of risks and possible benefits involved. The CCGs had identified a number of areas that required a greater level of

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assurance; for example, where there was the expectation that processes currently undertaken by NHS England would be delegated to the CCG under model 3. Those areas continued to be worked through with relevant CCG and NHS England teams. The findings of the due diligence process were detailed within Section 3 of the report and benefits and risk set out in Section 5. GP Members had been invited to vote on the two options; remain Co-Commissioning with NHS England (model 2) or support the move to fully delegated commissioning of primary care (model 3). Votes had been received with 12 practices voting in favour of a move to Model 3, seven to retain the status quo, two abstaining and two not having responded. The Governing Body was informed that discussions were on-going with NHS England to quantify risks. There was concern that NHS England might expect more from the CCG than it provided itself although it was anticipated that fully delegated commissioning should provide practices with increased support. The CCG’s ability to resource the increased workload was questioned. The Chief Officer advised that all questions raised could be taken forward for discussion at a meeting scheduled to take place with NHS England on 1 December 2016. The Governing Body endorsed the decision taken by its member practices to; apply for Fully Delegated commissioning - Model 3.


The Governing Body received a report from the Chief Corporate Services Officer

that provided a public record of relevant and material interests declared by members of the West Suffolk CCG Governing Body, its sub-committees, staff and member practices. The Governing Body was asked to review the current register, and consider whether any action in relation to non-responders might be required. The Governing Body noted the register and requested that those members of staff who had not responded be targeted by managers for a response.

16/117 HEALTH AND SAFETY

The Governing Body was provided with an update on current health and safety

issues. Key points from the most recent meeting of the Health and Safety and Risk Committee held on 14 November 2016 included;

The Committee had received an update of outstanding facilities management issues at Rushbrook House, which had included an update on the access to the Farm Car Park as well as the fixing of barriers to windows with low sills which presented a potential risk of falling to staff and visitors.

Progress against the Health and Safety annual plan was discussed. In all areas activities were up to date with the exception that the planned service level agreement review, which was due to take place in October 2016, was overdue. The matter was to be addressed in the near future.

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New guidance had been issued by the Health and Safety Executive in relation to manual handling. The guidance was to be reviewed and, if necessary, training revised.

Sickness and absence figures were reported, which indicated an overall increase in the percentage of staff reporting sickness. The matter was to be further reviewed by the Chief Officer Team.

Having queried the lack of lighting available at the farm car park, it was explained that the matter was currently being addressed and staff had been advised they were able to move their cars to the main car park later in the day if they wished. The Governing Body noted the content of the report.

16/118 GOVERNING BODY ASSURANCE FRAMEWORK

The Chief Corporate Services Officer presented the Governing Body Assurance

Framework (GBAF) for November 2016. The GBAF continued to be reviewed by the Chief Officers Team every month and by the Governing Body and Audit Committee at each of their meetings. Revisions to the GBAF were detailed within Section 2 of the report. The Chief Contracts Officer reported that it was anticipated the risk associated to continuing healthcare would be removed from the GBAF upon receipt of the next Internal Audit report The Governing Body noted and approved the GBAF as presented.

16/119 MINUTES OF MEETINGS

Presented by the Lay Member for Governance, consideration was given to the

minutes of the following meetings:

1) Audit Committee The unconfirmed minutes of a meeting held on 4 October 2016.

2) Finance and Performance Committee

The confirmed minutes of meetings held on 21 September 2016 and 19 October 2016.

3) Remuneration and HR Committee

The unconfirmed minutes of a meeting held on 18 October 2016 4) Clinical Scrutiny Committee

The unconfirmed minutes of a meeting held on 19 October 2016 5) CCG Collaborative Group

The unconfirmed minutes of a meeting held on 13 October 2016 6) Commissioning Governance Committee

Decisions from meetings held on 19 October 2016 and 16 November 2016 The Governing Body received and endorsed the presented minutes and decisions.

16/120 ANY OTHER BUSINESS

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_____________________________ _______________________ Chair (Dr Christopher Browning) Date

No items of other business were received.

16/121 DATE OF NEXT MEETING

The next meeting of the West Suffolk CCG in public was scheduled to take place on Wednesday 25 January 2017 at 0900 hrs in The Edmund Room, St Edmundsbury Cathedral, Bury St Edmunds, Suffolk

16/122 QUESTIONS FROM THE PUBLIC

Cllr Clements, having listened to the patient story, emphasized the need to improve links and access to mental health services. It was explained that the CCG’s mental health and learning disability workstream would take forward issues raised at today’s meeting, together with exploring increased emphasis on emotional wellbeing.

WEST SUFFOLK CCG Governing Body

ACTION LOG: 30 November 2016 (updated) MINUTE DETAILS ACTION BY WHOM TIMESCALE/UPDATE

Meeting of 30 November 2016

16/108 Integrated

Performance Report

Having reported that Addenbrookes had recently

agreed a STF fund the Chief Contracts Officer agreed

to provide the CCG’s Executive with further

information at a forthcoming meeting.

The achievement of only £100k of Quality Premium

from a potential £1.2m was disappointing. The need

to increase focus for 2017/18 had been recognized

and it was anticipated that the CCG’s Executive

would receive a detailed report for review within the

next few weeks.

Jan Thomas

Kate Vaughton

Scheduled for Executive on 8 February 2017

16/115 Primary Care

Commissioning –

Model 3

The Chief Officer advised that all questions raised

could be taken forward for discussion at a meeting

scheduled to take place with NHS England on 1

December 2016.

Ed Garratt Complete

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GOVERNING BODY

Agenda Item No. 06

Reference No. WSCCG 17-01

Date. 25 January 2017

Title

Community Engagement Group

Lead Chief Officer

David Taylor, Chair of Community Engagement Group

Author(s)

Jonathan Ford, Communications Manager

Purpose

To present the unconfirmed minutes from the Community Engagement Group meeting held on 22 December 2016.

Applicable CCG Priorities

1. Develop clinical leadership

2. Demonstrate excellence in patient experience & patient engagement

3. Improve the health & care of older people

4. Improve access to mental health services

5. Improve health & wellbeing through partnership working

6. Deliver financial sustainability through quality improvement

Action required by Governing Body:

The Governing Body is asked to consider and note the key items of discussion from the Community Engagement Group.

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West Suffolk CCG Community Engagement Group Thursday 22nd December 2016

1400-1630 West Suffolk House, Bury St Edmunds

PRESENT: APOLOGIES:

David Taylor (Chair) Jo Finn, WSCCG Lay Member Warwick Hirst Jane Ballard Anne Nicholls Michael Simpkin Kate Vaughton Carol Mansell Hayley Charman John Rapley David Dawson Peter Owen Gill Jones IN ATTENDANCE: Isabel Cockayne; Head of Communications, IESCCG and WSCCG Sue Clarke, Dietetic Advisor, IESCCG and WSCCG Amanda Stevens ( Healthwatch)

Item

Action

GENERAL BUSINESS

1. WELCOME & APOLOGIES FOR ABSENCE

The Chair welcomed everybody to the meeting and apologies for absence were noted. The chair thanked Peter Owens for kindly offering to take the notes of this meeting. Members introduced themselves and the Chair gave a brief and abridged historic overview of Bury St Edmunds. Some basic details about health services and the public perceptions about their own health were also provided.

2. MINUTES & ACTIONS ARISING

The minutes of the last meeting held on 27 October 2016 were approved by the meeting as an accurate record. Action 1 from August 25 meeting (To obtain an answer to the claim made that there is a high number of applicants for nurse training places and many are being turned away. BMcL to investigate further) is agreed to be carried forward with further information from the Chief Nursing Office. A new action was that more information about social care to be given to CEG meetings possibly through an invitation to a relevant council officer.

HC

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3. CHAIRMAN’S REPORT – David Taylor

DT gave a verbal report, which did not this time include any comments from the governing body as he had not been able to attend the last meeting. Notes from the governing body are available publicly. DT explained that a joint workshop with PPGs is planned for the New Year. DT also told members about the successful Haverhill Health Open Day held on 28th October.

4. LAY MEMBER’S REPORT – Jo Finn J Fi delivered the report, which included the report on the “Task and Finish Group Workshop for PPGs”. The meeting was held on 7th December and chaired by Jo Finn. In all, seven actions were agreed. Also, the “Connect Suffolk” report was discussed. Overall good progress was noted.

5. ENTER AND VIEW – Amanda Stevens

Amanda covered all aspects of Healthwatch Suffolk (HWS) Enter and View

Programme, presenting a comprehensive overview. HWS, set up locally in

2012, has mandatory powers of access to all premises (except domestic

residential) where health services are provided. Great care has been given

in providing robust processes and reporting. NICE and CQC guidelines are

followed and a close relationship exists with both. Care homes have been

their main focus to date, with positive feedback from all involved, patients,

care staff and management. A thoroughly objective view is aimed to be

taken in the reporting.

6.

GLUTEN FREE PRESCRIBING – Susan Clarke

SC gave an interesting overview of the current and recent status of Gluten

Free (GF) Prescribing. Since January 2016, adults have not been

prescribed GF products resulting in at least an £80K saving. Children are

still eligible for GF prescribing which amounted to £8K per annum. Overall

the complaints have been “dropping off”. Low-income families are advised

to discuss their situation with Welfare Benefit services.

Susan commented in response to John Rapley’s question on what causes

GF needs. There is a close tie with Diabetes and Cystic Fibrosis, although

not necessarily the cause.

7. FEEDBACK FROM CEG MEMBERS John Rapley - provided an overview of the East of England Ambulance Service, with special mention of the work of the Hospital Liaison Officer. Statistics included a 16% increase in blue light calls (year on year), with a 5-8% overall increase in callouts. Also, 31% of calls had resulted in home treatments, not requiring transport to hospital.

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Gill Jones- provided comments about care home support. Also a Diabetic Foot care report is due shortly. The maternity report was received favourably. The “Children’s Wellbeing Strategy” is ongoing. Michael Simpkin said that access to Haverhill GPs remains an ongoing issue. It is hoped that the Connect project will be rolled out to Haverhill soon.

8. AOB CCG Financial attendee needed. Andrew Eley suggested for the next meeting on “The Operational Plan”

J Fi IC

9. QUESTIONS FROM THE PUBLIC None

10. FORWARD PLANNER 16th Feb 2017 CEG meeting – Operational Plan – Andrew Eley. 16.20 – meeting closed.

11.

FUTURE MEETINGS WSCCG Governing Body, 25th January 2017, The Lecture room, St Edmundsbury Cathedral, IP33 1LS CEG, 16th February 2017, Newmarket, Memorial Hall.

GOVERNING BODY

Agenda Item No. 08



Title

Diabetes Service and Future Strategy

Lead Chief Officer

Dr Jon Ferdinand

Author(s)

Martin Bate, Project Manager

Purpose

To highlight the successful improvements in support for people with diabetes in west Suffolk and the future direction for diabetes care.









The Governing Body is requested to acknowledge the successful improvements in diabetes care achieved in the CCG area through closer working between GP practices and secondary care specialists.

The Governing Body is requested to note the on-going NHS England National Diabetes Treatment and Care Programme bid to access a share of £44m national diabetes funding for transformation in the areas of structured education, treatment targets and hospital inpatient care.

1. Background 1.1 In 2015/16 there were over 13,000 people aged 17 years and older with diabetes in the CCG

area and it was estimated that there are a further 3,500 adults with undiagnosed diabetes. In addition, there are around 700 children under the age of 17 with diabetes (the majority Type 1 supported by the acute care PbR Year of Care tariff).

1.2 The demand for services to support people with diabetes in west Suffolk is increasing with

around 800 new patients being added to GP Practice registers each year, over 90% of these being Type 2 diabetes patients.

1.3 In 2015, the CCG commissioned the extension of the West Suffolk Hospital Foundation Trust

(WSFT) Community Diabetes Nursing Service (CDNS) to support all CCG practices following a successfully evaluated pilot operation in Forest Heath in 2013/14. The aims of the CDNS are to:

Engage the diabetes population of west Suffolk through the opportunity to be seen by a diabetes specialist in their locality without the need to travel to hospital;

Upskill the primary care workforce by sharing diabetes knowledge and experience, delivered through mentored clinics with practice nurses and on-site support for the primary care team;

Increase the number of diabetes patients able to self-manage their diabetes. 1.4 The service was commissioned from April 2015 with funding to August 2016, beyond which

WSFT has continued to operate the service. 1.5 Primary care supported of the delivery of the new diabetes model with the CDNS though a

primary care enhanced service. The funding supported the additional workload for practices in 2015/16. This was based on engagement with the CDNS, improvements against the national diabetes treatment targets, and participation in the National Diabetes Audit

2. Key Issues 2.1 In 2016, the CCG climbed to 81st position in England for the achievement of the core diabetes

treatment targets. This significant improvement moved the CCG from a position of being ranked 209th out of 211 in 2013.

2.2 Closer working with GP practices, through the introduction of the CDNS, has helped the CCG’s

performance against the core treatment targets for diabetes to move from Quartile 1 (bottom) to Quartile 3 (second from top) in England.

2.3 The service is popular with patients, providing local support for people struggling with their

diabetes and has a high attendance rate at the practice-based clinics. 2.4 The service is popular with clinicians; receiving positive feedback from the primary care teams

and enabling the CCG to achieve 100% participation in the National Diabetes Audit for the first time.

2.5 Work continues to develop diabetes services further in Suffolk and the CCG is bidding to access

a share of £44m national funding for transformation in the areas of structured education, treatment targets and hospital inpatient care.

Improvements in diabetes care

Outcomes 2.6 Improved performance against the core treatment targets; the 2015/16 QOF results published in

October 2016 reported improvements in the achievement of two of the three core treatment targets with a higher proportion of diabetes patients more able to control their diabetes.

Target 2012/13 (England) 2015/16 (England)

DM007: Blood glucose (HbA1c) 52.0% (59.8%) 61.27% (60.06%)

DM003: Blood Pressure 65.1% (67.3%) 72.03% (70.59%)

DM004: Cholesterol 70.3% (72.9%) 69.20% (69.98%)

2.7 Improved control leads to the reduction of the risk of complications, with associated long-term

savings to the health economy. 2.8 The improvements have been highlighted by local press and BBC Radio Suffolk (Appendix A).

Patient education 2.9 The CCG commissions a DESMOND structured education course for patients newly diagnosed

with Type 2 diabetes. 2.10 In 2015/16, WSFT introduced a DAFNE structured education course for patients diagnosed with

Type 1 diabetes. 2.11 In 2015/16, 75% of newly diagnosed patients were referred to a structured education

programme, an increase of 5% from 2014/15.

Patient experience 2.12 Attendance rate at the CDNS clinics of 93% compared to only 81% in secondary care. 2.13 99% of patients said that they would be likely or extremely likely to recommend the service to

friends and family.

Clinical engagement 2.14 Feedback from the practices operating the mentored clinics has been overwhelmingly positive:

“Denise has been supportive, educational and the patients have found it really helpful to been seen in surgery and not hospital. The clinics have improved my knowledge, my practice and my confidence. I am hoping that they can continue so that my patients can be seen in surgery, and I continue being updated and educated” Practice Nurse.

“I am writing with regard to the Community Diabetes Service, which has been working with us to improve the service we are able to offer our patients since May this year. As a practice we have found this service extremely helpful, particularly the mentorship for our new diabetes nurse. This has both supported and encouraged her, and enabled her to build upon her limited diabetes skills. In addition, we have had very positive and encouraging feedback from our patients, who are very happy to be able to receive this level of clinical care locally, also from our doctors, as we are now beginning to see some improvement in our HbA1c levels. We would like to express our thanks for your support, and very much hope this service will continue.” Practice Manager

2.15 In 2015/16, every CCG practice participated in the National Diabetes Audit, an increase from only

17 practices in 2014/15. 2.16 Since April 2016, 19 of the 24 practices are continuing to access the benefits of the community

diabetes service.

Activity and Cost

2.17 Savings have been made in outpatients with over 1,000 fewer appointments at WSFT since the service commenced in April 2015. The total cost saving over this period has been in excess of £100k.

2.18 Wait times for outpatient appointments have reduced:

Before service Today

First OP 9 weeks 4 weeks

Follow-up OP 8-9 months < 6 months

2.19 The first 20 months of the CDNS have not realised the potential reductions in emergency admissions. A long-term investment is needed for savings to be realised over a 5-10 year period, as evidenced by Public Health1.

Future direction

2.20 The CDNS is continuing to work GP practices seeing patients across the west Suffolk localities. 2.21 NHS England has announced a £44m national fund to improve diabetes care based on four

programme priorities. CCGs have been invited to bid for a share of the funding. Bidding opened in December 2016 with closing date 18 January 2017. The bids were submitted by the Sustainability and Transformation Plan (STP) for North East Essex and Suffolk and the investment decisions will be notified by NHS England in March 2017.

2.22 The CCG have worked collaboratively with North East Essex and Ipswich and East Suffolk

CCGs to develop a STP bid for three priority areas

a) Structured Education: Aim to increase availability and uptake of education offering more places, backed by a large scale advertising campaign and practice incentives. Also, additional lifestyle support for patients.

b) Treatment Targets: Increase the use of technology for patient self-management.

Increase diabetes awareness with mental health. Introduce a performance dashboard and Year of Care planning in primary care supported by a practice incentive scheme.

c) Inpatient Nursing Services: Increase inpatient dietician support and health care support

to assist with inpatient care including monitoring and foot assessments. Set up and manage inpatient audit on length of patient stay.

1 Source: Public Health England, Diabetes UK, NHS England

3. Public Engagement

3.1 The service is popular with patients and has received positive feedback on individuals’ care and experiences.

4. Recommendation 4.1 The Governing Body is requested to acknowledge the successful improvements in diabetes care

achieved in the CCG area through closer working between GP practices and secondary care specialists.

4.2 The Governing Body is requested to note the on-going NHS England National Diabetes

Treatment and Care Programme bid to access a share of £44m national diabetes funding for transformation in the areas of structured education, treatment targets and hospital inpatient care.

Appendix A – Diabetes coverage in local press

East Anglian Daily Times – Thursday 15th December 2016

BBC Radio Suffolk – Dr Clark from WSFT interview on improved diabetes care in west Suffolk (from 1hr 18 mins 10 secs) - here

http://www.bbc.co.uk/programmes/p04hhbvp

GOVERNING BODY

Agenda Item No. 09



Title

In Vitro Fertilisation (IVF) Services

Lead Chief Officer(s)

Barbara McLean, Chief Nursing Officer

Author(s)

Barbara McLean, Chief Nursing Officer Andrew Eley, Deputy Chief Operating Officer

Purpose

To present to the Governing Body the issues raised in the public and patient engagement exercise, and to present the suggested CCG actions in response to those issues.









To consider the issues raised in the public and patient engagement exercise, and to review and agree the CCG actions.

To consider the recommendation from the CCG’s Executive to retain the policy as currently published.

1. Background 1.1 West Suffolk CCG is responsible for commissioning core healthcare services for people in the

area. It has worked with its sister CCG, Ipswich and East Suffolk, since 2013 to improve quality and make changes to services to realise cost benefits. In July of this financial year the CCGs highlighted that, although not currently in debt, £13 million of combined cost efficiencies needed to be made. The CCGs needed to make changes as they do not have enough money to continue delivering all the local healthcare services in the way they do now.

1.2 In the past 3 years, the West Suffolk CCG has made savings within its budgets to meet its

financial obligations, in part by using non-recurrent funds. The CCG does not have non-recurrent funds available in 2016/17 to use to help to balance its financial position, and has the largest financial efficiency challenge to date.

1.3 The financial forecast for 2017/18 and 2018/19 is now clearer following the conclusion of the

contracting round and the CCG will face a significant challenge over the next two years. 1.4 To help address financial problems both now and in the future, twin processes were launched.

The first has seen the CCG look at every single contract with each of its providers. The second was to propose to the public that changes were made to two of its services (In Vitro Fertilisation [IVF] and Marginalised and Vulnerable Adults [MVA]), and pay due regard to the views of patients and the public in the decision-making process.

1.5 An engagement exercise in the summer, carried out jointly between the CCGs, asked the public about a suggested change in offering two cycles of IVF for a couple experiencing fertility issues. The review of all contracts in June 2016 highlighted IVF treatments as a commissioned service to which changes could be made and a proposal was put to the public, to seek their views. The selection of this service was due to the relative high cost of the intervention for small numbers of people, without a ‘health gain’.

1.6 More than 800 people made comments on this issue, either online or through face to face

conversations held on the streets of towns across the CCGs’ areas. A focus group was also held specifically for those people affected.

1.7 At the Governing Body meeting held in September, members agreed to defer the final decision

until January 2017 to allow time to review a number of actions and potential changes to the CCG’s position, particularly on finances, and also to consider the quality of the services provided.

1.8 Quality Impact Assessment and Equality Impact Assessments for the proposals for IVF were created at the beginning of the process, and will be published alongside the final documents. The summary assessment for IVF concluded that reducing the service: “is likely to have a negative impact for those affected by fertility issues. It likely to see an increase in mental health conditions for those couples who have struggled to conceive successfully to date. Bearing in mind the above, any withdrawal of the service should be looked at on an annual basis to assess if it could be re-introduced.”

2. Key Issues

Engagement exercise 2.1 The CCGs set out a process for an engagement exercise from 19th July 2016 to 9th September

2016 to gather broad public and specific patient views, to conclude with an independent analysis of the feedback collected.

Proposal 1: Offering either no cycles or one cycle of fertility treatment for women. The CCG currently has a policy of offering two cycles of IVF, which is one less than National Institute for Health and Care Excellence (NICE) guidelines. Around 80% of CCGs across the country have made similar changes, with large areas of the country offering just one cycle. Offering no cycles would mean a saving of approximately £148,362 p.a. for the CCG. Offering one cycle would see savings of £85,902 p.a. Participants covered a number of themes in their narrative responses, including:

health service priorities;

health and care concerns;

fertility conditions;

adoption and alternative approaches to parenting;

funding. The table below sets out the numbers responses.

Total Total as

percentage

One Cycle 265 33%

Zero cycles 198 24%

Retain at 2 or increase 225 27%

Retain the IVF service 125 15%

No record 7 1%

Finances 2.2 The CCG still face financial challenges - both before the end of the year, and in future years.

Month 9 figures show a deficit of £1.3m for the CCG (overall budget £298.6m). 2.3 Next year, NHS England has indicated that the CCG’s allocation will be lower than expected. The

CCG has new contracts with some providers, based on a two-year guaranteed income arrangement, which is likely to support the CCGs in the medium term, but there is still much to do for the longer term.

Quality

2.4 The Quality Impact Assessment, did not establish any concerns with the quality of service provided. The service will continue to be commissioned outside of NICE guidance, which is not a mandatory requirement for commissioning. The responsibility of CCGs is to publish clear policies on the commissioning of clinical services and to commission services to meet the needs of the local population, with a duty in relation to financial sustainability.

2.5 The Quality Impact Assessment notes a potential impact in respect of the emotional wellbeing

and mental health for those affected by changes to the service. Monitoring of this impact is recommended and outlined further in this report.

2.6 The CCG’s assessment does not dispute the quality of the service or the clinical evidence of

efficacy available from NICE or The Human Fertilisation and Embryology Authority (HFEA). Action plan 2.7 The table below summarises the issues raised during the engagement exercise and the

suggested actions that might be taken. The CCG acknowledges the importance of recording any decisions made, taking into account the feedback provided during the engagement exercise.

ISSUE RAISED OUR ACTION

IVF

NICE guidelines suggest offering three cycles. Fertility services are deemed to be a reasonable cost and clinical effective use of NHS resources. The NHS could offer a finance plan for people who wish to pay for treatment. Individual Funding Requests (IFR) will be inundated if no cycles is the way forward. This would then possibly lead to less funding for other treatments on Individual Funding Requests. The Human Fertilisation & Embryology Authority (HFEA) has always strictly regulated the number of embryo that can be transferred during IVF treatment to reduce the chance of multiple pregnancies. European Society of Human Reproduction and Embryology (ESHRE) shows that in some other

There is evidence to show that there is little increase in successful pregnancies between two and three cycles. When NICE extended from two to three cycles in 2014, the CCG stayed the same. This will continue to be reviewed within the two year review period for clinical policies. In the absence of unlimited resources, the CCG has a responsibility of maintaining financial balance while meeting all local health needs. This is noted and no further action as it would add to the cost of running a CCG to set up finance planning. Clear guidance on who would be eligible will be produced. The IFR process is applicable in only individual and exceptional circumstances. The impact of this could be measured. If the difficult decision is made to reduce to zero or one cycle on financial grounds, there should be a review of neonatal cost increases as well as review of the policy within a year. It would be recognised that the CCG would be choosing to make cost savings for the short term.

European countries, and outside of the EU, there is often no statutory limit to the number of embryos transferred. The UK has pursued strict strategies to restrict multiple embryo transfers because of the complications for mothers and babies and high costs that arise out of multiple pregnancies. At least half of twins are born before 37 weeks (making them pre-term) with low birth weights, which puts them at a high risk of serious health problems. Over 90% of triplets are born before 37 weeks, and many are born sufficiently prematurely

If implemented, the CCG would review the effectiveness of this policy change in 12 months’ time.

Review 12 months after implementation, including the neonatal cost evaluation. Benchmarking should be done now.

Clear indications on when changes will come into effect and to whom this affects, e.g. to patients referred recently: i. For one cycle, share information on

other options available, working with providers

ii. For zero cycles, share information on what can still be provided for those with illnesses which affect fertility

Changes cannot happen overnight. A clear date would need to be agreed on and communicated to ensure our providers and patients are given sufficient notice.

i. Source information about other options

ii. Clear communications when decision is made

Consider and review in future any potential indirect consequences, e.g. mental health, family breakdown, that could possibly arise from this decision

The Contracts Team will work with our mental health providers, and Suffolk County Council, to provide information for those who might be affected

Use Bourn Hall as a way of getting information on changes to patients

The CCG will ensure Bourn Hall receives details of the final decision reached by the governing bodies

3. Public Engagement

3.1 Refer to paragraph 2.1 above. 4. Recommendation 4.1 The recommendation to the Governing Body, based on the information presented to the

Executive on 18th January 2016, is to retain the policy as currently published. This enables the provision of up to two cycles when the clinical and other criteria set out within the policy are met.

GOVERNING BODY Agenda Item No. 10



Title

Marginalised and Vulnerable Adult Service (MVA) Update.

Lead Chief Officer(s)

Richard Watson: Chief Redesign Officer

Author(s)

Eugene Staunton: Associate Director of Redesign

Purpose

This paper sets out:

An update on the engagement exercise.

To look at options for the future of the Health Outreach Service for Marginalised and Vulnerable Adults (North Essex Partnership Trust)

To review recommendations and decide on future actions.








Action required by Governing Body: To note report and endorse actions.

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1. Background

1.1 Between 19 July and 09 September 2016, an engagement exercise was carried out in which a proposal to withdraw the marginalised and vulnerable adults (MVA) service in West Suffolk CCG area and focus the service in Ipswich was made because of the paucity of clear evidence of its efficiency and outcomes of the outreach services.

1.2 It is a service which was made into a county-wide service to focus on disadvantaged areas in

2012. Over four years the service developed outreach services in Sudbury, Haverhill, Newmarket and Bury St Edmunds. This was on top of outreach services in Ipswich, Felixstowe, Leiston and Stowmarket. There were 300 people in the west of the county supported in 2015/16, compared to 1374 in the east. There was little more information than this.

1.3 Quality Impact and Equality Impact Assessments for the MVA were created at the beginning of the

process, and will be published alongside the final documents. 2. Brief overview of Engagement Objectives and Outcomes

2.1 Proposal 2: Removing the Marginalised and Vulnerable Adults (MVA) service in the west of the

county:

A proposal document was launched on 19 July with a clear process set out within it

A thorough engagement process was carried out including a total of 22 events from 19 July to 9 September - Health Scrutiny Committee members, Health and Wellbeing Board members and Healthwatch Suffolk were engaged Fifty staff took part, with help from GPs, lay members from both CCGs, a volunteer and five members of Healthwatch Suffolk staff

Some 235 Facebook posts were issued, resulting in 38,360 impressions; on Twitter there were 228 posts with a 15,152 engagement rate

Four press releases were issued which saw: two TV interviews; three BBC Radio Suffolk interviews; one Ipswich Town Radio interview; 11 press article

Some 580 comments were gathered on outreach service proposals

During the process, the EIA showed that more information was needed to gain greater insights into the patient experience - therefore focus groups and outreach clinic visits were carried out to find out more

MPs, councillors and support groups wrote in answer to the proposals

An independent assessment was prepared 2.2 Themes included:

Access to primary care was difficult in general, and particularly for this group

Mental health and drug and alcohol services

Joint working with partners, such as housing, social services, voluntary and public health

Transport problems from rural areas to urban areas

Views from partners, service users and those who best understood the service showed areas of need for the most vulnerable in society

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2.3 Guidance on using equality assessments to work out the impact of changes in services suggests that they should be live documents until the end of the process. Assessments are reviewed systematically throughout the process. The assessment for MVA concluded that negative impact would be certain, particularly among populations who find it difficult to access or use services, and are already at risk of disadvantage.

2.4 In September’s Governing Body, it was decided that in the light of the feedback from the public and

partners, a partnership approach was required, with an update returning to January’s Governing Body which is now recommending the recommissioning of the service in a more joined up way with the broader Suffolk system.

2.5 In November an analysis of the postcodes which were shared during the engagement process (not

many were) was made. In each CCG area roughly 55% of responders disagreed with the proposal to make the changes to the MVA service.

3. Partnership Progress

3.1 Suffolk County Council and the CCGs met on 1 November 2016 in Needham Market to inform

future commissioning. On 15 December 2016, the MVA service joined the commissioners and other stakeholders to jointly identify current issues and challenges, and to agree a shared system-wide outcome.

3.2 In preparation for the above workshop, Public Health reviewed the existing Health Needs

Assessment and updated it. This assessment supports a need for a service for the Homeless, Gypsies, Travellers and Roma, Migrants, Refugees and Asylum Seekers and BME groups. It forecasts future needs, such as Home Office expectations on incoming refugees from Syria.

3.3 The CCGs and Suffolk County Council (SCC) broadened the review to consider other services are

required to support vulnerable groups and enable them to access mainstream services, or indeed where they may require specialist services. The scope of the review included housing, health, social care, social wellbeing and financial inclusion. It is worth noting that the two CCG areas do not include Waveney, however SCC’s scope is Suffolk-wide due to their existing boundaries.

3.4 A package of service level data and background information was prepared, outlining the provider’s

current activity, identification of possible blockers in the system and staffing establishment details. The following key points, while not exhaustive, cover service delivery and interventions offered:

Qualified clinician at reception, undertaking triage in addition to reception duties and delivering weekly clinics, accompanied by Support Workers, undertaking mental health assessments and providing counselling sessions, with access to a GPwSI during the day

Safeguarding reviews undertaken and additional support provided to team members

Qualified general nurse reviewing known clients and assessing new clients

Support for the Traveller, Roma and migrant communities, Syrian refugees, Looked After Children assessing their needs and providing any necessary treatment/advice/signposting

Bilingual Support Workers undertaking street walks to engage with the homeless and others, providing advice and signposting

Soup Kitchens - two qualified clinicians who will work collaboratively with the Soup Kitchen service, available to review known clients, assess new clients and to provide treatment/advice/signposting to all

Weekly Multi-Disciplinary Team Meetings to provide clinical and managerial supervision, as this is a very high risk client group.

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Drug and Alcohol Session - run weekly by two qualified clinicians

Bury - two qualified clinicians (Mental Health Nurse and Senior Social Worker) spending time in these areas, both seeing known clients and assessing new clients

Ipswich Hospital and GP Surgeries - one qualified general nurse spending the day at IHT reviewing known clients and assessing new clients and time at practices

4.0 Recommendations 4.1 The MDT recommends that both Suffolk CCGs re-commission a county-wide service, in line with

the identified procurement timetable from the end of March 2017, with the new service to go live from 1 October 2017. The CCG’s Procurement Team have confirmed that a six month lead in time from initially going to market will be required. System partners collectively agree that this approach will support the most vulnerable and at risk individuals in our local communities. Without this approach, there will be more people from these groups reaching crisis point and needing care within hospitals instead of communities.

4.2 If agreed, it is proposed that the MDT finalises the service specification, and then goes to market

with the aim to mobilise the new service from 1 October 2017. This would include clarification of how the wider Suffolk system works best together in the interests of these vulnerable groups.

4.3 A mid to longer-term solution, suggested by the MDT, would be for members to consider

transferring the future commissioning of the MVA service across to Public Health, to better align the service with other local providers, with a funding allocation.

4.4 Governing Body members are asked to note the report and endorse actions on the next page

arising from these discussions.

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ISSUE RAISED DURING ENGAGEMENT OUR ACTION

Partners reported strongly that this was a group of people who required help. Points were made about the rising - if still low - numbers of refugees also being settled in the area A whole system review is required to ensure strategic leadership in this area.

Work is currently underway with partners to review those with chaotic lifestyles, enabling those people on the ground to work together more effectively.

Commissioners to look carefully at precise timings of changes.

A suitable lead-in time will be made when communicating this decision – to ensure our providers are given sufficient notice. An extension will be given to the current contract based in the Ipswich area, and discussions will take place with other commissioners reviewing those with chaotic lifestyles.

Promotion of services to the homeless about drug/alcohol/MH services would reduce strain on NHS services. This could be extended to broader employees etc.

A specific campaign to be supported by the commissioners and providers.

Some individuals do travel between sites. However there are issues around individuals feeling under pressure by visiting major urban areas, e.g. Ipswich means it is easier to score drugs or creates anxiety.

A redesign of the service will be carried out.

Review the requirements for mental health services.

The criteria will be looked at in the review of the mental health contract.

Review the requirements for drug and alcohol services and mental health

Best practice elsewhere in the country will be reviewed and lessons learned

Ensure a respectful environment is reached, so that people are listened to and begin to trust authority.

Learn from Cultural Competency training, produced by local providers.

of 2

GOVERNING BODY Agenda Item No. 11



Title

Procurement Update: Summary of Activity 2016/17

Lead Chief Officer

Jan Thomas, Chief Contracts Officer

Author(s)

Jane Garnett, Procurement Lead

Purpose

To update the Governing Body on the procurements completed since the last procurement update and those currently in progress and planned for 2016/17.








Action required by Governing Body: To note the work being undertaken and the evolving work programme for 2016/17.

1. Background 1.1 The table below summarises the current health service procurement activity.

Procurement Name

PQQ Bidders

ITT Bidders Awarded to Contract Start

Peri-Diagnosis Dementia

2 2 Sue Ryder 01/04/2017

Integrated Urgent Care

4 TBC TBC 01/10/2017

Constructive Dialogue

Passed through stage 1 gateway and now into detailed discussions regarding developments and contractual arrangements.

01/10/2017

1.2 Peri Diagnostic Dementia Services NHS West Suffolk CCG is working with NHS Ipswich & East Suffolk CCG and Suffolk

County Council to determine the future shape of Post Diagnostic Dementia Services. This procurement has been undertaken as a restricted procedure and is due to start on the 1st April 2017. The contract was awarded to Sue Ryder after a paper was presented to Governing Body in December.

1.3 Integrated Urgent Care (OOH / 111)

This procurement started in October 2016 and is running jointly with West Suffolk CCG and North East Essex CCG as part of the Sustainability and Transformation Plan (STP). The service specification includes elements from the care coordination centre currently run as part of Suffolk Community Healthcare.

1.4 Community Services (Constructive Dialogue) The CCGs have been involved in a Most Capable Provider (MCP) process to ascertain assurances around the alliancing proposals put forward. The MCP stage 1 concluded in December 2016 and recommended to Governing Body that the process moved into detailed discussions (stage 2), which will lead to a jointly developed innovation / development plan and contract. Initial discussions for this stage are now underway.

1.5 There are conversations about service transformation and re-commissioning which may

materialise as procurements during 2017/18; possibly including but not limited to : 1.5.1 Marginalised and Vulnerable Adult Services 1.5.2 Patient Transport Services 2. Recommendation 2.1 The Governing Body is asked to note the work undertaken and the evolving work

programme for 2016/17.

1

GOVERNING BODY

Agenda Item No. 12



Title

Integrated Performance Report

Lead Chief Officer

Barbara McLean, Chief Nursing Officer Lesley MacLeod, Chief Finance Officer Richard Watson, Chief Redesign Officer Jan Thomas, Chief Contracts Officer

Author(s)

Alex Briggs, Head of Corporate Intelligence

Purpose

To provide members with a summary of performance against national targets, contractual targets, clinical quality and patient safety issues, financial position and workstream activity.








Action required by Governing Body: To note the position regarding financial and service performance; review actions being taken with regard to patient safety and clinical quality issues; and any actions to mitigate risks or poor performance.

Integrated Performance Report

January 2017

1

Contents Part 1 – Clinical Quality & Patient Safety…………………………………………........................... Part 2 - Finance and Information……………………………………………………………………… Part 3 - Redesign………………………………………………………………………………………. Part 4 - Contractual Performance by Provider…........................................................................ Part 5 – PMO ……………………………………………………………………………………………..

3-5

6-8

9-10

11-12

13-15

2

Clinical Quality & Patient Safety

January 2017

3

Clinical Quality & Patient Safety – Executive Summary

4

Slight deteriorations on performance – some concerns/risks noted

Considerable deteriorations on performance – major concerns/risks noted

Improvements and/or continued good performance – no major concerns/risks noted

Area App Ref

Provider Nov Rating

Previous Rating

Headlines

Infection Prevention & Control (1)

3 - 6 West Suffolk Hospital NHS Foundation Trust

3 cases reported against a trajectory of 1, 1 = WSCCG patient, 2 out of area CCGs. YTD 19 against a YTD trajectory of 11. No cases of MRSA BSI reported

Suffolk Community Healthcare

No cases of CDI reported for November. YTD total is 2 against a year end trajectory of 2. No cases of MRSA BSI have been reported this year.

West Suffolk CCG 4 cases of CDI reported for the month against a monthly trajectory of 3 (1 acute and 3 non acute). YTD cases are 40 against trajectory of 29 (end of year target 45). No cases of MRSA BSI reported so far this year.

Harm Free Care Falls *Different RAG rating used

7 & 9 West Suffolk Hospital NHS Foundation Trust (2)

NR Novembers fall data has not been provided yet. The Trust continue to experience issues with the new reporting system e-Care and figures for falls per 1000 bed days are still unreported for this contractual year.

Suffolk Community Healthcare (3)

SCH recorded a figure of 16.96 for falls per 1000 bed days. SCH continue to work on their performance against falls and the issues are discussed regularly at the Clinical Quality meetings.

Harm Free Care Pressure Ulcers (4)

8 & 10 West Suffolk Hospital NHS Foundation Trust

26* 7, 5, 3 Pressure ulcers now reviewed to determine if they were avoidable or not for Aug, Sept & Oct. *Nov reported incidents not yet fully reviewed.


17 16, 12, 8

SCH reported 9 avoidable Grade 2 pressure ulcers for the month (7 community & 2 inpatient). There were also 8 avoidable Grade 3 pressure ulcers reported in month (6 community & 2 inpatient). No avoidable grade 4 pressure ulcers reported.

(1) Infection Prevention & Control – The RAG rating is subjective based on an expert review of the individual organisations overall infection prevention and control performance with particular consideration being given to performance in relation to MRSA BSI and C.Diff infection rates. (2) WSFT falls per 1,000 bed days Green ≤6.63: Amber 6.64 – 7.00: Red ≥7.01 (3) SCH falls per 1,000 bed days Green ≤8.6: Amber 8.61 – 9.5: Red≥9.51 (4) Total number of avoidable pressure ulcers reported

5

Area App Ref

Provider Nov Rating

Previous Rating

Headlines

Serious Incidents and Never Events (5)


5 4, 6, 4 There were 5 incidents reported for the month, including 1 Never Event (Wrong Route Analgesia)


0 0, 0,0 No comment

Norfolk & Suffolk Foundation Trust

1 1, 1, 4 There was 1 incident reported for the month of November 2016: Unexpected/potentially avoidable deaths – 1

East of England Ambulance Service

1 3, 1, 3 There was 1 incident reported for the month of November 2016: Unexpected / potentially avoidable injury causing serious harm – 1

Patient Experience (6)


Complaints data not reported for September, October and November. A&E FFT results 80%.


2 complaints received in the month., overall FFT score (98%) remains positive.

Norfolk & Suffolk Foundation Trust

11 complaints received in month.

EEAST NR 5 complaints received in month.

Care UK NR 1 complaint received in month for 111. 0 complaints recorded for OOH.

Transforming Care (7)

15 West Suffolk CCG

Care Homes (8)

38 - 40 West Suffolk CCG

NR Outstanding: 5: Good: 111: Requires Improvement: 40: Inadequate: 7

(5) Serious Incidents – The number of actual serious incidents raised by the individual organisations (6) Patient Experience - The RAG rating is subjective based on an expert review of the individual organisations overall patient experience performance with particular consideration being given to performance in relation to the Friends and Family Test and time frames to respond to complaints (7) Transforming Care - The RAG rating is subjective based on an expert review of the organisations overall performance (8) Care Homes - The RAG rating is subjective based on an expert review of performance within the care home sector

Finance & Information

January 2017

6

7

Rating Key Movement Key

On or better than target Improvement

Below target No Change

Deterioration

Finance – Headlines Month Ending 31st December 2016

Variance from Plan (£1.3m)

At month 9 financial performance is £1.3m behind plan but ahead of the Financial Recovery trajectory by £0.6m. Key adverse variances from plan are QIPP schemes in development (£3.3m), Acute services (£0.3m) and Prescribing (£0.2m) . These are mitigated by the use of Contingency (£1.1m) and underspends in Mental Health & LD Services (£0.2m), Other Programme (£0.6m), Other Primary Care (£0.1), Corporate Costs (£0.1m) and Community (£0.2m) .

Forecast Risks and Mitigations £0.0m

Based on the Financial Recovery Plan the CCG currently has a balanced forecast position. Key risks are QIPP Under delivery (£3.1m), Funded Nursing Care national price increase (£0.8m), additional ambulance costs (£0.2m), Property Services Market Rents (£0.8m). These are mitigated by Contingency (£1.5m), Central Property Services Funding (£0.8m), 15/16 Quality Premium (£0.1m), further prior year benefits (£0.2m) and Other Mitigations which the CCG is currently in the process of pursuing (£2.3m).

Underlying Surplus / (Deficit) (£3.9m)

Key drivers are potential under-delivery of QIPP shown as a risk in the current year and therefore at risk recurrently (£5.1m), risks to the current year position that are deemed to be recurrent in nature such as Funded Nursing Care price increase (£0.8m), plus any mitigations in the current year deemed to be non recurrent such as prior year benefits (£0.9m), Quality Premium (£0.1m).

QIPP Delivery 74%

At month 9 the CCG has delivered £7.73m of QIPP against a target £10.49m (74% delivery). The forecast delivery is £10.84m against a target of £14.0m. Key forecast variances from plan are Budgetary Control (£1.3m), Other Associates/NCA's Savings vs Budget + savings through benchmarking (£0.5m), Prescribing (£0.3m), Over the Counter Meds (£0.8m) and Market Management (£0.2m).

Key Metric Value Last 3 Months Movement

Rating Headlines

8

Finance – Key Variances Month Ending 31st December 2016

QIPP Schemes Under Development

(£3.3m) 100.0% This is the balance of budget virements awaiting approval by budget holders accountable for the delivery of the QIPP schemes within the Financial Recovery Plan. There has been a transfer of £0.8m YTD ,which has had a negative impact on the Acute Services variance.

Acute Services (£0.3m) (0.2%)

Mainly due to QIPP budgets moving to budget holders responsible for their delivery as per the Financial Recovery plan (£0.9m).Other key over performing contracts are IHT £0.2m, BMI £0.3m, PTS Contract £0.3m, Papworth £201k. These are being offset by under performance at Addenbrookes £0.5m, ECRs £0.3m and Commissioning Reserve £0.4m.

Prescribing (£0.2m) (0.6%) A favourable in month variance of £0.2m. GP prescribing is overspent by £0.4m post QIPP based on the month 7 data, QIPP delivery has increased and national price reductions have contributed to an overall improving position. Oxygen is overspent by £0.1m year to date, this should reduce as the new contract started from October.

Continuing Healthcare Services

£0.0m 0.3% Funded Nursing Care is £1.0m over spent, of which £0.6m is due to the nationally agreed 40% price uplift and £0.5m is due to a higher than budgeted volume of packages. This is being partially offset by an under spend in Continuing Healthcare packages of £1.0m.

Other Programme Services

£0.6m 51.0% This is due to £0.3m general reserve (budget virement), £0.1m GPIT underspend, £0.1m Quality Premium & £0.1m clinical academic reserve

Category Variance £m

Rating Last 3 Months Movement

Commentary%

Redesign

January 2017

9

Redesign Overarching Headlines • Sustainability and Transformation Plan (STP) bids are in development against four of the six national clinical priorities – mental

health, LD, diabetes and cancer and are due to be submitted on 18 January following a challenging timescale.

• Constructive dialogue phase one with alliance partners successfully concluded and planning now underway for phase two related to community services and implementing the revised model of care.

• A&E Taskforce underway with West Suffolk Hospital with a focus on flow through the hospital for patients admitted including daily MDT morning meetings and implementing the national good practice SAFER model.

• Revised Mental Health programme agreed with NSFT and clinical and managerial leads being agreed for each and clinical workshop held 6 December to discuss how to proceed with priority areas.

• NHSE monies secured for IAPT, Employment Support and CAMHS Waiting List Initiative. • Marginalised Vulnerable Adults (MVA) service model confirmed and decision sought from the Governing Body at its January meeting on how

to proceed. • LD Community Nurses pilot review undertaken and agreement to continue and mainstream the four Suffolk wide posts.

Information correct as 19 December 2016

Delivery RAG Status

Number of Schemes

Scheme Names

0

8 Proactive, reactive, pain, telederm, inhaler, prescribing recommendations, Scriptswitch and polypharmacy

7 LPP, ophthalmology, prevention, Gluten free, self care, generics and rebate schemes

Contractual Performance by Provider

January 2017

11

Contracts headlines

Current Month

Previous 6 months (most recent on left) Contract

The Ipswich Hospital Trust Nov

• A&E performance remains below the 95% requirement (86% in October). A system wide recovery plan is in place that will be managed through the A&E Delivery Board.

• Overall 18 week standards are being met. Urology performance was 86% against the 92% standard.

• All Cancer standards were met in November.

West Suffolk Hospital NHS Foundation Trust Nov

• A&E performance remains below the 95% requirement at 86.14% , recovery plans are in place for this along with diagnostics . Cancer performance has improved. Concern remains regarding RTT reporting issues due to E care.

Norfolk and Suffolk NHS Foundation Trust Nov

• Significant work on-going specifically in relation to safety. • Performance improving in many areas.

Suffolk Community Healthcare Nov

• Performance in most areas is at the required standard except for the 18 wk RTT for consultant led paediatric services. A review meeting has been arranged to discuss and agree next steps. Performance of the care coordination centre continues to be monitored through an action recovery plan.

Care UK: GP Out Of Hours

Nov

• All KPIs achieved in November. No performance concerns with the service currently

Care UK: 111 Nov

• The 111 service met the 60 second response standard 95% requirement at 97.9%. The service continues to fail to meet the warm transfer standard of 95% requirement but has improved on last month.

East of England Ambulance Service NHS Trust

Nov

• Red category response performance fell to 60% in November. A remedial action plan has now been agreed between EEAST and CCG consortium.

12

PMO

January 2017

13

14

• The PMO is now fully resourced and each workstream has its own dedicated PMO Manager who will work across both CCGs and Alliances

• An updated version of the PMO process will be put before the Finance and Performance Committee in January 2017

• The new Project Content dashboard for Chief Officers continues to be populated.

• Contact has been made with STP Director and PMO NEECCG in order to align our 17/18 portfolios for STP solutions.

• An ideas Generation Workshop to be held on 19th January 2017 at RBH

PMO Summary Sheet – January 2017

15

(Actual Savings = Actual YTD + Provision)

QIPP Delivery - Month 9 (December 2016)

Part 3 Clinical Quality & Patient Safety

Report

1

SUMMARY

2

Headlines

WSCCG YTD C.Diff total 17 cases against a trajectory of 15 – Page 3

SCH have not reported any Grade 3 or 4 pressure ulcers for their inpatient units this contractual year – Page 11

WSFT reported 1 Never Event for June – retained instrument – Page 13

Decrease in safeguarding referrals for August although still significantly above previous months– Page 16

Monitoring concerns with BUPA care homes continues – Page 38

Infection Control pages 3 – 6 Complaints pages 20 - 39

Falls pages 7, 9 Patient Experience pages 20 - 39

Pressure Ulcers pages 8, 10 & 11 Care Homes page 40 - 42

Serious Incidents pages 12 – 13

Never Events pages 12 – 13

SHMI pages 14

Safeguarding page 15 - 19

PALS pages 20 – 39

INFECTION PREVENTION AND CONTROL

Clostridium Difficile and MRSA

West Suffolk CCG – C-Diff

WSCCG reported 4 cases of CDI for the month of November against a monthly trajectory of 3.

This breaks down into 1 acute and 3 non acute (community) of which 0 were diagnosed out of area.

Total CCG YTD cases are 40 against YTD trajectory of 29 and an end of year trajectory of 45.

Non-acute YTD cases are 27 against a YTD trajectory of 18.

Those C.diff cases occurring in the Community Hospitals are included within the CCG figures and not WSH figures.



West Suffolk CCG – MRSA • 0 cases of MRSA reported in November 2016. • Therefore total MRSA YTD cases was 0 against a

trajectory of 0 and awaits final assignment for 1 case reported in October 2016.



West Suffolk Foundation Trust – C-Diff

• WSFT had 3 cases against a trajectory of 1, of which

1 are WSCCG patients & 2 are from out of area CCGs.

• WSFT YTD is 19 against a YTD trajectory of 11.

West Suffolk Foundation Trust – MRSA

West Suffolk Hospital Trust have reported 0 cases

of MRSA for the month of November 2016. Total MRSA YTD case are 0 against end of year

trajectory of 0.



Suffolk Community Healthcare– C-Diff • YTD is 2 (Felixstowe Hospital in May, Bluebird

lodge in Sept) against a YTD trajectory of 2.

The graph shows the whole service activity for East and

West Suffolk CCG

Suffolk Community Healthcare – MRSA • Total MRSA YTD cases are 0 against end of year

trajectory of 0.

The graph shows the whole service activity for East and

West Suffolk CCG

7

PATIENT SAFETY – HARM FREE CARE

Falls and Pressure Ulcers

West Suffolk Foundation Trust – Falls

The Trust reported 67 falls for the month of October. Novembers fall data has not been provided yet.

The Trust continue to experience issues with the new reporting system e-Care and figures for falls per 1000 bed days and

multifactorial falls assessments being completed on admission are still unreported on for this contractual year.

The CCG continue to work with the Trust to obtain missing reporting information that has been requested via the contract.

West Suffolk Foundation Trust – Pressure Ulcers

The Trust reported 20 Grade 2 pressure ulcers for the month of November. 14 cases are currently under review to determine avoidable or

unavoidable status.

The Trust reported 6 Grade 3 pressure ulcers for the month of November. 4 cases are currently under review to determine avoidable or

unavoidable status.

The CCG continue to work with the Trust to improve pressure ulcer reporting and clarify avoidable and unavoidable status of previously

reported pressure ulcers. Until clarification is provided the CCG will continue to report pressure ulcer figures as avoidable for previous months.

8



9



Suffolk Community Healthcare – Falls

SCH reported 58 inpatient falls for the month of November.

SCH recorded a figure of 16.96 for falls per 1000 bed days.

SCH continue to work on their performance against falls and the issues are discussed regularly at the Clinical Quality meetings

10



Suffolk Community Healthcare – Pressure Ulcers – Community

SCH reported 12 Grade 2 pressure ulcers for the month of November, 7 of which were deemed as avoidable.

There were 10 Grade 3 pressure ulcers reported in November, 6 of which were deemed as avoidable.

There were no Grade 4 pressure ulcers reported for the month of November.

11



Suffolk Community Healthcare – Pressure Ulcers – Inpatient

There were 4 Grade 2 pressure ulcers reported for the month of November, 2 of which were deemed as avoidable.

There was 2 Grade 3 pressure ulcer reported for the month of November, both of which were deemed as avoidable.

There were no Grade 4 pressure ulcers reported for the month of November reflecting a year to date position of zero.


Serious Incidents and Never Events

West Suffolk Foundation Trust • Serious Incidents – there were 11 incidents

reported for the month of November 2016 • Unexpected/potentially avoidable deaths – 2 (1x

Sub-optimal care of deteriorating patient, 1x Treatment Delay)

• Unexpected/potentially avoidable injury causing serious harm – 6 (6x Grade 3 Pressure Ulcer)

• Incident threatening organisations ability to continue to deliver an acceptable quality of healthcare services – 1 (1x Infection Control)

• Unexpected / potentially avoidable injury requiring treatment to prevent death or serious harm – 1 (1x Treatment Delay)

• Never Event – 1 (1x Wrong Route Analgesia)

Suffolk Community Healthcare • Serious Incidents – there were 2 incidents

reported for the month of November 2016 • Unexpected/potentially avoidable injury – 2 (2x

Grade 3 Pressure Ulcer)


Serious Incidents and Never Events

Norfolk and Suffolk Foundation Trust • Serious Incidents – there was 1 incident reported

for the month of November 2016 • Unexpected/potentially avoidable deaths – 1 (1x

Apparent/actual/suspected self-inflicted harm)

East of England Ambulance Service • Serious Incidents – there was 1 incident reported

for the month of November 2016 • Unexpected / potentially avoidable injury causing

serious harm – 1 (1x Slip, Trip or Fall)

14


Summary Hospital-level Mortality Indicator

CLINICAL EFFECTIVENESS

Transforming Care

Transforming Care Cohort

There were 3 patients in cohort in November for WSCCG.

2016 figures are calculated to the end of December 2016.

16

PATEINT SAFETY

Safeguarding

The total number of contacts received in October has remained relatively high and same compared to the preceding months, i.e. over

500.

600

550

Total Contacts 514

572 555

521 511

500

450

400

350

300

250

200

150

100

50

0

492 494 494 493

439

501 444

483

Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16

17

PATEINT SAFETY

Safeguarding

The below table indicates the outcomes for adult safeguarding.

Level 1-3 outcomes indicate the investigation stages.

Levels 1 -3 adult safeguarding investigation depending on severity and/or significance. The outcome for majority of the referrals received continue to be as ‘information only’ and a high number of referrals are signposted for

social care input. The overall number of referrals progressed to Level 1 and Level 2 thresholds have decreased in comparison to the

preceding months and this is a good indication that we are making more proportionate and appropriate decisions when considering

safeguarding adults procedures to be applied or not.

18

PATEINT SAFETY

Safeguarding

The vast majority of contacts originate from provider services. Such contacts account for around the same volume as the next six

referral sources combined

19

PATEINT SAFETY

Safeguarding

The highest Risk Locations identified are Own Home & Residential Care Home.

No Abuse Identified/BLUE (182) Own Home (161) Residential Care Home (70)

Hospital (28) Service within the Community (25) Nursing Care (18)

Any Other Setting (17) Other Person Home (6) No location recorded (4)

Public Space (0)

240 220 200 180 160 140 120 100 80 60 40 20 0

Location of Abuse

PATIENT EXPERIENCE

Total PALS activity across both CCGs for November 2016 was 286 calls showed compared with 751 for November 2015.

For locality breakdown, the overall figure for November for West Suffolk CCG was 116. There were 34 queries/concerns to the

service and 82 requests for out of contract transport approval.

The reduction in contacts to PALS

reflects the transfer of the

Emergency Dental Line and dental

enquiries to the 111 service and

Primary Care PALS issues to NHS

England from 1st September.

The number of concerns/enquiries

raised to PALS continued to

reduce during November.

Patient Advice and Liaison Service

0

200

400

600

800

1000

1200

Num

ber

of calls

Nov-15

Dec-15

Jan-1

6

Feb-1

6

Mar-1

6

Apr-16

May-

16

Jun-1

6

Jul-1

6

Aug-16

Sep-1

6

Oct-1

6

Nov-16

2015/16

Total number of calls received by PALS

PATIENT EXPERIENCE

Main topics raised by patients to the Patient Advice and Liaison Service during November 2016

Patient Advice and Liaison Service

Service

type

Number

of calls

Query type

Medication 5 Changed to generic medication or items that can be purchased over

the counter.

Dental

services

7 Dental emergencies/registration. Redirected to 111

GP 2 GP queries/registration. Referred to NHS England

PALS continues to work closely with the Medicines Management team following changes to the prescribing of generic medication

or removal of items from prescriptions which are available to purchase over the counter. Patients have contacted PALS with

concerns with the cost implications or intolerance to generic medication. PALS and Medicines Management have liaised with GPs

to ensure patients are prescribed appropriately.

The 82 requests for authorisation of transport for patients outside the contracted service provided by EoEAST were approved.

These included discharges from around the country and where patients required high levels of care on the journeys.

Example of good outcome from PALS intervention:

Patient contacted PALS as had been referred through the hip and knee pathway to AHP. Patient was unhappy with the pathway

and wait for physiotherapy appointment. PALS explained the pathway to the patient and contacted AHP who revised the

appointment and brought it forward from mid-December to the next working day.

PATIENT EXPERIENCE

Complaints

5 complaints were received during November 2016 for the West Suffolk CCG. A breakdown of these complaints is shown below;

West Complaint category Outcome and actions identified

CCG Patient care - Care needs not adequately met.

Complainant feels that patient care needs will not be

met by the hours offered via CHC package.

Passed to provider for investigation

EoEAST Waiting times – Other. Patient experienced

unacceptable delay with hospital transport

Awaiting patient consent

EoEAST Patient care - Moving and handling issues. Patient

sustained a fall while being moved from stretcher to

bed.


EoEAST Waiting times – Other. Patient unhappy with delay

experienced with hospital transport.

Passed to provide for investigation

NSFT Access to treatment or drugs - Access to services.

Complainant unhappy with diagnosis and the attitude of

the psychiatrist.


NHS Continuing Healthcare Appeals.

During November there were 2 CHC appeals received for WSCCG.

There are 16 appeals outstanding for WSCCG.

PATIENT EXPERIENCE

Complaints

Complaints data

In order to provide a consistent comparison from previous years the above chart shows combined East and West figures.

PATIENT EXPERIENCE

West Suffolk Foundation Trust

Patient Experience Report

PALS Queries

The data for April and September 2016 was not available and therefore omitted from the table.

Sep

16

Aug

16

Jul

16

Jun

16

May

16

Apr

16

Mar

16

Feb

16

Jan

16

Dec

15

Nov

15

Oct

15

Admissions, discharge and transfer

arrangements

7

Appointments – including delays and

cancellations

25 32 33 21 23 20 27 20 18 16

Communication 13 9 7 14 19 14 11 7

Compliments 9 8

Facilities services

Patient care including nutrition and

hydration

16

Other 75 48 59 39 32 30

Queries, advice and request for

information

21 24 40 56 33 70 85 48 62 66

TOTAL 68 65 80 91 150 154 185 107 123 136

PATIENT EXPERIENCE

West Suffolk Foundation Trust


Complaints

The data for September 2016 is not available and therefore omitted from the table below.

Sep-16 Aug-16 Jul-16 Jun-16 May-16 Apr-16 Mar-16 Feb-16 Jan-16 Dec-15 Nov-15 Oct-15

Admissions, discharge and transfer arrangements

6 1 1 2

All aspects of clinical treatment

Appointments – including delays and cancellations

7 8 4 5 2 1 2 8

Attitude of staff

Clinical treatment – general medicine group 4

12

4 1 1 4

Clinical treatment – anaesthetics 2

Clinical treatment – surgical group 4 4 1 5 5

Clinical treatment – Accident and Emergency 6 1 2

Clinical treatment – obstetrics and gynaecology

5 1 1

Communication 6 6 7 4 5 6 7 6 10 13

Other 4 1

Patient care – including nutrition/hydration 4 6 7 1 2 5 7

Privacy, dignity and wellbeing 2 1

Values and behaviour (staff) 6 5 3 1 5 8

Trust administration 2 1

Access to treatment or drugs 1

Restraint 1

Total 25 32 21 16 38 20 21 17 16 22 25

PATIENT EXPERIENCE

West Suffolk Foundation Trust Patient Experience Report

Friends and Family Test

WSFT - % of respondents who would recommend the service

PATIENT EXPERIENCE

West Suffolk Foundation Trust Patient Experience Report

Friends & Family Test

WSFT Maternity Services - % of respondents who would recommend the service

There is a requirement to ask the Friends and Family question four times across Maternity Services; at the 36 week

antenatal appointment, following birth in the delivery suite or birthing unit, post-natally on discharge from the post-natal

ward and lastly at the time of discharge in the community. The graph above shows the percentage of respondents who

would recommend the service. No results were submitted for in-patient post natal care for September 2016.

PATIENT EXPERIENCE



Complaints

2 formal complaints were received during November 2016 for Suffolk Community Healthcare. The breakdown for these

complaints by subject type is as follows;

Nov

16

Oct

16

Sep

16

Aug

16

Jul

16

Jun

16

May

16

Apr

16

Mar

16

Feb

16

Jan

16

Dec

15

Nov

15

CCC/APS 1

Children’s Services

(SALT)

1 1 1

Community Health

Team

1 1 1 2 3 1 2 1 2 3 1

Community Hospital 2 1 1 1

COPD 1 1

Podiatry 1

Tissue Viability

Nurse

1

MIU 1

Community

Paediatric Service

1 1 1 3

Wheelchair Service 1 1 1 1 1 2

Continence

Service

1

TOTAL 2 2 1 5 7 6 2 4 3 4 5 2 3

Complaint regarding Leg ulcer

clinic

Details: Complainant unhappy with the standard of clinical treatment provided at the leg ulcer

clinic with the belief that the poor treatment resulted in permanent damage to the patients legs.

Complaint regarding MIU Details: Complainant unhappy with how their request for assistance was

managed/handled by staff at the MIU.

Details of the complaints can be seen below

PATIENT EXPERIENCE


SCH - % of respondents who would recommend the service

The combined score for Suffolk Community Healthcare for November 2016 is 96%

PATIENT EXPERIENCE

Norfolk and Suffolk Foundation Trust


PALS

NSFT recorded a total of 34 PALS contacts across West Suffolk during November 2016. 9 contacts were out of area or did not

have their location recorded. A breakdown of the West and OOA/unknown location contacts are as follows;

Nov 16 Oct 16 Sep 16 Aug 16 Jul 16 Jun 16 May 16 Apr 16 Mar 16 Feb 16 Jan 16 Dec 15

Wes

t

NK Wes

t

NK Wes

t

NK West N

K

We

st

N

K

We

st

N

K

We

st

N

K

Wes

t

N

K

We

st

N

K

We

st

N

K

Wes

t

N

K

We

st

N

K

Access 2 2 1 1 1 2 2 1 1 1 2 2 2 Building

relationships 1 1 1 2 1

Communicati

on 15 2 16 6 15 6 9 2 8 2 26 1 6 2 5 1 24 1 1 1 8 1 14

Environment 1 1 1 1 Information 5 5 7 2 7 7 1 3 1 6 4 4 7 4 3 11 4 7 2 4 1 8 5 Other 1 Quality of

care 2 2 1 2 3 2 2 1 1 2 2 2 1

Waiting 5 2 2 2 1 2 1 1

TOTAL 25 9 31 8 27 15 16 5 10 1

1

35 9 12 1

0

11 6 39 5 12 5 15 4 24 6

PATIENT EXPERIENCE

Norfolk and Suffolk Foundation Trust

Subject of complaint Nov

16

Oct

16

Sep

16

Aug

16

July

16

June

16

May

16

Apr

16

Mar

16

Feb

16

Jan

16

Dec

15 Nov

15

Admission/discharge and

transfer arrangements 1 1 1 1 1 1

2 1 2

All aspects of clinical

treatment 6 4 8 6 3 3 5 4

6 5 2 2 2

Attitude of staff 4 1 2 1 1 1 3 1 3 2 2

Appointments/delay 1 1 1 1 1

Communication 3 1 3 1 2 1 1 2 3

Failure to follow agreed

procedures

Other 1 4

Patients privacy and

dignity 1 1

1

Patients property and

expenses 1

Personal records 1

TOTAL 11 9 13 9 9 7 14 7 7 9 6 7 12

11 complaints were received during November 2016 for Norfolk and Suffolk Foundation Trust in the West Suffolk area (6 of

these were county wide). The breakdown for these complaints by subject type is as follows;


Complaints

PATIENT EXPERIENCE


5 complaints and 0 PALS queries were received during November 2016 for the Ambulance Service (West Suffolk). The breakdown for

complaints by service type is as follows;


Primary Subject of

complaint

Nov

16

Oct

16

Sep

16

Aug

16

Jul

16

Jun

16

May

16

Apr

16

Mar

16

Feb

16

Jan

16

Dec

15

Nov

15

Attitude 1 1 1 2

Clinical treatment

and assessment 2 2 1 2 1 1 1 1

Communication and

call handling 2 1 1 1

Delay 2 1 3 1 3 1 5 2 4 4

Transport and driving 1 1 2 1 1 1

Patient Property 1

Equipment / vehicle 1

Safeguarding 2

Total 5 5 5 3 7 4 9 5 7 0 3 0 5

PATIENT EXPERIENCE


Cont…….

PALS queries

Primary

Subject of

Concern

Nov

16

Oct

16

Sep

16

Aug

16

Jul

16

Jun

16

May

16

Apr

16

Mar

16

Feb

16

Jan

16

Dec

15

Nov

15

Attitude 1 1 1 1

Delay 1 2 2 1

Transport And

driving

1

Communication

and call

handling

2

Total 0 0 1 0 0 2 0 1 5 3 0 0 1

PATIENT EXPERIENCE

NHS Out of Hours and 111

*Information extracted from 111 and OOH report November 2016

Nov

16

Oct

16

Sep

16

Aug

16

Jul

16

Jun 16 May

16

Apr 16 Mar

16

Feb

16

Jan 16 Dec

15

Nov

15

OOH 1 2 3 4 1 2 1 1

111 1 1 1 2 3 2 1 1

TOTAL 1 1 2 4 4 2 2 3 2 2 2 1 1

Subject (primary) Description

Not recorded

Complaint about the timeframe of a disposition following a pathways assessment. Patient was suffering

with mastoiditis and felt the disposition timeframe should have been higher.


PATIENT EXPERIENCE

GP Contract Issues log

Mar

2016

April

2016

May

2016

June

2016

July

2016

Aug

2016

Sept

2016

Oct

2016

Nov

2016

Number of queries per month 24 25 45 49 33 36 30 28 46

Number closed per month 5 13 18 23 13 14 4 7 19

Overall number outstanding on system

56 36 46 42 46 52 62 54 57

Queries by

Provider

Care UK 2 1 1 1 1 0 2 0 0

IHT 5 7 18 7 10 10 4 10 23

N&N 0 0 0 2 0 0 0 0 1

CUFT 2 0 2 1 1 1 1 0 2

Papworth 0 0 0 0 0 1 0 0 0

WSFT 4 1 3 14 12 9 12 7 10

NSFT 2 2 6 11 2 4 6 5 6

SCH 4 3 4 4 2 1 3 2 1

Private 0 0 0 0 0 0 0 0 0

Other 5 11 11 9 5 10 2 4 3

PATIENT EXPERIENCE

Please see table below for breakdown of queries in November 2016.

Concerns have been highlighted with the Head of Patient Experience and Clinical Quality and will be

taken forward at the Quality Review meeting and with the Contract Lead for the relevant Trust.

GP Contract Issues Log

Provider Query trends

WSFT 10 issues raised – 4 regarding communication including e-care, 2 referrals, 3

discharge summaries and 1 discharge home.

SCH 1 issues raised regarding reduction in numbers of district nurses

NSFT 6 issues raised – 1 regarding communication, 2 access to services,

I prescribing, 1 follow up and 1 referral.

TPP 2 issues raised regarding blood tests.

EoEAST 1 issue raised regarding communication (information not relayed by crew)

N&N 1 issue raised regarding communication (delays in correspondence)

CUFT 2 issues raised regarding referrals

PATIENT EXPERIENCE

The table below shows the

outstanding queries prior to

November 2016. Re-opened

indicates dissatisfied with

response. All providers are

chased for responses to

outstanding issues every month.

There continues to be a backlog

of issues (currently 25) with WSH

which remain open on the system.

GP Contract Issues Log

Provider Query trends Date Status

WSFT General x 1

General x1

Referral x 1

Follow up Appt x 1

Blood Tests x1

Communication x 1

Communication x 1

Test results x 1

Communication x 1

Referral x 1

Discharge summary x 1

Referral x 1

Communication x 1

Access to services x 1

Referral x 1

Meds on discharge x 1

Prescribing x 1

Meds on discharge x 1

Referral x 1

Referral x 1

Medication x 1

Communication x 1

Discharge x 1

Referral x 1

Communication x 1

03.09.15

22.09.15

13.11.15

13.01.16

04.02.16

02.03.16

03.03.16

13.05.16

06.06.16

15.06.16

17.06.16

27.06.16

01.07.16

05.07.16

06.07.16

14.07.16

19.07.16

19.07.16

23.08.16

26.08.16

30.09.16

10.10.16

14.10.16

18.10.16

20.10.16

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Re-opened

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

Outstanding

CGH Referral x 1 04.07.16 Outstanding

TPP Access to services x 1

09.12.15

Outstanding

Papworth Follow up x 1 11.08.16 Outstanding

CUFT Equipment x 1 25.08.16 Outstanding

(with Contract Lead)

Care UK Communication x 1 22.09.16 Outstanding

38

Care Homes

Information from Regulator (CQC)

Ratings: Outstanding: 5 (+2) Inadequate: 7 (no change) Requires Improvement: 40 (no change) Good: 111 (no change) Total homes captured (CQC database): 163 Updated: 3 January 2017

Joint Performance and Risk Analysis (CCG and SCC):

Provider Performance Panel Board – 2 December 2016

Risk ratings of 3 (highest): • Friars Hall (Nursing) (Lalitha Samuel) - This service has been struggling for some time, with support offered by all the agencies for at least the

last 2 years. Home has not been able to make required improvements or sustain any level of improvement. Significant failings identified at the end of November 2016, CQC inspected and placed positive conditions in relation to numbers of nurses on duty and the Notice of Decision to restrict admissions. Suffolk CC, CCG and Essex CC reviewed all residents and offered support to find alternative accommodation. W/c 19th December 2016 CQC were considering taking urgent action to close the home. The owner gave written notice that the home was to close on Friday 23rd December 2016. All agencies involved worked together and all residents were supported to move out by 22/12/16. There is an ongoing joint Police and CQC investigation into a death at the home. Follow up reviews will be arranged for people to ensure new placements are suitable. Multiagency lessons learnt review will be held and provider failure procedure updated – meeting scheduled for w/c 23/01/17.

Risk ratings of 2 (medium): • Kingfisher House (Nursing) (Four Seasons) - There are concerns that where improvements have been made, these have not been sustained.

There have been 3 recent safeguarding referrals, including concerns around staffing levels, call bells disconnected, 1 worker threatening a resident. CQC have advised they are planning to meet with the provider and may bring forward the re-inspection. ACS Contracts are working with the home and liaising with the regional manager. Joint Contracts and PST visit took place mid December 2016. PST have offered support which will commence in 2017.


39

Care Homes

Risk ratings of 2 (medium) CONT. • Bupa homes (Nursing) - Weekly telephone conferences are set up between Provider Support Team, Safeguarding, Contracts, CCG and CQC to

share updates, progress, issues. Bi-weekly meetings between Bupa’s Area Director and Contract team to discuss issues and progress against the Service Improvement Plans and to develop a performance monitoring model to take forward. ACS contracts are continuing to work with all of the homes.

• Rendlesham Care Centre (Nursing) (Caring Homes) - CQC have advised us that they have re-inspected. Report not yet published Due to the time taken to carry out criminal investigations, it is possible a service may have improved and be rated as Good, but the report will still need to reference the criminal investigation, this may cause confusion or concern for members of the public. ACS PST working with the home, record keeping workshop to be delivered Jan 2017. Manager reviewing Moving and Handling paperwork – PST to send a copy of SCC template. General support visit planned for early February. CCG have noted positive progress at the home, so are not currently working with the home (virtual support offered).

• Alice Grange (Nursing) (Barchester)- Healthwatch were contacted by a family member and have raised a safeguarding referral on their behalf in relation to the memory lane unit and a high number of ‘resident on resident’ incidents, lack of meaningful activities, staffing levels, call bells unanswered for 40 mins, lack of support with hydration and swallowing issues. There have been other referrals recently, 4 did not meet the threshold for safeguarding, 2 went through as level 2 enquiries.

• Highcliffe House (indep.) - There are 2 open CQC investigations under avoidable harm. 1 in relation to a resident who fell from a window and the other in relation to bowel impaction. The second investigation may be Police lead, CQC are awaiting confirmation. CCG met with the clinical lead at the end of September and offered advice around medication management and NMC standards. The clinical lead is now a permanent member of staff (previously agency). The provider has engaged an advisor to carry out some quality assurance work. ACS Contracts have met twice with the provider, the second meeting was more positive.

Risk Ratings Overall (Board only)

Note: Risk ratings are only attributed to providers/homes that have been escalated to Panel and/or Board meetings for discussion and is not indicative of whole market


40

Care Homes

Overall comment:

New CCG care home strategy being developed following changes in team which will tie in all strands of care home work within both East and West CCGs. Discussions commencing with West team w/c 7 November – postponed until January 2017 due to Friars Hall closure work.

East Suffolk Care Homes Forum – agenda for next meeting – 10 January 2016

Second meeting 1 September 2016 – shared approach CCG and SCC Chair – IESCCG Care Homes Clinical Support Manager Deputy Chair – SCC Provider Support Team Lead

For information:

CCG Educational update event for all care homes (East and West) 16 November 2016

DNACPRs:

Draft guidance document for care homes (and GPs):

Out for consultation


1

Finance & Information Pack December 2016

2

(Month 9 Ending 31st December 2016)

Contents

Financial Statement…………………………………………….………………………………………………………..………….…. 3 West Suffolk Hospital (WSFT) Activity….………………………………………………………………………………………. 4 Risks & Opportunities ……………………..….………………………………………………………………………………………. 5 Underlying Financial Position………………………………………………………………………………………………………. 6 Statement of Cashflow……………………………………………………………………………………………….……….….…… 7 Quality Premium ……………………………………………………………………………………………….…….……..………..... 8 System Wide View……………………………………………………………………………………………………….…….……… 9

3


• At month 9 the CCG is £1.3m behind

plan but financial performance is ahead of the Financial Recovery Plan trajectory by £0.6m.

• Key adverse variances are QIPP schemes in development (£3.3m), Acute Services (£0.3m) and Prescribing (£0.2m).

• These are mitigated by the use of Contingency (£1.1m) and underspends in Mental Health & LD Services (£0.2m) Other Programme (£0.6m), Corporate Costs (£0.1m) and Community (£0.2m).

Financial Statement

Source & Apps Budget Actual Variance Variance 16-17 Budget

£m £m £m % £m

Total Income 221.9 221.9 0.0 0.0 298.6

Acute Services 128.7 129.0 (0.3) (0.2%) 172.0Mental Health & Learning Disabil ity Services 19.8 19.6 0.2 1.1% 26.4Community Health services 21.0 20.8 0.2 1.0% 28.0Continuing Healthcare Services 12.6 12.5 0.0 0.3% 16.6Prescribing 30.6 30.8 (0.2) (0.6%) 40.4Other Primary care 2.4 2.3 0.1 3.1% 3.2Other Programme Services 1.2 0.6 0.6 51.0% 1.7Better Care Fund 3.9 3.9 0.0 0.0% 5.2Property recharges 0.0 0.0 0.0 0.0Non Recurrent Investment 0.0 0.0 0.0 2.9Contingency 1.1 0.0 1.1 100.0% 1.5Corporate Running Costs 3.7 3.6 0.1 2.4% 5.0Total Expenditure 225.1 223.2 1.9 0.9% 302.9

QIPP Schemes Under Development (3.3) 0.0 (3.3) 100.0% (4.3)

'In Year' Surplus/ (Deficit) 0.0 (1.3) (1.3) 0.0

Surplus brought forward from previous year 2.1 2.1 0.0 0.0 2.9

'Reported' Surplus/ (Deficit) for 16/17 2.1 0.8 (1.3) (62.4%) 2.9

YTD Full Year

4


• 16/17 Expenditure on activity at WSFT is on plan due to the block contract agreed.

• The table to the left shows the CCG view of M01 to M03. M04 to M08 is WSFT view and although challenges have been raised, the data validated by the CCG has not been used due to missing datasets.

• E-Care issues within the trust still remain a concern. The expectation is that this will be retrospectively corrected next few months.

West Suffolk Hospital (WSFT) Activity (Month 8 Ending 30th November 2016)

SLA Plan (Post QIPP) Act Var Var % Act YOY Var Var %

Plan (post QIPP) Act

Var to Plan Var % Nov 2015 YOY Var Var %

Outpatients first 4,486 4,537 (51) -1% 4,411 (127) -3% 26,991 27,991 (1,000) -4% 27,034 (957) -4%Outpatients follow-up 5,255 5,027 228 4% 5,128 101 2% 56,507 54,809 1,698 3% 56,029 1,220 2%Outpatients procedures 5,281 4,580 701 13% 4,994 414 8% 33,019 31,061 1,958 6% 31,819 758 2%Outpatients telephone 597 562 35 6% 597 35 6% 17,422 15,559 1,863 11% 17,077 1,518 9% Outpatients 15,619 14,706 913 6% 15,129 423 3% 133,939 129,420 4,519 3% 131,959 2,539 2%Outpatients Maternity 2,685 2,604 81 3% 2,642 38 1% 3,080 2,986 94 3% 6,043 3,057 51%Outpatients - other care package 259 323 (63) -24% 296 (27) -9% 1,149 187 962 84% 255 68 27%Outpatient unbundled imaging 1,523 1,466 58 4% 1,471 6 0% 15,507 15,471 36 0% 15,340 (131) -1%A&E 3,291 3,316 (25) -1% 3,175 (141) -4% 28,303 29,453 (1,150) -4% 28,087 (1,366) -5%Daycase 9,351 8,872 479 5% 9,008 136 2% 11,847 11,992 (145) -1% 11,558 (434) -4%Elective 6,420 6,039 381 6% 6,372 334 5% 2,142 1,918 224 10% 2,168 250 12% Elective 15,771 14,911 860 5% 15,380 470 3% 13,989 13,910 79 1% 13,726 (184) -1%Emergency non-elective 23,880 24,996 (1,116) -5% 23,128 (1,868) -8% 12,090 12,874 (784) -6% 12,058 (816) -7%Other non-elective 3,413 3,453 (40) -1% 3,109 (343) -11% 1,295 1,406 (111) -9% 1,353 (53) -4% Non Elective 27,293 28,449 (1,156) -4% 26,237 (2,212) -8% 13,386 14,280 (894) -7% 13,411 (869) -6%Emergency threshold adjustment (1,072) (1,555) 483 -45% (1,046) 509 -49%Readmissions (641) (657) 16 -2% (614) 43 -7%Contract Adjustments (806) (603) (203) 25% (882) (278) 32%SUS (National Data) 63,923 62,958 965 61,789 (1,170) -2% 209,353 205,707 3,646 208,821 3,114 1%

Cost and Volume excl drugs 2,731 2,579 151 6% 2,431 (148) -6%Pathology 176 176 (0) -0% 173 (3) -2%Drugs & Devices 2,904 3,161 (256) -9% 2,812 (349) -12%Block 1,280 1,280 0 0% 2,056 776 38%Winter - EEIT 516 516 (0) -0% 0 (516)Financial consequences (see table) 0 (22) 22 (608) (586)

71,530 70,648 882 (0) 68,653 (1,995) -3% 209,353 205,707 3,646 208,821 3,114 1%CQUIN 1,716 1,688 28 1,648 (40) -2% 0Block Contract Adjustment 0 910 (910) 0 (910) 0Contract Consequences annual (see table) 0

Total excluding contract SVs 73,246 73,246 (0) 70,301 (2,945) -4% 209,353 205,707 3,646 208,821 3,114 1%

Contract Adjustments CCG AdjSLA Plan Act Var Act Total

Colposcopy (119) (19) (100) 0 (19)First Attendance Adj (147) (87) (61) 0 (87)JC15Z (193) (66) (127) 0 (66)Patella Button (220) (194) (25) 0 (194)Rheumatology Infusion (130) (123) (7) 0 (123)Ambulatory Care 56 (8) 63 0 (8)Physiotherapy 0 (79) 79 0 (79)Podiatry 0 0 0 0 0Community Glaucoma (54) (28) (25) 0 (28)LPP 0 0 0 0 0

(806) (603) (203) 0 (603)

M8 YTD 2016 M8 YTD 2015Finance £'000 Finance £'000 Activity ActivityM8 YTD 2016 M8 YTD 2015

(see below)

5


Risks/Opportunities

• The table to the left provides the CCG’s anticipated view of risks and opportunities .

• The latest forecast anticipates a full year balanced position.

• The main risk continues to be QIPP under delivery of

£3.14m, CHC overspend mainly due to increased FNC rates and additional costs relating to Property costs.

• In order to achieve a balanced position the CCG will need to realise additional mitigations of £2.5m which is currently included in other mitigations.

RisksFull Risk

Value£m

Probability of risk being

realised%

Potential Risk Value

£m

Proportion of Total

%

CCGsAcute SLAs 0.24 100% 0.24 4.81%Continuing Care SLAs 1.00 76% 0.76 15.52%QIPP Under-Delivery 13.98 22% 3.14 63.77%Other Risks 0.78 100% 0.78 15.90%

TOTAL RISKS 16.00 4.93 100.00%Please enter the probability of succe

Mitigations

Full Mitigation

Value£m

Probability of success

of mitigating

action%

Expected Mitigation

Value£m

Proportion of Total

%

Uncommitted Funds (Excl 1% Headroom)Contingency Held 1.51 100.00% 1.51 30.65%Uncommitted Funds Sub-Total 1.51 1.51 30.65%Actions to ImplementOther Mitigations 2.52 100.00% 2.52 51.17%Mitigations relying on potential funding 0.90 0.90 18.19%Actions to Implement Sub-Total 3.42 3.42 69.35%

TOTAL MITIGATION 4.93 4.93 100.00%

NET RISK / HEADROOM (11.07) 0.00

6


Underlying Financial Position

• The underlying position shows the recurrent financial position of an organisation. It excludes all non-recurrent funding and expenditure. This then leaves the true on going spending position of the organisation against its recurrent allocation.

• The CCG has reported an underlying full year position of £3.9m deficit

• This is mainly due to the anticipated under delivery of the QIPP target.

• The YTD financial position also includes prior year benefit of £0.9m

Source & Apps 16-17 Budget

Other Non-Recurrent

Adjustments

Prior Year Impacts

Other FY effects

Underlying Position

£m £m £m £m £m

Total Income 298.6 (0.3) 298.4

Acute Services 172.0 0.0 0.3 172.4Mental Health & Learning Disabil ity Services 26.4 (0.2) 0.2 26.5Community Health services 28.0 0.0 0.1 28.1Continuing Healthcare Services 16.6 0.0 (0.0) 0.8 17.3Prescribing 40.4 0.0 (0.0) 40.4Other Primary care 3.2 0.0 0.0 3.2Other Programme Services 1.7 (0.1) 0.1 0.1 1.8Better Care Fund 5.2 0.0 0.0 5.2Property recharges 0.0 0.0 0.0 0.0Non Recurrent Investment 2.9 (2.9) 0.0 (0.0)Contingency 1.5 0.0 0.0 1.5Corporate Running Costs 5.0 (0.0) 0.2 5.1Total Expenditure 302.9 (3.2) 0.9 0.9 301.5

QIPP Schemes Under Development (4.3) 5.1 0.0 0.8

'In Year' Surplus/ (Deficit) 0.0 (2.1) (0.9) (0.9) (3.9)

Surplus brought forward from previous year 2.9 (2.9) 0.0

'Reported' Surplus/ (Deficit) for 16/17 2.9 (5.0) (0.9) (0.9) (3.9)

Underlying PositionFull Year

7


Statement of Cash Flow

At 31st December 2016 Total Assets employed were (£8.3m). At 31st March 2016 Total Assets employed were (£11.0m). • At 31st December 2016 significant liabilities were as follows:- Prescribing Creditor - £6.3m Payables and Accrued Expenditure with NHS Bodies - £4.3m Payables and Accrued Expenditure with Non NHS Bodies - £7.5m Continuing Healthcare Provision - £0.3m • At 31st December 2016 significant assets were:- Cash - £1.4m - as per Cash Flow Forecast Receivables with NHS and Non NHS Bodies: £1.8m Prepaid Expenditure - £5.9m Accrued Income - £0.7m

• West Suffolk CCG closed the month with a balance of £1.6m in the bank account at 31st December 2016. This has been adjusted to £1.4m on the Statement of Financial Position after accounting for unpresented cheques and BACS payments clearing in the following month.

• The CCG missed its cash target efficiency by £1.3m. NHS

England requires CCGs to limit the cash held in their bank accounts at the month-end to 1.25% of the main cash drawdown for the month. The CCG requisitioned £21,000k cash for the month. Under the KPI the target closing bank account balance was £263k. The CCG missed the target balance by £1,301k (£1,564k minus £263k) this month.

• CCG's Maximum Cash Drawdown (MCD) control total has been

set at £299.7m for 2016/17 (November 16 - £299.6m), this total is based on the control total for the Revenue Resource Limit but adjusted for non-cash transactions such as depreciation and reduced by the value of the CCGs planned surplus for the year.

Percentage of MCD utilised - 75.4% Percentage of months completed in year - 75.0%

Ipswich and East Suffolk CCG 16/17 16/17Statement of Cash Flows YTD Actual Forecast

Dec-16 Mar-17Period 09 Period 12

£m £mCASH FLOWS FROM OPERATING ACTIVITIESNet Operating Cost Before Interest (223.2) (298.6)Depreciation and Amortisation 0.1 0.1

(Increase)/Decrease in Current Assets (4.5) 0.3

Increase / (Decrease) in Current Liabilities 3.6 (0.2)

Increase/(Decrease) in movement in non cash Provisions (0.6) (0.9)

CASH FLOWS FROM INVESTING ACTIVITIES 0.0 (0.4)

NET CASH INFLOW/(OUTFLOW) BEFORE FINANCING (224.6) (299.6)

CASH FLOWS FROM FINANCING ACTIVITIESNet Funding 225.9 299.7Net Cash Inflow/(Outflow) from Financing Activities 1.3 0.1

NET INCREASE/(DECREASE) IN CASH AND CASH EQUIVALENTSCash and Cash Equivalents (and Bank Overdraft) at Beginning of the Period 0.1 0.1Cash and Cash Equivalents (and Bank Overdraft) at YTD 1.4 0.2

8


Quality Premium

Note – the data used for tracking is a combination of monthly, quarterly and annual performance and crosses various periods so should be used as an indication at this stage.

Maximum Quality Premium earnable is £1.2m. Final funds are provided in 2017/18 and cannot be used to support the 2016/17 position.

Currently the CCG is forecasting £108k on Quality Premium from 2016/17.

The cancer diagnosis at stages 1 and 2 are only published to Q3 14/15. The e-Referral metric has now been agreed with NHS Digital and shows the CCG position with the confirmed target for March 2017. WSFT reporting is under review on total referrals.

Maximum QP Value

Probability of Success

QP Projection

Latest Data

YTD Target

YTD Actual

Comments

Improving Antibiotic Prescribinga) Reduction in the number of antibiotics prescribed in primary care by 4% or equal to 1.161 items/STAR-PU

61,800£ On track £ 61,800 Q2 16/17

1.183 1.15 Quarterly data

b) Number of co-amoxiclav, cephalosporins and quinolones as a % of the total number of selected antibiotics prescribed in primary care to be reduced by 20% or lower than 10%

61,800£ Challenging - Q2

16/17 10.6% 12.4% Quarterly data

CancerCancers diagnosed at stages 1 and 2 to be greater than 60% or 4% improvement

20% 247,200£ On track 247,200£ Q3 14/15

60% 61.0% I year average to Q3 14/15

GP Practice

Increase the proportion of GP referrals made by NHS e-Referrals to 80% or improve by 20% compared to March 16

20% 247,200£ Possible - Oct-16 64% 25.7% WSFT are submitting incorrect total referrals due to E-Care issues. Estimated true achievement is closer to 40%

GP patient survey on overall experience for making a GP appointment (Question 18) to achieve 85% or improve by 3% from July 16

20% 247,200£ Possible - Jul-16 81% 78.0% July 2016 result is 78%. Next survey result published in July 2017.

Local Measures1. Mental Health - percentage of people 'moving to recovery' of those who have completed IAPT treatment

10% 123,600£ On track £ 123,600 Nov-16 50% 56.7% Target is 50% by Q4 16/17. Currently monitoring YTD performance.

2. Respiratory - Emergency Admission rate for children with asthma per 100,000 population to reduce by 5% compared to 15/16

10% 123,600£ Challenging - Nov-16 90 121 Shows number of admissions

3. Trauma and Injury - injuries due to falls per 100,000 population ages 65+, to reduce by 5% compared to 15/16 10% 123,600£ Challenging - Nov-16 667 750 Shows number of admissions

100% 1,236,000 432,600Potential ReductionsThe % of Referral to Treatment (RTT) pathways within 18 weeks for incomplete pathways

-25% (309,000) On track - Nov-16 92% 93.2%

A&E Waiting Time - total time in the A&E department -25% (309,000) Challenging (108,150) Nov-16 95% 86.8% WSFT position

62 day wait from urgent GP referral to first definitive treatment for cancer

-25% (309,000) Possible (108,150) Nov-16 85% 83.5%

Ambulance clinical quality - Category A (Red1) 8 minute response times (CCG Performance)

-25% (309,000) Challenging (108,150) Nov-16 75% 56.0% CCG level in 16/17.Actual result will be mapped to LSOA, so CCG performance is an indication

108,150Expected Quality Premium based on current known performance

10%

9


System Wide View

West Suffolk Hospital

• The reported Income and Expenditure position for October 2016 is a deficit of £0.2m, against a planned surplus of £0.7m, resulting in an adverse variance of £0.8m in October (£1.8m YTD). Broadly the YTD overspend relates to Escalation Beds £0.8m and Other Pay :A&E £0.3m Midwifery £0.2m.

• A significant cause of the deterioration in plan during October relates to the underachievement of the stretch CIP, being £0.7k (£3.9m from October to March 2017)

• The Trust is planning to make an annual deficit of £5.0m. • The Use of Resources Rating (UoR) (previously Financial Sustainability Risk Rating), is 3 YTD (1 being highest, 4 being lowest). (Source: M7 Board Report - Finance October 2016)

Addenbrookes (CUHFT)

• At the end of November (month 8) the Trust had a deficit of £37.3m, compared to the Month 6 Control Total Forecast deficit of £37.2m. • Clinical Income was £2.6m greater than budget and Total Expenditure was overspent by £2.9m. • The Trust's cash position stands at £24.7m. • The Trust's Use of Resources Rating is 3. • The year to date Cost Improvement Programme (CIP) performance is £1.2m greater than plan. (Source: CUH Integrated report to November 2016)

Ipswich Hospital

• The Financial plan 2016/17 is a deficit of £20.1m. YTD at M7 the Trust is on plan but risks remain to FOT including financial delivery on Winter pressures (£1m), TPP (range £0 - £5m), STF (£0-£2m). Plan assumes receipt of £7m Sustainability & Transformation funding in year, risk on element relating to A&E delivery and risks remain against this.

• Focus on workforce initiatives to reduce Agency spend remain and Trust and delivery of CIP are the focus areas for 2016/17, both are areas of risk in delivery.

• The cash position is favourable to plan for October by £0.8m, mainly due to the following receipt of settlement of Suffolk Community Healthcare invoices from WSH of £1.1m, receipt of Cambridge Community Services overdue invoices of £0.4m, receipt of Cap to Rev transfer from DH of £0.8m, receipt of TPP invoices of £1m and increase in non pay due to delayed payments due in prior months of £3.5m.

(Source: Ipswich Hospital Trust Board Meeting 24th November 2016)

Norfolk & Suffolk

Foundation Trust (NSFT)

• The retained deficit for the month was £0.3m which is in line with the annual plan, the year to date favourable variance remains at £0.2m. • The forecast for the year is a deficit of £4.8m by March 2017 in line with the agreed control total. • The financial performance of the Trust is assessed by NHS Improvement through the Financial Sustainability Risk Rating. Both our Plan and our

performance against the Plan are rated at a 2. It anticipated that this rating will continue throughout the year. • The 2016/17 CIP target is forecast to deliver the plan of £10m. • Cash held by the trust at 31 October was £9.1m which exceeds the plan. (Source: NSFT Board Minutes 24th November 2016)

East of England

Ambulance Service Trust

(EEAST)

• The Trust has a deficit of £4.4m for the seven months of the financial year, 2016/2017. This is against the planned position for a surplus of £1.2m an adverse variance to the plan of £5.5m.

• Cash Balances stand at £3.9m which is below plan. RAP income has been received in full for quarters 1 & 2, which has improved the cash position, however this will not get us back to planned levels. Cash is being reviewed continually and the following steps are in place to maximise our cash balance reduce pay runs to two weekly (to be timed so after receiving SLA income from CCG), stop non urgent capital work & increase our current efforts in credit control. Cash management steps are currently being reviewed to ascertain whether they can be relaxed.

• The Trusts Use of Resource rating YTD is 3. (Source: EEAST Financial Position report for Meeting 30th November 2016)

10


National Reporting Measures

Indicator Ref Description Framework

Reporting Frequency

Current Period

Current Period Target

Current Period Actual

Rolling 6 Months

Latest Applicable

TargetYTD Actual Comments

NHS 2.3.i Unplanned hospitalisation for chronic ambulatory care sensitive conditions (WC1.1.1) NHS Outcomes Monthly Nov-16 147 157 846 157 WSFT (indication of performance on Annual measure E.A.4)

NHS 2.3.ii Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s (WC1.1.2) NHS Outcomes Monthly Nov-16 28 32 111 32 WSFT (indication of performance on Annual measure E.A.4)

E.A.S.1 Estimated diagnosis rate for people with dementia NHS EC Annex A Support Measure

Monthly Nov-16 67% 63.6% 67% 63.6% WSCCG

NHS 3a Emergency admissions for acute conditions that should not usually require hospital admission (WC1.1.3) NHS Outcomes Monthly Nov-16 247 289 1479 2,073 WSFT (indication of performance on Annual measure E.A.4)

NHS 3.2 Emergency admissions for children with Lower Respiratory Tract Infections (WC1.1.4) NHS Outcomes Monthly Nov-16 58 58 31 115 WSFT (indication of performance on Annual measure E.A.4)

E.A.S.4 Healthcare acquired infection (HCAI) measure (MRSA) NHS EC Annex A Support Measure

Monthly Nov-16 0 0 0 0 WSCCG

E.A.S.5 Healthcare acquired infection (HCAI) measure (clostridium difficile infections) NHS EC Annex A Support Measure


E.B.1 The percentage of Referral to Treatment (RTT) pathways within 18 weeks for completed admitted pathways

NHS EC Annex B Measure


E.B.2 The percentage of Referral to Treatment (RTT) pathways within 18 weeks for completed non-admitted pathways



E.B.3 The percentage of Referral to Treatment (RTT) pathways within 18 weeks for incomplete pathways NHS EC Annex B Measure


E.B.S.4 Number of 52 week Referral to Treatment Pathways NHS EC Annex B Support Measure


E.B.4 Diagnostic test waiting times NHS EC Annex B Measure


E.B.5 A&E waiting time - total time in the A&E department NHS EC Annex B Measure

Monthly Nov-16 95% 84.5% 95% 86.8% WSFT

E.B.S.5 Trolley waits in A&E NHS EC Annex B Support Measure

Monthly Nov-16 0 0 0 0 WSFT

NATIONAL PERFORMANCE MEASURES - 2016/17 - WEST SUFFOLK CCG (1/2)

Enhancing quality of life for people with long term conditions

Helping people to recover from episodes of ill health or following injury

Treating and caring for people in a safe environment and protecting them from avoidable harm

Referral To Treatment Pathways

Diagnostic test waiting times

A&E waits

11


National Reporting Measures

Indicator Ref Description Framework

Reporting Frequency

Current Period

Current Period Target

Current Period Actual

Rolling 6 Months

Latest Applicable

TargetYTD Actual Comments

E.B.6 All Cancer 2 week waits NHS EC Annex B Measure


E.B.7 Two week wait for breast symptoms (where cancer was not initially suspected) NHS EC Annex B Measure


E.B.8 Cancer day 31 waits: Percentage of patients receiving first definitive treatment within one month of a cancer diagnosis



E.B.9 Cancer day 31 waits: 31-day standard for subsequent cancer treatments-surgery NHS EC Annex B Measure


E.B.10 Cancer day 31 waits: 31-day standard for subsequent cancer treatments-anti cancer drug regimens NHS EC Annex B Measure


E.B.11 Cancer day 31 waits: 31-day standard for subsequent cancer treatments-radiotherapy NHS EC Annex B Measure


E.B.12 Cancer 62 day waits: Percentage of patients receiving first definitive treatment for cancer within two months (62 days) of an urgent GP referral for suspected cancer



E.B.13 Cancer 62 day waits: Percentage of patients receiving first definitive treatment for cancer within 62-days of referral from an NHS Cancer Screening Service



E.B.14 Cancer 62 day waits: Percentage of patients receiving first definitive treatment for cancer within 62-days of a consultant decision to upgrade their priority status


Monthly Nov-16 90% 50.0% 89% 81.5% WSCCG - Target is Monthly National Average

E.B.15.i Ambulance clinical quality – Category A (Red 1) 8 minute response time NHS EC Annex B Measure


E.B.15.ii Ambulance clinical quality – Category A (Red 2) 8 minute response time NHS EC Annex B Measure


E.B.16 Ambulance clinical quality - Category A 19 minute transportation time NHS EC Annex B Measure


EBS7a Ambulance handover time - 1) Handover delays over 30 minutes NHS EC Annex B Support Measure


EBS7b Ambulance handover time - 2) Handover delays over 1 hour NHS EC Annex B Support Measure


E.B.S.1 Mixed Sex Accommodation (MSA) Breaches NHS EC Annex B Support Measure


E.B.S.2 Cancelled Operations NHS EC Annex B Support Measure


E.B.S.6 Urgent Operations cancelled for a second time NHS EC Annex B Support Measure


E.A.3 IAPT Roll Out NHS EC Annex A Measure

Monthly Nov-16 1.25% 1.3% 7.50% 10.0% WSCCG

E.A.S.2 IAPT Recovery Rate NHS EC Annex A Support Measure


E.B.S.3 Mental Health Measure – Care Programme Approach (CPA) NHS EC Annex B Support Measure


Cancer waits - 2 week wait

Cancer waits - 31 days

NATIONAL PERFORMANCE MEASURES - 2016/17 - WEST SUFFOLK CCG (2/2)

Cancer waits - 62 days

Ambulance Measures

Mixed Sex Accomodation

Cancelled Operations

Mental Health

Integrated Care Headlines

Project Finance RAG

Delivery RAG

£ Full Year Planned

£ Full Year Projection

£ YTD Planned

£ YTD Actual

Headlines

P18a - Redesign of Proactive pathways

£602,574 £40,150 £283,078 £0

- All Connect Implementation Manager posts recruited to except for 0.5 wte for the east - interviews scheduled for the w/c 9th January 2017. Locality plans now being taken forward with joint working being progressed across all 5 areas. - The acute frailty pathway established and frailty score now identified in ED supported by OPAT. Community frailty pathway is now an integral part of Connect but implementation is slow whilst Alliance development are in progress but planning for Frailty pilot in Bury Town has commenced with implementation scheduled for Feb/March. D2A for pathways 2 and 3 operational at Glastonbury Court and interim evaluation due February. - The senior clinical lead post for COPD and PR services beginning to have an impact but staff sickness affecting pace of change of working practices within the team remain an issue. - The Care Homes project and model, which was on hold over the summer is now

integrated into the approach for Connect. The Care Homes Clinical Support Manager is now working within and being supported by the quality team going forward, taking a pan Suffolk approach. This however has impacted on delivery. Suffolk-wide vision for Care Homes by the Quality team still to be agreed.

- EOL: Suffolk wide guidelines completed and for governance sign off in February.

P18c - Redesign of Proactive pathways - EIT ED Demand Mngt Grp

£395,209 £182,500 £195,848 £0

To assist the overarching approach to reduce emergency admissions and attendances, the following actions are in progress: • EIT data dashboard in place and informing the EDDM on a monthly basis to

improve activity and referral rates • CCG, SCH and WSFT continue to work to resolve the data aspects and fully

demonstrate the activity levels in the community and ED of EIT. This will include the activity and associated impact of the generic workers in the team

• EIT continued support to ensure full optimisation of service focussing on crisis intervention and appropriate interface support from other services (e.g. Integrated Neighbourhood Teams)

• EEAST ECP embedded in system offering additional admission avoidance support to ambulance crews

• HALO placement at front door of ED proved successful in reducing arrival to handover and subsequent clear times

• Work on-going to review the 111 to 999 referrals through a collaborative approach across EEAST and Care UK

Project Finance RAG

PMO RAG



£ YTD Planned

£ YTD Actual

Headlines

Child & Adolescent Mental Health

N/A N/A £0 £0 £0 £0

• Emotional Wellbeing Hub – Board met on 8 Dec (actions include demand modelling, data sharing and information governance and review of resource model) . Working group meet on 9 Jan. Next Board meeting in Jan. • Crisis – Working group met on 5 Dec. Actions include further mapping of current provision, gap analysis and survey to look at experience/impact of current provision (to be led by SPCN) • Digital workstream – resource agreed to support the development of the information and services directory for parents and carers • Perinatal proposal approved to reintroduce West Suffolk pilot and extend to both CCG areas • Connect service specification agreed on 20 Dec • CYP IAPT – Suffolk is now a member of the CYP IAPT London and South East Collaborative. Development of a workforce plan required. • Workforce development - Interim review of take up and impact of training offer since launch in May. Training accessible via CPD online.

CYP and Maternity N/A N/A £0 £0 £0 £0

CHILDREN’S COMMUNITY SERVICES (1+1) - CCGs have confirmed that providers have progressed through to second gateway as part of procurement process - further work to be completed by provider to assure CCGs regarding delivery of children's specification. Meeting with NEE CCG CYP and Maternity Leads 13/12/16 - LMS Board to be convened quarterly in line with Better Births Review recommendations. Inaugural meeting scheduled for 31/1/17.

Learning Disabilities

N/A N/A £0 £0 £0 £0

Nurse pilot (x4 posts) positive interim evaluation completed by Public Health in December 2016. Posts mainstreamed into core NSFT contract and taken through Clinical Executives week commencing 09.01.17 for information. NSFT- New Children and Family Home Treatment Teams- recruitment ongoing.

Mental Health - Crisis

N/A N/A £0 £0 £0 £0

PSYCHIATRIC LIAISON - Service at both Trusts reduced following withdrawal of funding in May 2016. Reduced draft specifications for both Trusts rewritten in Summer 2016 & NSFT have written a draft spec covering both Trusts. Contractual meeting held on 20 September with NSFT to discuss the specification. NSFT to do a revised iteration of the specification in relation to how inpatient queries may be managed & to look at ‘Front door’ KPI.

Mental Health – Early Intervention

N/A N/A £0 £0 £0 £0

WELLBEING SUFFOLK / IAPT TRAINING- Service delivery of numbers seen against prevalence dipped in October but showed improvement in November, meeting 50% recovery target. Mobilisation of new service complete primary care mental health development meeting set up to identify and manage any emerging issue. Service working with CCG to complete STP bid for funding to increase therapeutic interventions for Long Term Conditions and Medically Unexplained Symptoms - Deadline for submission 18 January 2016. 2) EARLY INTERVENTION IN PSYCHOSIS: Performance improvement January - 8 new cases against requirement for 5.5 new cases per month to achieve target numbers of 66 new cases pa. Business case for fully NICE compliant service received from NSFT. We are seeking further clarification about service's financial baseline this is due by end of March. MVA – contract with current provider extended to cover gap until procurement of new service from October 2017. Service specification for future model under development in partnership with current provider to ensure meaningful outcomes and KPIs.

MH & CYPM – New portfolio to be rated from January 2017

Project Finance RAG

PMO RAG



£ YTD Planned

£ YTD Actual

Headlines

Mental Health – Early Intervention

N/A N/A £0 £0 £0 £0

IMPROVED HEALTH & WELLBEING OUTCOMES FOR PEOPLE WITH SERIOUS MENTAL ILLNESS - NSFT employs physical health nurse and are meeting contractual target for physical health checks. DEMENTIA PATHWAY – paper drafted to go to Clinical Executive in early January to update on programme of work carried out to date, and to asked for their comment on the actions identified to improve and support the requirement for the CCGs to achieve the 67% diagnosis rate for dementia, and to confirm their commitment for a whole system approach to ensure successful delivery of the action plan. Achievement of the 67% diagnosis rate is currently demonstrated through the QoF register. This is currently based on CCG resident population and we have received notification that from 1 April 2017 there will be a change to how this percentage will be calculated in that it will be based on GP registered population. This means that this will have a positive impact on IESCCG by 2.1% but a negative impact of -5.3% on WSCCG JOINT WORK PROGRAMME WITH NSFT - Workshop with NSFT 6 December 2016 to agree priority areas for focused work. We have agreed operational and clinical and quality leads for each work area. First areas of focus will be on the Access and Assessment Team and Integrated Delivery Teams and Crisis Response.

Mental Health - Recovery

N/A N/A £0 £0 £0 £0

REHABILITATION RECOVERY PATHWAY: MH POOLED FUND MH & LD JCG requested: Supported housing proposal to JCG 20 September requesting contract extension to March 2018. Allows time for clarity on financial envelope for procurement during 2017/18, full VFM cost modelling and time to harmonise prices with existing providers with aim to secure a cost saving for all partners for 17/18. SUF - conduct in the round review of service user groups and funding to consider potential cost savings; £100k funding for personal budgets - potential double funding - money to be released back to CCGs; Suffolk Family Carers and Libraries Information Service - to align into one contract by April 2017. Libraries performing well, good VFM, SFC room for improvement. NSFT report struggling to complete carers’ assessments; Suffolk Night Owls funded for 2016/17 - will require evaluation to determine future funding

MH & CYPM – New portfolio to be rated from January 2017

Planned Care

Project Finance RAG

Delivery RAG



£ YTD Planned

£ YTD Actual

Headlines

P1 – Pain

£362,518

£125,323

£181,752

£35,708

• A project plan to deliver the new integrated pain model as an Alliance is in production with a deadline for completion of the plan and project set-up complete by the end of December. The project workbook will be updated as part of this planning exercise.

P2 – Telederm £74,376 £0 £39,090 £0

• In November 2016 100 reports were produced through the Teledermatology of which 72 (72% ) were treated in primary care and 26 (26%) were treated in secondary care.

• All actions on the project plan have been completed within timescales. • The project is able to go live from 1st December as planned, however

due to WSFT staffing issues it has been agree to commence the service on 9th January 2017.

• It is planned for some referrals to be made through the system week commencing 5th December in order to provide WSFT consultants with a run through and familiarise them with the process.

P5 – LPP £850,000 £850,000 £425,225 £322,459

• The full roll-out of the Clinical Threshold Service (CTS) process is discontinued. ENT and Orthopaedics continue to be live within the service.

• The T18a and b Hip and Knee policies will be considered by COG in December 2016.

• Prior Approval process for ENT is in development and will be the first service to go live. A sleep apnoea process is being developed for the agreed pathway.

• The service is live and referral re going through. The turning off/rejection of direct referrals by WSFT and BMI is waiting for the meeting with the LMC who have raised concerns. Work is starting on developing the Rheumatology pathways into the service.

P15 – Ophthalmology

£80,841 £40,000 £32,475 £15,034

• The STP Executive Board agreed that Ophthalmology is business as usual. WSFT are taking the glaucoma specification to procure the service.

P16 - Prevention, Self Care & Shared Decision Making

£18,378 £18,378 £9,300 £63,063

• Diabetes prevention and management work has bene put on hold. • Atrial fibrillation detection and management work has been put on hold. • Respiratory work to be taken forward with the mobilisation of Suffolk

Wellbeing.

Prescribing

Project Finance RAG

Delivery RAG



£ YTD Planned

£ YTD Actual

Headlines

P6.1 – Gluten Free £50,000 £87,154 £20,398 £38,866

P6.2 - Self Care £30,000 £30,000 £12,239 £16,416

P6.3 - Generics £70,000 £70,000 £28,558 £25,855

P6.4 - Inhaler Devices £150,000 £75,000 £61,195 £0

P6.5 Prescribing recommendations

£550,000 £550,000 £224,381 £187,831

P6.6 ScriptSwitch £150,000 £75,000 £61,195 £17,190

P6.7 Rebate Schemes £50,000 £50,000 £20,398 £41,656

P6.8 Polypharmacy £200,000 £100,000 £81,593 £31,748

Contractual Performance

Appendix Pack

Appendix Pack

January 2017

1

Finance

What are the top 3 risks and issues?

Rank Risk Owner Likelihood Impact Mitigation

1 Delayed Transfers of Care (DTOC). This impacts on the Trusts ability to meet the A&E 4 hour standard. Currently reported for November at 10%

CCG/IHT/Local Authority

High High

• CCG DTOC task force working with IHT to reduce delays • A+E delivery board to focus on some of DToC issues • Market review for care homes on-going • Daily ‘mini’ Red to Green to reduce DTOCs • Launch of intensive ‘ward by ward’ ‘Red to Green’ discharge process review of all wards.

2 MSK/Gastro/Ophthalmology transformation. Risk that delay will mean outcome improvements and savings are not realised as anticipated.

CCG/IHT Med Med • Task & finish groups and operational delivery board in place • New contractual models required, MSK service variations complete and service started from

1st October. SV ready for signature

3 A&E performance. Failure to see and treat patients in a timely manner presents risks to patient outcomes.

CCG’s/IHT/A+E delivery board

High Med • A+E delivery board headline focuses are discharge to assess , patient flow, nurse streaming,

111 and 999 referrals . Improvement trajectory in place for compliance April 2017

Ipswich Hospital NHS Trust Performance

The Ipswich Hospital - Guaranteed income contract with the Trust for 16/17 agreed at

£182.25m (includes physio, dermatology, Echo, Nuffield and CQUIN).

Clinical Quality

RAG Indicator National Constitutional Indicators Change

RTT 18 weeks

Urology breaching 92% standard at 86% in November. Updated RAP and additional actions to achieve 92% by new target date of March 2017. Overall IHT compliant with 18 wks.

↔

999 Handover delays

During November 267 hours were lost due to ambulance staff being unable to hand over patients to ED. This is a monthly increase of 80 lost hours.

↓

Diagnostic 6 weeks

Diagnostics 6 week target. November 98.9%. Target 99%. Improvement continued for 4th straight month . Expect to fill vacant consultant radiologist position in January 2017. Compliance expected from February 2017.

↑

A&E 4 hour A&E performance. November performance 86.2% YTD 91.5%. RAP in place and to be driven as part of A+E delivery board - still significant issues to resolve (staffing, acuity, ops management, volumes and delayed transfers of care (DTOC))

↓

Performance Indicator Threshold Sep Oct Nov Change mth on

mth YTD Comments

MRSA - Total number of MRSA: Hospital

0 0 0 0 ↔ 0 AF – S05

C.Diff - Clostridium difficile Incidence 18 per

year 1 3 3 ↔ 17

Same target and trajectory as 2015/16 Significant outbreak in May excluding May 10 cases in year. AF – S08

Clinical - Pressure Ulcers - No. of hospital acquired pressure ulcers that are avoidable

0 2 1 5 ↓ 30

Grade 2, 3 and 4 avoidable only. November – 5 x grade 2, 0 x grade 3, 0 x grade 4.

Nutrition Assessment

95% 88% 90% 89% ↔ 88% Still improving overall trend, planned service improvement work in 17/18 contract to improve nutrition performance

Falls Assessments within 24 hours of admission

95% 89% 92% 89% ↓ AF – S40

Updates • DTOC task group supporting reduction in IHT DToCs. percentage. • All Cancer targets compliant in November, although Cancer referral

rates continue to increase • New outpatient follow up backlog trajectory received, still reducing

backlog and target of 0 by April 2017 • Consultant to consultant access policy training will take place in

January to reduce C2C referrals

Finance/Activity


West Suffolk Hospital NHS Foundation Trust Performance

• WSCCG - Based on months 1 to 5 the Trust was £793k under plan. However this is still subject to change/validation and the Trust has had to make corrections in previous months due to issues with the use of E Care.

• IESCCG -

Updates • Continued system wide priority on managing winter pressures, ED,

DTOCS and Trust internal flow • Winter escalation beds open on G9 as from 07/11/16 for 5 month

period • 20 rehab beds opened at Glastonbury Court • NHSI segmentation at Level 2 • 2017/19 contract now signed with guaranteed income (GIC) • On going implementation of e-care to realise maximum benefits

RAG National Quality requirement Performance Change

A & E - 4 Hour Target 84.50% ↓

Cancer 2ww 97.50% ↑

Cancer 2WW Symptomatic breast 99.20% ↑

18 Week RTT-Incomplete 92.09% ↓

RTT waits over 52 weeks 1 breach ↔

Diagnostics within 6 weeks –Oct 99.40% ↑

RAG Local Quality requirement (Oct data) Performance Change

Stroke – admission to unit within 4 hrs 76.32% ↓

Acute Oncology Service: Door to Needle 88.00% ↑


1 Failure to sustain A&E performance at required level (95%)

Trust/CCG High High • ED Delivery Board established to oversee systemwide actions and response • FLOW action group to take effect 02/12/16

2 Unable to accurately report RTT position post e-care implementation

Trust/CCG High High • Continuing priority focus for validation of waiting list and staff training • Trust agreed position with NHSI to continue reporting based on best estimate • Detailed plans from trust awaited

3 Financial position, failure to deliver CIP/QIPP plans CCG/Trust Med Med • Block contract with GIC for 17/18 now agreed

Clinical Quality

Performance Indicator Threshold

Aug Sept Oct Change mth on mth

YTD (2016) Comments

MRSA - Total number of MRSA: Hospital 0 0

0

0 ↔ 2

C.Diff - Maintain Clostridium difficile Incidence below target (total incidence pre review)

16 per year

3

2

3 ↓ 17(total

incidence –pre review)

3 in October, 2 awaiting outcome, 1 at arbitration.

YTD 17 – of which 9 non trajectory, 2/5 trajectory and outcome of 3 awaited

Clinical - Pressure Ulcers - No. of hospital acquired pressure ulcers (Avoidable & Unavoidable)

0

11

15

25 ↓ 114

25 in October – 15 x Grade 2, 10 x Grade 3. YTD, 37 avoidable, 64 avoidable , 13 pending

Falls per 1000 bed days 5.6 No data

No data

No data ↔

4.98

No of falls: 62 June, 61 July, 56 August., 61 Sept, 68 Oct. Data per 1000 bed days not available

Mixed Sex Accommodation breaches

0

0

0

0 ↔

5

Finance/Activity



1 Underachieving against red ambulance targets resulting in potential safety and outcomes risks to patients.

EEAST/ CCG

High High

• Weekly performance meeting in place with EEAST and commissioners, focus on Red 1 agreed • EEAST increasing PAS and agency paramedics to support service during recruitment and

training, EEAST regional to date region additional £4.1 million additional resource • New EEAST handover procedure and early escalation for ‘live’ delays in place with acutes

2

Increasing call volume and balance of Red to Green calls changing with increasing Red calls impacting on overall service delivery. The risk is the more serious red calls are not seen in a timely manner.

EEAST/ CCG

Med High

• 111 and 999 are meeting monthly to review referred calls. • 111 New training program being rolled out through December. • Conveyances of 19-64 year old group is being reviewed as seemingly a high proportion of this

cohort are discharged without requiring follow up or leave without any consultation • EEAST operating model and RAP focuses on Red achievement actions and progress discussed

in weekly performance meeting

3 Recruitment/Staffing , EEAST continues to struggle to recruit and retain sufficient levels of qualified staff to meet target requirements.

EEAST High High • On-going recruitment plan and increased PAS to support through this process • Development of Operational plan to encourage career pathway • Discussions/plans with other Providers to scope potential staff cross working ongoing.

East of England Ambulance Service NHS Trust Performance

Current annual activity 16/17 +1.59% (570 cases) above contract, additional cost £95,555

RAG Indicator Comments Change

Red 1,2 75% 8 mins

November Red 1 performance 60.1% (IESCCG), Red 2 performance 59.68% (IESCCG).

↔

Arrival to Handover >15mins

Un-validated Handover Delays 267hours in November increase of 80 hours from October and increase of 155 lost hours from November 2015.

↓

Handover to clear

Un-validated October EEAST data 255 hours lost over 15 minutes for handover to clear. ↓

Green 2 75% 30mins

November Green 2 performance 48%

↔ Clinical Quality

Performance Indicator Threshold Aug Sep Oct Change mth on mth

YTD – 12mths

Comments

ROSC (Return of Spontaneous Circulation) at time at arrival at hospital

27% 45% 0% 21% 21% 31% October number of cases 29

Outcome for Cardiac Arrest – Survival to Discharge overall survival rate

7% 15% 0% 4% 4% 8.6% October number of cases 26

Outcome for Cardiac Arrest – Survival to Discharge – Utstein comparator group

25% 33% No

case 100% -% 42%

October number of cases 1

Outcome for Cardiac Arrest – Survival to Discharge STEMI appropriate care bundle

81% 100% 100%

100% 0% 90% October number of cases 6

Stroke - FAST positive stroke patients HASU <60mins 56% 69% 48% 62%

14% 53%

October number of cases 34

Updates • CQUIN – Clinical Support Desk increased hear and treat volume to 6.9%

of calls from April benchmark 5.2%. Target remains 9% by March 17 . • Red activity increasing overall EEAST 8% above plan. 14% increase year

on year. • Performance against RAP - Red 1 Trajectory not meeting for Q3 (1.38%

under) Tail breaches however are not increasing. • Ambulance delays at hospitals have reached 40,000 lost ambulance

hours in the first 7 months of the year across the East of England Region

Finance: I&ESCCG and WSCCG



1 A number of Conditions Precedent were agreed for 2017-19 contract with the Provider.

CCG/NSFT Med High • Work is currently underway to achieve agreed actions • Work plan is to be agreed jointly with the Provider in January ‘s contract meeting.

2 MH Outcomes measures (PROMS/SWEMWEBS/FFT) are not clearly defined and agreed with the Provider.

NSFT Med High

• NSFT is working on their internal Performance Accountability Review Group and internal Task and Finish Group to look at outcomes measures for both adult and CYP.

3 Implementation of the Mental Health Five Year Forward View must do’s.

CCG/NSFT High High • 17/19 MH Contract reflected principles of alliance working within existing finite resources. • Updated Service spec for priority areas such as crisis care, AAT, IDT and Out of Area beds .

Norfolk and Suffolk MH NHS Foundation Trust

Suffolk CCGs Quality

RAG Indicator Comments (n.b. November data is provisional)

Change

Early Intervention in Psychosis (EIP)

8 new cases against 5.5 cases per month. Monthly total of 34 against a cumulative trajectory of 44 ↑

CPA: 7 day follow up post inpatient care

98.4 % against 95% target.

↑

CPA: completion and quality

Below standards on completion and documentation of core elements. Assurance given by NSFT that this will be on track by March 2017.

↔

15 weeks referral to treatment: children and young people

95.6 % against standard of 95%.

↑

15 weeks referral to treatment: adults

96.1% against standard of 95% ↑

Psychiatric liaison 4 hours (ED): 99.3% (November) against 95% 8 hour maximum stay in ED: no breaches in October (await RCA’s for previous months ).

↑ Clinical Quality

Performance Indicator

Threshold Sep Oct Nov Change mth on mth

YTD Comments

MCA Training 95% 97.1 % 97% 96.4 % ↑ ↑

November data is unvalidated

DOLS Training 95% 97.2 % 96.5 % 96.1% ↑ ↑

November data is unvalidated

Nb Primary care MH contract is covered in a separate contract

Update • NHSE central funding allocated to address CAMHS waiting list for

psychological therapies • Review of AAT service underway. • CCG/NSFT bidding process underway for IAPT and Psychiatric Liaison

Service • Review of memory assessment service underway

Performance

Finance/Activity



1 Red ambulance ‘inappropriate’ levels increase, taking capacity needed for higher priority cases.

CCG Medium High • Care UK continue to work through project plan. Training with all HA’s completed to strengthen probing

skills and how ‘inappropriate calls’ can be highlighted and managed. • Care UK are discussing nationally and will be sharing best practice through local sites / Networks.

2 Increase in ED referrals as a side effect of reduction in green ambulances could impact on the 4 hour A&E target and patient outcomes.

CCG Medium High

• Trajectory agreed with 111 service with the aim of delivering a reduction of ED referrals . Trajectory has not been met for 2 months and Care UK will be issued financial penalties as a result.

• Review of ED validation via the existing Ambulance Validation line to be discussed at next contract meeting.

3 Lack of clinical intervention at first patient contact or call back within 10 minutes. Risk of patients opting to use a more expensive resource such as ED.

CCG High Med

• Care UK performance below target which is in line with national benchmarking due to difficulty in recruiting clinical staff. Breach report reviewed at monthly contract meetings focused on safety and ‘live’ clinical oversight of any queue is monitored for risk and process has been reviewed by CCG.

• Clinical contact trajectory in place with NHS England (30%)to drive resolution of calls to services other than ED & Ambulance.

111 contract activity based on 170000 calls a with cap and collar 10% prior to marginal rates being applied. Financial KPI’s now focussed on 999 and ED only.


OOH KPI’s OOH speak to KPI’s and local KPI’s all met trajectory in November. No performance concerns with the service currently.

↑

111 – Calls answered in 60 secs

Performance in November achieved 97.9% against a trajectory of 95%. ↔

111 - Warm Transfer

Performance for Warm Transfer achieved 43% in November. Combined target of calls warm transferred or a call back within 10 minutes from a clinician, Suffolk achieved 79.8% which is a small improvement from October.

↑

999 despatch from 111

% of calls being despatched to 999 from 111 increased to 12.36% in November compared to 11.12% in October. Number of ambulances dispatched from 111 was 1803.

↓

Clinical Quality

Performance Indicator Threshold August Sept Oct Comments

Local Health Advisor Audits (111) over 3 months employment

86% 100% 100% 100% 5 HA’s currently on action plans

Local Clinical Advisor Audits (111) over 3 months employment 86% 100% 100% 70%

No CA’s are on action plans. October performance on track for resolution by November in order to achieve 100%.

Suffolk Clinicians paper records documentation and assessment audit (OOH) 90% 98% 98% 98%

Reminder about recording medication for current condition and when to call back including worsening conditions

Suffolk Clinicians voice recording audits (OOH) 90% 98% 96% 95%

Confirm patient details are correct, discuss how to access further help

Assessment of Care Environment (OOH) (November)

n/a n/a n/a n/a Monthly audits following Care UK audit schedule

0

5000

10000

15000

20000

Calls Answered

KPI penalties

Update • Care UK are meeting the trajectory set for % of Green Ambulances

being diverted to a more appropriate service following clinical validation. 111 re-directed approximately 409 of these calls in November.

• ED referrals from 111 was 7.82% in November which was a slight improvement on October (8.16%). This continues to be over the planned trajectory of 6.5%. Financial sanctions are in place for this KPI which will be closely monitored.

• NHS England have tasked the service with 30% clinical contact on all calls by March 2017. Trajectory for compliance has been submitted and on track.

Performance

Care UK Limited – 111 & Out of Hours

Finance



1

The paediatric Speech and Language Therapy service waiting list has reduced however the additional funding has been used and the implementation date of the new integrated service model is significantly delayed (planned to go live Sept 2016) The waiting lists could increase in the interim.

Trust High High

• SCH has accepted additional CAMHS transformation money to reduce wait length up to March 2017.

2 There are gaps in adult Speech and Language Therapy across SCH, NSFT and the acute hospitals and groups of patients may be at risk of clinical harm

CCG High High

• Providers continue to submit IFRs for patients with dysphagia/ swallowing issues.

• A working group is reviewing the pathways and will intended to make recommendations to close the gaps in December 2016. This work is delayed and recommendations will be shared in February, 2017.

3 A lack of domiciliary care capacity which significantly impacts community and acute hospital flow.

SCC/WSFT and IHT

High High • IHT and WSFT review the cohort of patients admitted to the community

hospitals and identify actions to reduce acute readmissions.


Quality


Response Times

The Local Health Care Teams met response times for referrals within 4 hours, 72 hours, and 18 weeks. Achieved 18 week RTT for all adult Consultant and Non Consultant led services. ¼ of children were seen outside of 18 wk RTT for the consultant paediatricians. A paper setting out the issues and remedy is due in January.

↔

Care coordination centre

% of calls answered in 60 seconds was 93.12% SCH exceeded the milestone in the Remedial Action Plan ↑

Delayed Transfers of care

The number of DTOCs in November increased to 48 , the highest ever levels. This equates to 673 days lost and is 47% of the total bed numbers. Re-admission to acute hospital is ~20% which is being reviewed.

↑

Clinical Quality

Performance Indicator Threshold Nov YTD(from Oct 2016)

Comments

MRSA - Total number of MRSA: Community Hospital 0 0 0

Clostridium difficile – minimise rates of Clostridium difficile 4 per year 0 0

Pressure ulcers – reduce Grade 2 & 3 avoidable pressure ulcers (in-patient units)

Grade 2 -13 Grade 3 – 2

4 - G2 2 – G3

6 – G2 3 – G3

Pressure ulcers – zero Grade 4 avoidable pressure ulcers (in-patient units)

0 0 0

Falls – number of inpatient falls resulting in moderate or severe harm No more than 1.25 per month

0 0

Mixed Sex Accommodation breaches 0 0 0

NHS Friends and Family Test (% of patients who would recommend SCH services)

85% 96%

Number of formal complaints 2

Number of formal compliments 36

£0.00

£1,000,000.00

£2,000,000.00

£3,000,000.00

£4,000,000.00

M7 M8 M9 M10 M11 M12

IESCCG

WSCCG

Performance

Update • SCH launches a public equipment amnesty campaign in January to aim

to reduce equipment waste. • The % of Children in Care Initial Health Assessments completed in

28 days of receiving all paperwork increased significantly in November to 80%.

• In mid 2016 year there were issues with reduced capacity in the COPD service. The service has now recovered and referrals and admission prevention activity has doubled.

• SCH is planning a quality improvement initiative with nursing homes to improve the management of continence issues

Outstanding Performance Notices

Contract RAG

Performance Issue Contract Notice Stage

Last 3 months performance

Ch

ange

fro

m

pre

v. m

on

th Current Status

Sep Oct Nov

WSFT Acute Oncology Service: 1 hour door to needle time ‘DTN’ for all Service Users presenting to A&E or MDU with suspected neutropenic sepsis.

Target: 100% overall 85% for Contract Management

Exception Report (ER201516_01)

84.00% 88.00% Data not available

↑ • Breaches continue to occur in the ED – there were 3 in

October. Themes continue : missed opportunities to use the antibiotics PGD and medical staff requesting bloods results before initiating antibiotics.

A&E performance 78.95% 82.35% “ ↑

100% 100% “ ↔ MacMillan Unit

A&E: Percentage of A&E Attendances where the service user was admitted, transferred, or discharged within 4 hours of their arrival at an A&E dept

Remedial Action Plan

88.21% 86.14% 84.50% ↓

• Recovery plans being implemented and monitored via the A&E Delivery Board: improvement actions include Streaming, triage, frailty, workforce review, patient flow improvements, ED alterations, e-care, implement discharge to assess and Trusted Assessor policy.

Diagnostics: percentage of Service users waiting 6 weeks or more from referral for a diagnostic test (operating standard of no more than 1%)

Remedial Action Plan

8.2% 3.6% 0.6% ↑

• Breaches occurring predominantly in Endoscopy . Improvement actions on schedule include: outsourcing capacity to private provider; identifying further internal rooms and radiologist capacity; and appointed Sonographer -commencing October. Un-validated position for November – target met

Delayed transfers of care of occupied bed capacity (no more than 3.5%

5.3% 7.1% Data not available ↓

• Recovery plan and improvement trajectory in place – to reach contracted standard in March 2017: Range of actions: in place re improving flow , Doing things differently /red to green weeks, escalation processes, patient transport and discharge to assess models. Outcome of most recent DtD and Perfect week presented to October ED Delivery Board who are now monitoring the action plan for recovery.

Outstanding Performance Notices

Contract RAG

Performance Issue Contract Notice Stage

Last 3 months performance

Ch

ange

fro

m

pre

v. m

on

th

Current Status

Sep Oct Nov

EEAST

• Red 1,2 and 19 (Suffolk wide R1 used for last 3 months performance)

RAP trajectory and details agreed

69% 62% 63% ↑

• Remedial Action Plan in place covering Red 1 call improvement for 16/17.

• Focus is on Red 1 performance and is being monitored at weekly Performance Improvement Groups with additional detailed reporting. Increased finance is agreed as part of RAP for 16/17 on improving performance. Staffing fill has to be achieved over EEAST footprint and hear and treat performance.

NSFT 12 months review: Care Programme Approach (CPA) review

Target: 95% Exception Report 2016-17-02

95.9% 95.6% 98.4% ↑ • Solid performance over the last 5 months.

12 months review: nCPA patient review

Target: 95% 81.7 % 86% 86.5% ↑

• NSFT anticipated recovery in November. Improvement noted, however new recovery trajectory is required.

Access and Assessment Team Over 18s 4 hrs emergency assessment

Target: 100%

Exception Report 2016-17-01

93.3% 83.3 % 100 % ↑

• November data is validated and performance against agreed trajectory. RAP has been agreed.

Over 18s 72 hrs urgent assessment

Target: 98% 80.8 % 83.9% 100% ↑

• November data is validated and performance is against agreed trajectory. RAP has been agreed.

Over 18s 28 days for routine assessment

Target 95% 78.5% 75% 81.3% ↑

• November performance is validated. RAP has been agreed with recovery forecast in December.

Care UK 111 Warm Transfer • Performance against these national

metrics continues to be non compliant • Target: >95

Warning Notice (WN1314-02)

39.1% 43.3% 43% ↔

• Benchmarking across the country has demonstrated that providers are struggling to hit this KPI due to issues in recruiting clinical staff. The CCG continues to monitor closely.

of 5

GOVERNING BODY

Agenda Item No. 13



Title Financial Performance Committee – Terms of Reference

Lead Chief Officer Amanda Lyes – Chief Corporate Services Officer

Author(s) Colin Boakes – Governance Advisor

Purpose To establish a finance and performance framework which enables the CCG to proactively manage its financial, performance and quality, innovation, productivity and prevention (QIPP) agenda and also provide assurance about delivery and sustained performance in these areas to the Governing Body by reviewing and approving performance reports and remedial action plans.








Action required by Governing Body: To approve the Financial Performance Committee terms of reference as appended to the report.

1. Background 1.1 In a publicly funded healthcare system, the public rightly demands high standards of

efficiency and cost effectiveness from both commissioners and providers of services. This proposal therefore establishes a new Financial Performance Committee that through its oversight and scrutiny ensures that the CCG operates within its agreed budget and initiates plans and necessary actions to maintain financial balance.

2. Key Issues 2.1 The CCG has established a committee reporting to the Governing Body to be known as the

Financial Performance Committee. 2.2 The Committee is established in accordance with West Suffolk CCGs Constitution, Detailed

Financial Policies, Standing Orders and Scheme of Delegation.

2.3 The Committee provides assurance about financial performance to the Governing Body by

reviewing and scrutinising performance reports and remedial action plans in detail prior to submission to Governing Body meetings.

2.4 The Financial Performance Committee is accountable to the CCG Governing Body and

operates within agreed delegated powers.

2.5 The Committee will meet monthly and more frequently on an as required basis.

2.6 Minutes of Committee meetings will be recorded and presented to the Governing Body at

each of its meetings. 3. Patient and Public Engagement (if appropriate)

N/A 4. Recommendation 4.1 The Governing Body is requested to note the report and approve:

4.1.1 Establishment of the Financial Performance Committee

4.1.2 The attached Committee terms of reference

WEST SUFFOLK CLINICAL COMMISSIONING GROUP

FINANCIAL PERFORMANCE COMMITTEE

TERMS OF REFERENCE

1. OVERVIEW

(i) The CCG has established a committee reporting to the Governing Body to be known as the Financial Performance Committee

(ii) The Committee is established in accordance with West Suffolk CCGs Constitution,

Detailed Financial Policies, Standing Orders and Scheme of Delegation 2. PURPOSE OF THE COMMITTEE

The purpose of the Committee is to: (i) Establish a financial performance framework which enables the CCG to proactively

manage its financial, performance and quality, innovation, productivity and

prevention (QIPP) agenda

(ii) Provide assurance about financial performance to the Governing Body by reviewing

and scrutinising performance reports and remedial action plans in detail prior to

submission to Governing Body meetings

(iii) Ensure that the CCG operates within agreed budgets and initiating plans and

necessary actions to maintain financial balance

(iv) Demonstrate the achievement of value for money and provide confidence to the

Governing Body and wider public that the CCGs resources are being used

effectively and efficiently

(v) Facilitate a culture of openness and probity around the delivery of effective financial

performance management

3. ROLE OF THE COMMITTEE

On behalf of the Governing Body, the Committee exercises its functions by having the necessary oversight and scrutiny of financial performance in relation to:

(i) The current and forecast in year financial position, receiving detailed reports

including progress towards meeting targets agreed within the CCGs financial plans

(ii) Implementation of QIPP schemes and receiving updates on both the financial and

performance activity for each

(iii) Achievement of any CCG incentive schemes and receiving reports of the actual and

forecast performance for each

(iv) Reviewing the CCG’s medium term financial plan

(v) Implementation of any investments &/or transformation schemes receiving reports

of the actual and forecast performance for each

(vi) Receiving and reviewing departmental delivery plans

(vii) Challenging where necessary the actual performance of agreed plans in order to

achieve targets

(viii) Ensuring the resolution of key performance issues

4. AUTHORITY (i) The Financial Performance Committee is accountable to the CCG Governing Body

and operates within agreed delegated powers 5. MEETINGS (i) The Committee will meet monthly and more frequently on an as required basis

(ii) Minutes of Committee meetings will be recorded and presented to the Governing

Body at each of its meetings (iii) Agendas and any papers for Committee meetings will be circulated to members at

least five days in advance 6. MEMBERSHIP (i) Membership of the Financial Performance Committee comprises:

Lay Members of the Governing Body

CCG Chair

Chief Officer

Chief Finance Officer

Chief Corporate Services Officer

GP Members of the Governing Body

Practice Manager Members of the Governing Body

(ii) The third shared Lay Member will Chair the Committee (and until appointed the Lay

Member for Governance will temporarily chair the committee) (iii) In the absence of the designated Chair, another of the Lay Members will Chair the

meeting (iv) Others, for example Chief Officers and Associate GP’s may be asked to attend

meetings of the committee to discuss specific agenda items as and when required. (v) A quorum shall comprise at least three members, one of whom shall be the Lay

Member and two other members (vi) Where voting is required and in the event of an equality of votes, the Chairman shall

have a casting vote (vii) The Chief Operating Officer will provide a secretary to service the committee and

he/she will attend to take minutes. 8. REVIEW (i) The Committee will review its own performance and effectiveness on an annual

basis including running costs, membership and terms of reference. The Governing Body will approve any resulting changes to the terms of reference or membership.

9. AUTHOR

Colin Boakes - Governance Advisor

Date Approved:

Review Date:

of 6

GOVERNING BODY

Agenda Item No. 14



Title Clinical Scrutiny Committee – Terms of Reference

Lead Chief Officer Amanda Lyes – Chief Corporate Services Officer

Author(s) Colin Boakes – Governance Advisor

Purpose To address the action arising from Minute 16/031 at the Clinical Scrutiny meeting held on 24 August 2016 in terms of redefining the Committees purpose and terms of reference.








Action required by Governing Body: To approve the Clinical Scrutiny Committee terms of reference as appended to the report.

1. Background 1.1 At the meeting on 24 August 2016, the Committee approved the terms of reference as

currently fit for purpose, whilst requesting that the Chief Corporate Services Officer review them in light of the original Internal Audit report.

1.2 The original Internal Audit report on clinical governance was dated 15 October 2013 and was

undertaken to provide assurance that clinical governance processes within the CCG were effective and ensure that clinical objectives were met.

1.3 The overall conclusion of the audit was that improvements needed to be made in the CCG’s

clinical governance process to ensure that its clinical objectives were actually met. The main structural change recommended was for the Executive Committee to act as a formal sub-committee of the Governing Body on a monthly basis, so that it meets best practice in terms of enhancing the Governing Body’s oversight of clinical quality, performance and risk.

1.4 At that time, the committee that was most relevant to clinical governance was the CCG

Executive Committee. 1.5 The CCG responded to the report by stating that further to discussion by the Executive

Committee, it had been agreed that it would formalise meetings every two months, as a sub-committee of the Governing Body, with separate terms of reference that clearly designated the meetings as a focus for clinical governance, reflecting the audit recommendations.

1.6 Further to debate regarding titles for the formalised committee, the terms of reference for the

new Clinical Scrutiny Committee were subsequently produced and approved by the committee in August 2013.

1.7 Since the original Internal Audit report of 2013, Price Waterhouse Coopers (PWC) presented

their own review of CCG capacity and capability in July 2016, drawing similar conclusions in regard to the Clinical Scrutiny Committee and the oversight of clinical governance.

2. Key Issues 2.1 Clinical governance is a systematic approach to maintaining and improving the quality of

patient care within a health system. It is a framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.

2.2 The Clinical Scrutiny Committee’s terms of reference were written with the intention of

ensuring that as a formal sub-committee of the Governing Body, the committee would provide a dedicated forum for the oversight of clinical governance as set out in the internal audit report recommendations.

2.3 The committee terms of reference have again been thoroughly reviewed and with the

exception of the membership, are still considered fit for purpose. 2.4 The principal issue arising from the review centres upon how the committee has been

functioning and its agenda. 2.5 It would appear that the committee has been focused upon the same issues as the CCGs

Executive Committee rather than providing a dedicated forum for clinical governance matters to be discussed. .

2.6 Highlighted in the PWC report was that the scope of the Clinical Scrutiny Committee

described to them by Governing Body members included a stronger focus on financial scrutiy than indicated in the terms of reference. They were also told that the Clinical Scrutiny

Committee provides scrutiny over all areas of WSCCG’s business, not limited to clinical governance, bearing out the conclusions of our own review.

3. Patient and Public Engagement (if appropriate)

N/A 4. Recommendation 4.1 The Governing Body is requested to consider the report and approve:

4.1.1 That the Clinical Scrutiny Committee re-focuses its function as a dedicated forum for

the oversight of clinical governance.

4.1.2 The attached terms of reference.

WEST SUFFOLK CLINICAL COMMISSIONING GROUP

CLINICAL SCRUTINY COMMITTEE

TERMS OF REFERENCE

1. OVERVIEW

Clinical governance is a systematic approach to maintaining and improving the quality of patient

care within a health system. It is a framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.

2. PURPOSE OF THE COMMITTEE As a formal sub-committee of the CCG Governing Body, the purpose of the Clinical Scrutiny Committee is to: (i) Provide a dedicated forum for the oversight of clinical governance.

(ii) Provide assurance to the Governing Body and Audit Committee that the CCG has

the necessary clinical governance arrangements in place to meet its objectives. (iii) Ensure effective clinical engagement in clinical governance processes, utilising

clinician’s specific expertise and knowledge of local communities and public/ patient involvement.

(iv) Facilitate a culture where clinical quality, patient experience and patient safety are

of the highest priority. 3. ROLE OF THE COMMITTEE The role of the Clinical Scrutiny Committee is to: (i) Support the highest standards of clinical quality and patient safety. (ii) Develop and monitor clinical quality standards and scrutinise integrated

performance reports.

(iii) Oversee and scrutinise clinical work streams and pathways for planned and integrated care in order to ensure appropriateness and effectiveness.

(iv) Provide the Governing Body and Audit Committee with demonstrable evidence of scrutiny, challenge and escalation where necessary.

(iv) Receive, review and approve clinical policies and procedures. (v) Monitor providers’ compliance with CQC Essential Standards, National Service

Framework requirements, NICE recommendations/guidance and local performance standards.

(vi) Review Serious Untoward Incident and Child/Adult Safeguarding Reports

monitoring the relevant action plans to identify areas of learning and change. (vii) Monitor clinical risks, by reference to the Governing Body Assurance Framework

(GBAF), satisfying itself and assuring the Audit Committee that the mitigating actions for each clinical risk identified are reasonable and that action plans are being progressed.

(viii) Ensure commissioned services sustain high quality and patient focused care. (ix) Support a culture of clinical safety. (x) Ensure that the relevant recommendations arising from external and internal

reviews and guidance pertaining to clinical governance, are implemented in an appropriate and effective manner.

4. AUTHORITY The Committee is accountable to the CCG Governing Body and operates within agreed delegated powers. 5. MEETINGS The Committee will meet every two months. Minutes of its meetings will be presented to the next available meeting of the CCG Governing Body in public. Agendas and any papers for Committee meetings will be circulated to members at least five days in advance. A Committee and Governance Officer will attend to formally minute the proceedings. 6. MEMBERSHIP

(i) Membership of the Clinical Scrutiny Committee comprises: Lay Members CCG Chair Chief Officer Chief Nursing Officer GP Members of the Governing Body Practice Manager Members of the Governing Body

(ii) The CCG Chair will Chair the Committee

(iii) Others, for example Chief Officers and Associate GP’s may be asked to attend meetings of the committee to discuss specific agenda items as and when required.

(iv) A quorum shall comprise of at least 4 members one of whom shall be the Lay

Member or Chief Officer and 2 GP members.

In the absence of the Chairman, those members present shall choose one member to chair the meeting. Where voting is required and in the event of an equality of votes, the Chairman shall have a casting vote. 7. VIEW The Committee shall review its own performance and terms of reference on an annual basis. 8. AUTHOR Colin Boakes Governance Advisor Date Approved: August 2013

Last Review: August 2016

Next Review:

of 2

GOVERNING BODY

Agenda Item No. 15



Title

Freedom of Information

Lead Chief Officer

Amanda Lyes, Chief Corporate Services Officer

Author(s)

Norman Pottinger, Information Governance and Risk Manager

Purpose

To update the Governing Body on Freedom of Information activity within the CCG








Action required by the Governing Body: The Governing Body is asked to note the report

1. Background 1.1 The Freedom of Information Act 2000, provides a general right of access to information

held by public authorities, including the NHS. Anyone can request information and has the right to be told:

Whether the public authority holds the information, and

If it does, to be provided with the information

The management delivery team handles requests on behalf of both West Suffolk CCG and Ipswich and East Suffolk CCG.

2. Key Points

2.1 This report covers the first three quarters of 2016/17 to the end of December 2016. 2.2 Requests still continue to be received at an average of around 20 per month. Almost all of

these cover both CCGs with only one or two being directed specifically to one or other CCG.

2.3 The majority of requests are answered within the 20 days allowed under the Act, during the

last quarter (October to December) only one request was responded to outside of this timeframe.

2.4 The source of requests remains consistent and the majority still come from requesters

identifying as members of the public. It is likely however that a large proportion of these are actually journalists, or people making requests on behalf of commercial organisations.

Interest groups are also responsible for high numbers of requests and patterns seem to develop depending on what is being reported in the newspapers and on TV.

The media (local and national) also make a number of requests, again generally related to issues currently being discussed by parliament or other media sources.

2.5 The main topics relate to the commissioning of services by the CCGs, and also financial

questions relating to allocation of resources. 2.6 A graphic representation and a table accompany this report.

3. Future Action

3.1 The information governance and risk manager will continue to manage the responses to requests for information received under the legislation.

FOI requests received for period 01/10/2016 to 31/12/2016

Total number of FOI requests received

I&ESCCG & WSCCG 57 I&ESCCG only 0 WSCCG only 1

58

Answered within 20 days 49 Not answered within 20 days 1 Not due for response 8

58

Source of request

Commerical Healthcare 3 Education 0 General Business 3 Healthcare Media/Publication 0 Interest Group 13 Local Media 3 Members of Public 16 MP 7 National Media 11 Professional Body 1

58

Type of information request

Commissioning 16 Contracts 3 Financial 12 HR 3 ICT 4 Other 7 Prescribing 7 Treatements/Tariff 6

58

Main directorate responsible

Chief Nursing Office 6 Chief Operating Office 19 Contracts Office 15 Corporate Services 6 Finance Office 9 Other 0

58

FOI Requests received 2016/2017

0

10

20

30

40

50

60

70

80

90

Qtr 1 (April - June) Qtr 2 (July - September) Qtr 3 (October - December) Qtr 4 (January - March)

2013/14

2014/15

2015/16

2016/17

of 2

GOVERNING BODY

Agenda Item No. 16



Title

Governing Body Assurance Framework

Lead Chief Officer


Author(s)

Norman Pottinger, Information Governance and Risk Manager

Purpose

To provide the Governing Body with the updated CCG Governing Body Assurance Framework (GBAF) document for January 2017








Action required by Governing Body: The Governing Body is requested to review and approve the updated GBAF for January 2017

of 2

1. Background

Content of the GBAF is reviewed by the Chief Officers Team every month and by the Governing Body and Audit Committee at each of their meetings.

2. Key Points 2.1 Further to review by the Chief Officers Team, the following amendments/additions have

been incorporated:

Risk 24 A&E failing to meet 4 hour standard presenting a potential risk to patient safety and experience.

Actions 2 and 3 revised Additional action (number 5) added Amended key controls

Risk 27b Poor performance of mental health services Action number 3 revised

Governing Body Assurance Framework and

Action Plan

2016 - 2017

Version Control:

MONTH

VERSION No

REVIEWED BY

SUMMARY OF CHANGES

April 2016

37

COT 18 April 2016 Clinical Scrutiny Committee 27 April 2016

Approved

May 2016

38

COT 16 May 2016

Governing Body 25 May 2016 Audit Committee 7 June 2016

Approved

June 2016

39

COT 20 June 2016

Approved

July 2016

40

COT 18 July 2016 Governing Body 27 July 2016

Approved

August 2016

41

COT 15 August 2016

Clinical Scrutiny Comm’ 24 August 2016 Audit Committee 6 September 2016

Approved

September 2016

42

COT 15 September 2016

Governing Body 28 September 2016 Audit Committee 4 October 2016

Approved

October 2016

43

COT 10 October 2016 Clinical Scrutiny Comm’ 19 October 2016

Approved

November 2016

44

COT 14 November 2016

Governing Body 30 November 2016 Audit Committee 6 December 2016

Approved

December 2016

45

COT 5 December 2016 Clinical Scrutiny Comm’ 14 Dec 2016

Approved

January 2017

46

COT 16 January 2017

February 2017

47

March 2017

48

Board Assurance Framework

Overview

The Governing Body Assurance Framework (GBAF) provides the NHS West Suffolk Clinical Commissioning Group (CCG) with a simple but comprehensive method for the effective and focused management of risk. Through the GBAF the CCG Governing Body gains assurance that risks are being appropriately managed throughout the organisation. The GBAF identifies which of the organisation’s strategic objectives may be at risk because of inadequacies in the operation of controls, or where the CCG has insufficient assurance. At the same time it encompasses the control of risk, provides structured assurances about where risks are being managed and ensures that objectives are being delivered. This allows the Governing Body to determine how to make the most efficient use of resources and address the issues identified in order to improve the quality and safety of care. The GBAF also brings together all of the evidence required to support the Annual Governance Statement. The GBAF should be seen as a working document and will be updated regularly by the Chief Officers Team, monitored by the Audit Committee and reported to the Governing Body at each of its meetings. The GBAF is linked to the CCG Risk Register, the content of which is also provided for review by the Chief Officers Team. A flow chart setting out how risks are identified and managed is set out overleaf. In order to ensure consistency in the risk assessment process, the likelihood and consequences of all risks on the Risk Register are assessed against the former National Patient Safety Agency (NPSA) 5X5 risk matrix and those scoring 15 and above migrate to the GBAF and thereby inform the Governing Body agenda. Once added to the GBAF, a risk should remain in place until its RAG rating has been mitigated to a score of 1-6 when it is considered manageable and therefore no longer a strategic concern. The 5X5 risk matrix and subsequent red, amber, green (RAG) score identify the level at which identified risks will be managed within the organisation. It also assigns priorities for remedial action, and determines whether risks are to be accepted on the basis of the colour bandings and risk ratings. In terms of evaluation of effectiveness, the RAG rating system is also used to present how well the agreed controls are operating.

RISKS IDENTIFIED THROUGH:

External Assessment &

Audit + Guidance & Alerts

Serious Incidents, Complaints, Public Health &

Quality Issues

Public & Stakeholder

Engagement

Business & Service Delivery

Plans

CCG Governing

Body Own & Manage Risks & the Chief

Officers Team Reviews the Risk

Register/GBAF

Governing Body

Assurance Framework

Overview & Scrutiny by

the Audit Committee

Assurance to the

Governing Body

Individual Risks Jointly Managed by Designated Chief

Officers & Clinical Leads

Work Stream Risk

Assessments

Review by Clinical

Scrutiny Committee

RAG Score Framework

Likelihood score → 1: Rare 2: Unlikely 3: Possible 4: Likely 5: Almost Certain

Consequence score ↓

5: Catastrophic 5 10 15 20 25

4: Major 4 8 12 16 20

3: Moderate 3 6 9 12 15

2: Minor 2 4 6 8 10

1: Negligible 1 2 3 4 5

The subsequent red, amber, green (RAG) scores identify the level at which identified risks will be managed within the organisation. It also assigns priorities for remedial action, and determines whether risks are to be accepted on the basis of the colour bandings and risk ratings. In terms of evaluation of effectiveness, the RAG rating system is also used to present how well the agreed controls are operating within the following classifications:

RAG Score

Progress

Risk Assessment

Revising Risk Ratings

CRITICAL (15-25)

There may be significant gaps in controls to ensure effective management.

Controls are in place but insufficient resources

Controls are in place but external forces may be preventing progress.

There are insufficient controls in place to address the cause or source of the risk

Controls are considered insubstantial or ineffective

Controls are being implemented but are not yet in place

If this risk were to materialise, the situation could be irrecoverable in terms of the CCGs reputational/financial well being and or service continuity.

If controls are inadequate then the revised risk rating increases

If controls are uncertain, the revised risk rating stays the same as the original risk rating

If they are perceived as adequate, then the revised risk rating decreases

CHALLENGING (8-12)

Progress is being made but there is concern that the objective may not be achieved. Additional controls or management action is being taken to improve the likelihood of success.

There are few controls in place, which are considered substantial and/or effective and address the cause of the risk. The consequences of the risk materialising, though severe, can be managed to some extent via contingency plans.

MANAGEABLE (1-6)

Progress is being made in accordance with plans. There are no significant concerns.

The risk is considered to be small and there are sufficient controls in place which address or substantially effective the cause of the risk. The consequences of the risk materialising can be managed via contingency plans.

In order to determine the likely consequence arising from an identified risk and using the 5X5 matrix:

Define the risk explicitly in terms of the adverse consequence or consequences that might arise

Use the table below for examples, by risk domains, to determine the consequence score relevant to the risk identified

Consequence score (severity levels) and example of descriptions

1 2 3 4 5

Risk Domains Negligible Minor Moderate Major Catastrophic

1. Impact on the safety of patients, staff or public (physical/psychological harm)

Minimal injury requiring no/minimal intervention or treatment. No time off work

Minor injury or illness, requiring minor intervention Requiring time off work for >3 days Increase in length of hospital stay by 1-3 days

Moderate injury requiring professional intervention Requiring time off work for 4-14 days Increase in length of hospital stay by 4-15 days RIDDOR/agency reportable incident An event which impacts on a small number of patients

Major injury leading to long-term incapacity/disability Requiring time off work for >14 days Increase in length of hospital stay by >15 days Mismanagement of patient care with long-term effects

Incident leading to death Multiple permanent injuries or irreversible health effects An event which impacts on a large number of patients

2. Quality/complaints/audit

Peripheral element of treatment or service suboptimal Informal complaint/inquiry

Overall treatment or service suboptimal Formal complaint (stage 1) Local resolution Single failure to meet internal standards Minor implications for patient safety if unresolved Reduced performance rating if unresolved

Treatment or service has significantly reduced effectiveness Formal complaint (stage 2) complaint Local resolution (with potential to go to independent review) Repeated failure to meet internal standards Major patient safety implications if findings are not acted on

Non-compliance with national standards with significant risk to patients if unresolved Multiple complaints/ independent review Low performance rating Critical report

Totally unacceptable level or quality of treatment/service Gross failure of patient safety if findings not acted on Inquest/ombudsman inquiry Gross failure to meet national standards

3. Human resources/ organisational development/staffing/ competence

Short-term low staffing level that temporarily reduces service quality (< 1 day)

Low staffing level that reduces the service quality

Late delivery of key objective/ service due to lack of staff Unsafe staffing level or competence (>1 day) Low staff morale Poor staff attendance for mandatory/key training

Uncertain delivery of key objective/service due to lack of staff Unsafe staffing level or competence (>5 days) Loss of key staff Very low staff morale No staff attending mandatory/ key training

Non-delivery of key objective/service due to lack of staff Ongoing unsafe staffing levels or competence Loss of several key staff No staff attending mandatory training /key training on an ongoing basis

4. Statutory duty/ inspections

No or minimal impact or breech of guidance/ statutory duty

Breech of statutory legislation Reduced performance rating if unresolved

Single breech in statutory duty Challenging external recommendations/ improvement notice

Enforcement action Multiple breeches in statutory duty Improvement notices Low performance rating Critical report

Multiple breeches in statutory duty Prosecution Complete systems change required Zero performance rating Severely critical report

5. Adverse publicity/ reputation

Rumours

Potential for public concern

Local media coverage – short-term reduction in public confidence Elements of public expectation not being met

Local media coverage – long-term reduction in public confidence

National media coverage with <3 days service well below reasonable public expectation

National media coverage with >3 days service well below reasonable public expectation. MP concerned (questions in the House) Total loss of public confidence

6. Business objectives/ projects

Insignificant cost increase/ schedule slippage

<5 per cent over project budget Schedule slippage

5–10 per cent over project budget Schedule slippage

Non-compliance with national 10–25 per cent over project budget Schedule slippage Key objectives not met

Incident leading >25 per cent over project budget Schedule slippage Key objectives not met

7. Finance including claims

Small loss Risk of claim remote

Loss of 0.1–0.25 per cent of budget Claim less than £10,000

Loss of 0.25–0.5 per cent of budget Claim(s) between £10,000 and £100,000

Uncertain delivery of key objective/Loss of 0.5–1.0 per cent of budget Claim(s) between £100,000 and £1 million Purchasers failing to pay on time

Non-delivery of key objective/ Loss of >1 per cent of budget Failure to meet specification/ slippage Loss of contract / payment by results Claim(s) >£1 million

8. Service/business interruption

Loss/interruption of >1 hour

Loss/interruption of >8 hours

Loss/interruption of >1 day

Loss/interruption of >1 week

Permanent loss of service or facility

9. Environmental impact

Minimal or no impact on the environment

Minor impact on environment

Moderate impact on environment

Major impact on environment

Catastrophic impact on environment

RISK NUMBER: 02 DATE RISK ADDED:

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DESCRIPTION OF STRATEGIC RISK

GRANULAR OPERATIONAL RISKS

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KEY CONTROLS ESTABLISHED

ASSURANCE OF CONTROLS

RAG RATING OF

GAPS IN CONTROLS

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ACTION POINTS & TARGET DATES FOR

COMPLETION

L

M +

CB

Failure to achieve financial balance in 2016-17, secure financial sustainability from 2017/18 and deliver optimum service from the financial resources available

Failure to achieve financial balance in 2016-17.In 2015-16 the CCG delivered the mandated surplus through the use of a number of non-recurrent items such as Contingency and Transformation funding. The CCG has not addressed the underlying recurrent deficit.

In 2016-17 the CCG have a QIPP target of approximately £13.98m, of which £5.6m was unidentified at the beginning of the financial year.

Addenbrookes move to National Tariff increases the risk of failure to deliver.

Increasing demand in acute Trusts activity. Providers require extra financial support to maintain or meet clinical quality and contractual standards.

Increase in prescribing costs.

Cost pressures from Continuing Healthcare activity specifically the nationally agreed 40% increase in Funded Nursing Care prices.

4x5

20

Project management approach to delivery of the QIPP plans. PMO in place

Continue to benchmark and horizon scan to identify further QIPP opportunities.

Focus on activity levels at acute provider with clear actions to mitigate against over performance

West Suffolk FT maximum contract value agreed reduces the level of risk in year only

Close monitoring of the delivery of QIPP initiatives through KPI’s

Encourage innovative changes to improve efficiency

Participation in regional and national discussions

Clinical Executive and Governing Body review of expenditure and significant investments

Market Management Workstream

Review progress on the system implementation on a regular basis through Finance & Transformation Meetings with WSFT. Any escalated issues will be raised at the contract monitoring meeting /

COT

Project managers appointed

GP engagement

Governing Body

NHS England performance reviews

Internal & External Audit

Monthly SLA provider meetings

Finance & Performance Committee

Turnaround Director Appointed

CCG PRIORITY:

Deliver financial sustainability

Integrated performance report area. Finance and Performance

█

CHALLENGING

4x5

20

4x5

20

1. Finance Risk Summit to identify further QIPP and prioritise work

Target: End of April 2016 Completed

2. Prioritise work 16/17

Target: End of April 2016 Completed:

3. QIPP project management, tracking and prioritisation

Target: Tracking part of monthly reporting process Completed:

4.Prioritisation CHC Project board milestones

Target: Monthly review Completed:

5. Monthly identification of risks and opportunities

Target: Monthly review Completed:

6. Financial Recovery Plan Target: Plans in place by end of June then ongoing monthly reporting

Target: June 2016 Completed: Draft Completed

CEO: CEO meeting.

Draft Financial Recovery plan submitted to NHS England to mitigate overspends.

8. Negotiate contract values with WSFT and Addenbrookes to reduce risk.

Target: Resolve before the end of the April 2016 Completed

9. Develop short term and medium term Financial Recovery Plans

Target: Mid July 2016 Completed: Draft Completed

See following sheet for next risk

RISK NUMBER: 06 DATE RISK ADDED: NOVEMBER 2012

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COMPLETION

BM

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B

Failure to achieve national mandatory local reduction trajectories for Clostridium difficile as set out in NHS England: Clostridium difficile objectives for NHS organisations in 2016/17 and guidance on sanction implementation. (Failure to achieve outcome ambition 7: ‘making significant progress towards eliminating avoidable death in our hospitals caused by problems in care’ set out in : NHS England Everyone Counts: Planning for patients 2014/15 to

Primary Care Staff ownership of non-acute episodes of CDI for clinical review and shared learning for practice improvement and across all CCG Primary Care Providers.

Lack of Community IPC Lead

Lack of capacity in acute provider to cover implementation of IPC standards within the community provider

The CCG IPC Lead conducting themes and trend analysis of non-acute episodes of CDI

CCG IPC Lead attendance at all acute onset PIRs

CCG Medicines Management Team in collaboration with the IPC Lead in supporting antibiotic prescribing in Primary Care CCG IPC Lead monitoring antibiotic prescribing in Acute

4x4

16

Robust RCA/PIR process for each provider case and submitted to CCG for assessment.

Audit programme of CQC recommended IPC standards (to include antibiotic prescribing) in all CCG commissioned services

CCG attendance at PIR reviews and IPC Committee meetings

Provider delivery of targeted infection control education and audit in all CCG commissioned services.

16/17 trajectory agreed in SLA – ceiling for 16 Acute cases and 29 non-acute cases (45 in total)

Bi-monthly reviews of PIR findings at Infection Prevention Network

External scrutiny provided

Monitoring of PIR process and audit results at QRG evidencing the standards are being met

Minutes of HCAI Reduction Network available to Chief Nursing Officer

System wide action plan updated in line with PIR outcomes with bimonthly review at HCAI Reduction Network, demonstrating implementation of detailed actions

CCG scrutiny of CDI cases reported within the PHE data capture system

INTERNAL AUDIT PLAN:

4.2 Monitoring of Contracts ; 1.4 Clinical Quality – Overview

Work in collaboration with system to implement recommendations from C diff PIRs.

█

CHALLENGING

3x4

12

3x4

12

1. Annual Review of CCG Infection Prevention Strategy

Target: May 2016 Completed: June 2016

2. Annual Review of HCAI Reduction Network priority focuses. Awaiting HCAI Network approval

Target: July 2016 Completed: July 2016

3.Annual review of IPC Lead work plan


4. CDI Reduction plan to be reviewed and updated. Delay pending meeting.

Target: July 2016 Completed: September 2016

5. CDI Reduction plan to be implemented Updated, now out for consultation Implementation Target now October 2016

Target: October 2016 Completed:

6. Develop information pack for GP in collaboration with prescribing work stream and pass to Medicines Management for progression

Target: January 2016 Completed: February 2016

Care via PIR process audit results and minutes of Antimicrobial Stewardship Committee

by Public Health England

Key learnings shared at primary care training sessions

Acute providers sharing learning from PIRs with relevant clinicians.

CCG PRIORITY:

To ensure high quality local services

Integrated performance report area. Clinical Quality and Patient Safety

6 Roll-out of CDI RCA Tool for community onset CDI

Target January 2016 Completed: February 2016

7. Roll out of IP training for PBIP Leads


8. PBIP Lead Network to be set up to share learning from RCAs and other IP issues.

Target: October 2016 Completed: September 2016

9. Development and piloting of an Antibiotic Stewardship Audit Replaced with submission of ABX CQUIN Part B

Target: September 2016 Completed: September 2016


RISK NUMBER: 20 DATE RISK ADDED: MAY 2014

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COMPLETION

RW

+ S

A

Failure to redesign and commission services covered by the Urgent Care and Health and Independence reviews within required timescales

Potential for services to fall out of contract

Risk that the full potential benefits of a transformational redesign are not met leading to patient care being adversely affected and inefficiencies in the system

Reputational damage to commissioners

4x4

16

Contracts in place with the Consortium (West Suffolk Hospital, Ipswich Hospital and Norfolk Community Services) for adult and children’s community services plus extension of contract to 111 and Out of Hours with Care UK all running to October 2017.

Redesign of core components of the Urgent Care and Health and Independence Review underway since mid-2015 such as development of Connect East Ipswich, creation go Crisis Action Team and Frailty Assessment Base at Ipswich Hospital.

Clinical Executive considered and agreed approach to wider redesign of services for commissioning by October 2017 in November 2015.

Programme staff recruited to and project

COT review

Executive Group review

Health & Wellbeing Board review

Governing Body Review

Area Team Strategic Plan Review

CCG PRIORITY:

Demonstrate excellence in patient experience and patient engagement

Improve the health and care of older people

Improve access to mental health services

Improve health and wellbeing through partnership working

Deliver financial sustainability through quality improvement

Integrated performance report area.

█

CHALLENGING

3x4

12

3x4

12

1. Contingency plans to be developed and approved

Target: September 2014 Completed: Yes Sept 2014

2. Contingency plans to be implemented

Target: December 2014 Completed: Yes December 14

3. Complete 1+1 procurement and extensions

Target: June 15 (On track) Completed: Yes July 2015

4. Submit vanguard bid for collaborative arrangement

Target: Feb 2015 Completed: Yes Feb 2015

5. Agree next steps on vanguard work with system

Target: April 2015 Completed: YES April 2015

6. Develop Shadow ICO Board

Target: Oct 15 Completed: Yes

7. Agree scope and approach to redesign of 1+1 contracts

Target: Nov 15 Completed: Yes Nov 15

8. Develop project plan for redesign of 1+1 services by Oct 2016

T

plan in development.

Associate Director Redesign leads agreed for each component part of the work programme and a fortnightly delivery group meeting involving all parts of the two CCGs in place.

Task and finish groups set up with wider system partners for each of the component parts of the programme to develop the clinical models and specifications.

Clinical Workstream Target: Mid Jan 2016 Completed: Yes

9. Commence clinical workshops for development of models of care for – children, proactive services and reactive services

Target: February 2016 Completed: Commenced Jan 2016

10. Development of financial model and business case

Target: September 2016 Completed: Yes Sept 2016

11. Approval of clinical models , financial model and commissioning approach by the Clinical Executive

Target: October 2016 Completed: Yes Oct 2016

12. Approval of contract award for Integrated Urgent Care Service

Target: April 2017 Completed:

13. Approval of contract award for community services

Target: September 2017 Completed:


RISK NUMBER: 24 DATE RISK ADDED: JANUARY 2015

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COMPLETION

JT

+ S

A

A&E failing to meet 4 hour standard presenting a potential risk to patient safety and experience.

Clinical risk of patients not being seen in appropriate timescales or insufficient beds to accommodate appropriate environments.

Risk of patient experience deterioration due to long waits.

Risk of breaching constitutional obligations.

4x3

12

Where required, daily system wide teleconferences designed to ensure all actions to improve patient flow are taken

Team of escalation managers in place to support system and directors on call.

Service review completed - on site - transformation programme

Implementation of new A&E Board as per NHSE guidance

Recovery trajectory: Apr 17 - 95%

Daily performance information monitored, regular discussions and monthly formal contract meetings.

CCG PRIORITY:

Improve health and wellbeing through partnership working

Integrated performance report area. Contractual Performance

█

CHALLENGING

3x4

12

3x4

12

1. Continued close working across the health system with the intention of improving 95% performance for future months throughout 2016/17 contract year

Target 95% to be met monthly: Completed: Remedial Action Plan with recovery trajectory and associated actions in place with WSFT to enable achievement of target by October 2016

2. Complete actions from A&E Delivery Board Action Plans:

a. Improve streaming options in A&E

b. Improve NHS111 call triage and streaming to clinicians

c. Improve ambulance triage and streaming to alternative responses

d. Improved patient flow within the hospital

e. Improved discharge from hospital

Target: March 2017 December 2016 update: Actions are monitored monthly by the A&EDB. Completed:

3. Contracting to seek assurance

at SLA meetings

T

Target: Review monthly Completed: Ongoing agenda item at contracting meetings

4. New A&E Board to replace SRG

Target: September 2016 Completed: First meeting taken place

5. Flow Action Group (FLAG) launched at WSFT with system Task Force support to delivery SAFE to improve internal flow and discharge (Dec 16)

Target: Feb 2017 Completed:


RISK NUMBER: 27a DATE RISK ADDED: July 2015 (Renumbered January 2016)

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Potential impact of service quality delivered by NSFT CQC Inspection report February 2015 highlighted serious concerns in service quality and rated the Trust inadequate overall Trust internal mock CQC inspection report identifies that the Trust has failed to make significant improvement in areas of concern identified in the CQC inspection report of February 2015 Monitor concluded investigation into Trust finances in June 2015 and notes breach of license – Potential for actions to address presenting compromise to quality of services CQC Re-inspection report October 2016 gave the Trust an overall rating of requires improvement,

Reduction in quality of service and inability to meet performance and clinical quality targets

Maintaining safer staffing levels in accordance with NICE & NQB guidance

Adverse financial position may impact adversely on the quality of care delivered

Potential increase in contract issue log referrals

4x4

16

Monthly meetings to review / challenge quality performance

On-going development of quality dashboard

Attendance at monthly stakeholder assurance meetings led by NHS Improvement / CQC

Oversight of quality improvement plans (trust / local) and monthly monitoring of progress by quality team and workstream

Support for NSFT mock CQC inspections and feedback

Announced and Unannounced quality improvement visits

Sign off provider CIPs and associated QIAs

Monitor primary care contract issues and Trust response

Demonstrated improvement against identified contractual key performance indicators evidenced through quality dashboard escalation of issues via SLA meetings

Confidence that NSFT have structures in place to deliver the required quality improvements

Assurance that actions detailed in the quality improvement plan have been implemented

Test that actions detailed in the quality improvement plan have resulted in changes at an operational level

To ensure that CIP schemes do not have an adverse impact on quality

Timely response to

█

CHALLENGING

4x4

16

4x4

16

1. Regular quality review meetings to review performance against defined key performance indicators throughout 2016/17

Target March 2017 Completed: August 2016

2. Support NSFT to develop a visual quality dashboard promoting visual assessment of performance against agreed thresholds and allowing trends to be identified. Scrutiny on data quality/accuracy (Lorenzo implementation at monthly QRG)

Target: : Monthly Completed: June 2016

3. CCG attendance at monthly stakeholder assurance meetings to review and challenge progress to deliver quality improvements

Target: Monthly Completed: March 2016

4. Review of progress against quality improvement plans (Trust / Local) prior to each quality review meeting throughout 2016/17

Target: March 2017 Completed: August 2016

T

however “Are services safe” continued to be rated as inadequate.

contract issues with effective learning reducing numbers

Joint review of plans to act on the areas of concern identified in the Trust mock CQC inspection report.

CCG PRIORITY:



5. Schedule quality improvement visits to Suffolk based NSFT services organised and currently ongoing review programme

Target: May 2016 Completed: May 2016

6. Schedule meeting to gain assurance of robust process to sign off CIPs and to review QIAs associated with the CIPs to assess potential negative impact on quality

.

Target: September 2016 Completed: July 2016

7. Provide clarity of CCG Mental health / Learning disabilities commissioning strategy, implement Transforming Care Programme, Review in June 2016

Target: June 2016 Completed: March 2016

8. Support NSFTs mock CQC inspections planned for 2016, review June 2016

Target: June 2016 Completed:

9. Alignment of quality and SLA meetings to allow lead GP attendance – review June 2016

Target: June 2016 Completed: June 2016

10. Gain assurance that the trust has robust plans to improve the concerns identified through the mock CQC inspections, in a timeframe to ensure compliance before the next CQC inspection, Monitor Work Plan and review June 2016

Target: June 2016 Completed: June 2016

11. Expand contractual reporting requirements based on findings of October 2016 CQC report

Target: November 2016 Completed:

12. Monitor progress against Trust quality improvement plan post October 2016 CQC report.

Target: November 2016 Completed:


RISK NUMBER: 27b DATE RISK ADDED: January 2016

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RAG RATING OF

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COMPLETION

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Poor performance of mental health services

There was an absence of performance data between May and September due to the roll out of Lorenzo, the Trust’s new information system

Performance against a number of key areas has fallen significantly in this period

Key areas such as the access and assessment team (AAT), 7 day follow up for inpatients, memory assessment services, care plan reviews and overall waiting times have deteriorated

Service Users are not receiving timely interventions

4x4

16

Contract Performance

Notices for AAT, 7 day follow up and care plans issued. RAPs to be agreed

Information Notices issued on data completeness and data quality

Exception Notices issued for AAT, CMAS, CPA (completion date column amended to reflect this)

Reported to the

workstreams, Clinical Executive and Governing Body as appropriate

CCG PRIORITY:



█

CHALLENGING

3x4

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3x4

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1. AAT Recovery

Target: December 2016 November unvalidated data suggests the Trust is behind trajectory to recover performance in December 2016. A revised plan will be requested 2. CMAS Joint Review

Target September 2016

Update 10/16: Underway, timeline extended and due to report Oct 2016 Completed: Review complete pathway revisions to be finalised by March 2017. 3. CPA 12 Month Review

Target: November 2016

CPA reviews at standard. Non CPA review November unvalidated data suggests the recovery trajectory has been missed at 87.9% compared to the standard of 95%. A revised plan will be requested. Completed:

T

impacting on their health and wellbeing.


RISK NUMBER 31 DATE ADDED October 2016

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DESCRIPTION OF

STRATEGIC RISK

GRANULAR

OPERATIONAL RISKS

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KEY CONTROLS

ESTABLISHED

ASSURANCE OF

CONTROLS

RAG RATING

OF

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CONTROLS

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ACTION POINTS &

TARGET DATES FOR

COMPLETION

BM

c

High risk that patient

safety standards will

be compromised due

to issues that have

been experienced by

West Suffolk

Hospital NHS

Foundation Trust

following the

implementation of e-

care.

WSFT have experienced

more patients exceeding

referral to treatment

standards:

18 weeks

2 week wait – cancer

patients

31 / 62 day standards –

cancer patients

Since e-care

implementation.


more patients exceeding

the 4 hour wait standard

in A&E since the

implementation of e-care

and have reported that

more neutropenic

patients failing to receive

antibiotics within 1 hour of

arrival and that they are

failing to meet certain

stroke standards due to

4 x 4

16

WSFT internal reporting

reviewed to gain

oversight of all

reportable quality

metrics.

Referral to treatment

times regularly

discussed at contractual

meetings

RCA’s completed for all

patients breaching

referral to treatment time

standards (2ww, 31/62

day standards, 18

weeks)

Detailed RCA’s

completed for all cancer

patients waiting over 100

Reporting to WSFT

those quality metrics

that have not been

reported.

Number of patients

waiting in excess of

the referral to

treatment standards

decreases

Patients are not

experiencing harm as

a result of waiting in

excess of the

standard waiting

times

Patients are not

experiencing harm as

a result of waiting in

excess of the

█

CHALLENGING

3 x 4

12

3 x 4

12

Issue raised at quality

meeting in September and

WSFT stated all the efforts

regarding providing a

validated position

Target: Sept 2016

Completed: Sept 2016

RCAs reviewed at each

monthly quality meeting

Target: Sept 2016


Review of complaints /

PALs issues at each

monthly quality meeting

Target: Sept 2016


Continued failure to produce

data to confirm risk to be

escalated as per contractual

routes

Target: October 2016

Completed:

T

issues operational issues

within A&E.


issues reporting against

all the contractual quality

indicators. They are

therefore unable to

provide assurance

internally or to the CCG

that patient safety and

quality standards are

being robustly monitored

and maintained.

days to receive definitive

treatment

As per NHSE guidance.

Review of complaints /

PALs issues to monitor

for patient harms

resulting from delays in

treatment

Contractual performance

levers

standard waiting

times

No evidence that

patients are reporting

experiencing harm

due to prolonged

waiting times

Priority - To ensure

high quality local

services

IPR – Contractual

Performance

3.If RTT failure confirmed

then formal remedial action

to be requested and

performance managed.as

per contractual terms

Target: November 2016

Completed:

of 40

GOVERNING BODY

Agenda Item No. 17



Title

Minutes of Meetings

Lead Chief Officer


Author(s)

Jo Mael, Corporate Governance Officer

Purpose

The report incorporates for endorsement, minutes and decisions from the following meetings;

a) Audit Committee

The unconfirmed minutes of a meeting held on 6 December 2016. b) Finance and Performance Committee

The confirmed minutes of meetings held on 16 November and 21 December 2016

c) Clinical Scrutiny Committee

The unconfirmed minutes of a meeting held on 14 December 2016 d) CCG Collaborative Group

The unconfirmed minutes of a meeting held on 22 December 2016 e) NHS England-West Suffolk CCG Joint Commissioning Committee

Unconfirmed minutes from a meeting held on 30 November f) Commissioning Governance Committee

Decision from a meeting held on 21 December 2016








Action required by Governing Body: To endorse the minutes as attached to the report whilst noting that ‘unconfirmed’ minutes remain subject to change by the relevant Committee/Group.

Unconfirmed Minutes of a Meeting of the West Suffolk Clinical Commissioning

Group Audit Committee held on Tuesday 6 December 2016 PRESENT Bill Banks - Lay Member for Governance (Chair) Peter Knights - Governing Body Member IN ATTENDANCE Neil Abbott - Head of Internal Audit Colin Boakes - Governance Advisor Mark Game - Head of Accounting and Control Lisa George - TIAA Mark Hodgson - Ernst and Young: External Audit Sarah Learney - Continuing Healthcare Programme Manager (Items 16/100-16-104 only) Lesley MacLeod - Chief Finance Officer Jo Mael - Corporate Governance Officer

16/100 WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed everyone to the meeting and apologies for absence were noted from: Kevin Limn - Tiaa Amanda Lyes - Chief Corporate Services Officer Kevin Bernard - Governing Body Member Melanie Richardson - Ernst and Young: External Audit


No declarations of interest, additional to those already published, were received.

16/102 MINUTES OF THE PREVIOUS MEETING

The minutes of the West Suffolk CCG Audit Committee held on 4 October 2016 were approved as a correct record.

16/103 MATTERS ARISING AND REVIEW OF ACTION LOG

There were no matters arising and the action log was reviewed and updated with comment as follows; 16/092 – Continuing Healthcare – the Audit Committee was advised that complaints and appeals were the responsibility of the CCG’s quality team who provided monthly updates to the continuing healthcare team. 16/095 – Policy on Standards of Business Conduct and Conflicts of Interest – having further questioned the extent of the CCG’s responsibility in respect of declarations of hospitality and gifts by member practices, the Governance Advisor agreed to review the relevant wording of the CCG’s policy note. The Committee was informed that the Local Medical Committee had recently questioned the need for declarations by practice managers. It had now been agreed that such declarations would be voluntary and only required if the role was linked to the CCG, or the practice manager was a partner or shareholder of a business venture. The LMC would be writing to practice managers to clarify the new arrangements.

(The Chair agreed that agenda item 9 (Continuing Healthcare) be taken next).

16/104 CONTINUING HEALTHCARE

The Committee was in receipt of a report which provided an update on continuing healthcare progress. Key points highlighted included;

Since the previous Audit Committee meeting continuing healthcare had been subject to a further internal audit, for which an initial conclusion of ‘limited’ assurance had been reported in relation to the need to carry out reviews of patients in receipt of continuing healthcare funded care. A draft report had been issued for comment with the management response expected to suggest that recognition of the extent of work undertaken by the team be incorporated.

Previously Un-assessed Periods of Care (PUPoC) – dates from NHS England for the next cohort were expected in the near future. Ipswich and East Suffolk CCG’s Clinical Executive had agreed the process for managing the next cohort i.e. using an external provider and the same paper was being presented to West Suffolk CCG’s Executive on 14 December 2016.

The CCG had been informed there would be two quality premiums linked to continuing healthcare for 2017/18. The key performance indicators would be associated to the assessment of cases within 28 days and requirement for 80% of assessments to take place outside the acute setting.

The backlog was currently 40 (down from 924).

The team was experiencing difficulties in obtaining archived medical notes from primary care support services and the matter had been highlighted as a risk. That might impact on the closure of backlog cases within 2016/17.

It was questioned why continuing healthcare QIPP delivery for Ipswich and East Suffolk CCG was so much higher than that for West Suffolk CCG. It was explained that whilst there was no identified reason, the two QIPP schemes associated with completing reviews were being carried out within existing resources (additional staff associated with delivering QIPP had not been recruited due to financial turnaround) and the two schemes associated with commissioning (care home placements or domiciliary packages of care) were subject to market influences and the availability of care. The Committee was advised that a prioritisation process for reviews was currently being developed from both a quality and financial perspective. The Committee noted the report. Having recognised that continuing healthcare progress was reported to various other Committees and the internal audit report would be presented to the next meeting, the Committee agreed that, for the immediate future, there was no need for it to receive further continuing healthcare updates.

16/105 EXTERNAL AUDIT BRIEFING

The Committee was in receipt of a CCG Audit Committee briefing from the

External Auditors which included information on;

Sustainability and Transformation Plans

Governing Culture: practical considerations for the Governing Body and its Committees

Cambridgeshire and Peterborough CCG’s contract with Uniting Care Partnership to provide older peoples and adult community services.

Confirmation by the Treasury that public sector exit packages would be capped at £95,000.

NHS national tariff payment system 2017/18 and 2018/19

Reporting on the gender pay gap. Having noted the upcoming HR and pay changes (Exit Package and Gender Pay Gap calculations) detailed within the briefing, the Committee requested that the Chief Corporate Services Officer be asked to provide assurance to the next meeting that the CCGs’ procedures would be compliant with the latest guidance. External auditors had met with the Chief Finance Officer to consider the forthcoming audit, review risks and determine a timetable. The delivery of QIPP and its impact on the year end position had been identified as a key risk going forward. The Committee noted the external audit briefing.

16/106 INTERNAL AUDIT REPORT INCLUDING PROGRESS IN RESPECT OF

INTERNAL AUDIT RECOMMENDATIONS The Head of Internal Audit presented the internal audit progress report with highlighted points being;

Two internal audit reports in relation to a review of key financial systems and financial reporting and budgetary control had been finalised since the previous meeting and were presented under agenda item 07.

Internal audit was currently making good progress against its annual plan for 2016/17. It was likely that the scheduled internal audit of QIPP would be deferred to February 2017 as whilst the project management office had developed processes, time for the processes to be embedded was required.

No terms of reference had, as yet, been issued for the IT support contract audit.

With regard to progress in respect of internal audit recommendations, the Committee was informed that, whilst some recommendations associated to Individual Funding Requests had been suggested for closure by the Chief Nursing Officer, evidence remained outstanding. It was anticipated that the evidence would be received, and the recommendations closed, prior to the next Audit Committee meeting. The Head of Internal Audit agreed to discuss the acquisition of evidence with the Chief Nursing Officer. Having recognised that ‘limited’ assurance given to budgetary control might have been influenced by the timing of the audits, it was suggested that a review of the audit should be carried out. The Committee noted the content of the report.

16/107 INTERNAL AUDIT REPORTS

The Committee received the following reports from internal audit: Review of Key Financial Systems The assurance assessment for the review of both CCGs’ arrangements resulted in an overall ‘substantial’ assurance level being achieved. The Committee accepted the report. Review of Financial Reporting and Budgetary Control The overall assurance assessment for the review resulted in a ‘limited’ assurance level being achieved. That was because, at the time of the audit, detailed project plans as to how the 2016/17 Financial Recovery Plan would be achieved were not

available. The assurance assessment was questioned by the Committee given than, at the time of the audit, there had been ongoing work to develop the necessary QIPP savings and the in-year budget reporting position was forecasting a balanced outturn. The internal auditors explained that a priority one recommendation had automatically triggered the ‘limited’ assurance level. Since receipt of the report, the CCG’s Deputy Chief Finance Officer had provided internal audit with a response which contained actions to address the recommendations. As discussed previously, the importance of reviewing progress before issue of internal audit’s final opinion was highlighted. The Head of Internal Audit agreed to discuss the timing of a review, together with the scheduling of a QIPP audit, with the Chief Finance Officer outside of the meeting. The Committee accepted the report.

16/108 LOCAL COUNTER FRAUD REPORT

The Committee was in receipt of the latest Local Counter Fraud Report. Key points included;

The report contained information from a recent review of NHS Protects functions and services which, it was explained, were unlikely to affect the CCG’s relationship with Tiaa.

Since the previous meeting, the Local Counter Fraud Specialist had carried out fraud and bribery awareness training for 27 staff. Other training sessions were scheduled.

There had been two new fraud alerts issued regarding PBX/Dial through fraud and HMRC tax rebate scams.

There had been no new referrals to counter fraud. The Committee noted the report.

16/109 GOVERNING BODY ASSURANCE FRAMEWORK (GBAF)

The Committee was in receipt of the current version of the GBAF for review. Amendments and additions were detailed within Section 2 of the report. Concern was raised that a number of action points aligned to risks were historic. Whilst retention of action points to complete an audit trail was required, the need to include agreed future actions and review the need for new actions was highlighted. It was also queried whether, in light of recent performance issues, there might be a need to review the ratings of Risk 24 associated with A&E performance, and Risk 31 associated to the introduction of e-care at West Suffolk Hospital. The Committee noted the report and the Governance Advisor agreed to feedback comments to the Chief Corporate Services Officer.

16/110 INFORMATION GOVERNANCE UPDATE

The Committee was in receipt of a report from the Chief Corporate Services Officer which provided an update on the current position with Information Governance (IG) management. The Committee was re-assured that the CCG was on track to achieve a Level 2 score within all the required elements of the information governance toolkit. The Committee noted the report.

16/111 WAIVERS OF COMPETITIVE TENDERING

No waivers of competitive tendering were received.

16/112 ANNUAL PLAN OF WORK

The Committee reviewed and agreed the annual plan of work as presented. Following suggestion by the Chief Finance Officer, it was agreed that issues identified from the Price Waterhouse Cooper report on the CCG’s governance arrangements and progress against the subsequent action plan be included on the work plan for report to the next meeting.

16/113 ANY OTHER BUSINESS AND REFLECTION

No other items of business were raised. It was felt that the meeting had been conducted satisfactorily and all agenda items dealt with effectively.


The next meeting of the CCG’s Audit Committee was to be held on Tuesday 7 February 2017 at 2.00pm in the Paddock Meeting Room at Rushbrook House.

_____________________________ ______________________ Chairman (Bill Banks) Date

Minutes of WS CCG Finance & Performance Committee held on Wednesday 16 November 2016 from 0900 - 1100

Room 14, Ground Floor, West Suffolk House

PRESENT: APOLOGIES: Dr Simon Arthur, GP Governing Body Member Bill Banks, Lay Member – Governance (Chair) Dr Christopher Browning, GP Governing Body Member and CCG Chair Andy Eley, Deputy Chief Operating Officer Jo Finn, Lay Member – Patient and Public Involvement Ed Garratt, Chief Officer Amanda Lyes, Chief Corporate Services Officer Barbara McLean, Chief Nursing Officer Lesley Macleod, Chief Finance Officer Dr Bahram Talebpour, GP Governing Body Member Jan Thomas, Deputy Chief Officer/Chief Contracts Officer Kate Vaughton, Chief Operating Officer Dr Firas Watfeh, GP Governing Body Member IN ATTENDANCE: Ameeta Bhagwat, Finance Manager Chris Singleton, Head of PMO MINUTES: Jo Wyatt, Office Manager and EA to Chair, COO & DCOO

Kevin Bernard, Governing Body Member Dr Andrew Hassan, GP Governing Body Member Peter Knights, Governing Body Member Richard Watson, Chief Redesign Officer

Item Action 1. WELCOME & APOLOGIES

The Chair welcomed all to the meeting and apologies were noted.

2. DECLARATIONS OF INTEREST

There were no new declarations of interest expressed.

3. MINUTES OF F&P COMMITTEE – 19/10/16

The minutes of the Finance & Performance Committee held on 19/10/16 were reviewed and agreed as a true and accurate record of the meeting.

4. MATTERS ARISING

There were no matters arising from the meeting of 19/10/16.

5. ACTION LOG – 19/10/16

The Chair presented the Action Log, and the following update was provided:

Terms of Reference The CCSO advised that the final Terms of Reference would be presented at the committee on 21/12/16.

6. MONTH 7 FINANCIAL POSITION

The CFO presented the financial position as of month 7. Headlines

Variance from plan At month 7 financial performance is ahead of the Financial Recovery Plan trajectory by £0.7m. However at this point the Recovery Plan forecast an improving position but there is still an in month deficit. Key adverse variances from plan are QIPP schemes in development (£2.5m), Continuing Healthcare (£0.1m) and Prescribing (£0.3m). These are mitigated by the use of Contingency (£0.9m) and underspends in Mental Health & LD Services (£0.2m) Other Programme (£0.3m), Corporate Costs (£0.1m) and Community (£0.1m).

Forecast risks and mitigations Based on the Financial Recovery Plan the CCG currently has a balanced forecast position. Key risks are QIPP Under delivery (£3.5m), Funded Nursing Care national price increase (£0.7m), additional ambulance costs (£0.2m), Property Services Market Rents (£0.8m). These are mitigated by Contingency (£1.5m), Central Property Services Funding (£0.8m), 15/16 Quality Premium (£0.2m), further prior year benefits (£0.2m) and Other Mitigations which the CCG is currently in the process of pursuing (£2.4m).

Underlying surplus / (deficit)

Key drivers are potential under-delivery of QIPP shown as a risk in the current year and therefore at risk recurrently (£4.5m), risks to the current year position that are deemed to be recurrent in nature such as Funded Nursing Care price increase (£0.8m), plus any mitigations in the current year deemed to be non-recurrent such as prior year benefits (£0.8m), Quality Premium (£0.2m).

QIPP Delivery At month 7 the CCG has delivered £4.8m of QIPP against a target £8.1m (post NHSE reporting this position has improved to £5.6m which is 69% delivery). The forecast delivery is £10.5m against a target of £14.0m. Key forecast variances from plan are Budgetary Control (£1.4m), Prescribing (£0.6m), Over the Counter Meds (£0.8m) and Market Management (£0.5m). BB queried why there is an in month deficit. The CFO advised that this is due to QIPP in development and that finance are trying to identify. It was noted that overseas visitors is a cost pressure in the West. Discussions took place in regards to the unidentified QIPP; all members felt that efficiencies need to be identified and the unidentified QIPP has to be eradicated. The CFO stressed that rigour has to be applied to individual expenditure lines. Discussions took place in regards to the GIC; the CFO advised that this contract allows there to be a minimum risk to both the CCG as commissioners and the Acute as a provider. She added that there is a need to work together to drive down demand. It was noted that the Service Transformation Board are working on a number of schemes. With regards to the GIC, it was noted that the Trust are currently £0.5 - £0.75m below plan, and that discussions are on-going in this regard. However, it was noted that the underperformance may be due to e-Care as opposed to actual under performance. BB queried if the relationship between the unidentified QIPP and the QIPP figure is built into next year’s financial plan; further discussions took place in regards to the

QIPP target for next year. It was noted that the figure of £9.5m assumes that we locate one off savings, and that the CCG need to achieve recurring savings of £9.5m by 03/18. Condensed Income & Expenditure Members noted the QIPP schemes in development. The DCO/CCO advised that in regards to the overspend in CHC, if the FNC impact of £0.4m had not occurred the CHC position would be underspent by £1.3m. The DCFO explained the QIPP report on the detailed report. The COO commented that it is easier for the committee to see the actuals, rather than what is presented to NHSE. With regards to Addenbrooke’s, challenges have been made in respect of the invoice validations. Recovery Trajectory The trajectory indicated that the position would continue to deteriorate to a low point of a £2.3m in year deficit at month 7. From month 8 onwards the trajectory shows a stabilisation and steady improvement to a £1.96m deficit by month 9 as the benefits of the additional QIPP schemes and recovery actions are realised with a further acceleration towards breakeven in the final quarter. Progress to Date

The month 7 position is better than the recovery trajectory due to the impact of the recovery actions and QIPP delivery which have begun to stabilise costs in a number of areas. However at this point the Recovery Plan forecasts an improving position but there is still an in month deficit. If the current variance is extrapolated to the end of the financial year the closing position would be an in year deficit of £2.9m which is an improvement of £2m from the month 3 risk adjusted forecast deficit of £4.9m. As the impact of the recovery actions is expected to increase throughout the year this will improve further. Top 10 Variances The CFO requested that the committee focus their attention on the top 10 variances; these were noted by the committee. She added that as much information is being shared with the committee for openness and transparency. Members agreed that the information provided was useful. With regards to the three Acutes being overspent, BB queried if anything can be done. The CFO advised that contractual discussions are on-going with all providers. The COO stressed that conversations need to take place to that there is a push to get those unidentified QIPP identified. It was noted that at the beginning of the year there was an unidentified QIPP of £5.6m, which resulted in a series of lockdown events. It was agreed that the areas that require a deep dive be identified and discussed at future committees. The DCO/CCO commented that difficult conversations may need to take place in respect of the £2.5m challenge, and the CCG may have to make radical decisions. She added that whilst Demand Management is working on this, but there may be decisions made such as suspension of non-elective emergency surgery or prescribing holidays. SA commented that suspending non-elective emergency surgery will produce a back

log for next year. The DCFO advised with regards to the £750k due from the Trust, there is a risk that this will not be forthcoming. The CO queried that in regards to the recovery trajectory, what are the things that are going to deliver that trajectory, and if they are not achievable then we do need to take actions. He also queried if the actions we have in train are achieving. The DCO/CCO advised that in regards to the fines from Addenbrooke’s, they have now signed off their STF totals, which therefore means that the fines are effectively off the table. This has left a hole of a £0.25m and assumptions had already been made that this will not come to fruition. The COO commented that the review of QIPP should be a continuous process and not just be reviewed at this committee. The CFO advised that we will not go into 17/18 with unidentified QIPP; if we have then we will be absolutely clear about our plans to identify that QIPP. She stressed that we have to have accountability and ownership before we go into the next financial year. BB queried if there is a process or a workshop in place to actively identify savings that haven’t already been identified. He added that there needs to be a structure, with the right group of people to work on this. The DCO/CCO advised that this links in with the rebuilding of the PMO. The CO suggested that a workshop be organised for 23/11/16; members agreed. CS advised that a “menu of opportunities” has been circulated by NHSE in regards to ideas generation. It was noted that schemes are being worked up with the Acute. The COO advised that she attended a Right Care Workshop on 15/11/16, where delegates were advised that 40% of the Right Care data pack has to be achieved. NEE also attended the workshop and brought ideas to the table. JF suggested that the CCG follow through on some of the ideas suggested by members of the public in regards to the IVA/MVA consolation. The CO agreed, and suggested that this be looked at during the workshop on 23/11/16. The CFO advised that I&E in year position is looking positive, but added that they are further ahead in the process. It was noted that feedback from NHSE in respect of our plans for next year is that both CCGs have been flagged red and amber in regards to QIPP. It was noted that C&Ps QIPP target is 6.5%, and ours is 3.1%. The regulator potentially will see this has not high enough. The CCG have to demonstrate that we are getting a grip and increasing pace. The DCO/CCO commented that discussions need to take place in regards to resources, as there is not enough West specific staff, particularly in Planned Care. She added that the team has been decimated due to internal opportunities. There is not enough resource in the West. It was agreed that discussions in this regard take place at COT. SA commented that when looking at East successes, these should be replicated in the West, particularly in regards to clinical successes. However, he added that we are never going to have efficiencies in the system if we don’t change demand, patient habits etc. The CFO advised that in regards to the 17/18 plan detail is being awaited in regards to the transformational and transactional change coming out of STP.

FW agreed with SA, querying how much control does the CCG have in respect of the Acute as it is an on-going issue. The COO advised that we are much better placed now than other parts of the system, and reminded members that there is a Portfolio Board in place. The Chair thanked the CFO for the paper. The Committee noted the paper.

8. QIPP

CS presented members with the Month 7 QIPP report, reminded members of the two RAG ratings. It was noted that MDTs are to re-start in regards to the Top 8 areas. It was noted that medicines management have put all schemes in place but are not delivering. It was noted that in respect of prescribing over the counter drugs, the public appear to be very keen on this so this may be work further work. BB commented that given the high risk of QIPP delivery, and the high degree of certainty that these will fail, this will mean that the amount will be higher. CS advised that health checks are being undertaken on all schemes, and that a degree of rigour is being applied in respect of adjustments. CS advised that there is currently a lack of capacity within PMO, but that two posts have been recruited to. The CO commented that there needs to be a dashboard with scheme by scheme detail. CS presented members with an update on the PMO. The COO commented that we all have a role to play in the process and need to shift our mind set and ensure that this is the direction of travel we do go in. The Chair commented that there needs to be sight of the Turnaround Directors Final report; the CO advised that this report will be brought to the Workshop on 23/11/16. The Chair thanked CS for the report. The Committee noted the report.

7. DRAFT FINANCIAL PLAN 2017/18 – 2018/19

It was noted that a summary of this draft report was taken to the Executive on 09/11/16. 1046 – AE left the meeting. The following headlines were noted: Control Target The plan meets the control targets set by NHS England for both 2017/18 and 2018/19. By the end of 2018/19 the planned cumulative surplus meets the 1% Business Rule. Efficiency Savings The savings target is £9.4m in 2017/18 and £9.4m in 2018/19. 1% Non-Recurrent Fund The plan meets the requirement for a 1% Non-Recurrent Fund with half of the fund uncommitted in each year as part of the national Risk Pool. Provisional commitments against the balance are:

£0.8m - GP 5YFV £3 per head (£0.3m in 2017/18, £0.5m in 2018/19)

£1m - Dual running and set up costs required for STP solutions in 2017/18.

Contingency

The plan includes the required 0.5% contingency.

Mental Health Investment Standard

The plan meets the standard.

Discussions took place in respect of the summary plan. It was noted that the same level of rigour of PMO is being replicated through East, West and North East Essex. A Programme Director has been appointed by the STP, and a Project Lead has been identified. The PoP is being developed. It was agreed that the detail needs to be shared with the committee. It was noted that the work plans are to be validated by the Programme Director, and that a significant amount of collaborative work has been taking place. It was noted that the CCG is accountable if these programmes fail. With reference to the detailed plan, the CFO explained the content. The DCO/CCO reminded members that contract negotiations are on-going, and that the Trust has made a counter offer in regards to our flat cash offer. It was noted that the contract value is £110,450k (face value), which includes the uplift for community services. She advised that a letter is being drafted in response to this counter offer to tease out the Trust’s expectations and will include caveats. The DCO/CCO advised that it is hoped that an agreement will be reached by w/c 14/12/16 that will be bring us in on target. She added that the FD at the Trust is an advocate for the STP and ACO and is committed to making the system work. It was noted that if the offer of £110,450k comes in where we need it to be, this will effectively lock in £3m QIPP and will be under the same terms as this year. It was recognised that reinvestments need to be done through shared governance. The CO commented that on the face of it this is a great starting place, adding that we need an end of year deal that feeds into a better deal for next year. Members noted the following risks that are currently not reflected:

2016/17 Out turn

Likely requirement to return any shortfall from 2016/17 within the 2 years.

Property Services market rate funding Additional charges from moving to market rates potentially not fully funded by NHSE in 17/18.

CHC Historic Claims Claims beyond the value of 16/17 risk pool contributions included in the budget.

Community contract pressures A range of pressures highlighted by the Provider including: Dressings, Continence products, Equipment.

Additional contract costs post procurement Community contract post 1st Oct 2017. OOH/111 contract post 1st Oct 2017.

TPP Additional TPP costs post withdrawal of CUHFT.

BCF Suffolk County Council requested significant additional BCF funding in the 16/17 negotiations. Members noted the timetable in respect of submission of the plans to NHSE.

It was noted that by the next Finance & Performance Committee, scheduled for 21/12/16, contractual discussions will have concluded with providers. BB queried the variable changes in some areas; the CFO advised that this could be due to links with specialist commissioning and therefore could be technical in nature. The Chair thanked the CFO for the report. The Committee noted the report.

9. CHC DEEP DIVE

The DCO/CCO presented a paper in respect of CHC benchmarking standards. She advised that CHC are near to hitting their post-QIPP budget and that there are opportunities to go further. It was noted that the CCG has a lot of CHC patients, but spend per patient is low. The following benchmark data was noted: National For FNC & Standard CHC patients, both CCG’s rank in the bottom 10 and therefore the spend per eligible patient is very low. Both CCG’s rank in the middle quartile for Fast Track spend. Activity – across all 3 categories, both CCG’s rank in the upper quartile so therefore have a high overall number of eligible patients. IESCCG rank in the top 10 in terms of the number of eligible FNC patients. Demographic IESCCG & WSCCG rank in the bottom two for spend per eligible patient in FNC & Standard CHC. For Fast Track, IESCCG rank in the middle with WSCCG slightly higher in fourth. In terms of the number of eligible patients, IESCCG rank in the top 4 across all 3 categories and are the highest in FNC. WSCCG rank in the top 5 across the three. Conclusion This benchmarking suggests (particularly in FNC & Standard CHC), that the spend per eligible patient is very low and controlled in comparison with the rest of the country. The lower the ranking (i.e. closer to 209th) the better the position of the CCG. In terms of the metrics: £/eligible patient is low or the number of eligible patients YTD is low.

Our £/Eligible Patient is Low = GOOD (ranked low).

However, the number of eligible patients is high = BAD (rank higher).

Essentially, the benefit we get from having a low £ per patient is offset by the large number of eligible patients. The DCO/CCO advised members of the actions that are already underway or proposed for 17/18. These were noted by the committee. It was noted that peer reviews are being undertaken with NEE, who have low numbers of eligible CHC patients. The CO thanked the DCO/CCO for the succinct briefing, advising there is anxiety in regards to the work on-going in West Norfolk as the AO is leaving. The DCO/CCO advised that this is in relation to the “5 Q’s”, which was developed by the AO at West

Norfolk CCG. The DCO/CCO advised that correspondence has been received and that she will take this forward and share documentation accordingly. It was noted that the AO of West Norfolk CCG is to present the scheme at the regional CHC Forum and that NHSE are to obtain the methodology and share. The Chair thanked the DCO/CCO for the report. The Committee noted the report.

10. ANY OTHER BUSINESS

There were no further matters of business discussed. The meeting closed at 1127.

11. DATE AND TIME OF NEXT MEETING Wednesday 21 November 2016, 0900 – 1100, Room 14, Ground Floor, West Suffolk House

Minutes of WS CCG Financial Performance Committee held on Wednesday 21 December 2016 from 0930 - 1130

Room 14, Ground Floor, West Suffolk House

PRESENT: APOLOGIES: Dr Simon Arthur, GP Governing Body Member Bill Banks, Lay Member – Governance (Chair) Kevin Bernard, Governing Body Member Dr Christopher Browning, GP Governing Body Member and CCG Chair Andy Eley, Deputy Chief Operating Officer Jo Finn, Lay Member – Patient and Public Involvement Ed Garratt, Chief Officer Dr Andrew Hassan, GP Governing Body Member Amanda Lyes, Chief Corporate Services Officer Lesley Macleod, Chief Finance Officer Dr Bahram Talebpour, GP Governing Body Member Jan Thomas, Deputy Chief Officer/Chief Contracts Officer IN ATTENDANCE: Chris Armitt, Deputy Chief Finance Officer Linda Lord, Chief Pharmacist MINUTES: Jo Wyatt, Office Manager and EA to Chair, COO & DCOO

Peter Knights, Governing Body Member Barbara McLean, Chief Nursing Officer Richard Watson, Chief Redesign Officer Kate Vaughton, Chief Operating Officer Dr Firas Watfeh, GP Governing Body Member

Item Action 1. WELCOME & APOLOGIES

The Chair welcomed all to the meeting and apologies were noted. The Chair noted the change in title of the committee from Finance & Performance Committee to Financial Performance Committee.

2. DECLARATIONS OF INTEREST

There were no new declarations of interest expressed.

3. MINUTES OF F&P COMMITTEE – 16/11/16

The minutes of the Finance & Performance Committee held on 16/11/16 were reviewed and agreed as a true and accurate record of the meeting.

4. MATTERS ARISING

With reference to the minutes of the meeting of 16/11/16, JF referred to the public feedback in regards to the IVA/MVA consultation which was not discussed at the workshop held on 23/11/16. The CO commented that this matter was discussed at the Governing Body held on 30/11/16, where it was agreed to defer the decision until the Governing Body of 25/01/17. He advised that comms would then be shared with the public to advise that we have listened to their feedback. JF thanked the CO for this, commenting that this will close the loop.

5. ACTION LOG – 16/11/16

The DCOO presented the Action Log, and the following update was provided:

Lack of West specific resource to be discussed at COT The CO advised that this matter was discussed at COT and it was agreed that:

CHC reviews for the West to be prioritised

Acceleration of financial recovery work in the West, with Chief Officers being told that this is a priority

Re-focusing of priorities for the COO The Chair thanked the DCOO for the update. The Committee noted the update.

6. OPERATIONAL PLAN SIGN-OFF (INCLUDING FINANCIAL PLAN)

The DCOO presented members with the Operational Plan 2017/19, noting that the Governing Body has delegated the sign off of this plan to the Financial Performance Committee. 0943 – BT joined the meeting. It was noted that members have previously been presented with draft plans which were submitted to NHSE on 24/11/16. The DCOO advised that NHSE have assessed the plans against a number of Key Lines of Enquiry and provided an overall assurance rating for the CCG. Overall the CCG’s draft plan was rate “Green”, although some areas required further detail and supporting evidence. In light of this feedback, the plan has been reviewed and amended. It was noted that finance and activity plans have been part of an on-going review with NHSE. It was noted that the Operational Plan will be presented to the Governing Body on 25/01/17. The Chair queried if we are confident that we have responded to the changes suggested by NHS; the DCOO confirmed that we are, stressing that the draft plan has already been assured as “Green”, and therefore any additional submissions will be given the same level of assurance from NHSE. The CFO presented members with the Financial Plan, advising that this is to be submitted to NHSE on 21/12/16. She advised that there have been several changes and iterations based on further guidance received from NHSE, some of which was received late. It was noted that the plan is based on the current year outturn, and that it is a dynamic document. The following headlines were noted:

Control Target The plan meets the control targets set by NHSE for both 2017/18 and 2018/19. By the end of 2018/19 the planned cumulative surplus meets the 1% business rule.

Efficiency Savings The savings target is £10.1m in 2017/18 and £10.4m in 2018/19.

1% Non-Recurrent Fund The plan meets the requirement for a 1% Non-Recurrent Fund with half of the fund uncommitted in each year as part of the national Risk Pool. Provisional commitments against the balance are:

£0.8m – GP 5YFW £3 per head (£0.3m in 2017/18, £0.5m in 2018/19)

£1m – Dual running and set up costs required for STP solutions in 2017/18

£0.9m – Dual running and set up costs required for STP solutions in 2018/19 Mental Health Investment Standard The plan meets the standard Members noted the baseline growth in respect of the allocation changes. Members noted that there has been a significant change in respect of the non-recurring adjustment due to specialist commissioning in relation to Addenbrooke’s amounting to £1.6m. It was noted that several CCGs, including WS CCG, are challenging and appealing this decision in terms of both the lateness and value of the decision. The DCFO advised that this has been conceded at a national level and transitional funding of £150k has been allocated. SA commented that in regards to the contract with WSFT, adjustments of £1.6m were originally made due to the re-classification of specialist commissioning, which has been accepted by the Trust. It was noted that the Trust will be keen to recover this amount from NHSE. Members noted the baseline adjustments. The DCO/CCO advised that the CHC risk pool for PUPoC is to be rolled forward, although further detail has yet to be received. As a result, the work approved by the Executive on 14/12/16 in regards to NEL CSU has been suspended until the detail has been received. The CO commented that the QIPP challenge is positive (in terms of a reduced QIPP target compared to previous years), particularly as we are seeing better traction in regards to QIPP, adding that there has been a significant step change. The CO advised that a flat cash contract has been agreed with the Trust, adding that this is excellent news, and that this locks in 30% of our QIPP for next year. 1005 – BT left the meeting. The DCFO advised that if you look at this proportionally, the Trust receive a third of our money so therefore have a third of our QIPP. It was noted that we also have a £30m contract with Addenbrooke’s, as well as contracts with Papworth etc. The Chair commented that 3.5% is a challenging QIPP target. The DCFO advised that the average QIPP target for CCGs is 4%, and that some are 5.5% – 7%, without a block contract. Members noted the growth assumptions. Members noted the efficiency savings. 1011 – BT returned to the meeting. It was noted that project management arrangements to deliver the STP solutions in place. The CFO advised that contracts negotiations with Addenbrooke’s, adding the contract may be significantly less that what is in plan. The DCO/CCO advised that all other contracts with Acute providers are PbR, and therefore activity is being tracked and repatriation is being looked at. She stressed that demand management is vital, adding that the managing activity will allow us to

be better at analysing activity. The Chair questioned the resilience of the financial plan underpinning the operational plan, adding that as there are significant risks, particularly in regards to QIPP, that we may need a bigger QIPP plan than identified. The CFO advised that meetings are being scheduled with the Finance Team and budget holders to stretch QIPP. The Chair commented that this is essential, adding that resilience plans need to be in place, and that we need to challenge ourselves. If we do not do this we will have unmitigated risks in 04/17. The CO agreed, adding that we have Q4 to build our QIPP plans, which is an advantage of having to submit our plans early. It was agreed that progress would be monitored throughout the financial year. The Chair questioned if members are happy that we have a good integrated plan; in that, where investment is needed, the money is available; and that the service plan won’t be steered off course by having to find additional QIPP. The DCOO advised that both the CCG and NHSE have undertaken triangulation exercise in this regard, and that no concerns have been raised. JF congratulated the DCOO and the CFO on the plans, adding that they have never been so well resonated before. The DCOO presented members with the Activity Plan, advising that this underpins the financial plan. Members noted the following:

Growth is based on the STP plan, with the exception of non-elective activity where internally the growth has been increased to reflect current run rate.

QIPP consists of the STP solutions targeted at acute activity.

The activity has been profiled based on historical trends and adjusted for the change in working days and calendar days.

The activity triangulates with the financial plan submission at assumption level, as both are based on the STP plan.

The activity plan has been approved by NHSE. With regards to performance trajectories, members noted the following:

Performance trajectories and supporting levels of activity have been established to ensure the requirements of the national (NHS Constitution) targets are achieved

Where applicable, the activity growth assumptions have been used in line with the overall activity plan

For 2017/18-19 there a number of additional targets (e.g. mental health) for which trajectories have also been submitted, and for which significant work with NSFT is needed to achieve. It was noted that some new measures have no contractual mechanisms in place to deliver, and will need further work to deliver (e.g. E.O.1 waiting time for wheelchairs). It was noted that the Contracts and Transformation teams will work through any gaps and develop a plan. The CFO stressed that the trajectories are used to hold us to account and for us to hold providers to account. It was noted that a paper in respect of the Quality Premium will be brought to the committee on 18/01/17. The DCO/CCO suggested that in 04/17 a report be shared with members showing the performance against the planned trajectories. This was agreed, and the DCFO advised that a monthly template is received from NHSE, although there is a time delay. It was agreed that there be early view at the FP Committee with a national view being shared upon receipt. Members unanimously approved the following:

CCG Operational Plan 2017/18-2018/19

CCG Financial Plan 2017/18-2018/19

CCG Activity Plan and Performance Trajectories The Chair thanked the DCOO, DCO/CCO, CFO and their teams for the tremendous amount of work they have put in to thisexcellent and ambitious plan. Comfort break: 1029 – 1038.

7. TERMS OF REFERENCE

Following several amendments and iterations, the CCSO presented the Terms of Reference for the Financial Performance Committee. It was noted that BB will continue to Chair until the new lay member, Steve Chicken, joins the CCGs. Members noted the following as the core membership:

Lay member

CCG Chair

Chief Officer

Chief Finance Officer

Chief Corporate Services Officer

GP Members of the Governing Body

Practice Manager Members of the Governing Body It was noted that the DCO/CCO and CNO will be invited to attend as and when required. The Chair queried if there is a process in place to determine who would chair in the event of the nominated be unavailable. It was agreed that this would be actioned and included in the ToR. Members approved the revised ToR. The Chair thanked the CCSO for the report.

AL

8. MONTH 8 FINANCIAL POSITION

The CFO presented the financial position as of month 8. Headlines

Variance from plan At month 8, financial performance is ahead of the Financial Recovery Plan trajectory by £0.3m. However at this point the Recovery Plan forecast a significant upward trend but the current position is flat compared to month 7. Key adverse variances from plan are QIPP schemes in development (£2.9m), Acute services (£0.3m) and Prescribing (£0.4m). These are mitigated by the use of Contingency (£1.0m) and underspends in Mental Health & LD Services (£0.2m), Continuing Healthcare (£0.1m) Other Programme (£0.5m), Corporate Costs (£0.1m) and Community (£0.2m)

Forecast risks and mitigations Based on the Financial Recovery Plan the CCG currently has a balanced forecast position. Key risks are QIPP Under delivery (£3.3m), Funded Nursing Care national price increase (£0.8m), additional ambulance costs (£0.2m), Property Services Market Rents (£0.8m). These are mitigated by Contingency (£1.5m), Central Property Services Funding (£0.8m), 15/16 Quality Premium (£0.2m), further prior

year benefits (£0.2m) and Other Mitigations which the CCG is currently in the process of pursuing (£2.4m).

Underlying surplus / (deficit)

Key drivers are potential under-delivery of QIPP shown as a risk in the current year and therefore at risk recurrently (£4.7m), risks to the current year position that are deemed to be recurrent in nature such as Funded Nursing Care price increase (£0.8m), plus any mitigations in the current year deemed to be non-recurrent such as prior year benefits (£0.8m), Quality Premium (£0.2m).

QIPP Delivery At month 8 the CCG has delivered £6.7m of QIPP against a target £9.3m (72% delivery). The forecast delivery is £9.2m against a target of £14.0m. Key forecast variances from plan are Budgetary Control (£1.3m), Other Associates/NCA's Savings vs Budget + savings through benchmarking (£0.5m), Prescribing (£0.3m), Over the Counter Meds (£0.8m) and Market Management (£0.2m). It was noted that the ambition is to achieve an on year break even position without any year-end flexibility. 1045 – LL joined the meeting.

Recovery Trajectory

The trajectory indicated that the position would continue to deteriorate to a low point of a £2.3m in year deficit at month 7. From month 8 onwards the trajectory shows a stabilisation and steady improvement to a £1.96m deficit by month 9 as the benefits of the additional QIPP schemes and recovery actions are realised with a further acceleration towards breakeven in the final quarter.

Progress to Date

The month 8 position is better than the recovery trajectory due to the impact of the recovery actions and QIPP delivery which have begun to stabilise costs in a number of areas. However at this point the Recovery Plan forecasts a significant upward trend but the current position is flat compared to month 7. If the current variance is extrapolated to the end of the financial year the closing position would be an in year deficit of £2.4m which is an improvement of £2.5m from the month 3 risk adjusted forecast deficit of £4.9m. At this point in the discussions, the Committee agreed to discuss all aspects of the Financial Recovery Plan for 2016/17, including those scheduled under item 10 on the agenda. The DCO/CCO commented that the problem continues to be QIPP schemes under development, as what we have said we would deliver we have and that it is the gap that we still have not achieved. CB commented that we know what the big thing is we can do (CHC Reviews) and the little things (anything else in Prescribing), but questioned if there are any other ideas. It was noted that CHC is under budget across both CCGs. With regards to the output from the financial recovery workshop held on 23/11/16, the CFO advised that the actions were discussed and updated at the Executive of 14/12/16. She advised that the main themes were:

CHC – it was noted that the DCO/CCO is to present a paper in this regard further in the agenda.

Prescribing – it was noted that LL is to present a paper in this regard further

in the agenda. Underperformance at WSFT – it was noted that the CFO and DCFO are meeting with the FD at the Trust on 21/12/16 regarding the potential claw back of £750k of the first £1m of underperformance.

SA raised his concerns, as we require short term savings, querying if the repatriation of patients from Addenbrooke’s and BMI has been communicated with GPs. The CO commented that repatriation is a big opportunity next year. It was noted that the DCO/CCO has been having discussions with BMI, and that patients and specialities that can be repatriated have been identified at Addenbrooke’s. With regards to Newmarket Hospital, it was noted that the CCG is finally in receipt of the status of Addenbrooke’s licence to locate at the hospital. A comms strategy with NHSPSC is being developed in this regard. It was agreed that this is an important strategy for next year, and that here will be savings from 01/17 – 03/17 in terms of outpatient activity. CHC - The DCO/CCO presented a paper to provide an immediate option to increase NHS CHC QIPP savings in 2016/17, to highlight the associated risks and to agree next steps. Two options were presented to members; SA raised a concern that this may impact on the relationship with I&ES, and suggested that we seek their agreement first. The DCO/CCO advised that this would be a temporary arrangement. The CO advised that this will be discussed at the collaborative meeting on 22/12/16. Members noted that the QIPP plan in the East is ahead of plan. Members supported Option 2, specifically:

To support the suspension of work on the remaining 10 I&ES CCG backlog cases until 01/04/17

To support the completion of the remaining 18 WS CCG backlog cases

To support the completion of CHC reviews for West patients only from early 01/17 – 31/03/17.

Members agreed that this change in priorities for the CHC team also needs to be endorsed by the I&ES Executive and flagged to the Audit Committee/NHSE for their information and approval. The DCO/CCO advised that additional social worker/OT/physio resource will need to be employed (at £22k cost to the CCG) to participate in MDTs for every review; it was noted that these costs have been included in the saving projection. The DCO/CCO advised that it is hoped that the “5 Q’s” will be established by the end of Q4. It was noted that there was a session in relation to the “5 Q’s” held at RBH on 20/12/16 held by Sue Crossman. The session was well received, and it was noted that the Trust are planning on running the “5 Q’s” in parallel with red to green week (w/c 02/01/17). It was noted that this may reduce CHC conversions which would mean the team will be further ahead in regards to CHC reviews. The DCO/CCO requested that the CHC team are not held to account if the targets are not met, as the team are working over and above. With regards to the “5 Q’s”, it was noted that Sue Crossman is to attend a future Executive. Prescribing - LL presented a paper in regards to the Medicines Management

Financial Recovery. Members noted the following:

• 2016-17 full year prescribing QIPP target is £1.25m • M6 data shows delivery of £442,270 against the M6 target of £614,603 • M7 data shows further £624,141 to be delivered in Q4 2016-17 • A headline financial recovery plan was presented to the WSCCG Executive on

14/12/2016. Agreement made to pursue a range of additional actions during Q4 2016-17

• A decision on the adjusted RAP scheme, with Executive recommendations, will be made by the Governance Committee on 21/12/2016

• Key learning taken from I&ESCCG is that enhanced engagement with all practices is crucial for success in delivery of QIPP savings

Members noted the revised prescribing work plan for 12/16 – 03/17. LL advised that Sheila Murnion is happy to present a report to the Executive in respect of biosimilars if required. Discussions took place in regards to the enhanced practice visits, and it was noted that a there is an Associate GP who holds the prescribing portfolio. It was therefore agreed that a report be shared at the Executive in regards to Associate GPs and their respective portfolios. It was agreed that a script be developed for GPs to use when undertaking an enhanced practice visit, and that the practice specific pack be shared with practices at their monthly meetings with the Head of Practice Support. Discussions took place in regards to ScriptSwitch; it was noted that the potential £5k savings are just for Q4 and are additional savings. LL advised that there are 3 Practices in the West that are not using ScriptSwitch. Following discussions it was agreed that the CO, DCO/CCO and CFO meet to discuss if a West specific FR taskforce be established. AH reminded members of the success that the prescribing team have achieved; previously 70% of practices were in the red, now only 2 practices are overspent. It was noted that one is 1.69% overspent, and the other is 2.8% overspent. It was suggested that the focus be on these practices. The DCOO stressed that the best GP to utilise to increase engagement are the Governing Body GPs, as they are aware of the issues. It was noted that AH, BT and FW have visits booked, and AH suggested that two GPs attend the meeting. It was agreed that monthly Prescribing Leads meeting take place for the next three months; LL advised that dates are already in the diary. KB suggested that there be a prescribing presence at Locality Meetings; LL advised that this is already in place. With regard to the overall Financial Recovery Plan 2016/17, the Chair asked for assurance that there is a programme of work that aims to close the financial gap in-year and that it is being actively managed. It was agreed that the CO and the DCO/CCO pull this together, and that progress is reported to the Executive and the next Financial Performance Committee. The Chair thanked the CFO, the DCO/CCO and LL for the papers. The Committee noted the papers. 1159 – LL left the meeting.

9. QIPP

The CFO presented the PMO summary sheet for 12/16. It was noted that an amended version of the PMO process will be shared with the

Committee in 01/17. The Chair thanked the CFO for the report. The Committee noted the report.

10. FINANCIAL RECOVERY ACTIONS UPDATE

This paper was presented in agenda item 08.

11. ANY OTHER BUSINESS

With regards to repatriation, AH suggested that for the five relevant practices in Newmarket and Haverhill we ascertain who offers the choice to patients (i.e. GP or Secretary). A meeting could then be arranged with them so that we can sell the concept of repatriation. It was suggested that this could be led by the Planned Care lead. There were no further matters of business discussed. The meeting closed at 1202

12. DATE AND TIME OF NEXT MEETING Wednesday 18 January 2017, 1000 - 1200, Room 14, Ground Floor, West Suffolk House

Unconfirmed Minutes of WSCCG Clinical Scrutiny Committee held on

Wednesday 14 December 2016 from 0830 – 1015hrs Ground Floor Room 14, West Suffolk House, Western Way,

Bury St Edmunds, IP33 3YU PRESENT: Dr Christopher Browning GP Governing Body Member and CCG Chair (Chair) Bill Banks Lay Member – Governance Dr Simon Arthur GP Governing Body Member Kevin Bernard Governing Body Member Jo Finn Lay Member – Public and Patient Engagement Ed Garratt Chief Officer (Part) Dr Andrew Hassan GP Governing Body Member Chris Hooper Deputy Chief Nursing Officer Dr Crawford Jamieson Secondary Care Lead (Part) Peter Knights Governing Body Member Amanda Lyes Chief Corporate Services Officer Jan Thomas Chief Contracts Officer Kate Vaughton Chief Operating Officer Dr Firas Watfeh GP Governing Body Member Richard Watson Chief Redesign Officer IN ATTENDANCE: Lynne Fuller Infection Control Lead Nurse (Part) Sarah Learney Deputy Chief Contracts Officer- System Resilience and Operations (Part) Vicki Newberry Clinical Assurance and Professional Lead (Part) Jo Mael Corporate Governance Officer Jane Webster Deputy Chief Contracts Officer 16/052 WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed everyone to the meeting and apologies for absence were noted

from; David Kanka Assistant Director of Public Health Barbara McLean Chief Nursing Officer Lesley MacLeod Chief Finance Officer Dr Bahram Talebpour GP Governing Body Member


No declarations of interest were received.

16/054 MINUTES OF PREVIOUS MEETING

The minutes of the meeting held on 19 October 2016 were reviewed,and approved, as a correct record.

16/055 MATTERS ARISING & REVIEW OF ACTION LOG

There were no matters arising and the action log was reviewed and updated.

16/056 TERMS OF REFERENCE

The Committee was reminded that, at its previous meeting, it had asked that the Chief Corporate Services Officer further revise the Committee’s terms of reference in light of comments made at the meeting.

As a result, revised terms of reference were being presented today for approval that included a reduced core membership of the Committee and retention of the CCG Chair as Chair of the Committee. During discussion, it was suggested that the merit of taking a different approach to agenda setting in order to incorporate ‘deep dive’ of specific areas should perhaps be explored. The Committee agreed its revised terms of reference for presentation to the Governing Body for approval.

16/057 INTEGRATED PERFORMANCE REPORT

The Committee was in receipt of the Integrated Performance Report that was, in the

main, the same as that presented to the Governing Body in November 2016. The Committee questioned the appropriateness of the same information being presented for consideration at today’s meeting, together with whether the finance information should be presented to Clinical Scrutiny in light of establishment of the Finance and Performance Committee. The Chief Operating Officer agreed to review the content of future agendas. Clinical Quality and Patient Safety Key points highlighted included;

Incidences of C.Difficile were ahead of trajectory with their being 33 year to date against a trajectory of 22.

West Suffolk Hospital had reported 61 falls for September 2016 and the CCG continued to work with the Trust to improve reporting of falls per 1000 bed days.

Suffolk Community Healthcare – the highest numbers of falls were at Bluebird Lodge where the layout presented challenges to the management of falls. An action plan to address the issue had been received from the provider.

Pressure ulcers at West Suffolk Hospital had increased in October 2016. There were currently capacity issues within the tissue viability team. Root cause analysis information continued to be reviewed to identify any learning opportunities.

The Committee questioned the grade of reported pressure ulcers and the Deputy Chief Nursing Officer agreed to clarify and report back to members outside of the meeting. Having noted that reporting requirements associated to pressure ulcers had changed over the last five years, the need to work with West Suffolk Hospital in order to gain assurance that policies were being adhered to, was emphasized. Having questioned whether pressure ulcers might be an area to consider a ‘deep dive’ for the next meeting, the Committee was advised that the contract permitted ‘deep dive’ into certain areas and ‘open access’ to Trust meetings. In light of discussion the Committee agreed that prior to the next Clinical Scrutiny Committee on 22 February 2017 the CCG’s Executive be presented with further information regarding pressure ulcers in order to determine if a ‘deep dive’ by the Committee was necessary. (Dr Crawford Jamieson joined the meeting) Finance As the finance section of the report was now subject to consideration by the new Finance and Performance Committee, it was suggested and agreed that only a short summary be presented to the Clinical Scrutiny Committee in future.

Redesign Key points highlighted included;

Susanna Howard has now been appointed as Programme Director for the Sustainability and Transformation Plan (STP) and appointment of the Chair was yet to be confirmed. Feedback on the STP by the regulators had been positive.

The CCG had recently been notified of a bidding process for additional recurrent funding in relation to four of the STP’s clinical priorities. Bids are to be submitted by 18 January 2017 and required sign off at STP level. Work was currently underway to consider how best to facilitate engagement across the STP area. The Chief Redesign Officer agreed to circulate a link for access to detail of the bidding process to members outside of the meeting.

It was recognised that the bidding process was likely to favour those STP areas that were more organised. The Committee was reassured that the bidding process would be carefully managed in order to facilitate timely bids and, where applicable, ensure linkage to the Digital Roadmap.

Norfolk and Suffolk NHS Foundation Trust - relationships had improved and the CCG was now working more closely with the Trust in respect of transformation. A recent clinical workshop had been well attended by both clinical and managerial staff. There was an ambition to have new service models in place by September 2017.

The single point of access urgent care service procurement had been paused in light of information received from NHS England advising that procurement over a wider area would be expected. Opportunities were currently being explored. A key concern was the need to have something in place at the time of contract end in October 2017. Challenges associated with how any procurement might be aligned with the alliances, expansion of the 111 service, together with how a 24/7 out of hours’ service could be provided at a local level, were highlighted.

The Vanguard programme was likely to be launched in the New Year. To date there was no information or guidance on the bidding process.

The West Suffolk Hospital Task Force had been established for two weeks, with flow throughout the hospital being seen as a key issue affecting the A&E four hour target. Work with the hospital had identified that ward rounds were not effective in some areas. It was suggested that as 75% of patients on wards were frail there might be benefit from ensuring they were looked after by specialists in that field. As the hospital was a teaching hospital, there could be opportunity for it to pursue frailty excellence. The need to increase the use of frailty scores and care plans was emphasized.

Contracts West Suffolk Hospital – cancer and diagnostic performance had improved although concern remained with regard to the validation of referral to treatment information. Addenbrookes – referral to treatment performance remained of concern and, in particular, with regard to the number of patients waiting longer than 52 weeks. No Suffolk residents were among those waiting longer than 52 weeks. Suffolk Community Healthcare – speech and language therapy performance was currently being monitored closely. Care Coordination Centre performance had improved following instigation of an action plan. East of England Ambulance Service Trust – performance continued to be of concern and subject to a remedial action plan. Having questioned why the number of 111 calls that became 999 calls was high in Suffolk, the Committee noted that a contractual ‘deep dive’ was planned which was to incorporate consideration of staff morale. The Committee noted the content of the report.

(Ed Garratt left the meeting)

16/058 INFECTION CONTROL – RESPONSE TO ACTION 16/045

As requested at its meeting held in October 2016, the Committee was presented with examples of root cause analysis and post infection reviews. The CCG’s Infection Control Lead Nurse explained that the CCG had a performance indicator of 45 infection control cases for 2016/17 and there had been 33 cases within the first six months. Not all of those 33 cases had been diagnosed at West Suffolk Hospital, some had been diagnosed at Norfolk and Norwich and Addenbrookes. An Infection Control Reduction Network agreed reporting timescales and processes, together with the format of post infection reviews, examples of which were attached to the report. Following review if all criteria had been achieved there were no financial sanctions applied, where criteria had not been achieved learning and actions were identified. The CCG worked with practice based leads in respect of community cases. Having questioned areas for improvement it was explained that West Suffolk Hospital had recognised the need to increase the availability of single rooms and doors on bays when undertaking refurbishment of wards. During discussion, it was highlighted that the prevalence of E-coli was likely to be the next key area to address. It was also suggested that there might be benefit from considering faecal transplant for those patients having more than one episode of C.Difficile infection. The Committee noted the content of the report and requested that benchmarking information be included within future reports. (Sarah Learney and Vicki Newberry joined the meeting and Lynne Fuller left)

16/059 CONTINUING HEALTHCARE (CHC) UPDATE

The Clinical Scrutiny Committee was in a receipt of a report from the Chief Contracts

Officer that provided an update on the progress of Continuing Healthcare. Key points included;

A recent internal audit had concluded ‘limited’ assurance that was linked to the facilitation of reviews. Progress made by the team had been recognised and there was no longer a requirement to provide regular reports to the Audit Committee as long as Clinical Scrutiny continued to receive updates.

All cases had been closed within NHS England’s target timeline for the PUPoC (01/04/2004–31/03/2012)

The CHC Assurance toolkit had been completed in accordance with the NHSE deadline (30 September 2016).

The backlog had now declined to 39 cases from 956.

At Month seven finances were on track. An increase in funded nursing costs had resulted in a £1.2m overspend across the service (split 70:30 East and West).

The CCG was below its planned QIPP delivery. Five schemes were aligned to continuing healthcare with two associated to the review of cases. Upon completion of the backlog of cases, resources were to be transferred to the facilitation of reviews.

Commencement of the Discharge to Assess ‘5Q care test’ model as utilised in West Norfolk was being pursued.

The team would be carrying out a recruitment campaign for a physio or OT to assist multi-disciplinary team reviews.

Having questioned the differing financial position East to West as detailed within the

report it was explained that the management of fast track patients by the acute trusts might be a contributing factor. West Suffolk Hospital referrals were subject to review by a palliative care team to ensure they were appropriate whereas that was not the case at Ipswich Hospital. As a result, patients from Ipswich Hospital were often in the system longer with the impact of reviews likely to have greater effect. This has resulted in a higher proportion of CHC capacity being focussed on I&E patients. Care home quality issues within East Suffolk were also contributing to increased reviews in that area. The need to commence reviews within West Suffolk care homes in order maximise impact was recognised. The Chief Executive of West Norfolk CCG was scheduled to give a presentation on the Discharge to Assess model at Rushbrook House on 20 December 2016 to which members were invited. The need to ensure clarity and identify West Suffolk opportunity during phase two was emphasized. The Committee noted the report.

16/060 POLICIES FOR APPROVAL

The Committee was in receipt of the NHS Continuing Healthcare Equity and Choice

Policy for approval, which it was explained, had been updated to provide clarity as to how services were commissioned. Key changes included;

Following extensive patient and public engagement an additional section on enhancements had been incorporated which aligned with information for patients on the CCG’s website.

There was an additional section setting out expectations and limitations.

The policy included guidance with regard to individuals living at home.

There was now information and guidance in respect of the breakdown of care packages.

The Committee was reassured that the policy had been developed in line with co-funding rules. Having reviewed the policy it was suggested that development of similar policies for other areas such as individual funding requests, equipment, prescribing and complex children cases might prove beneficial. After review, the Committee approved the policy as presented and requested that the Chief Officer Team review the development of policies in other areas as highlighted above. (Sarah Learney and Vicki Newberry left the meeting)

16/061 GOVERNING BODY ASSURANCE FRAMEWORK

The Committee was in receipt of the current version of the CCG Governing Body

Assurance Framework (GBAF) that was reviewed by the Chief Officer Team every month and by the Governing Body and Audit Committee at each of their meetings. Amendments/additions were set out within paragraph 2.1 of the report. The Committee was informed that following discussion at the Audit Committee on 6 December 2016, the Chief Officer Team would be reviewing actions set out within the report to ensure they remained current. Whilst completed actions would be retained for the purposes of audit, they would be ‘greyed’ out to enable easy reference to current actions. The Committee approved the GBAF as presented.


Wednesday 22 February 2017, 0900-1100 hrs, Training Room 2, Green Duck,

Technology House, Western Way, Bury St Edmunds, Suffolk, IP33 3SP

Ipswich & East Suffolk Clinical Commissioning Group West Suffolk Clinical Commissioning Group

Unconfirmed Minutes of the CCG Collaborative Group meeting held on

Thursday, 22 December 2016, 11.00am in the Pavilion, Rushbrook House

PRESENT Martin Smith (MS) CCG Collaborative Group Chair Dr Christopher Browning (CB) Chair, West Suffolk CCG Governing Body Graham Leaf Lay Member (Governance) Ipswich & East Suffolk CCG Dr Mark Shenton (MS) Chair, Ipswich and East Suffolk CCG Governing Body Ed Garratt (EG) Chief Officer, Ipswich & East Suffolk and West Suffolk CCGs IN ATTENDANCE Jo Mael (JM) Corporate Governance Officer Minute

Action

16/049 Welcome and apologies The Chairman welcomed everyone to the meeting and apologies for absence were noted from; Bill Banks (BB) Lay Member (Governance) West Suffolk CCG

16/050 Declarations of Interest

No declarations of interest were received.

16/051 Minutes of meeting held on 13 October 2016

The minutes of a meeting held on the 13 October 2016 were considered and agreed as a correct record.

16/052 Matters arising and review of action log

There were no matters arising from the previous minutes and the action log was reviewed and updated with comment as follows; 16/045 – Individual Funding Request Team Update – the Group was informed that recommendations from an internal audit had now been completed and the Chief Nursing Officer was due to meet with the Head of Internal Audit within the next few days to close all actions.

16/053 Chief Officer Update

The Collaborative Group was in receipt of a paper from the Chief Officer which identified key updates since the previous meeting. Key points highlighted and comments included; Finance

At Month 8 – Ipswich and East Suffolk CCG was £500k ahead of plan. West Suffolk CCG was £1.6m behind plan.

Ipswich and East Suffolk CCG was the best performing within the East region and West Suffolk CCG was ranked within the middle,

All main contracts had now been signed for a two year period. As the

Ipswich Hospital contract now included AHP, there would be need to monitor activity closely going forward.

Alliance Working

The CCGs Commissioning Governance Committees had recently agreed to support the Most Capable Provider (MCP) process in relation to the Community Services contract.

Thought would need to be given as to how the CCGs might develop in order to support the Alliances going forward. A new version of MCP for primary care was currently out to consultation and would need to be incorporated into the process.

The Sustainability and Transformation Plan (STP) had been rated as the most improved plan and NHS England was supporting a potential vanguard bid for Suffolk.

It was agreed that the CCG Collaborative Group would receive an update on the STP to future meetings and that a work-plan would be developed for close monitoring.

The Collaborative Group was advised that the STP contained a detailed savings plan which was aligned to both CCG Operational Plans. Savings were to be generated, in the main, from improved demand management.

Ipswich Hospital/Colchester Hospital partnership scenarios were due to be published in January 2017.

Primary Care

Collaboration discussions across Suffolk continued and included the exploration of development of ‘one clinical community’.

Ipswich practices were considering commitment to estates proposals.

Primary Care delegated commissioning had been agreed by both CCGs. Applications had been submitted and awaited national approval.

There had been increased focus on GPIT to support improvement. Performance

A&E performance at both acute hospitals continued to be an area of concern and a taskforce was in place at West Suffolk Hospital.

Delayed Transfers of Care (DTOCs) – the Ipswich Hospital taskforce had reduced DTOCs and received national BBC coverage.

Norfolk and Suffolk NHS Foundation Trust performance remained poor. A meeting with the Trust was to be held in the New Year in an attempt to drive improvement.

Organisational Development

There was ongoing engagement with staff in respect of the forthcoming move to Endeavour House.

Regular Chief Officer/Deputy Chief Officer meetings were being held in relation to organisational development.

A staff recognition programme was to be launched.

There had been regional leadership awards and Health Service Journal awards recognition. The newly appointed Midlands and East Director of Education England had asked if he might visit the CCGs and was to be invited to a forthcoming training and education event.

Quality The Collaborative Group noted the content of the report.

EG

16/054 Service Performance Review Report The Collaborative Group was in receipt of the most recent Service Performance Review report which provided more detailed information to support the Chief Officer update. The Collaborative Group noted the report.

16/055 Any Other Business

No items of other business were received. 16/056 Date of next meeting

Dates 2016

09 February 2017 The Pavilion 11.00am

Unconfirmed Minutes of a meeting of the NHS England/West Suffolk CCG Governing Body

Joint Commissioning Committee held in public on Wednesday, 30 November 2016 at The Lecture Room, St Edmundsbury Cathedral, Bury St Edmunds, Suffolk, IP33 3LS

PRESENT: Jo Finn Lay Member for Patient and Public Involvement, WSCCG (Chair) Bill Banks Lay Member: Governance and CCG Vice Chair, WSCCG Wendy Cooper NHS England Representative Ruth Manning-Brown Deputy Chief Finance Officer, WSCCG Stuart Quinton Suffolk Primary Care Contracts Manager, NHS England Kate Vaughton Chief Operating Officer, WSCCG Dr Christopher Browning West Suffolk CCG Chair Andy Yacoub Healthwatch IN ATTENDANCE: Jo Mael Corporate Governance Officer, WSCCG David Pannell Suffolk GP Federation (Items 16/20-16/24 only) Lois Wreathall Head of Primary Care, WSCCG

16/20 WELCOME AND INTRODUCTIONS

The Chair welcomed everyone to the meeting and introductions were made.

16/21 APOLOGIES FOR ABSENCE

Apologies for absence were noted from: Ed Garratt Accountable Officer, WSCCG Cllr Tony Goldson Health and Wellbeing Board Dr Crawford Jamieson Secondary Care Doctor, WSCCG Lesley MacLeod Interim Chief Finance Officer, WSCCG Jan Thomas Chief Contracts Officer, WSCCG Matthew Thorpe NHS England, Head of Finance (Direct Commissioning)


No declarations of interest, other than those already published, were received.

16/23 MATTERS ARISING AND REVIEW OF OUTSTANDING ACTIONS

There were no matters arising and the action log was reviewed and updated with comment as follows; 16/15 – Primary Care Support Services Performance Standards – the Committee was advised that a letter had been sent to the provider and, to date, no response had been received. In response to an earlier action in respect of the Primary Care Estates Strategy, the CCG’s Head of Practice Support reported that a Strategy had been developed and submitted to NHS England following presentation to the

CCG’s Executive. Feedback was awaited and once permitted to do so by NHS England, the Strategy could be wider circulated.

16/24 SUFFOLK GP FEDERATION

David Pannell, Chief Executive of Suffolk GP Federation was welcomed to the

meeting and proceeded to provide the Committee with an update on development of the GP+ scheme. The Committee was informed that the GP+ pilot had commenced in Ipswich on 7 September 2015 and in Bury St Edmunds on 7 December 2015. The aim was to facilitate GP hubs that provided additional evening and weekend access to primary care services. The hubs were staffed by GPs, nurse practitioners and other clinicians with each shift having a GP lead responsible for managing the shift and workload. 15 minute appointment slots were offered and clinicians had opportunity to share learning during a half hour discussion period at the end of the shift. Expansion of the service was being sought in East Suffolk with the facilitation of three local hubs which would receive patients booked by practices and the 111 service but would not receive emergency department or ambulance service calls. It was anticipated that local hubs would be co-located with the out of hours’ service where possible. The hubs were manned by local GPs from local practices and, to date, there had been no resourcing issues as clinicians felt the hubs were nice environments in which to work. Patient feedback had also been positive. It was noted that the service had been well set up and had assisted practices with demand. Whilst walk-in access was not available, it would be more likely should there be future co-location at A&E. It was suggested that it might be feasible to utilize technology to encourage increased take-up of Sunday appointments. The Committee noted the update and that the Suffolk GP Federation was due to publish a report in January 2017 which would include evaluation of the service. David Pannell was thanked for his presentation.

16/25 PRIMARY CARE CO-COMMISSIONING

The CCG’s Chief Operating Officer reminded the Committee that the CCG had

been invited, by NHS England, to consider whether it wished to move to Model 3 in April 2017 or remain within the current joint commissioning arrangements (Model 2). The deadline for CCGs to apply was 5 December 2016. The CCGs had undertaken a thorough and robust process of due diligence. Areas identified for due diligence had been scrutinised robustly, including a detailed breakdown of the financial implications associated with model 3, clarification of some key areas and a better understanding of the level of risks and possible benefits involved. The CCGs had identified a number of areas that required a greater level of assurance; for example, where there was the expectation that processes currently undertaken by NHS England would be delegated to the CCG under model 3. Those areas continued to be worked through with relevant CCG and NHS England teams. GP Members had been invited to vote on the two options; remain Co-Commissioning with NHS England (model 2) or support the move to fully delegated commissioning of primary care (model 3). The vote had resulted in 12 practices having voted in favour of moving to Model 3, seven voting to

maintain the status quo, two abstaining and three practices not responding. A meeting was to be held with Ipswich and East Suffolk CCG on 1 December 2016 to define the model going forward. NHS England’s Suffolk Primary Care Contracts Manager reported that NHS England had recently issued an offer letter to CCGs in respect of future resource. The Committee noted the update.

16/26 PRIMARY CARE CONTRACTS AND PERFORMANCE MONITORING

The purpose of the report was to provide an update to the Committee in

relation to;

List Closures

Enhanced Services (ES)

Prime Ministers Challenge Fund Centre (GP+) List Closures No west Suffolk practices had applied to close their lists Local Enhanced Services Following formal approval of the PMS Development Framework, associated Enhanced Services (ES) had been amended to ensure parity between contracts. Practices had continued to provide services under the existing 2015/16 ES contracts whilst discussions were taking place. The contracts team was about to issue the 2016/17 ES contracts Prime Minister’s Challenge Fund Centre The Prime Ministers Challenge Fund was initiated to support local health economies to put in place schemes that would enable primary care to work at scale to provide general practice services in the evening and over the weekends. The Suffolk GP Federation, working with the two Suffolk CCGs developed a successful bid. The scheme was resourced for an initial one year period. The West Suffolk CCG was not allocated funds for 2017/18, and was working with NHS England to identify monies to keep the service open.

The Committee noted the content of the report.

16/27 GENERAL PRACTICE ACCESS FUND

The Committee was reminded that, at its previous meeting, it had been

informed that the national NHS England team had confirmed the core requirements scheme providers had to comply with during 2016/17 in providing access to general practice outside of core hours. As advised earlier, the Suffolk GP Federation had been the provider of what was known as the Suffolk GP+ scheme in Suffolk. A contract had now been drafted and was currently being reviewed by the CCG and the provider. It was aimed to have the contract signed by the end of November 2016 which would trigger the second tranche of funding. The core requirements had been translated locally (and included in the contract) as meaning:

An additional 200 hours consultation capacity per week (or 800 x 15 minute appointments) rising to 300 hours per week (or 1200 x 15 minute appointments) by 31/03/17

Services to be provided from a main hub in Ipswich and from sub-hubs in Bury St. Edmunds, Felixstowe, Saxmundham and Stowmarket

Within Ipswich and East Suffolk, 50% of the appointments to be offered

at the Ipswich hub and 50% from the three sub-hubs

The Ipswich hub would be open 6.30pm to 9pm weekdays; 9am to 9pm Saturdays, Sundays and Bank Holidays. The other three sub-hubs to open on weekday evenings, Saturdays, Sundays and Bank Holidays, with hours being matched to identified local demand.

Appointments would be both pre-bookable and same day appointments.

In order to deal with demand elsewhere in the health system, the source of referrals had been stipulated as a 75% target from general practice; 12.5% from NHS 111; and 12.5% from ambulance and A&E departments.

(The scheme provider would be paid on a costs incurred basis only in respect of the period 1/4/16 to 31/10/16 and then at £6 per head of population with effect from 1/11/16 to reflect mobilisation of appointments to meet the new criteria from that date). With effect from 1 April 2017, the GP+ contract would become the responsibility of Ipswich and East Suffolk CCG. The Committee was advised that funding of the contract had been incorporated within the CCG’s future financial plans. The Committee noted the verbal report and NHS England’s Suffolk Primary Care Contracts Manager agreed to provide details of the planning requirements around future funding levels.

16/28 GENERAL PRACTICE RESILIENCE PROGRAMME

The General Practice Resilience Programme (GPRP) was part of a wider

programme of work to deliver the General Practice Forward View (GPFV). The programme built on work previously done with the Vulnerable Practice Pilot Programme and was there to enable practice transformation rather than just deal with crisis points. It was intended that the programme was delivered in line with Strategic Transformation Plans (STPs). The programme aimed to deliver support for practices to become more sustainable and resilient, better placed to tackle the challenges they faced now and into the future, and to secure high quality care for patients. It was a four year programme, with £40m invested nationally. £16m was available nationally in Year 1, of which £68.3k had been allocated to the West with £34.2k for each of years 2, 3 and 4. The offer of support to practices was to be tailored to meet the needs of the practice/ groups of practices by providing access to:

Diagnostic services to quickly identify areas for improvement support

Specialist advice and guidance e.g. HR,IT

Coaching/Supervision/Mentorship

Practice Management Capacity Support

Rapid Intervention and management support for Practices at risk of closure

Co-ordinated support to help practices struggling with workforce issues

Change management and improvement support to individual practices or group of practices

NHS England, CCGs and Local Medical Committees had collaboratively identified 88 GP practices for support within the East, using a set of criteria within the six domains of Safety, Workforce, External perspective Organisational Issues, Efficiency and Patient Experience. 4 of the 88 practices were within the CCG’s area.

A Project Delivery Office had been set up to coordinate all the activities required to implement the programme, map all available support across the whole of the programme to ensure maximum usage, together with procuring

additional support if required. The Committee noted the verbal report.

16/29 PRIMARY CARE SUPPORT SERVICES UPDATE

NHS England’s Suffolk Primary Care Contracts Manager reported that

following concern raised at the previous meeting issues in respect of medical records and supplies to practices had been recognised by NHS England and escalated with the provider. The provider had put a recovery team in place and intensive support was being provided to improve performance and reduce medical record transfer backlogs. It had been noted that a number of practices had incurred additional costs as a result of the poor performance and NHS England, at a national level, was current reviewing the situation. The central contact centre initiated by NHS England had been overwhelmed and it was anticipated that a Gateway communication would be issued by NHS England to all contractors within the next few weeks, informing them of the triage process for urgent issues. The Committee noted the update.

16/30 CARE QUALITY COMMISSION (CQC)

The Committee was in receipt of a report that sought to inform about Care

Quality Commission (CQC) inspections of West Suffolk GP practices. Paragraph 3.1 detailed the outcome of inspections in respect of individual practices. CQC reports, to date, indicated that the quality of primary care services in West Suffolk was “good”. The Inspectors had not identified any whole scale areas for improvement but highlighted individual needs and opportunities for improvement. Swan and Lakenheath surgeries had been rated as “requires improvement” following their recent inspections. Lakenheath received an inadequate rating for ‘safe services’ and all elements had now been addressed, with the practice having improved to a ‘good’ rating. Ratings were however unable to be revised on the CQC website until re-inspection had taken place. Action plans addressing all aspects of the inspections had been put in place and the Head of Primary Care continued to provide support to practices prior to and after the CQC inspection. The Committee was advised that support in respect of patient expectation was also available from Healthwatch should practices require it. The Committee noted the content of the report.


The next meeting of the Joint Commissioning Committee was scheduled to

take place, in public, on Wednesday 22 February 2017, from 1.00pm – 3.00pm in the Conference Room, West Suffolk House, Western Way, Bury St Edmunds, Suffolk, IP33 3YU. All members agreed to ensure that, for future meetings, papers were made available for circulation with the agenda prior to the meeting.

16/32 QUESTIONS FROM THE PUBLIC

No members of the public were present.

WEST SUFFOLK CCG COMMISSIONING GOVERNANCE COMMITTEE

Decision Record 21 December 2016

Commissioning Governance Committee Members:

COMMITTEE: Bill Banks Lay Member: Governance (Chair) Johanna Finn Lay Member: Patient and Public Engagement Ed Garratt Chief Officer Lesley MacLeod Chief Finance Officer Jan Thomas Deputy Chief Officer/Chief Contracts Officer

1 INTEGRATED URGENT CARE – PROGRESSION - PQQ TO ITT

WSCCG/CGC 16-10

Decision The Chief Contracts Officer reported that the Integrated Urgent Care (IUC)

tender had now completed the pre-qualification stage of the process. The Pre-Qualification Questionnaires (PQQ) had been evaluated to secure the necessary reassurances that the organisation(s) bidding for the work had the capacity, capability and eligibility to satisfy the minimum requirements of the CCGs. The purpose of the presented report was to detail the outcome of the PQQ which had been undertaken in conjunction with West Suffolk CCG and North East Essex CCG. As agreed, the tender was following a restricted procedure. This meant that, if approved by the Commissioning Governance Committee, the tender would move onto an Invitation to Tender stage which would be evaluated for award. The purpose of the Invitation to Tender was to understand the proposed delivery method and secure reassurances that the proposals met the needs of patients in the safest and most reliable form. The Commissioning Governance Committee approved progression of all four providers through to the Invitation to Tender stage.

2 COMMUNITY SERVICES GATEWAY 1 PROGRESSION

WSCCG/CGC 16-11

Decision The Commissioning Governance Committee was in receipt of a report from

the Chief Contracts Officer which provided information on the Community Services contract currently held by West Suffolk NHS Foundation Trust which was due to end on the 31 October 2017. In September 2016 the CCG’s Clinical Executive and Governing Body undertook a Most Capable Provider process with existing system providers, as permitted under the Procurement Patient Choice and Competition (No. 2) Regulations 2013. The Most Capable Provider (MCP) process was designed to understand whether an alliance of existing

system providers would be able to offer a unique set of opportunities which could not be delivered by any other group(s) of providers. The contract form had not yet been agreed, however the commissioners committed to a long term contract (est 8-10 years) to ensure continuity and time for providers to succeed. The report went on to detail the Most Capable Provider process and the outcome of the Gateway 1 evaluation. The Commissioning Governance Committee; 1. Agreed the progression of the alliances through gateway 1 to start

detailed negotiations around vision, service delivery and contracts; which would culminate in a mutually agreed delivery plan; innovation plan and an agreed service contract which, once ratified, could be moved towards signature.

2. Agreed with the increased involvement commitment in order to

facilitate and aid the potential transformation.

3. Agreed to approve any decisions from this process due to the conflict of interests present

3 REVISED VERSION OF THE REWARDING APPROPRIATE

PRESCRIBING (RAP) SCHEME, 01 JANUARY – 31 MARCH 2017

WSCCG/CGC 16-12

Decision The Committee was in receipt of a report which demonstrated savings

delivery via the current Rewarding Appropriate Prescribing (RAP) scheme, together with proposals for achieving further savings in the final quarter of 2016/17. The Commissioning Governance Committee subsequently;

1. Approved the implementation of the revised RAP Scheme for Q4. 2. Acknowledged that practices would be allowed to choose to either

continue with the current RAP Scheme or move to the revised version. 3. Approved that practice payments should be capped at £255,842k.

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