governing body agenda thursday, 2 july 2015, …...5.1 governing body assurance framework hs gb1 5...

Governing Body

AGENDA

Thursday, 2 July 2015, 10:30-13:00 Arreton Community Hall, Main Rd, Arreton, Newport, Isle of Wight PO30 3AA

1. 1.1

1.2 1.3

Apologies for absence: Declaration of interests Confirmation that the meeting is quorate

JR JR JR

GB15-017

10:30

2. Minutes of the last Governing Body Meeting 28 May 2015 JR GB15-018 3. Matters Arising

3.1 Schedule of Actions from the 28 May 2015

JR

GB15-019

10:35 4. Chair / Chief Officer Report

4.1 Wessex Assurance Quarter 4 Meeting JR/HS Verbal 10:40

5. Items for Assurance 5.1 Governing Body Assurance Framework HS GB15-020 5.2 Performance Report LO GB15-021 5.3 Risk Register HS GB15-022 5.4 360 Stakeholder Survey HS GB15-023 5.5 IOWNHST CQC Action Plan Update LK GB15-024 6. Items for Approval 6.1 Budget Update LO GB15-025 7. Items to receive for information / discussion 7.1 Audit Committee Summary 21.5.15 & 27.5.15 HS GB15-026 7.2 Quality and Patient Safety Summary 7.5.15 IR GB15-027 7.3 Clinical Executive Minutes 21.5.15 HS GB15-028 8. Urgent Business JR 9. Motion to exclude the Press and Public JR - that representatives of the press, and other members of the public, be

excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest’, (Section 1 (2), Public Bodies (Admission to Meetings) Act I960)

Date of Next Meeting – Thursday 3 September 2015, 10:30 – 13:00 – Hunnyhill Room, Riverside

Centre, The Quay, Newport, Isle of Wight PO30 2QR

Governing Body Declaration of Governing Body Members’ Interests Sponsor: Helen Shields, Chief Officer

Summary of issue:

This paper sets out the relevant and material interests of the members of the CCG Governing Body. It represents the Register of Interests as required by the Standing Orders in accordance with the NHS Code of Accountability.

This paper supports the CCG Governing Body to fulfil its Standing Orders in accordance with the NHS Code of Accountability.

Action required / recommendation:

The CCG Governing Body is being asked:

• To receive and note the register of interests of members and ensure that members play no part in discussion or decision where a conflict of interest is established.

• To receive any oral updates on the interests of members.

Principle risk(s) relating to this paper:

There are no risks relating to this paper.

Other committees where this has been considered:

This paper has not been considered at any other committee.

Financial / resource implications:

There are no financial or resource implications arising from this paper.

Legal implications / impact:

There are no legal implications arising from this paper.

Public involvement /action taken:

There has been no public involvement or action taken.

Equality and diversity impact:

This paper does not request decisions that impact on equality and diversity

Author of Paper: Rebecca Berryman, Governance Support Officer

Date of Paper: May 2015

Date of Meeting: 2 July 2015

Agenda Item: 1.2 Paper number: GB15-017

1

Declaration of Interest

1. Introduction

1.1 The NHS Code of Accountability requires the Governing Body to declare interests which are

relevant and material to the Governing Body of which they are a member.

1.2 Interests which should be regarded as “relevant and material” are:

• Directorships, including non-executive directorships held in private companies or PLCs (with the exception of those of dormant companies);

• Ownership or part-ownership of private companies, businesses or consultancies likely or

possibly seeking to do business with the NHS;

• Majority or controlling share holdings in organisations likely or possible seeking to do business with the NHS;

• A position of authority in a charity or voluntary organisation in the field of health or social

care;

• Any connection with a voluntary or other organisation contracting for NHS services;

• Research funding/grants that be received by an individual or their department;

• Interests in pooled funds that are under separate management (any relevant company included in this fund that has a potential relationship with the CCG must be declared);

1.3 Any Governing Body Member who comes to know that the CCG Governing Body has entered

into or proposed to enter into a contract in which he/she or any person connected with him/her (as defined in the Standing Orders) has any pecuniary interest, direct or indirect, the Governing Body member shall declare his/her interest by giving notice in writing of such fact to the CCG Governing Body as soon as practicable.

1.4 The Chief Officer will ensure that a Register of Interests is established to record formally declarations of interests of Governing Body Members. Interests will be declared at Governing Body meetings to ensure they are known to the public.

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2. Register of Interests

Name Relevant and Material Interests Dr Joanna HESSE Clinical Executive Member

Joanna is: A GP Partner at Esplanade Surgery, Ryde, Isle of Wight. Joanna undertakes private practice within Esplanade Surgery, Ryde, Isle of Wight.

Last Updated /Noted: May 2015 David NEWTON Governing Body Lay Advisor

David is: Director of Social Enterprise Foundation CIC and Social Enterprise Foundation Members Ltd. A Senior Partner at Corporate Impact. Contracted by Priory Asset Management. A facilitator for the Patient and Public Involvement Lay Member Network.

Last Updated / Noted: May 2015 Loretta OUTHWAITE Chief Finance Officer

Loretta is a School Governor at the Island Free School. Last Updated / Noted: December 2013

Frederick Psyk Governing Body Lay Advisor

Frederick has no declarations of interest. Last Updated / Noted: November 2014

Dr Ian Reckless Secondary Care Doctor

Ian is: Employed by Oxford University Hospital NHS Trust as Consultant Physician, Clinical Director, Neurosciences. Undertakes voluntary ad hoc work with Royal College of Physicians Honorary Senior Clinical Lecturer, Oxford University. Co-applicant on a number of research grants including Engineering and Physical Sciences Research Council. Author, Oxford University Press and Blackwell-Wiley (royalties)

Last Updated / Noted: September 2014 Dr John Rivers Chair, Clinical Executive Member

John is: A GP Partner at Shanklin Medical Centre, Shanklin, Isle of Wight. John undertakes private medicals and reports with general practice. President of Cruse Bereavement Care IW

Last Updated / Noted: April 2014 Helen Shields Chief Officer

Helen’s husband is Head of Podiatry and Orthopaedic Triage at IW NHS Trust.

Last Updated / Noted: October 2014 Lindsay Voss Governing Body Nurse

Lindsay is: Lay member for National Catholic Safeguarding Commission

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Lindsay’s husband is employed in Pharmaceutical industry (Eli Lilly and Company)

Last Updated / Noted: May 2015

4

Governing Body Minutes of the Governing Body 2 July 2015

Sponsor: Helen Shields, Chief Officer

Summary of issue: Minutes of the previous Governing Body Meeting 28 May 2015.

Action required/ recommendation: To approve the minutes

Principle risks: There are no risks relating to this paper.


This paper has not been considered at any other committees.

Financial /resource implications: There are no financial or resource implications.

Legal implications/ impact: These minutes form a formal public record of the previous meeting.

Public involvement /action taken: The Governing Body was held in public.

Equality and diversity impact: There is no equality and diversity impact relating to this paper.

Author of paper: Rebecca Berryman, Governance Support Officer

Date of Paper: 29 May 2015


Agenda Item: 2 Paper number: GB15-018

1

NHS Isle of Wight Clinical Commissioning Group: Governing Body

Minutes of Part 1 of the CCG Governing Body held on 28 May 2015 at 10:30 at Bembridge Community Centre, Steyne Park, Steyne Road, Bembridge, Isle of Wight PO35 5UL

PRESENT: Dr John Rivers (JR) – CCG Chairman (Chair) Helen Shields (HS) – Chief Officer David Newton (DN) –Governing Body Lay Advisor Loretta Outhwaite (LO) – Chief Finance Officer Frederick Psyk (FP) – Governing Body Lay Advisor Dr Joanna Hesse (JH) – CCG Clinical Executive

IN ATTENDANCE: Caroline Morris (CM) – Head of Primary Care and Corporate Business (Item 5.1, 5.3, 6.1 and 6.4) James Cotton (JC) Business Administrator (Item 6.4) Lindsay Voss (LV) – Governing Body Nurse (observer)

MINUTED BY: Rebecca Berryman (RB) – Governance Support Officer

15-001 Apologies for Absence Apologies for absence were received from Dr Ian Reckless, Secondary Care Doctor.

Lindsay Voss was welcomed and introduced as the new Governing Body Nurse; she would be observing the meeting.

15-002 Declarations of Interest The Governing Body received paper GB15-001 Declaration of Interests. The following

changes were highlighted: • JH no longer undertakes Out of Hours work at the Beacon Health Centre. • DN is a facilitator for the Patient and Public Involvement Lay Member Network.

15-003 Confirmation the Meeting is Quorate Confirmed. 15-004 Minutes of the Last Governing Body Meeting 26 March 2015 The Governing Body received paper GB15-002 Minutes of the last Governing Body

Meeting 26 March 2015. The minutes were approved as accurate, with the following comment. • LO highlighted on p.6 it was recorded that the CCG were successful in their business

case to draw down £400k from surplus. It was confirmed that this had now been rejected by NHS England, as the CCG’s financial allocation was over target.

The Governing Body approved the Governing Body Minutes of the 26 March 2015 15-005 Matters Arising

The Governing Body received and noted paper GB15-003 Schedule of Actions from 26

2

March 2015, noting the following comments: • 14-103 – Better Care Fund (BCF) to be included within the CCG budget – LO confirmed

that a paper would be provided at the next meeting. • Deprivation of Liberty Safeguards (DoLS) - FP asked if there was an update in relation

to DoLs. It was confirmed that a letter had been sent to the IOW NHS Trust (IOWNHST), there is still concern regarding the number of DoLS applications, therefore a contract notice would be issued. It was requested that an update regarding DoLS was presented at the next Governing Body meeting.

ACTION: DoLS update to be presented to the next Governing Body Meeting. LK 15-006 Chair and Chief Officers Update

The Governing Body received a verbal update from the Chair and Chief Officer regarding Vanguard. My Life a Full Life (MLAFL) was the Island’s response to the challenges in Health and Social Care. The focus of the MLAFL programme is for integration across all sectors of health and social care, and the development of locality working. The Five Year Forward View from NHS England and the Department of Health (DOH) supported the direction that the Island was already going in. Part of the Five Year Forward View was for new models of care to be developed. Expressions of interest were therefore requested for organisations to bid to become a Vanguard site to a lead on the development new care models, which will act as the blue prints for the NHS moving forward and the inspiration to the rest of the health and care system. MLAFL were successful in this bid and became 1 of 29 Vanguard sites in the country. With the support of the Vanguard programme, the Island can go further faster with the MLAFL programme; the programme will therefore be known as “My Life A Full Life”, powered by Vanguard. A recent two day visit by the New Models of Care Team was a success, the team were very impressed with what they saw; the good work that has been achieved so far, and plans for moving forward. HS commented that the leadership team were viewed as strong by the New Models of Care Team. JR highlighted this is a fantastic opportunity for the Island and the New Care Models Team is keen to support the Island.

The My Life A Full Life (MLAFL) programme, powered by Vanguard, aims to fundamentally change and improve the lives of people on the Island. MLAFL is about organisations working together in partnership with the voluntary and independent sectors, the Isle of Wight Clinical Commissioning Group (CCG), the Isle of Wight Council (IWC), the Isle of Wight NHS Trust (IWNHS Trust) and One Wight Health (the federation of all 17 Island GP Practices), providing for people’s individual needs, to enable them to take control of their lives and plan for their future health and social care needs. This work is based on the partners’ five year vision for integrated health and social care on the Island.

In response to an email received from a member of the public prior to the meeting regarding Vanguard, JR highlighted the following:

• In relation to Locality Hubs, the aim of these is to break down boundaries and to look

3

at how practices can deliver services differently. The Locality Teams have just been established so this work is in the very early stages of development.

• The aspiration of a one shared healthcare record is key, to ensure that all health and care professionals have access to all the information regarding their patient. It is also hoped that patients can access these records. With regard to Care Plans, patients need to be empowered and be able to understand their own health requirements.

• The Care Navigator pilot is currently being reviewed to ensure that they are equitable for all GP Practices on the Island.

It was emphasised that patient engagement is key to the MLAFL programme. The public will need to be engaged on the future model of healthcare for the Island. HS highlighted that the next steps were for a value proposition (business case) to be presented at the end of June with the MLAFL proposals. One of the first pieces of work proposed is to undertake a Clinical Services Review of all healthcare services on the Island. DN requested that patient and public involvement was started early in the process. HS confirmed that contact had been made with Dorset CCG who had recently undertaken a similar review. They had both a clinical group and a patient group of equal status; HS emphasised the importance of the public being on the journey with MLAFL powered by Vanguard.

Items for Assurance 15-007 Governing Body Assurance Framework Proposal The Governing Body received paper GB15-004 Governing Body Assurance Framework

Proposal, presented by CM. The Governing Body Assurance Framework (GBAF) identifies the key risks to the organisation’s objectives. This proposal is the first step to creating the 15/16 GBAF. It sets out revised objectives and the critical success factors. There are five overall objectives proposed, this is one more than last year. The fifth reflects the level of organisational change that will be required in the next 12 months as the MLAFL programme takes shape. The objectives are linked to the CCG Senior Team’s individual objectives through the appraisal process. FP commented that when making changes it is easy to forget about culture. HS commented that culture was reflected in the Organisational Development Plan across the system. FP further commented that it would be useful to demonstrate what the CCG’s base position is. He suggested being more candid particularly in relation to Constitutional Targets, if it is know that standards will not be met, this should be acknowledged. JH commented that is would be useful to define progress, improvement and be clear on what the CCG is aiming to achieve. CM explained the matrix setting out the gaps and actions will be built on and presented to the next meeting.

4

FP commented that the Wessex Area Team (WAT) use a different matrix to the CCG. He suggested it would be useful to have an appendix where the CCG self-assess against the WAT matrix. CM agreed to review.

The Governing Body approved the Governing Body Assurance Framework Proposal. 15-008 Year End Performance Report

The Governing Body received a Year End Performance Report presentation from LO. The report highlighted the following: • 12 of the 17 Constitution targets were met. • 50% of the Quality Premium (13/14 performance) was achieved. • IOWNHST achieved 94% of quality improvement schemes (CQUINS) • The CCG meets monthly with the Trust Development Agency (TDA) to review the

IOWNHST’s CQC Action Plan. FP queried if there were still issues the Trust hadn’t actioned. HS confirmed there were a few areas outstanding. It was agreed that an update was presented at the next meeting.

• CCG Mandatory Training reached 94%. • CCG Appraisals reached 99%. • The CCG has a low sickness record. • The CCG had average staff turnover. Provisional Data • There were 6 mixed sex accommodation breaches in April. • The A&E 4 hour 95% target for April was 92.1% and May 92.5% to date. • There were 4 beaches for Referral to Treatment (RTT) >52 weeks. • C Difficile is above target for April. HS reported that in addition to the System Resilience Group an Executive System Resilience Group has now been established in order to understand system pressures. DN asked how far forward can commissioning decisions be planned. It was confirmed that a Demand Plan is put together in conjunction with providers. There is concern regarding the IOWNHST’s ability to deliver the demand plan, therefore contingencies have been put in place with mainland providers who can deliver the activity. It has been negotiated with mainland providers that transport costs will be met for patients travelling for treatment to the mainland. Communication needs to be shared with the public and GP Practices.

The Governing Body noted the Performance Report. ACTION: IOWNHST CQC Action Plan Update to the next Governing Body Meeting. LK 15-009 Risk Register

The Governing Body received paper GB15-005 Risk Register, presented by CM. The Risk Register has been completely reviewed and overhauled for the new financial year. There will be greater ownership of risk and each risk is reviewed at team performance

5

management meetings. The Commissioning Officers Group (COG) and the Clinical Executive review the Risk Register on a monthly basis.

The Governing Body noted the Risk Register. 15-010 Wessex Assurance Quarter 3 Report

The Governing Body received paper GB15-006 Wessex Assurance Quarter 3 Report, presented by HS. The report wasn’t received in a timely manner; this will be fed back to NHS England. It was noted the plan for an acute service review had been superseded by MLAFL Powered by Vanguard with a Clinical Service Review.

The Governing Body noted the Wessex Quarter 3 Report. Items for Decision 15-011 Annual Report and Accounts

The Governing Body received paper GB15-007 Annual Report and Accounts, presented by CM/LO. CM highlighted that national guidance dictates the content of the Annual Report, however this year the CCGs report is more concise. Key CCG staff contributed to the report and accounts. The Audit Committee have reviewed the process and a draft version on the 21 May 2015. A small number of changes have been made to both the Annual Report and Accounts following a review by the Audit Committee. LO reported that the CCG had met all its Statutory Financial Duties. External Audit had made no qualifications. There was one issue in relation to differences in property services figures. The issue will be reported, however as it is not material it will not affect the outcome of the audit. A specific letter of representation of why the CCG believe their position to be correct has been completed. FP confirmed that as Audit Committee Chair he was satisfied that all amendments suggested by the Audit Committee had been made and he was satisfied that the Annual Report and Accounts present the CCG’s year in an appropriate, comprehensive, balanced and coherent way. Each Governing Body Member read the following disclosure to the Auditors: “As far as I am aware there is no relevant audit information of which the CCG’s auditors are unaware.” “I have taken all steps that I ought to have as a member of the Governing Body, in order to make myself aware of any relevant audit information and to establish that the CCG’s auditors are aware of that information.” IR sent his apologies for the meeting; however he signed his declaration prior to the meeting.

The Governing Body approved Annual Report and Accounts

6

15-012 Operational Plan

The Governing Body received paper GB15-008 Operational Plan, presented by LO. The Operational Plan was formally approved in April 2015 however, due to a national directive to increase non-elective admission by 2%, plans needed to be amended to reflect the directive. The impact creates a £432k increase. A contract variation with the IOWNHST needed to take place. The contract is a payment by results contract and will be closely monitored. A new section outlining 8 high impact interventions has been included within the Operational Plan. FP queried what type of company One Wight Health were, it was confirmed they were a Limited company with profit and owned by GP Practices.

The Governing Body approved the Operational Plan. 15-013 Better Care Fund (BCF)

The Governing Body received paper GB15-009 Better Care Fund (BCF), presented by HS. As a result of the directive to increase the 2% non-elective activity, the BCF needed to be updated.

The Governing Body approved the Better Care Fund. 15-014 Sustainable Development Management Plan

The Governing Body received paper GB15-010 Sustainable Development Management Plan, presented by JC and CM. It is a requirement for CCG’s to have a Sustainable Development Management Plan (SDMP) under the national Public Health Outcomes Framework. The SDMP outlines the CCG’s ambitions to reducing its direct environmental impacts and embedding sustainability principles in the activities of the organisations. The SDMP is in conjunction with the IOWNHST to work together to align strategies and optimise outcomes. The SDMP has been used as an exemplar for others to follow. It was queried why the Council were not involved, CM explained that due to the complexity of the Council’s remit it couldn’t be incorporated in to this version of the SDMP. DN asked what the next steps were. CM confirmed that an action plan had been put together and once approved the action plan would be implemented. JC was congratulated on the impressive SDMP, it was noted that this fitted well with integration and the MLAFL programme.

The Governing Body approved the Sustainable Development Management Plan.

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15-015 Policy Recommendation 003: The Use of Partial Knee Arthroplasty in Patients with

Osteoarthritis Knee The Governing Body received paper GB15-011 Policy Recommendation 003: The Use of Partial Knee Arthroplasty in Patients with Osteoarthritis Knee, presented by HS. There were issues identified that the paper did not include any background contextual information for the Governing Body to gain a clear understanding. It was highlighted that this was also raised by the Clinical Executive who recommended the policy for approval to the Governing Body. DN also expressed concern with regard to the way the front sheets are presented, particularly in relation to Equality and Diversity. It was agreed for all Policy Recommendations there needs to be a covering paper that outlines the Isle of Wight commissioning context as well as the process the policy has been through before being signed off. JR highlighted this policy outlines that the pathway for the procedure needs to be clear, to ensure patients are receiving the correct and most suitable treatment.

The Governing Body approved the Policy Recommendation 003: The Use of Partial Knee Arthroplasty in Patients with Osteoarthritis Knee

ACTION: A covering paper outlining the commissioning context and process each policy

recommendation has been through to be included with all policy recommendations. HS

Items to Receive / for Discussion 15-016 The Governing Body noted the following terms of reference and sub-committee

minutes: • Joint Adult Commissioning Board Terms of Reference • Quality and Patient Safety Committee Minutes 26.3.15 • Clinical Executive Minutes 19.3.15 and 16.4.15 • Audit Committee Annual Report • Remuneration Committee Annual Report

15-017 Urgent Business

FP reported that David Grist, Associate Lay Member had been appointed and would be a member of the Audit Committee.

15-018 Motion to exclude the Press and Public

JR read the following statement: “that representatives of the press, and other members of the public, be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest’, (Section 1 (2), Public Bodies (Admission to Meetings)”

15-019 Date of Next Meeting: Thursday 2 July 2015, 10:30- 13:00 - Arreton Community Hall, Main Rd, Arreton, Newport, Isle of Wight PO30 3AA

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Circulation: Members In attendance:

For Information (Agenda):

Dr John Rivers – CCG Clinical Executive (Chair) Fredrick Psyk – Lay Member (Deputy Chair) Dr Joanna Hesse – CCG Clinical Executive Helen Shields – Chief Officer Loretta Outhwaite – Chief Finance Officer David Newton – Lay Member Dr Ian Reckless – Secondary Care Doctor Lindsay Voss – Governing Body Nurse

R Berryman (Minutes) Caroline Morris

Gillian Baker Loretta Kinsella For Information (Minutes): Karen Morgan, Head of Quality Linda Rann, Sue Lightfoot, Rachael Hayes, Dawn Berryman, Eleanor Roddick - Heads of Commissioning, Andy Brandham, Deputy Head of Medicine’s Management, Caroline Morris – Head of Corporate Business Rebecca Wastall – Deputy Chief Finance Officer

Invited: Gillian Baker

9

Governing Body

Matters arising: Schedule of Actions – Part 1


Summary of issue: Actions identified from previous meeting together with updates on progress to date and expected completion dates

Action required/ recommendation:

To gain assurance that the actions requested by the Governing Body are in train

Principle risks: There are no risks associated with this paper.


This paper has not been considered at any other committee.

Financial /resource implications:

There are no financial or resource implications in relation to this paper.

Legal implications/ impact:

There are no legal implications or impact relating to this paper.

Public involvement /action taken: There has been no public involvement in this paper.


Author of paper: Rebecca Berryman, Governance Support Officer


Date of Meeting:


1

Isle of Wight Clinical Commissioning Group: Governing Body SCHEDULE OF ACTIONS TAKEN FROM THE MINUTES 28 May 2015 – part 1

Date of Meeting

Minute No

Action Lead Update Due Date Status

26.3.15 14-103 BCF to be included within the CCG budget. LO May 2015 BCF funding is within the CCG budget and sits within each service area it relates to. Information will be shared post Annual Accounts to show which lines it is within. June 2015 BCF included in Budget Update paper on the 2.7.15 agenda.

July 2015 Closed

28.5.15 15-005 DoLS update to be presented to the next Governing Body Meeting.

LK Included within the CQC Update to the Governing Body agenda on 2.7.15.

July 2015 Closed

28.5.15 15-008 IOWNHST CQC Action Plan Update to the next Governing Body Meeting.

LK Update on the Governing Body agenda 2.7.15. July 2015 Closed

28.5.15 15-015 A covering paper outlining the commissioning context and process each policy recommendation has been through to be included with all policy recommendations.

HS This will be actioned for the future. July 2015 Closed

2

Governing Body Governing Body Assurance Framework


Summary issues:

The Governing Body Assurance Framework is presented completed with risks and actions plans at this meeting. This is a living document and will continue to develop across the financial year. It is likely that further risks will be identified as the MLFL vanguard project becomes clearer and key work programmes are developed more fully. At this stage in the year, there are some gaps in controls, however there are action plans in place to develop controls or mitigate the risks articulated.

Action required / recommendation:

The Governing Body is requested to review the GBAF to ensure that they are assured that the risks and action plans are appropriately captured and articulated.

Principle risk(s) relating to this paper:

The areas of high risk for the CCG at this point in the year include: 3.10 – Failure to deliver savings from the Better Care Fund 3.20 – Failure to manage within running costs 3.50-3.80 – Failure to achieve the NHS Constitution targets 4.50 - The risk inherent in this GBAF are associated with the uncertainty the rapid development of the MLFL programme creates against the agreed objectives of the CCG.


The objectives and critical success factors in this document were agreed at the previous Governing Body meeting in May. The risks have been developed by the key director leads and will now be monitored through performance review meetings and through COG.

Financial / resource implications:

Objective 3 articulates the financial and resource risks that could affect the CCG over this financial year.

Legal implications / impact:

Failure to achieve NHS constitution targets will result in significant scrutiny from and additional reporting to NHS England and ultimately the Department of Health. This would create additional work within the CCG which would detract from the considerable change programme in place.


Public/stakeholder engagement and involvement is a key objective identified within this document and will be subject of a significant work plan as the MLFL programme is progressed.


Equality impact assessments to support key work programmes within the GBAF are routinely produced. Overall the achievement of these work programmes will have the effect of reducing inequalities across the nine protected characteristics.

Author: Caroline Morris, Head of Primary Care and Corporate Business

Date of Paper: 24 June 2015

Governing Body Meeting 1 June 2015

GOVERNING BODY ASSURANCE FRAMEWORK 2015/16

Key Controls Sources of Assurance Gaps in control/Assurance

4*3

4*3

2*4

4*3

3*3

1.20

New priorities are agreed, particularly in relation to vanguard.

Critical Success Factor 1: Deliver the priorities in the delivery plan

1.10

- June '15 - New priorities to be agreed with Clinical Executive by end September 2015 dependent on ability to appoint additional capacity.- June '15 - Value Proposition to be agreed by end July 2015

Repo

rtin

g Co

mm

ittee

1.30

January 2016GB

June 15 - Commissioning Leadership Group to review workload.June 15 - JACB to agree priorities.

Action plan to address gapsOwner

Review/Completion date

Capacity of the teams to undertake the work with an increase in routine business taking priority e.g. NHS England assurance processes.

- June '15 - Notes of Performance Review Meetings.- June '15 - Quarterly Delivery Plan reports to Clinical Executive.- June '15 - Notes of Clinical Executive Meetings.

- June '15 - Unclear as to availability of additional support.- June 15 - Lack of clarity in what assurance will be required by NHS England.- June 15 - Caps on running costs limit capacity.

- June '15 - Monthly review of capacity against plan. If required proposals for reprioritisation to Clinical Executive.- Consideration of additional capacity across the teams if required.

Ongoing review throughout the year

GB/LO/LK/HS/CM

- June '15 - Performance Review Meetings monthly with all the teams.- June '15 - 1:1 fortnightly meetings with Heads of Commissioning/ Service Leads.

(What could prevent this objective being achieved?)

(What controls do we have in place to assist in securing the delivery of this objective?)

(Where can the Governing Body gain evidence that our controls/systems on which we place reliance are effective?) Se

pt A

ssur

ance

leve

l

(Where we are failing to put controls/systems in place)Ju

n As

sura

nce

leve

l

Objective 1: To implement our clinical commissioning strategy.

Principle Risks

CE

Nov

Ass

uran

ce L

evel

Jan

Assu

ranc

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vel

Mar

Ass

uran

ce le

vel

Year

End

Ass

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severity x likelihood

CE

September 2015GB/LO/CM

- June '15 - resources required to be identified and requested as part of vanguard value proposition- June 15 - Project plan to be developed to support integration with timelines according to capacity.

- June '15 - transitional support required to effect change process.- June 15 - We haven't determined level of support required to develop integrated commissioning.

- June '15 - Notes of Clinical Executive Meetings.- June 15 - Notes of JACB.

- June '15 - New priorities to be agreed with Clinical Executive in accordance with capacity.- June '15 - Value Proposition to be agreed with NHS England as part of the Vanguard Status.

Sept 2015GB/LO/LK/HS/CM

- June '15 - Active early planning for recruitment e.g. maternity leave cover.- June '15 - Internal secondments of staff to key roles.

Scope of what is included in integrated commissioning is difficult to define.

- June '15 - Integrated Leadership Group report for approval to JACB.

- June '15 - Notes of Integrated Commissioning Leadership Group.- June '15 - Reports to JACB.

June '15 - Scoping report not yet produced.

- June '15 - Matrix of commissioning activities to be produced and reported to the JACB. September 2015

GB

1.50

Issues arising from very different cultures and ways of commissioning service between Public Health, Adult Social Care and CCG.

- June '15 - Workforce monitoring reports as part of performance reports.- June 15 - Notes of COG meetings.

- June '15 - Maternity cover to be agreed by July '15- June 15 - Discussions weekly at COG regard vacancies.

1.40

Critical Success Factor 2: Progress joint commissioning with the Local AuthorityCapacity of the CCG teams to engage in integration work on top of existing priorities.

- June '15 - Performance Review meetings monthly with all teams.- June '15 - 1:1 fortnightly meetings between Heads of Commissioning and Deputy Chief Officer to prioritise workload.- June '15 - Integrated Commissioning Leadership Group developed and meeting

- June '15 - Notes of Performance Review meetings.- June '15 - Notes of Integrated Commissioning Leadership Group.June 15 - Notes of JACB meetings. CE / JACB

- June '15 - Integrated Leadership Group established.


-June '15 - Project Plan to be developed and agreed

- June '15 - OD Plan to be created- June '15 - Facilitated workshops to work through creating a new culture.

JACB1.60

Staff posts not filled and gaps in cover.

- June '15 - agree process for covering maternity leave- June 15 - identify potential sources of cover.- More efficient working across commissioning with reduction of duplication with LA

Review August 2015GB/LO/LK/HS/CM

CE

JACB



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3*4

4*3

4*3

3*3

4*3

3*3

Failure to work systematically with wider patient groups and the public to support strategy delivery

Notes of Performance Review Meetings.Quarterly Delivery Plan reports to Clinical Executive.Notes of Clinical Executive meetings.Notes of JACB.

June 15 - 'Lack of understanding of how Local Authority will prioritise work.

-June '15 - Proposal document for co-locating staff for JACB.

June 15 - 'Priorities to be agreed at leadership group and proposed to JACB particularly when projects required as part of vanguard are clearer.

November 2015GB

1.90

- June '15 - New priorities to be agreed with Clinical Executive by end September 2015 dependent on ability to appoint additional capacity.- June '15 - Value Proposition to be agreed by end July 2015

September 2015GB


- June 15 - plan to resolve issues is required across all organisations

1.70

Ability to co-locate staff due to lack of physical space and issues of IT system access.

- June '15 - Stakeholder strategy in place with relevant tools and techniques

Capacity of the teams to deliver the development priorities due to increases in routine work.

Critical Success Factor 3: Develop the better care fund schemes and establish a monitoring regime

1.80

Failure to work closely with stakeholders to engage with the right groups in a systematic and methodical manner

- June '15 - Stakeholder strategy in place with relevant tools and techniques- June '15 - Governing Body and sub committee front sheets in place

- June '15 - Stakeholder strategy- June '15 - internal audit report - June '15 - Governing Body and sub committee front sheets recording engagement

- June '15 - programme of work to be developed based on strategy and delivery plan

- June '15 - develop plan (CM)

- June '15 - programme of work to be developed based on strategy and delivery plan

- June '15 - develop plan (CM)

JACB

December 2015CM/GB

Critical Success Factor 4: Engage the public, service users and carers in the delivery of the strategy

JACB

December 2015CM/GB

- June '15 - Performance Review Meetings monthly with all the teams.- June '15 - 1:1 fortnightly meetings with Heads of Commissioning/Service Leads.- June '15 - Establishment of Integrated Commissioning Leadership Group.- June '15 - JACB in place and monitoring implementation.

- June '15 - Integrated Commissioning Leadership Group will produce report for approval to JACB.

New priorities are agreed, particularly in relation to vanguard.

New priorities to be agreed with Clinical Executive.Establishment of Integrated Commissioning Leadership Group. JACB in place and monitoring implementation and agreeing priorities.

Notes of Clinical Executive Meetings.Notes of JACB.

CE

- June '15 - New priorities to be agreed with Clinical Executive in accordance with capacity.- June '15 - Value Proposition to be agreed with NHS England as part of the Vanguard Status.

September 2015GB/LO/LK/CM/HS

JACB

1.13

1.11

CE

1.12

Risk of overlap and confusion in stakeholder engagement between CCG strategy and vanguard while new programme is developed and put in place

- June '15 - MLFL/vanguard programme engagement work stream

- June '15 - none at present

September 2015CM/HS

CE

- June '15 - Stakeholder strategy- June '15 - internal audit report - June '15 - Governing Body and sub committee front sheets recording engagement

- June '15 - work programme with vanguard work stream required

- June '15 - agree who from the CCG will lead this work programme - June '15 - Develop work programme



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2x3

3x3

3x3

Objective 3: To meet the statutory finance and NHS Constitution targets set for us by NHS England.

The Quality indicator's (QI) in the contract are not achieved because the Trust has not appropriately resourced or invested in the workforce to deliver the requirements set out in the contract.

- June 15 - None identified

June '15 - DoQ to develop constructive supportive meetings with the DoN at the Trust.

-June '15 - Minutes and Action Tracker from CQRM and Contractual Review meetings. - June '15 - Terms of Reference (ToR) for both meetings. - June '15 - Email correspondence including formal letters regarding early escalation of concerns.

March 2016LO

The Local CQUINs are not fully achieved because the Trust does not allocate appropriate resources to ensure achievement of the Key Performance Indicators (KPI's).

June '15 - Progress against CQUINs will be monitored quarterly at the CQRM and the Contract Review meetings. - June '15 - The Quality Team meet regularly with the Quality Leads in the Trust to gain assurance on in-year progress. - June '15 - Director of Quality (DoQ) will escalate to Director of Nursing (DoN) if slippage occurs.

- June '15 - Regular meetings.

June '15 - None identified June '15 - None identifiedJune '15 - Minutes and Action Tracker from monthly CQRM and Contractual Review meetings. - June '15 - Director of Quality and Director of Nursing meet monthly. June '15 - Head of Quality meets with Quality Leads regularly.

Critical Success Factor 1: The CCG meets all its financial targets as set out in the guidance for 2015/16

- June '15 - DoQ prioritises the Quality Team work programmes to ensure appropriate oversight and scrutiny. 'June '15 - Regular monitoring and early escalation of safeguarding demand. -June '15 - Working closely with the Safeguarding Boards and Safeguarding Designated Nurses to ensure Safeguarding standards are met. -June '15 - Supporting the Trust to invest in adequate Safeguarding resource. Escalation to Clinical Executive and Governing Body if there is a significant increase.

June '15 - Minutes and Action Tracker. Evidence actions and early escalation. Terms of Reference (ToR)

- June '15 - Develop effective working relationship with Safeguarding Boards.

March 2016 LK

CEC

CEC

Competing agendas and a limited workforce in the Quality team prevented robust scrutiny and oversight. Significant increase in Safeguarding concerns and Serious Case reviews (SCR's). Inadequate Safeguarding resource in the Trust.

Objective 2: To demonstrate measurable improvement in the quality and safety of our commissioned servicesCritical Success Factor 1: Achieve the local CQUINs set for our providers by the end of the financial year.

2.10

-June '15 - The QI's are reviewed monthly at the CQRM and the Contract Review meetings. - June '15 - Regular meetings with the Trust DoN and Quality Team are held to escalate slippage early. 'June '15 - QI for 2015/16 were jointly agreed with the Trust. Terms of Reference (ToR) for CQRM were jointly agreed with the Trust and were reviewed in June 2015.

Critical Success Factor 3: Achieve all the local quality indicators in the schedules for quality and safeguarding by the end of the financial year.

Critical Success Factor 2: Achieve the quality indicators in the contracting schedules throughout the year.

CEC

March 2016LK

2.20



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4*4

3*3

4*3

4*5

4*5

- June '15 - as for 3.50 above

4*5

3.30

3.40

The CCG fails to meet is resources limit in 15/16 due to contract over-performance on cost per case contracts

- June '15 - Monthly performance reviews- June '15 - Monthly Contract meetings

- June '15 - 15/15 demand plan- June '15 - Performance Reports

Critical Success Factor 2: Meet the NHS Constitution targets set by NHS England

LO CE

- June '15 - Lack of clarity on how additional administration costs relating to the vanguard project will be treated within running costs

- June '15 - None at present

The CCG fails to secure additional resources to support the return of primary care and specialised commissioning responsibilities.

- June '15 - Close and regular working with NHS England Wessex Area Team

- June '15 - Continue to escalate to NHS England

Failure to meet RTT:- Admitted patients in 18 weeks;- patients >52 weeks;- cancelled operations rebooked within 28 days; - second cancellation

3.20

- June '15 - recurrent solution for 16/17 and beyond required- June '15 - Medium term financial plan required.

- June '15 - Plan to be put in place to develop a medium term financial plan.

CE

3.10

LO

- June '15 - Budget statements- June '15 - Central Reporting- June '15 - Performance Reports

- June '15 - minutes from JACB and Clinical Exec

CE


LO

- June '15 - Review of running costs at COG on a regular basis- June '15 - forecast recurrent spend post 15/16

- June '15 - National Guidance- June '15 - Correspondence (e-mails) referring

- June '15 - Lack of clarity /information from NHS England

CE

The CCG fails to operate within its running costs allocation

- June '15 - JACB- June '15 - Clinical Executive Meeting

- June '15 - Extend monthly running costs forecasts to post 15/16- June '15 - Seek clarity from national teams on treatment of vanguard administration costs.

August 2015LO

CE

Failure to achieve target for no mixed sex accommodation

3.60

Failure to meet A&E target - patients waiting >4hrs

- June '15 - As above - June '15 - As above - June '15 - As above plus implementation of 8 high impact interventions

- June '15 - robust plans to implement 8 high impact interventions to be presented to System Resilience Group

3.50

- June '15 - Monthly performance reviews- June '15 - monthly contract meetings- June '15 - System Resilience Group- June '15 - Monthly Officer Level meetings- June '15 - Meetings with mainland providers

- monthly performance reports and discussion of issues at Clinical Executive Committee- Action plans developed in NHS Trust and agreed with CCG - Agreements with mainland providers to see patients

- June '15 - action plans developed within the NHS Trust are not yet delivering the required outcomes - June '15 - plans to support patients to choose and point of referral require further work

- June '15 - plans to encourage use of Choose and Book system to support patient choice at point o referral to be firmed up by end July 2015 November 2015

LO/GB

LO/GB

Implementation of commissioning strategies under the better care fund do not deliver the savings required by the CCG across health and social care system post 2015/16

CE

- June '15 - As above

3.70 LO/GB CE

- June '15 - As above - June '15 - as for 3.50 above



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5*3

5*3

5*3

3*3

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2*4

Failure to agree the Island Premium as part of the cost base review

- June '15 - As above - June '15 - As above - June '15 - As above - June '15 - As above

GB

March '16LO

CE

Failure to progress towards delegated commissioning

- June '15 Draft constitution submitted to NHS England in January and March 2015

- e-mail correspondence re: changes with NHS England

3.80

9 July 2015CM

GB

4.30

- June '15 - Minutes of steering group- June '15 - updates at Clinical Executive Committee

- June '15 - None at present - June '15 - None at present

June 15 - none at present - awaiting application guidance from NHSE

Critical Success Factor 3: understand the IOW Trust cost base and quantify the “island premium” by 31 March 2016

3.12

- June '15 - Close regular working with NHS England allocations Team

- June '15 - correspondence and e-mails with national allocations team

Failure to agree an action plan with NHS England by 31/3/16

- Regular escalation through NHS England required

3.11

- June '15 - continue to pursue NHSE for feedback on outstanding changes

- June '15 - continue to pursue NHS England and resolve issues as they arise (CM). End July

CMGB

4.20

Logistics for joint meetings not put in place effectively

-June '15 - Dates agreed and in diaries- June '15 - Early work plan devised- June '15 - ongoing liaison with NHS England

- 'June '15 - Dates in key individual's diaries

- June '15 -Agenda for first meeting to be developed and agreed- June '15 - urgently resolve issues re: chairmanship of committee

- June '15 Agenda to be agreed for first meeting on 9 July (CM) - June '15 - Resolve chair role (CM)

Failure to achieve Mental Health Care Programme Approach (CPA) - % of people followed up within 7 days of an inpatient episode

- June '15 - As above - June '15 - As above - June '15 - as for 3.50 above - June '15 - as for 3.50 above

LO/GB CE

- June '15 - Currently awaiting formal response from NHS England to letter requesting action

- None at present

LO CE

Critical Success Factor 1: establish robust joint commissioning arrangements for primary care

- June '15 - develop project plan - June '15 - ensure constitution is agreed prior to a further submission for change

3.90

Failure to complete cost base review

- June '15 - Cost Base Review Steering Committee includes CCG CFO

LO CE

Critical Success Factor 4: agreed an action plan with NHS England regarding the CCG allocation by the end of the financial year.

Objective 4: To work constructively with partners and the public for the wellbeing of our patients and communities.

4.10

Latest version of CCG constitution with co-commissioning amendments is not approved

- June '15 - Project plan to be developed by July 2015

October 2015CM



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4*4

4*3

4*3

3*3

3*3

Critical Success Factor 1: demonstrate improved engagement with the membership

August 2015LO

CE

4.40

Capacity and skills of teams to deliver ambitious programmes at pace.

- June '15 - Programme management of all key areas.- June '15 - Regular reporting of programme delivery.- June '15 - Governance structure providing oversight and direction

Critical Success Factor 3: deliver the joint infrastructure strategies (estates and IT)

- June '15 Papers to MLAFL Board including programme updates.- June '15 - Notes of MLAFL Board.- June '15 - Notes of Clinical Executive.

5.10

-June '15 - Clear TOR for joint commissioning and agreement from membership

-June '15 - none at present - June '15 - feedback mechanism to GPs needed following joint committee meetings.

- June '15 - agree coms with practices within the CCG and NHSE (CM) End July 2015

CMGB

5.20

The outcomes of the review of GP Localities and the monthly meetings does not improve the sense of connection between CCG and its membership

June '15 - Discussion with GP practices regarding new focus for locality meetings'June '15 - work programme for localities agreed with other commissioners

Joint Commissioning of primary care undermines relationship with GPs as more performance management is expected of the CCG

-June '15 - none at present - June '15 - Review of localities not complete

- June '15 - Complete review of localities

August 2015CM

JCPC

- June '15 - Vanguard infrastructure work stream in place

-June '15 - Vanguard Value proposition contains infrastructure work stream

- June '15 - Future governance of infrastructure work stream to be determined including CCG leadership/involvement

- June '15 - Agree future governance of infrastructure work stream. (HS) August 2015

LOCE

September 2015HS

Critical Success Factor 2: deliver the joint priorities within the MLFL programme

4.50

Uncertainty while the MLFL programme is integrated with the Vanguard bid is not resolved in good time to produce results

- June '15 - none at present - June '15 - none at present

CE

June '15 - As above - June '15 - Programme Board to be re-established- June '15 - Programme methodology to be established by MLAFL Board.

Objective 5: To create and agree an OD Plan and change in culture within the CCG

Results of GT IT reprocurement fails to support joint working

4.70

- June '15 - Project Board in place - June '15 - procurement process in place (mandated by HSCIC)- June '15 - Project management in place

-June '15 - Project Board paperwork and minutes- June '15 - GP involvement in decision making process

- June '15 - Future governance of infrastructure work stream to be determined including CCG leadership/involvement

- June '15 - further discussion with preferred bidder regarding integration options (CM)

- June '15 - Programme Board not yet established.- June '15 - Report of methodology not yet agreed.- June '15 - Additional vanguard funding not yet approved.

- June '15 - Business case/value proposition to be completed by 30th June (HS)- June '15 - Programme methodology to be established by MLAFL Board.

July 2015HS CE

4.60

Failure to progress joint infrastructure strategies



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4*3

4*3

3*3

4*3

4*2

Resources to support OD is not forthcoming from Vanguard monies

- June '15 - channels to support membership are not fully developed

- 'June 15 Further develop web site and extranet- June '15 complete review of localities - June '15 - re-explore locality work plans and peer review

CM 'June CE

Failure to recruit to Coms and Engagement Manager post

- June '15 - JD drafted and funds in place to cover role- June '15 - Verbal agreement from NHS Trust to host role

June '15- none at present

- June '15 - Locality minutes- June '15 - Notes to members - June '5 - Extranet and web site

- June '15 - Written agreement with NHS Trust required to codify expectations and agreements

- 'June '15 - formalise arrangements with Trust (CM) - June '15 - Chase for advert (CM) Sept 2015

CMCE

Critical Success Factor 3: support the development of a joint OD plan across the system.

5.80

5.30

Work to improve relationships with other stakeholders undermines reputation with GP practices

- June '15 - continued focus on localities via monthly meetings - June '15 - regular notes to members by JR - June '15- CCG extranet supporting GP practices to manage both performance improvement and contract compliance

5.40

- June '15 - None at present - June '15 - Training required for staff filling in frontsheets in respect of patient engagement and equality - June '15 - Review business processes to ensure all statutory functions are explicitly considered in the CCG's work

- Develop and deliver training (CM) - Review of business processes (CM/GB)

September 2015CM

GB

-June '15 - none at present

Critical Success Factor 2: Implement the stakeholder strategy

4.60

Failure to develop Governing Body assurance metrics providing assurance on the CCG's fulfilment of its statutory function

GB

- June '15 - Vanguard value proposition development

June '15 - Vanguard value proposition

- June 15 - no further actions identified at this stage


June 2015CM

GB

4.40

5.70

MLFL vanguard project OD stream is not fully integrated with the CCG OD stream

- June '15 - none at present - June '15 - none at present - June '15 - ensure CCG is represented on relevant groups

- June '15 - Clarify relevant groups taking this forward within the MLFL/Vanguard programme (CM)

-June '15 - Work with PPI Lay Member to consider relevant metrics for reporting to Governing Body- June '15 - Work with commissioning staff, Quality and through Vanguard to ensure data is captured with minimum bureaucracy

Sept 2015CM

Failure to improve reporting on public and patient involvement on Governing Body and sub-committee front sheets

August 2015CM

GB

- June '15 - Vuelio system in place-June '15 - Internal Audit commissioned to review stakeholder engagement

- June '15 - Vuelio can report data captured

- June '15 - Metric(s) to be developed and agreed by Governing Body for inclusion in performance report- June '15 - increase use of Vuelio to capture patient engagement to populate reporting. - June '15 - consider role of Datix/soft intelligence in reporting patient engagement



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KeyHS - Helen Shields, Chief OfficerGB - Gillian Baker, Deputy Chief OfficerLO - Loretta Outhwaite, Chief Finance OfficerLK - Loretta Kinsella, Director of Quality and Clinical ServicesCM - Head of Corporate Business and Primary Care ER - Eleanor Roddick, Head of Community CommissioningKM - Karen Morgan, Head of QualityLR - Linda Rann, Head of Acute CommissioningSL - Sue Lightfoot - Head of Mental Health Commissioning

LK CE

Other Serious Corporate Risks

System Resilience

A3

Concern regarding the achievement of NHS constitutional targets for A&E and RTT due to insufficient bed capacity and flow issues through the IOW NHS Trust. Reference with 2014/15 Risk Register Y2/13

April 15 - SRG Action plan in place

Safeguarding Adults Capacity and Capability in IOWNHST

The CCG will not meet its constitutional or quality premiums targets despite appropriate levels of financial investment. Unable to achieve assurance from NHSE resulting in closer monitoring and oversight of CCG operations.

CCG Designated Nurse for Safeguarding Adults. Safeguarding Adults Board. Quality schedule within the Contract. Quality meetings with the NHS Trust.

- June 2015 - a joint proposal has been taken to the Joint Adult Commissioning Board for a new Band 7 Care Home post to assist with admission avoidance and early discharge. The post would be a joint post between the Local Authority and CCG.

The CCG has reviewed the Trust BC and supported the proposal with the expectation that TEC agreed funding - March 2016. All SIRIs involving vulnerable patients reviewed by DoQ & Safeguarding designated nurse and concerns escalated to Trust/TDA/NHSE - February 2016.

Care home closures or bed reductions/ service specification limitations due to negative CQC inspections

-None at present Proposal for joint post with LA for a care home lead to support care homes and prevent negative CQC inspections - March 2016. Proposal for relocation of Trust rehabilitation beds to Solent Grange to release bed capacity - Nov 2015.

LK CE

- June 2015. Trust has produced Demand and Capacity Plan. Concern remains regarding the Trust's ability to achieve targets. Increase in shift of elective activity to mainland urgently required. Consideration of bed capacity proposals in June. Solent Grange still not CQC compliant; will reapply in July 2015.

RTT Recovery Action Plan produced - July 2015. Delivery of SRG Action Plan - Ongoing (Review July 2015). Greater Assurance of Care Homes - Start Date July 2015.Communications Plan with GP's and General Public awareness June 2015.

GB CE

A1

A2

CCG Designated Nurse for Safeguarding Adults. Safeguarding Adults Board. Quality schedule within the Contract. Quality meetings with the NHS Trust.

- June 2015 - LK is working closely with IOWNHST with regard to Safeguarding arrangements.

Governing Body: Performance Report July 2015

Sponsor: Loretta Outhwaite, Chief Finance Officer

Summary of issues:

1. The Governing Body is presented with a CCG Performance Report in a format that seeks to provide assurance on key performance indicators associated with Quality; NHS Constitution; CCG Outcomes Framework and Financial performance to note and comment upon.


The Governing Body is invited to:

Note and comment on the content of the Performance Report.

Principle risks:

Key Risks for the Performance Report include: Complexity and wide range of metrics and indicators with differing measurement for different purposes (eg COF, Quality Premium, CCG Assurance process) – systems in development and embedding – risk of missing vital information on all indicators continuously. Availability of data due to Health & Social Care Act compliance with Patient Identifiable Data for CCGs. New systems not yet agreed at NHS England level.


Information contained in the report has been considered at: Clinical Executive Quality & Patient Safety Committee Contract Review Meetings Internal Performance Review Meetings


Over-performance on contract activity could result in financial pressure where contracts are PBR based.

Legal implications/ impact: There are no significant legal issues within the Report.


Report is publicly available and provides patients and public with information on the CCG’s financial position and use of resources.


Requirement of providers and CCG to ensure all patients are treated in line with rights set out the in the NHS Constitution.

Author of Paper: Robert Snow, Performance Officer


Date of Meeting: 2 July 2015 Agenda Item: 5.2 Paper number: GB15-021

Isle of Wight Clinical Commissioning Group

Governing Body

Summary Performance Report

July 2015

(M.I. – April 2015)

Governing Body, Performance Report (July 2015)

Purpose of report

• This is the Isle of Wight Clinical Commissioning Group (CCG) Governing Body Performance Report for July 2015.

• The report includes information for Month 1 – April 2015, where available.

• This Performance Report describes the performance for the nationally reportable performance measures which are the responsibility of CCGs as set out in the NHS England documents of “Everyone Counts: planning for patients 2014/15”; the “CCG Quality Premium Guidance” and the “CCG Assurance Framework 2014/15” covering both quality and access measures.

Content

• Part 1 - Summary Comments – Overview to the year’s performance, and Balanced Scorecard

• Part 2 - Performance Outcomes

o Outcomes for the Quality KPIs and NHS Constitution with further detail on performance exceptions only.

o Financial report M1 Finance Position

• Part 3 – “Focus On”

o CQC Intelligent Monitoring – Published May 2015


Part 1 - Summary Comments

Highlights

• Compared with the preceding month, the Trust experienced a reduction in the numbers of new SIRIs in May with a total of 4 while there were no (zero) new SIRIS in month for the CCG.

As at the end of May, the numbers of SIRIs that had not been completed in time and had therefore breached the deadline for completion stood at seven (Grade1) and one (Grade 2) for the Trust (with no RCA received to date by the CCG), and a single Grade 1 breach of deadline for which the CCG was responsible.

Overall, when compared with the adjusted figures for March, total numbers of Pressure Ulcers (total Grades 2-4) occurring in both a Hospital and a Community setting were lower for April and with the exception of Community Grade 3 PUs, missed the revised targeted reductions for 2015/16.

• The CCG received one Complaint and no Concerns in April/May.

• There were no reported cases of MRSA bacteraemia in month for April. However, there are two potential cases for May for which Post Infection Reviews are being undertaken. One of these cases which occurred in the wider CCG Community and identified during the course of screening at A&E (IWNHST) has since been confirmed.

• Performance for April remained above the target level for Venous Thromboembolism (VTE) Risk Assessment.

• Performance by the Island’s NHS111 service for ‘calls answered within 60 seconds’, continued to meet the required target of ≥95%, for April.

The provisional results for May suggest that the rate for ‘calls answered within 60 seconds’ was met again in month.

• The reported rates by IWNHST in April for Ambulance Category A calls, demonstrated achievement of target for both Red1 and 19 minutes categories but with the rate for Red 2 marginally missing the target rate.

Provisional results for May suggest that all targets were met in that month.

• There no (zero) reported case of a 12 hour Trolley Wait breach in April and provision results for May suggest that the same outcome had been achieved for a second month.

• Diagnostics performance continued to be within the >99% target in April.


Part 1 - Summary Comments

Lowlights

A total of four cases of C.difficile were reported for April, exceeding the target number of three cases for the month. Two of these cases occurred at the IWNHST, one was in the wider Community and the other occurred at University Hospital Southampton.

Achievement of the 95% target for Accident and Emergency performance for breaches of less than 4 hour waits was missed in April (91.9%), with the variance from target having widened when compared to the rate achieved in March (94.29%). Increased levels of attendance and pressures on bed availability reported as due to discharge delays, have continued to contribute to this outcome. There were a total of nine consecutive days in April where the IWNHST was at Black Alert status.

A further failure to meet target is indicated for May.

18 week RTT – the target for Admitted continued to be missed in April (69.75%), with a significant diminishment to the rate achieved when compared with the previous month (83.31%). While the targets for both Non-admitted and Incompletes were met, there was a further reduction to the rates achieved. Both the trends demonstrated and performance outcomes achieved by the IWNHST in April were similar to those of the CCG, with Admitted being missed and both Non-Admitted and Incompletes met. Performance outcomes for the three mainland Trusts for April has continued to prove to be inconsistent with all but UHS failing to achieve a single target in month.

There were four 52 Week plus waiter breaches reported for April that were assigned to the Isle of Wight CCG. Three were Admitted – two T&O cases (IWNHST) and one ‘Other Speciality’ (UHS). In addition was the one Incomplete – an Ophthalmology case (IWNHST) previously reported in March. All four patients have since been treated.

Performance rates for Cancer treatments in April, failed to meet target in three areas: ‘Treated in <31 days of diagnosis; ‘Treated in <31 days - Surgery’ and ‘Treated in <62 days - urgent referral to treatment’.

Response rates for the Friends and Family Test fell in month for all three areas when compared to the rates achieved for March. After two consecutive months in of achieving better than the National Average, the response rate for Maternity (births) slipped back to below the rate for April. Rates for both A&E and Inpatients also fell, but this appears to be in line with a general trend demonstrated by many of the Trusts in the Wessex region.

The percentage rates for those Recommending the service was marginally lower for Inpatients but demonstrated an improvement in month for both A&E and Maternity (Births).

There were six reported breaches associated with Mixed Sex Accommodation in April. These all occurred at the Isle of Wight NHS Trust and as a single incident on the one day within the period the Trust were at Black Alert status.

The total number of Contract Notices being applied across all providers stands at six.


Part 1 – Balanced Scorecard (Performance on a Page – POAP)

Key Metrics to provide a high level early indicator of overall CCG performance against quality, key performance standards, financial efficiency, organisational efficiency. <<A3 copy provided for insertion.>>


Part 2 – Performance Summary – Quality Dashboard This Section provides exception reports and key highlights for quality outcomes. The dashboard provides a summary of outcomes by month, Year to Date and Trend (May 2014 – Apr 2015).


Part 2 – Performance Summary – Quality & Patient Experience

Serious Incidents Requiring Investigation

In April, the Trust reported a total of 5 new SIRIS occurring in month, while for May the number was four. By comparison the CCG reported no (zero) new SIRIs in month for either April or May.

As at 31 May 2015 (and since 1 April 2014):

IWNHST: o 19 Grade 1 SIRIs had not been completed within 45 days.

- Seven Grade 1 SIRIs had breached the 45 days to complete investigation (including 1 ‘Stop the Clock’) and where the CCG had not received a final RCA

o Two Grade 2 SIRIs had not been completed within 60 days

- One Grade 2 SIRI had breached the 60 days to complete investigation and where the CCG had not received a final RCA

CCG: o 1 Grade 1 SIRIs that had breached the 45 days to complete investigation.

NB: While an RCA may have been received, these cases may still be under review and answers to queries referred to the Trusts have not been resolved.



Action:

The CCG has written to the Trust on account of two separate SIRIs (one Mental Health and one Acute), to request that external investigations are undertaken. The CCG will then review the final reports.

In the interim, additional training in May and June 2015 will help to increase the number and skills of investigating officers.

New SIRI guidance (from 1 April 2015) will extend the investigation time for all SIRIs to 60 days and allow ‘cluster’ investigations of SIRIs such as Pressure Ulcers and Falls. This will allow for a more effective use of resource for investigations, thereby improving the time it takes to investigate.



Pressure Ulcers: Local target: Reduce total numbers (Hospital / Community) against IWNHST 2015/16 target reductions.

Local Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD

Actual Annual Target

Reduction in Pressure Ulcers - Hospital

Grade 2 30% reduction ≤5 monthly) 9 9 5

Grade 3 50% reduction ≤ 0.5 monthly 1 1 0.5

Grade 4 Zero cases 4 4 0

Reduction in Pressure Ulcers - Community

Grade 2 30% reduction ≤8 monthly 14 14 8

Grade 3 50% reduction ≤ 1 monthly 0 0 1

Grade 4 50% reduction ≤ 1 monthly 7 7 1

Total numbers for reported Pressure Ulcers in April had fallen compared with the adjusted total number for March. However, with the exception of Grade3 (Community) the totals reported in April for all other Grades across both settings, failed to achieve the targeted monthly reductions in numbers.

Total numbers in an Acute setting remained fairly similar to the total for March. There was a similar outcome in the Community setting for Grades 2 and 3 PUs, but an increase by two on the total of Grade 4 PUs between months.

The Tissue Viability Nurse continues to support ward staff with recognition and management of patients at risk but the current higher numbers of patients staying longer is continuing. Validation of avoidable pressure injury continues and deterioration of existing pressure injury is now being reported separately so that reduction can be monitored but this is not currently split.

Incidence of pressure ulcer development in the Community continues to cause concern and remains challenging. A further Awareness week was undertaken in March 2015 with on-going training and support for care homes being available.

NB: It should be noted that cases of Grades 3 and 4 are subject to investigation and may subsequently be re-graded.

Actions:

In view of the new SIRI guidance, which allows incidents such as Pressure Ulcers to be ‘clustered’ for review, this may provide a better opportunity for themes and trends to be identified, helping to enable the Trust to target actions across the organisation and not just in response to single cases.

The contractual IOW quality indicator (2015/16) for the reduction of pressure ulcers has been strengthened and there will be a specific focus on pressure ulcer prevention over the coming year, with a monthly monitoring of performance at CQRM will continue.


Part 2 – Performance Summary – Quality & Patient Experience continued…

HCAI: MRSA – CCG: National Target Zero tolerance

There were no reported cases of MRSA assigned to either the IWCCG or IWNHST for April 2015.

However, there are two potential cases for May, both identified at IWNHST and for which a Post Infection Reviews investigations are currently being undertaken by the IWCCG Head of Quality. The PIR for one of these two cases, which occurred in the wider Community and was identified as a part of the screening process on entry at A&E, has since been confirmed and will appear in the results for May.

MRSA - IWCCG Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD

2014/15 – Number in month 0 0 0 0 0 0 0 1 0 0 0 0 1

2015/16 – Number in month 0 0

2015/16 - Cumulative total 0 0

CCG April 2015

Variance to projected total. at April 15

South Eastern Hampshire 1 1

West Hampshire 1 1

Fareham & Gosport 0 0

Dorset 0 0

Isle of Wight 0 0

North East Hampshire & Farnham 0 0

North Hampshire 0 0

Portsmouth 0 0

Southampton 0 0

Wessex Area (Cumulative totals as at April 2015)

Source: Public Health England (via South Commissioning Support Unit, Performance Portal)



Healthcare Acquired Infections – C.Difficile: National Target: 28 maximum

Wessex Area (Cumulative totals as at April 2015)

Source: Public Health England (via South Commissioning Support Unit, Performance Portal)

CCG April 2015

YTD (2015/16)

Variance to projected total. at

April 2015

West Hampshire 18 18 10

South Eastern Hampshire 7 7 5

Fareham & Gosport 6 6 4

Dorset 17 17 2

Portsmouth 6 6 2

North Hampshire 4 4 1

Isle of Wight 4 4 1

Southampton 4 4 -

North East Hampshire & Farnham 1 1 -1

CCG:

There were a total of four cases reported for April. Of these, two cases were indicated to have occurred at the IWNHST (Acute) setting, a single case at University Hospital Southampton and one case in a Non-acute setting. The total of four exceeded the monthly planned total and is, therefore above the number projected to meet the annual target of 28 cases.

IWNHST:

The two cases in month for IWNHST was above the planned total of one for the month of April. (Annual target 2015/16 = 7 cases)

Action:

At the CQRM Meeting held on 5 June 2015, it was proposed that the CCG and IWNHST work closely together to review C.Difficle cases island wide, to identify areas where additional focus could impact on the numbers of cases.

At the Trust all cases will continue to be subject to root cause analysis to identify actions necessary to ensure the trajectory remains achieved, the Trust and CCG are due to work together to address C.Difficile across the Hospital and community settings.

An additional IOW quality indicator has been included in the 2015/16 contract, looking particularly at early screening and detection of HCAIs and isolating and cohorting practices.



Friends and Family Test: National Targets: Response rates improvement Q1-Q4 / Score Improvement Q1-Q4

The following is a summary for the results achieved by IWNHST for the last four months up to and including April 2015:

IWNHST Q1 2015/16 Jan Feb Mar Apr

Q2 14/15 Average

Q3 14/15 Average

Q4 14/15 Average

Q1 15/16 Average

Trend

A&E

Response rate 18.6% 16.71% 15.73% 14.44%

14.72% 23.09% 16.99% % Total Eligible/Responses 2,081/387 1,909/319 2,244/353 2,286/330 8,023/1,181 6,340/1,462 6,234/1,059 /

% Recommending 91.21% 87.15% 91.50% 93.64%

61/81.99% 89.98% 89.95% % -

% Not recommending 3.10% 7.84% 3.97% 2.73%

4.23% 4.97% % -

Inpatients

Response rate 56.37% 54.86% 51.18% 44.19%

38.71% 40.58% 54.13% % Total Eligible/Responses 612/345 514/282 594/304 774/342 2,542/984 2,458/997 1,720/931 /

% Recommending 95.07% 95.39% 97.37% 96.78%

80/96.31% 95.86% 95.94% % - % Not recommending 0.87% 1.42% 1.32% 1.75%

1.45% 1.20% -

Maternity Question 2: Birth

Response rate 29.00% 26.61% 29.00% 13.95% 16.55% 25.93% 24.92% % Total Eligible/Responses 100/29 109/29 100/29 86/12 441/73 391/98 309/77 /

% Recommending 100% 100% 100% 100% 80/100% 97.5% 95.40% % - % Not recommending 0% 0% 0% 0% 1.2% 1.15% % -

NB: The NHS England review of the patient FFT, published in July 2014, recommended a move away from the Net Promoter Score (NPS) and the introduction of a simpler

scoring system in order to increase the relevance of the FFT data for NHS staff, patients and members of the public. Based on the findings of the review, NHS England is now calculating and presenting the FFT results as a percentage of respondents who would/would not recommend the service to their friends and family. This change was introduced with the release of the results for September and user testing of the presentation of the FFT results is being undertaken on the NHS Choices website.

There was a general decline in the response rates across all three areas in the first month of 2015/16, although in each case the level of satisfaction with each service area, expressed as a rate for those ‘Recommending’ remained high.

For April, the combined average response rate (A&E and Inpatients) for IWNHST was 29.32% which was above the combined National average of 20.54%.

By comparison, the combined percentage for those responding who recommended the service (A&E and Inpatients) was 95.06% for the IWNHST which was better than the National average of 91.51%.

The response rate for Maternity (Births) at IWNHST fell below the National average of 23.57% and that for the Wessex Region of 26.84%.

While the results for the IWNHST appear disappointing, there appears to have been a fall in rates experienced by a number of trusts as reflected by the National average performance and those of the three mainland Trusts (see over). Of these Salisbury saw the greatest variance between March and April (ten percentage points), with the IWNHST performing better than Salisbury in month. In the case of Inpatients, UHS experienced the widest margin of difference (over forty percentage points0, with the IWNHST result bettering each of the three Trusts in month. In respect of rates for those recommending the IWNHST was in line with the average across all three mainland trusts for both A&E and Inpatients.

In terms of Maternity (Births) response rates, the IWNHST fell below both UHS and PHT but exceeded Salisbury which again achieved a poor rate of response at just over three percent. In terms of rates for those recommending the service performance was matched by PHT and Salisbury but remained marginally better than UHS.



Mainland Trust performance (Performance comparison):

A&E Inpatients

Response rate % % Recommending Response rate % % Recommending

Jan Feb Mar Apr Jan Feb Mar Apr Jan Feb Mar Apr Jan Feb Mar Apr

UHS 31.3% 29.0% 22.8% 22.0% 90.3% 91.7% 92.1% 89.6% 36.4% 48.6% 63.4% 21.9% 97.1% 95.3% 94.8% 95.8%

PHT 16.1% 16.9% 18.5% 17.5% 94.9% 95.4% 95.6% 96.4% 36.6% 36.5% 39.2% 36.5% 96.5% 96.7% 96.5% 97.0%

Salisbury 22.1% 26.1% 22.8% 12.8% 95.5% 94.5% 94.6% 95.0% 40.6% 50.8% 47.9% 40.2% 95.5% 94.2% 96.7% 93.6%

Maternity (Birth - Question 2) Response rate % % Recommending

Jan Feb Mar Apr Jan Feb Mar Apr

UHS 23.9% 29.7% 33.3% 27.5% 97.7% 95.6% 93.6% 97.7%

PHT 36.1% 30.5% 23.3% 23.3% 97.8% 99.2% 21.4% 100%

Salisbury 6.6% 7.7% 7.0% 3.3% 100% 100% 100% 100%

Action:

The FFT will not feature as a National CQUIN in 2015/16, but will remain in the NHS Contract, requiring the Trust to continue submitting monthly data. This will be monitored by the CCG.



Improving Access to Psychological Therapy (IAPT): National Target for Isle of Wight 22%

Indicator Target 2015/16

Apr 15

May 15

Jun 15

Jul 15

Aug 15

Sep 15

Oct 15

Nov 15

Dec 15

Jan 16

Feb 16

Mar 16

Improved access to psychological services:

The proportion of people that enter treatment against the level of need in the general population.

22%

Numerator: No. of people who receive psychological therapies

262

Denominator: No. of people who have depression and/or anxiety disorders

1,087

Percentage 24.1%



The annual target of 22% is consistent with the one applied for the previous year (2014/15). Performance in the final quarter of that year had been annualised (per the directive given by NHS England) and despite some reduction in the rates achieved in that quarter, overall a rate exceeding 22% was achieved in each of the three months. This achievement has continued through to the first month of 2015/16.

The reported rate of 24.1% exceeds both the target of 22% in month, and when converted to a cumulative rate, the current performance exceeds that required to meet the trajectory required to achieve that target rate for the year.

In comparison, the rate for ‘The proportion of people who complete treatment and who are moving to recover’ failed to achieve the target of 50% in month with a reported rate of 47.06% given. This outcome is consistent with the performance achieved for the same month in 2014/15, although there was an improvement seen in the second half of that year with the target rate achieved for four of the six months. Performance for this target will, however, often prove challenging since the numbers captured for inclusion will include Cluster 4 patients, who rarely move to recovery.

Action:

Performance for these indicators and the outcomes achieved will remain a focus for scrutiny by commissioners via the monthly Contract Officer Level Meetings.



Emergency Re-admissions: No National Threshold

NB: The analysis includes all readmissions and uses recognised exclusions to facilitate national benchmarking as per PbR guidance. Without clinical review of all admissions it is difficult to determine if the readmission is related to the previous discharge.

Performance in month was 5.29%, marginally reduced from the revised rate for March but above the rate achieved in the same month for 2014/15.

It should be noted that the numbers are subject to on-going validation review and revisions are made to the numbers and rates in subsequent months to the date of their being reported initially.

2015/16 April May June July August Sept Oct Nov Dec Jan Feb Mar

Year to Date

Emergency Re-admissions within 30 days

Actual 889 76 76

Admissions 18,495 1,437 1,437

% 4.81% 5.29% % % % % % % % % % % % 5.29%

Performance. in month 2014/15 4.98% 4.19% 5.20% 5.97% 4.97% 4.34% 5.22% 4.55% 4.28% 4.34% 4.28% 5.43%

Action:

Quarterly quality audits of acute re-admissions will continue in 2015/16 identifying key themes and actions in response, to be monitored at CQRM. Separate audits of re-admissions will also be undertaken in Mental Health services, looking at related and unrelated readmissions.


Part 2 – Performance Summary – NHS Constitution


Part 2 – Performance Summary – NHS Constitution continued…

RED – Target missed; AMBER – Performance achieved within 5% of meeting target; GREEN – Target achieved.

The failure to achieve the target for Admitted has continued through to 2015/16 as reflected in the results for April, with a diminished performance result at 69.75% when compared with the preceding month. While the targets for both Non-admitted (96.06%) and Incompletes (93.00%) continued to be achieved in April, the rates given were also down on the previous month.

IWNHST A similar trend was seen with the results for the IWNHST with both non-Admitted and Incompletes achieving target but again with reduced rates when compared to March and with performance for Admitted having failed to achiev target and slip to 65.83%. Contributing to these outcomes had been the backlog that had developed due to the pressures experienced in A&E and cancellations for Non-Elective procedures driven by the nine days the Trust was on Black Alert.

Mainland Trusts The inconsistencies in performance achieved by each of the three mainland trusts monitored continued into the new financial year with just one Trust achieving a single target. In the majority of cases, performance in April was below the rates reported for March.

o UHS – This was the only Trust to achieve any of their three targets in April with the rate for Incompletes at 93.00%. Performance for Admitted reversed form achievement to failing target, while performance for Non-Admitted was below that achieved in March. The Trust continues to experience capacity issues which impact on the performance achieved.

o PHT – The improvements in performance seen with the results achieved for March, ewere reversed with PHT failing to achieve target across all three categories in April. Again, the rates achieved in month were down on those reported for the previous month, with the exception being Admitted where some slight increase was seen, but continuing to miss target.

o Salisbury – Again, anay improvement in performance suggested by the results for March were reversed in April with all three targets being missed in month. Performance rates continue to be exagerated by the low numbers of patients involved..

18 week Referral to Treatment: National Targets: Admitted 90%; Non-Admitted 95%; Incompletes 92%

2015/16 IWCCG IWNHST UHS PHT Salisbury Admitted Non-Adm Incompletes Admitted Non-Adm Incompletes Admitted Non-Adm Incompletes Admitted Non-Adm Incompletes Admitted Non-Adm Incompletes

May 92.4% 94.97% 91.78% 94.9% 95.3% 92% 65.9% 89.3% 88.4% 84.6% 88.7% 94.2% 100% 100% 97.6%

June 91.65% 93.12% 93.45% 92.57% 93.09% 93.77% 77.78% 83.33% 86.06% 100% 93.88% 91.93% 100% 100% 95.74%

July 86.68% 94.36% 92.2% 86.91% 94.28% 92.36% 79.66% 91.3% 85.85% 93.94% 94.83% 93.06% 85.71% 100% 97.73%

August 83.97% 90.35% 91.75% 83.72% 90.23% 91.90% 84.62% 86.67% 86.38% 90.0% 94.0% 92.41% 100% 100% 87.5%

September 80.32% 93.44% 94.93% 79.22% 93.45% 95.60% 82.98% 88.00% 85.60% 90.0% 92.05% 91.39% 100% 100% 82.22%

October 80.89% 94.68% 95.14% 82.14% 94.84% 95.46% 70.49% 86.49% 93.48% 79.31% 95.52% 91.14% 50.00% 100% 83.78%

November 82.23% 95.49% 96.26% 82.45% 95.56% 96.60% 74.07% 96.97% 95.05% 75.00% 90.00% 89.73% 100% 100% 92.5%

December 88.04% 95.98% 96.03% 88.14% 95.99% 96.49% 96.30% 95.00% 93.48% 66.67% 93.48% 86.43% - - 90.24%

January 84.97% 96.83% 95.86% 85.05% 96.92% 96.47% 84.91% 96.97% 91.06% 64.29% 98.11% 86.16% 75.0% 100% 88.89%

February 84.70% 96.76% 96.25% 85.27% 97.18% 96.74% 82.35% 86.96% 92.11% 74.19% 93.18% 88.40% 66.67% 75.0% 88.89%

March 83.31% 96.44% 93.71% 81.68% 96.52% 93.94% 91.53% 94.34% 90.23% 72.41% 94.34% 91.06% 100% 100% 85.00%

April 69.75% 96.06% 93.00% 65.83% 96.30% 93.07% 81.25% 91.11% 93.00% 82.05% 89.66% 90.57% 66.67% 75.00% 80.49%

516/359 2,384/2,290 7,694/7,156 398/262 2,385/2,291 7,086/6,595 48/39 45/41 243/226 39/32 58/52 159/144 3/3 2/2 34/40



Actions:

IWNHST:

Despite the IWNHST undertaking additional activity across all specialities, as predicted, the IWNHST failed to meet the target for admitted in April. The CCG are continuing to work closely with the Trust to outsource activity to local mainland providers, in particular with regard to T&O, Urology and General Surgery.

IWNHST - Activity and capacity modelling on a weekly level has been developed, and shared with the CCG. This will enable General Managers to plan and monitor weekly outpatient and inpatient activity against targets, alongside managing the impact of emergency and medical activity upon elective activity during 2015/16.

Mainland Trusts:

Contract Query Notices via lead Commissioners for RTT performance remain in place with University Hospital Southampton (UHS).

Commissioners will continue to raise with the Lead Commissioner and Trusts to highlight patient waiting times and actions to appoint within target.

Patients waiting >52 weeks – National Target: Zero

For April, there were a total of four reported breaches of individuals having had to wait 52 weeks plus for treatment:

3 x Admitted – 2 x T&O (IWNHST) Patients were admitted for diagnostic procedures and not treated at first admission. Therefore, they had to be re-listed for

treatment. Subsequent capacity problems in the Trust delayed the patient’s procedure further but both now treated (21/04/2015 and 22/04/2015)

1 x Paediatric Orthopaedic (UHS) Patient’s treatment was delayed due to capacity issues. Not treated until 10 April 2015.

1 x Incomplete (Ophthalmology) This relates to a patient previously reported for March, who was not administratively added to the waiting list when they were

listed for their second eye cataract planned procedure with a wait time of approx. 62 weeks. Although a Date to admit was raised for this patient in a timely manner, it was logged in the wrong place and hence the booking team were unaware of it. The date to admit should have been logged on 23 January 2014 but was actioned on 2 April 2015. The patient has a treatment date of 26 May 2015, the delay extended due to patient choice.

Actions:

A review of the circumstances responsible for the breaches that occurred with the Diagnostic cases has been undertaken and areas for improvement introduced.

All of the above cases had dates for treatment in April or May which have now been completed. As a consequence there are no additional 52 week waiters anticipated and therefore no further actions required at this time.



Cancer: Nine National Targets

RED – Target missed; AMBER – Performance achieved within 5% of meeting target; GREEN – Target achieved.

IWCCG – 2015/16 Target Q2 14/15 Q3 14/15 Q4 14/15 Mar 15 Apr 15 Year to

Date

Seen within 2 weeks of referral 93% 95.80% 97.96% 96.87% 97.51% 97.27% 11/403 97.27%

Seen within 2 weeks of referral - Breast Symptoms 93% 91.20% 97.40% 97.27% 98.57% 98.46% 1/65 98.46%

Treated in <31 days of diagnosis 96% 96.12% 98.44% 97.87% 97.47% 94.05% 5/84 94.06%

Treated in <31 days - Surgery 94% 94.83% 95.59% 100% 100% 85.71% 3/21 85.71%

Treated in <31 days - Drug Treatment 98% 100% 100% 100% 100% 100% 0/40 100%

Treated in <31 days - Radiotherapy 94% 94.87% 96.88% 95.88% 96.43% 100% 0/32 100%

Treated in <62 days - urgent referral to treatment 85% 84.78% 84.11% 85.56% 85.19% 70.73% 12/41 70.73%

Treated in <62 days - Consultant upgrade 86% 100% 100% 100% <<Nil>> <<Nil>> 0/0 <<Nil>>

Treated in <62 days - Screening service 90% 85.71% 100% 92.00% 90.00% 90.00% 1/10 90.00%

Mainland Trusts – performance for island registered patients

IWNHST – 2015/16 Target Q2 14/15 Q3 14/15 Q4 14/15 Mar 15 Apr 15 Year to Date

Seen within 2 weeks of referral 93% 96.21% 97.03% 96.90% 97.47% 97.24% 11/399 97.24%

Seen within 2 weeks of referral - Breast Symptoms 93% 91.63% 97.35% 97.27% 98.57% 98.46% 1/65 98.46%

Treated in <31 days of diagnosis 96% 98.54% 100% 99.46% 98.33% 96.88% 2/64 96.88%

Treated in <31 days - Surgery 94% 95.74% 98.00% 100% 100% 100% 0/14 100%

Treated in <31 days - Drug Treatment 98% 100% 100% 100% 100% 100% 0/38 100%

Treated in <31 days - Radiotherapy 94% <<Nil>> 100% <<Nil>> <<Nil>> <<Nil>> 0/0 <<Nil>>

Treated in <62 days - urgent referral to treatment 85% 87.55% 86.07% 88.34% 91.11% 73.61% 9.5/36.0 73.61%

Treated in <62 days - Consultant upgrade 86% 100% <<Nil>> 100% <<Nil>> <<Nil>> 0/0 <<Nil>>

Treated in <62 days - Screening service 90% 90.91% 100% 95.56% 94.12% 94.44% 0.5/9.0 94.44%

2015/16 UHS PHT

Q2 14/15

Q3 14/15

Q4 14/15

Apr 15 Year To

Date Q2

14/15 Q3

14/15 Q4

14/15 Apr 15

Year To Date

Seen within 2 weeks of referral 100% 100% 100% 100% 0/2 100% 100% 100% n/a n/a 0/0 n/a

Seen within 2 weeks of referral - Breast Symptoms n/a 100% n/a n/a 0/0 n/a n/a n/a n/a n/a 0/0 n/a

Treated in <31 days of diagnosis 91.30% 100% 100% 90.91% 1/11 90.91% 76.19% 84.21% 75.00% 66.67% 2/6 66.67%

Treated in <31 days - Surgery 100% 90.91% 100% 100% 0/2 100% 75.00% 83.33% 100% 25% 3/4 25%

Treated in <31 days - Drug Treatment 100% 100% 100% 100% 0/2 100% 100% 100% n/a n/a 0/0 n/a

Treated in <31 days - Radiotherapy 97.73% 93.57% 94.92% 100% 0/20 100% 90.91% 100% 97.37% 100% 0/12 100%

Treated in <62 days - urgent referral to treatment 100% 100% 60.00% 75.00% 0.5/2.0 75.00% 25%% 33.33% 50.00% 33.33% 1.0/1.5 33.33%

Treated in <62 days - Consultant upgrade 100% 100% 100% n/a 0/0 n/a 100% n/a n/a n/a 0/0 n/a

Treated in <62 days – Screening service n/a n/a n/a n/a 0/0 n/a 66.67% n/a 60.00% 50% 0.5/1.0 50%



Performance in April 2015 resulted in the targets being missed for three of the cancers pathways:

Treated in <31 days of diagnosis – target 96% April 2015: 94.05%

Treated in <31 days – Surgery – target 94% April 2015: 85.71%

Treated in <62 days - urgent referral to treatment – target 85% April 2015: 70.73%

Contributing to these outcomes were the performance achieved by the isle of Wight Trust, Portsmouth Hospitals Trust and University Hospital Southampton:

Treated in <31 days of diagnosis – IWNHST 1 x Tumour type: Breast Surgery - Cancelled as patient unwell on day of admission, treatment rebooked to next available list. 1 x Tumour type: Lower Gastrointestinal – Patient required consultant anaesthetist at surgery.

UHS Tumour type – Upper Gastrointestinal – Original treatment date 12 April, cancelled due to no HDU bed available. Rebooked for 24 April but cancelled again for the same reason (HDU lost booking card)

PHT Tumour type: 2 x Urological – For each, Elective capacity inadequate (patient unable to be scheduled for treatment within standard time)

Treated in <31 days – Surgery – PHT Tumour type: 3 x Urological - For each, Elective capacity inadequate (patient unable to be scheduled for treatment within standard time)

Treated in <62 days - urgent referral to treatment – IWNHST 1 x Tumour type: Gynaecological – Consultant illness and theatre capacity 2 x Tumour type: Lower Gastrointestinal – 1 x required consultant anaesthetist at surgery; 1 x patient choice to delay initial investigation. 1 x Tumour type: Breast – referred from other tumour site, diagnosed with breast primary. 1 x Tumour type: Upper Gastrointestinal – referred to Tertiary Centre for investigation. 2 x Tumour type Gynaecological – both referred from other tumour site, diagnosed with ovarian primary. 2 x Tumour type Urological (excluding testicular) – both case as, MDT discussion to determine treatment plan took place late in pathway.

UHS Tumour type: Gynaecological – Delays to diagnostics on Isle of Wight.

PHT Tumour type: Urological (excluding testicular) –Elective capacity inadequate (patient unable to be scheduled for treatment within standard time). Tumour type: Head & Neck – other reasons.

Action:

Performance is subject to active ongoing monitoring and discussion by acute commissioners with all providers.

Contract Penalties have been applied.



Category ‘A’ Ambulance Calls: National targets: Red 1 and Red 2 75%; 19 minutes 95%

Performance results for April were mixed, with two of the three categories of call achieving target in month and while Red 2 missed the target rate the margin of variance from target was narrow and within 5% of the target rate.

Early indications suggest that the targets were met for may by IW Ambulance Trust for all three categories: ‘Red 1’ 75.0%.; ‘Red 2’ 75.4% and ’19 minutes’ 96.3%

Target April May June July Aug Sept Oct Nov Dec Jan Feb Mar YTD

Category A – Red 1 75% 75.00% % % % % % % % % % % % 75.00%

Category A – Red 2 75% 74.39% % % % % % % % % % % % 74.39%

Category A – 19 mins. 95% 96.03% % % % % % % % % % % % 96.03%

Action:

Performance continues to be monitored on a weekly basis by Commissioners.



A&E <4 hour wait for admission, treatment or discharge – National target 95%

Performance for April demonstrated a deterioraton in achievement against the rate achieved for March while the provisional outcome for May suggests some limited recovery although overall performance has remained below the target rate of 95%, both at CCG and IWNHST levels.

In April there was a significantly higher amount of activity than planned with over 3,500 attendances to the Emergency Department. Performance against the 4 hour standard for April was 91.9% and this reflected this increase in activity and that the IW NHS Trust was on Black Alert for a sustained period during the Month. Bed pressures, including the increased pressure on community bed availability prevented patients flowing through the system.

IWCCG Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD

A&E <4 hour wait

14/15 96.15% 94.23% 95.96% 96.39% 97.05% 95.44% 93.85% 91.58% 92.54% 88.19% 85.73% 94.29% 93.6%

15/16 91.90% 92.67% % % % % % % % % % % 92.23%

No Attending 14/15 5147 6481 5301 7158 5352 4891 5712 4523 4904 5495 4777 4953 64,694

No Attending 15/16 6502 4952 11,454

Breaches 14/15 198 374 214 259 158 223 351 381 366 649 682 283 4,137

Breaches 1 527 363 890

IWNHST Apr 14 May 14 Jun 14 Jul 14 Aug 14 Sep 14 Oct 14 Nov 14 Dec 14 Jan 15 Feb 15 Mar 15 Year to

date

Beacon WIC 100% 100% 100%

Emergency Dept. 87.4% 88.6% 88.0%

A&E <4 hour wait 92.1% 92.8% % % % % % % % % % % 92.5%

Action:

The IW NHS Trust is developing a Capacity and Demand management plan which will highlight the actions required to tackle both elective and non-elective capacity issues in order to meet the National standards.

The plan will include a series of actions and opportunities. An example is the proposal of increasing acute bed capacity through moving rehabilitation beds into a community site. This option is still being reviewed.



Ambulance Handover: National Target 100% for Handovers and Crew Green-Up time

Performance rates have continued to fluctuate at a monthly interval and failed to achieve the target rates for both Handovers and Green-up time.

o Handovers completed within 15 minutes (National Target: 100%) – Performance in April at 70.45%, demonstrated improvement on the rate achieved in March (65.21%). In month there had been a general improvement seen in the rates achieved with each of the various time groups applied and not just those within 15 minutes.

o Crews ready to accept new calls within 15 minutes of handover (National Target 100%) – A similar trend of improvement was also demonstrated in April for ‘green-Up time, achieving 72.27% in month, compared with 68.91% in March.

In each case, the performance achieved in April were the best rates for more than six months and were achieved despite the Trust having been on either Red or more significantly Black Alert for extended periods during the month.

Action:

The level of Ambulance handover delays recorded in April decreased compared to recent months. This was despite the considerable pressures being experienced within the Acute Trust.

The impact of the CAS upgrade is expected to improve the quality of data and reporting. Currently data quality is a recognised issue. The CAD upgrade has been delayed due to system supplier issues.



Other Key Metrics

Trolley waits – National Target: Zero Local Performance: Zero. There were no reported cases for April 2015 and provisional results for May suggest that a similar outcome will have been achieved for that month. Similarly there are currently no indications of there having been occurrences in June.

Diagnostics – National Target: >99% Performance for Diagnostics in April was at 99.81%. There were a total of three patients in month, reported to have waited for more than six weeks, one having occurred at each of the following Trusts: IWNHST (Peripheral Neurophys); University Hospital Southampton (Urodynamics) and University College London Hospitals (MRI Scan).

Cancelled Operations – National Targets: 100% / Zero In April there were three reported occasions (from seven) where there has been a breach for ‘cancelled operations rebooked in 28 days’ represented as a rate of 57.14% (target 100%).

All three were Urology cases and were due to beds not being available.

(NB: Adjustments to reported occurrences may be made in subsequent months following investigation and review of occurrences).

In month there was one reported case for a ‘cancelled operation cancelled for a second time’. This was due to a cancellation needing to be made to allow for treatment of a more critical patient.

Mixed Sex Accommodation – National Target: Zero There were a total of six cases reported for April. These all occurred in a single incident at the IWNHST during the period the Trust was on Black Alert. Incurring the breaches was made to avoid potential 12 hour trolley waits

Mental Health Care Programme Approach – National Target: 95% The target was missed in April with a result of 89.47% registered for that month. This was incurred as a result of a failure with three individual patients. Each case has been reviewed and Action Plans put in place to ensure that contact details have been taken. Performance will be subject to on-going review as an action at the monthly Contract Level Meetings held by the Trust and CCG.


Part 2 – Performance Summary – Contract Query Notices

Contract Query notices

The following Contract Query Notices are currently in place:

a) University Hospital Southampton (UHS) – RTT 18 week performance levels achieved – Unsatisfactory remedial plan received. (Oct 2013 - On-going). IWCCG letter sent to CEO, to which a response has been received.

b) Commissioning Support Unit (CSU) – Information Technology Performance Notice. (Dec 2014 - On-going).

c) IWNHST Mental Health Services – Managerial and Clinical Leadership. (Jan 2014 - On-going). Due to be withdrawn, subject to receipt of a Memorandum of Understanding between the IWNHST and Hertfordshire Partnership University Foundation Trust.

d) PHT – Diagnostics (6 week wait failure re Ultrasound and MRI). (Sept 2014 - On-going).

e) PHT – Electronic Discharge Summaries (Failure of dataset / Method of delivery and timescales). (July 2014 - On-going)


Part 2 – Performance Summary – Financial Report M1

This Part provides details of the current financial position of the CCG. A forecast outturn position is included. In-month cost and activity variance is also illustrated.

<<There is no report included for Month 1>>

The first report for 2015/16 will be for Month 2 (May 2015).


Part 3 – “Focus On”

CQC Intelligent Monitoring – Published May 2015

What is CQC’s Intelligent Monitoring?

For each indicator there is a comment to describe the level of risk from “no evidence of risk” to “elevated risk”.

The full report for the Isle of Wight NHS Trust is available at the CQC website.

Each trust is placed into a band and the Isle of Wight NHS Trust is in Band – Recently Inspected

Trusts that have not been recently inspected are placed in Bands from 1 to 6 (1 = highest risk, 6 = lowest risk).

The new Intelligent Monitoring tool has been developed to give our inspectors a clear picture of the areas of care that

need to be followed up within an NHS acute trust or a specialist NHS trust. The system is built on a set of indicators

that look at a range of information including patient experience, staff experience and performance. The indicators

relate to the five key questions we will ask of all services: are they safe, effective, caring, responsive, and well-led?

http://www.cqc.org.uk/sites/default/files/R1F_105v3_WV.pdf


Part 3 – “Focus On”

The table below shows the banding, risk score, risk type and risk description for the main provider trusts:

Trust (Hyperlink to report)

Band May 2015

Band December

2014

Overall Risk Score

Risk Type Risk

Isle of Wight NHS Trust

Recently Inspected

Recently Inspected

9

Elevated Risk

Safeguarding concerns (25-Feb-14 to 24-Feb-15)

Elevated Risk

Composite Indicator: In-hospital mortality Endocrinological conditions

Risk Composite of Central Alerting System (CAS) safety alerts indicators (01-Apr-04 to 31-Jan-15)

Risk Parliamentary & Health Service Ombudsman (01-Apr-14 to 30-Sep-14)

Risk Composite of PLACE indicators (29-Jan-14 to 17-Jun-14)

Risk TDA Escalation score (01-Nov-14 to 30-Nov-14)

Risk Composite Indicator: NHS staff survey questions relating to abuse from other staff (01-Sep-14 to 31-Dec-14)

Portsmouth Hospitals NHS Trust

Recently Inspected

5 5

Elevated Risk

Composite indicator: A&E waiting times more than 4 hours (01-Oct-14 to 31-Dec-14)

Risk Composite indicator: In-hospital mortality - Haematological conditions

Risk SSNAP Domain 2: overall team-centred rating score for key stroke unit indicator (01-Jul-14 to 30-Sep-14)

Risk TDA - Escalation score (01-Nov-14 to 30-Nov-14)

University Hospital Southampton NHS Foundation Trust

Recently Inspected

5 11

Elevated Risk

Dr Foster Intelligence: Composite of Hospital Standardised Mortality Ratio indicators (01-Jul-13 to 30-Jun-14)

Elevated Risk

Composite indicator: A&E waiting times more than 4 hours (01-Oct-14 to 31-Dec-14)

Risk Never Event incidence (01-Feb-14 to 31-Jan-15)

Risk Composite indicator: In-hospital mortality - Nephrological conditions

Risk Composite indicator: In-hospital mortality - Trauma and orthopaedic conditions and procedures

Risk Composite of knee related PROMS indicators (01-Apr-13 to 31-Mar-14)

Risk A&E Survey Q18: Were you given enough privacy when being examined or treated? (01-Jan-14 to 31-Mar-14)

Risk Monitor - Continuity of service rating (02-Mar-15 to 02-Mar-15)

Risk GMC - Enhanced monitoring (case status as at 23-Mar-15)

Salisbury NHS Foundation Trust

6 6 1 Risk Composite indicator: In-hospital mortality - Musculoskeletal conditions

http://www.cqc.org.uk/sites/default/files/R1F_105v3_WV.pdf

http://www.cqc.org.uk/sites/default/files/RHU_105v3_WV.pdf

http://www.cqc.org.uk/sites/default/files/RHU_105v3_WV.pdf

http://www.cqc.org.uk/sites/default/files/RHM_105v3_WV.pdf



http://www.cqc.org.uk/sites/default/files/RNZ_105v3_WV.pdf

http://www.cqc.org.uk/sites/default/files/RNZ_105v3_WV.pdf

Performance on a Page CCG Level Indicators unless othewise noted.

Monthly performance unless otherwise noted.

A

Qua

lity

Pre

m

CO

F

M/L

Annual Target/

Required trend

YTD Month Trend B

Qua

lity

Pre

m

CO

F

M/L

Annual Target/

Required trend

YTD Month Trend

Forecast

Serious Incidents Requiring Investigation: Never Events (All Providers) M 0 0 Apr-15 0 Finance Efficiency: Underlying recurrent surplus L ≥1% N/A Apr-15 N/A

Finance Efficiency: Contingency utilised (cumulative YTD) Annual Target £1,025k L ≤1% N/A Apr-15 N/A

Finance Efficiency: Surplus Annual Target £2,050k L ≥1% N/A Apr-15 N/A

Finance Efficiency: Invoice payment (Value): <30 days % achievement (cumulative %) L 95% N/A Apr-15 N/A

Finance Efficiency: Invoice payment (Volume): <30 days % achievement (cumulative %) L 95% N/A Apr-15 N/A

VTE Risk Assessment (IWNHST) M >95% 100.0% Apr-15 100.0% Finance Efficiency: Debtors >30 days L ≤ 5% N/A Apr-15 N/A

Slips Trips and falls resulting in injury (IWNHST) M Reduce 13 Apr-15 13 Finance Efficiency: Creditors >30 days L ≤ 5% N/A Apr-15 N/A

Mortality: Summary Hospital-level Mortality Indicator (SHMI) - IWNHST M Down 1.056 Oct 13 -Sep 14 N/A Finance Efficiency: Liquidity cash balance % of drawdown L tbc N/A Apr-15 N/A

Strategic Plan: QIPP Savings Achievement % Annual Target £2,805k L % > target N/A Apr-15 N/A

Running Costs: Total £25 per head of population (% within target) Annual Target £3,478k L % > target N/A Apr-15 N/A

Number of new complaints and concerns in month (CCG) L N/A 1 May-15 2 Workforce: Mandatory Training Completed % (YTD) L > 95% N/a Apr-15 92.93% Number of complaints referred to the Ombudsman and upheld (CCG) L 0 0 May-15 0 Workforce: Appraisals Completed % (YTD) L > 95% N/A May-15 11% Friends & Family Test: Response Rate: In-patients (IWNHST) M Increase 44.19% Apr-15 44.19% Workforce: Absence % L < 3% 3.6% Apr-15 3.6% Friends & Family Test: Response Rate: AE (IWNHST) M Increase 14.44% Apr-15 14.44% Workforce: FTE Absence Days Lost in month (YTD = cumulative total to date) L Reduce 69.2 Apr-15 69.2 Friends & Family Test: Response Rate: Maternity (at Birth) (IWNHST) M Increase 13.95% Apr-15 13.95% Workforce: Vacancies (CCG) L N/A 1 May-15 N/A

Workforce: Number of FTE GPs per 1,000 weighted population (Recommendation 60) L N/A N/A May-15 53.9 CCG Assurance: Quarterly Status (Assured/Assured with Support) M A/AWS AWS Q3 14/15 N/A Q

Healthcare acquired infections: MRSA (CCG) M 0 0 Apr-15 0 Number of Information Governance breaches L 0 0 May-15 0 Healthcare acquired infections: C.diff (CCG) M < = 20 4 Apr-15 4 Continuing Care – Number of Appeals that were upheld L 0 0 Apr-15 0 No. of days IWNHS Trust was at Red Alert L N/a 11 Apr-15 11 Number of FOI requests not responded to within 20 working days L 0 N/a May-15 0

Operating Plan: Improved Access to Psychological Services (IAPT) – Access (IWNHST) M/L 22% 24.1% Apr-15 2.01% Healthcare Contracts: Contract Notices Outstanding (All providers) L N/A 5 May-15 N/A

Operating Plan:Improved Access to Psychological Services (IAPT) – Recovery (IWNHST) M 50% 47.06% Apr-15 N/A Number of Contracted Providers with CQC Enforcement Actions L 0 0 May-15 0

Operating Plan: Dementia Diagnosis Rate M/L 66.7% Apr-15 N/A Number of Section 71/75/256 Agreements in place L N/A

Operating Plan: Winterbourne View: achievement of Action Plan milestones M 100% 100% Apr-15 100% Healthcare Contracts: CQUINS: % achieved in quarter (IWNHST) L 100% 94.1% Q4 14/15 N/A Q

CCG Assurance Domain 1: Are patients receiving clinically commissioned, high quality services?

C

Qua

lity

Pre

m

CO

F

M/L

Annual Target/

Required trend

YTD Month Trend D

Qua

lity

Pre

m

CO

F

M/L

Annual Target/

Required trend

YTD Month Trend

Forecast

Ambulance: Cat A calls < 8 minutes (Red 1) M 75% 75.00% Apr-15 75.00% Delivery Plan Milestone Achievement (% achieved in quarter) N/A 41.58% Q4 14/15 38.87% QAE: Patients waiting <4 hours M 95% 91.90% Apr-15 91.90% Patient Engagement: Indicator to be developedNo waits for decision to admit to admission (trolley waits) over 12 hours M 0 0 Apr-15 0 No. demonstrating health improvement (pre vs post course of pulminory rehabilitation) L N/A N/A QRTT: Admitted patients in 18 weeks: CCG M 90% 69.75% Apr-15 69.75% No. of people first attending Type 2 Diabetes Education - Retention Rate (Cumulative %) L ≥75% 79.2% Apr-15

RTT: Non-admitted patients in 18 weeks: CCG M 95% 96.06% Apr-15 96.06% PYLL - Proxy: Rate for deaths due to Cerebrovascular diseases <75 years M Reduce 175.2 2011/13 N/A QRTT: Incomplete non-emergency pathways M 92% 93.00% Apr-15 PYLL - Proxy: Rate for deaths due to Ischaemic heart disease <75 years M Reduce 530.0 2011/13 N/A QRTT: Patient waiting >52 weeks M 0 4 Apr-15 4 PYLL - Proxy: Rate for deaths due to Neoplasms <75 years M Reduce 682.3 2011/13 N/A QCancelled Operations re-booked in 28 days M 100% 57.14% Apr-15 57.14% PYLL - Proxy: Rate for deaths due to Respiratory diseases <75 years M Reduce 80.1 2011/13 N/A QCancelled Operations - second cancellation M 0 1 Apr-15 1 Operating Plan: Percentage of diabetic patients whose last cholesterol was 5mmol or less M/L 71% Q4 14/15 73% QDiagnostics: Patients waiting >6 weeks from referral M >99% 99.81% Apr-15 99.81% Case Management: Advanced Care Plans in Place (2015/16 target 1,145 ACPs) L Increase Apr-15 50 Cancer patients seen <14 days after urgent GP Referral M 93% Apr-15 Prescribing: IW GP Practice prescribing performance compared to England Average L Lower Mar-15 -7.2% Cancer: All Cancer patients wait from diagnosis to 1st definitive treatment <31 days M 96% Apr-15 Number of contacts received by GP "Intelligence Line" L Increase 2 May-15 7 Cancer: Urgent referral treatment <62 days M 85% Apr-15 My Life a Full Life (metrics to be confirmed) M/LMixed Sex Accommodation Breaches M 0 6 Apr-15 6 Dexa Scan/Osteoperosis drugs - under development L Q

MH: CPA: % people on CPA followed up , 7 days following in-patient episode M 95% 89.0% Apr-15 89.0% Joint Sensory Impairment - No.s receiving hearing aid maintenance support. L N/A Nov-Jan 2015 928 Q

Activity trends (ALL): YTD: - Acute Elective Spells (Operatng Plan) M <x% of plan -10.8% Apr-15 -10.8% Better Care Fund: Delayed transfers of care from hospital in month (YTD: rate per 100,000 population) M Reduce 210 Apr-15 150

Activity trends (ALL): YTD: - Acute Non-elective (Operating Plan) M <x% of plan 3.5% Apr-15 3.5% Activity trends (ALL): YTD: - All First Outpatient Attendances (Operating Plan) M <x% of plan 7.3% Apr-15 7.3% GP Referrals to Secondary Care (IWNHST): YOY %>2014/15 L 0% 12.0% Apr-15 N/A Emergency Readmissions within 30 days (IWNHST) M ≤ 4% 5.29% Apr-15 5.29% Total Referrals (IWNHST): YOY %>2014/15 L 0% 6.5% Apr-15 N/A Number of potential Emergency Admissions managed by Crisis Reponse Team intervention L Increase

Number of Ambulatory Care Clinic Types in Place L Increase 14 Apr-15 14

RAID Programme: under development

MH - Parity of Esteem -under development M Increase

Unplanned readmissions to Mental Health within 30 days of mental health inpatient discharge (17 years+) M Reduce 151.4

Oct 2013 - Sep 2014

prov.N/A

Q

Proportion of adults in contact with secondary care Mental Health services in paid employment M Increase 1.10%Oct 2013 - Sep 2014

prov.N/A

Q

Hea

lthca

re C

ontra

ct

Activ

ity

Fina

nce

Wor

kfor

ce

CCG Assurance Domain 2: Are patients and the public actively engaged and involved? CCG Assurance Domain 3: Are CCG Plans delivering better outcomes for patients?

N/A

M

NH

S C

onst

itutio

n

NHS Constitution

CCG Assurance Domain 4: Does the CCG have robust governance in place?CCG Assurance Domain 6: Does the CCG have strong and robust leadership?CCG Assurance Domain 5: Are CCGs working in partnership with others?

CCG Assurance Domain 1: Are patients receiving clinically commissioned, high quality services?CCG Assurance Domain 3: Are CCG plans delivering better outcomes for patients?

Quality Outcomes Finance and Governance

Serious Incidents Requiring Investigation (SIRIS): As at 31.05 total numbers in 2015/16 (all grades) for IWCCG where investigation has not been completed within timescale

Pressure Ulcers: All Grades (2-4) - Number in month (improvement on 2014/15)

Operating Plan: Improved reporting of medication related safety incidents - % of medication Patient Alerts with intervention responses reported to the CCG within 30 days of alert issue

Patie

nt S

afet

yPa

tient

Exp

erie

nce

M/L

Reduce

Reported PerformanceNo. / % Period



96.78%

1


Strategic Plan

Self-

Car

e &

Man

agem

ent

Prim

ary

Car

e D

evel

opm

ent

Inte

grat

ed

Car

e

Lead

ersh

ip

& Pa

rtner

ship

35

Gov

erna

nce

20% Q

Unplanned hospitalisation for chronic ambulatory care sensitive (CS) conditions (adults)

Q

Q

Q

Rate of emergency admissions for asthma, diabetes or epilepsy per 100,000 population - <19 year olds

Clin

ical

Out

com

es

Friends & Family Test: In-patient Responses - % recommending (IWNHST)

M

M

Increase 96.78% Apr-15

0 1 Apr-15

≥ 20%

35 Apr-15

20% Q4 14/15

Reduce

Men

tal H

ealth

Rate of emergency admissions for children with lower respiratory tract infections

Emergency admissions for acute conditions that should not usually require hospital admission (per 100,000 patients)

M Reduce

M

Better Care Fund: The Percentage of older people (65 years+) remaining at home 91 days from discharge from hospital into rehabilitation/reablement services

Urg

ent

Car

e

M Reduce

ReduceM

M Increase

Q

Q750.5Oct 2013 - Sep 2014

prov.

92.2% Q4 14/15

561.2Oct 2013 - Sep 2014

prov.

376.1Oct 2013 - Sep 2014

prov.

292.6Oct 2013 - Sep 2014

prov.

N/A

N/A

N/A

N/A

Governing Body Risk Register Summary Report Sponsor: Helen Shields, CCG Chief Officer

Summary of issue:

The has been one new risk added to the risk register since the last report: • Y2/17 Primary Care Anticoagulation Service requires further

updating. A number of issues regarding this service have surfaced as the new specification has been put together and some practices are less enthusiastic about providing the service given the additional knowledge and skills required by NICE guidance. The implications must be resolved in the next few months before a new service is procured.

There was one error on the risk register where a risk was identified as high risk but should have been medium: • Y2/01 CCG allocation – this is a medium risk rather than high risk.

This is because there is little risk this financial year, but the longer term consequences for funding on the island continues to be of significant concern.

In June, the Clinical Executive reviewed all high risks and assured itself that appropriate action plans were in place. It further reviewed the risks associated with safeguarding to ensure that all appropriate actions are being taken to reduce risk in this area. Overall the level of risk identified within the CCG is stable at this point in the year with action plans in place to address gaps in control.


The Governing Body is asked to review the summary report and determine whether it is assured that the CCG is its capturing and managing risks appropriately.

Principle risks:

Failure to produce a meaningful risk register could result in the CCG failing to take the required actions to ensure that it meets its targets and statutory duties.


All changes to risk are discussed at the Commissioning Officer’s Group as they arise. In addition, the risk register is reviewed in detail monthly at the Clinical Executive and the outcomes of that review are detailed within the Clinical Executive minutes. Individual risks are discussed with teams during performance review meetings.


There is no change to the financial implications contained within the risk register and no new resources required to manage the risks


Taken as a whole there is no material change to the overall risk in relation to legal implications.


Patient and public involvement is undertaken where appropriate to mitigate the level of risk against each line of the risk register.


Impact on equality and diversity is considered in each of the risks raised with a view to ensuring that they do not impact adversely on the CCG’s statutory responsibilities.

Author of Paper: Caroline Morris, Head of Primary Care and Corporate Business.




Governing Body July 2015

GB15-022 Risk register summary

Months >12 >6 >3 New

Risks 7 5 4 1

Risks added to register

1 Ref Score1 Y3/17 12

Risks removed from the register

/

Risks with Increased Score

Ref Score

NONE IN JUNE

Increased Scores

Reduced Scores

Risks with Reduced Score

Ref Score

Y3/1 15 CCG Allocation Reduction

High RisksCommissioningCorporate

Finance

Quality Safeguarding adults capacity and capability in Trust

17

Title

Title

TitlePrimary Care Anticoagulation service requires significant updating

NONE IN JUNE

system resilience

Care home closures / bed reductions

Summary Risk Register

Risk Distribution by Objective

Activity

Total Time on Register

0

1

0123456

Comm Fin Qual Corp

High

Medium

Low

Governing Body Stakeholder 360o survey 2015 Sponsor: Helen Shields, CCG Chief Officer

Summary of issue:

Each year a stakeholder survey is commissioned by NHS England to look at the CCG’s success at building relationships with stakeholders and whether stakeholder relationships remain central to CCG commissioning. This very short summary outlines the key learning from the report and actions that the CCG is recommended to undertake.


The Governing Body is asked to review the recommendations arising from the analysis of the survey results and consider whether the CCG should take any further action.

Principle risks:

Stakeholder relationships are crucial to the success of the CCG, particularly in relation to the integration agenda and to provide assurance on the quality and safety of commissioned services. The key risk here is that


A longer more detailed version of this report has previously been circulated to the Governing Body. It will also be discussed by the key Governing Body sub committees to ensure all learning has been derived from the survey and any consequent action plans are monitored effectively.


The quality function within the CCG is very small consisting of 2.6 WTE including the newly appointed Director. An additional quality manager resource is being considered to ensure the appropriate levels of assurance can be provided to strengthen this area in line with the feedback from this survey.


The CCG has a statutory duty to involve stakeholders in undertaking its work, both in terms of involving organisations but also in ensuring it is receiving the right advice. The survey suggests that the CCG has achieved these two duties effectively in the opinion of our key stakeholders. This should provide assurance to the Governing Body that the arrangements we have in place are effectively in discharging the statutory duty.


Patient group feedback is a crucial part of this survey. All patient groups reported that they felt they had effective relationships with the CCG and a good working relationship. All reported that they were both informed and involved in the work of the CCG.


This survey in itself has no impact on equality or the nine protected characteristics, however, representatives of groups representing the following two protected characteristics were included in the survey:

• Age – specifically older people • Disability – both physical and mental disability

Both groups were positive about their relationship with the CCG.

Author of Paper: Caroline Morris, Head of Primary Care and Corporate Business.




Stakeholder 360o Survey 2015 – High level summary

BACKGROUND

The CCG participated in a 360o survey between 10 March and 7 April 2015. The survey has two stated two objectives:

• To look at the CCG’s success at building relationships with stakeholders. • To examine whether stakeholder relationships remain central to CCG commissioning.

Isle of Wight CCG had an 87% response rate (n=34)

The survey is structured across the six domains used for the assurance process by NHS England. These are:

• Domain 1: Are patients receiving clinically commissioned, high quality services? • Domain 2: Are patients and the public actively engaged and involved? • Domain 3: Are CCG plans delivering better outcomes for patients? • Domain 4: Does the CCG have robust governance arrangements? • Domain 5: Are CCGs working in partnership with others? • Domain 6: Does the CCG have strong and robust leadership?

MAIN FINDINGS

Overall the survey indicates that the CCG is working well and succeeding across all domains with high levels of satisfaction and very low levels of dissatisfaction. Even so, there is some learning that the CCG can garner from the results as follows:

Two key themes emerge from the survey:

• The CCG needs to demonstrate that it is effective in monitoring the quality agenda, particularly in relation its activities to promote continuous quality improvement.

• The visibility and influence of clinical leadership outside the CCG needs to be improved and strengthened.

Other specific areas that should be considered for improvement include:

• the need to increase confidence amongst stakeholders about the way decisions are made in the CCG

• The need to Communicate more effectively outside traditional networks • The need to provide better feedback on the actions the CCG has taken when an issue is raised

Prepared by: Caroline Morris

Date: 10 June 2015

Governing Body

IOWNHST CQC ACTION Plan Update


Summary of issue:

The Care Quality Commission (CQC) inspected the Trust in June 2014 and identified an overall rating as requires ‘improvement’. This comprised of a range of enforcement and compliance actions. In response a detailed Quality Improvement Plan, approved by the Trust Board, and supported financially by the Isle of Wight CCG was developed by the Trust to inform a Quality Framework, with the objective to ensure a more holistic approach to safe, quality and responsive care and to action all the areas of improvement identified in the CQC report. The Trust initially prioritised the enforcement actions and the warning notices were removed by the CQC in December 2014. This report provides an update on the trusts current progress against the CQC recommendations and provides a statement on the CCG level of assurance and actions the CCG is taking to ensure it is confident that the Trust is taking the appropriate actions.


The Governing Body is asked to note the level of assurance and approve the actions taken.

Principle risks: The CCG is perceived to be commissioning sub-standard or unsafe Quality care and services.


This report will be shared with the QPSC.


The CCG needs to ensure appropriate outcomes from its investment in delivering the QIP.

Legal implications/ impact: A potential concern if the Trust fails CQC re- inspection.

Public involvement /action taken: None.


Equality and Diversity has been taken into account in the preparation of this paper. There are no material impacts either positively or negatively on protected groups.

Author of Paper: Loretta Kinsella, Director of Quality.

1




2

Report on the Trusts CQC Inspection Action Plan

July 2015

1. Introduction The Care Quality Commission (CQC) inspected the Trust in June 2014 and identified an overall rating as requires ‘improvement’. This comprised of a range of enforcement and compliance actions.

In response a detailed Quality Improvement Plan, approved by the Trust Board, and supported financially by the Isle of Wight CCG was developed by the Trust to inform a Quality Framework, with the objective to ensure a more holistic approach to safe, quality and responsive care and to action all the areas of improvement identified in the CQC report. The Trust initially prioritised the enforcement actions and the warning notices were removed by the CQC in December 2014. This report provides an update on the trusts current progress against the CQC recommendations 1.1 Actions and Leads In June 2014, 102 areas of concern were identified by the CQC and the Trust has been working to implement the required actions and recommendations. They did this through identifying key theme area and allocating an Executive Trust lead to be responsible for each key theme. Table 1 Status of Actions

Table 2 Executive Leads Theme Lead Clinical leadership, staff engagement, culture Katie Gray Governance Mark Price

Theme Number of Actions Completed Actions Outstanding Clinical Leadership, Staff Engagement & Culture

34 28 6

Governance 39 29 10 End of Life 5 1 4 Recruitment & Retention

5 2 3

Patient caseload & flow

19 12 7

Total 102 72 30

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End of life care Mark Pugh Recruitment & retention Jane Pound Patient caseload & flow Shaun Stacey/Alan Sheward

Each action has an outcome or success factor and each aggregated key theme has draft key performance indicators. 2. CCG Governance The Quality Improvement Plan is monitored monthly by the Clinical Quality Review Meetings and in conjunction the CCG attends monthly integrated assurance monitoring meetings with the Trust Development Authority (TDA) the regulatory body for non- Foundation Trusts. These consist of an operational monitoring group, attended by the CCG Head of Quality and the CCG Chief Officer and Director of Quality attends the Strategic group. The TDA and the CCG has provided detailed feedback and support to the Trust to assist them in getting to their current level of performance, which despite a protracted lead in time now more clearly demonstrates assurance against the CQC recommendations. 2.1 Progress against trajectory All actions remain ahead of trajectory with the exception of the must do action, which relates to the appointment of a lead nurse qualified in the care of children in emergency care and having a children’s registered nurse per shift in the emergency department, which was due for completion in March 2015. Seven Compliance actions are due to be completed by 30 September 2015 and one on safer staffing by March 2016 2.2 Trust Governance and Sustainability A key area of concerns raised by the TDA and reinforced by the CCG was the Boards understanding and oversight of Quality assurance and improvement throughout the Trust and sustainability of actions taken. At the June Strategic integrated meeting the Trust identified the following actions were now in place;

• The Board will receive monthly QIP reports from the Quality & Clinical Performance Committee (QCPC).

• A Quality matrix dashboard has been developed, which identifies Key Performance Indicators (KPI’s), categorised into the compliance actions, must dos and should dos. Alan Sheward Director of Nursing is the Executive Lead.

• The QCPC will monitor the QIP and provide assurance to the Board on the 30 outstanding actions.

• Minutes from the external integrated stakeholder meetings to be shared with the QCPC.

• Risks in relation to non-compliance to be placed on the risk register.

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• All KPIs to be added to the Quality matrix to ensure sustainability. 2.3 Key Risks identified by the Trust

• Appropriate staffing skill mix for paediatric emergency department and community in-patient wards.

• Staff responsibility under Mental Capacity Act and Deprivation of Liberty Standards (DoLS).

3. CCG concerns on Deprivation of Liberty Standards applications In January 2015, approximately 5 DoLS had been raised in the Trust. The CCG has raised several times via the contractual meetings and the CQRMs (including formal letters sent to the Trust by the Chief Officer) that the CCG is concerned about very low level reporting of DoLS. In addition, it was noted that the Trust was an outlier when benchmarked against other Trusts in Wessex. The CCG has continued to raise it concerns about DoLS and safeguarding capacity and leadership within the Trust. By year end 2014/15, 39 DoLS had been raised, which was an improvement, but it still remains very low based on the high elderly population on the Island. Educating and training staff in understanding mental capacity is fundamental to ensuring appropriate numbers of DoLs are raised. To date 136 staff have now received DoLS training, but these have primarily been nursing staff and the Trust has now recognised that the medical staff who are often in the position to advocate for vulnerable patients require training and these staff will therefore be the next cohort for training. In April and May 2015, 12 DoLS have been reported. The CCG has reviewed the Trust internal business case for Adult Safeguarding resources and is fully supportive, which is fundamental to supporting staff to understand and care appropriately for people with reduced mental capacity. In addition a contractual notice has been sent by the CCG. 4. CCG Assurance: The Trust initially struggled to develop a comprehensive and cohesive Quality Improvement Plan (QIP). In particular it tended to view the required improvements and actions identified by the CQC as separate to the Trust’s overarching Quality strategy. It also illustrated that the Trusts Governance systems and processes were not mature enough or embedded systematically throughout the organisation to demonstrate sustainable compliance.

The CQC inspection took place in June 2014 and we are now one year on. Both the TDA and the CCG whilst recognising improvements are being made, have been concerned about the pace and scale of improvement which has been slow.

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However, at the integrated meeting held with the TDA in June there was a noticeable improvement in the evidence provided at a granular level with clearer lines of accountability and reporting systems through to Board. In addition, the Trust has commissioned a consultancy agency to undertake an external governance review and the TOR have been shared with the CCG. An area of development for the Trust is in identifying mitigating actions that it will need to take in relation to some of the outstanding actions and the need to clearly demonstrate that it can sustain performance against the KPIs developed. Another key challenge is engagement of the whole multi-disciplinary workforce and effective leadership to ensure Quality care and services are provided every day to all patients and their carers. 4.1 CCG Actions

• The Trust’s Quality Improvement Framework and Plan has been agreed as a local CQUIN for 2015/16 and will be monitored via the Clinical Quality Review Meeting (CQRM) and reported to the Quality and Patient Safety Committee for review.

• The Chair and Director of Quality plan to attend the QCPC meetings and a meeting with the chair has been arranged for July 2015.

• The Chief Officer supported by the Director of Quality will continue to work closely with the TDA and gain assurance via the Integrated delivery meetings.

• The Director of Quality holds monthly 121s with the Director of Nursing. • A joint SIRI panel between the CCG and the Trust will commence in July 2015

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Governing Body Final Financial Plan and Budget 2015/16 Sponsor: Loretta Outhwaite, Chief Finance Officer

Summary of issue: The NHS Isle of Wight Clinical Executive have reviewed and recommended for approval to the CCG Governing Body, 2015/16 Final Financial Plan and Budget.


To approve the Final 2015/16 Financial Plan and Budget for NHS Isle of Wight CCG.

Principle risks:

The financial plan and budget is subject to some further changes in relation to final contracts agreed with NHS providers. A final version will therefore be presented at a future meeting.


This paper has been to the Clinical Executive Committee on the 18th June 2015. The Interim Financial Plan and Budget 2015/16 was approved by the Governing Body on the 26th March 2015.


Detailed in the report.


Not applicable.


The 2015/16 Final Financial Plan and Budget is in line with the CCG’s Strategy, which has been developed with public and patient engagement.

Equality and diversity impact: No implications

Author of Paper: Loretta Outhwaite

Date of Paper: June 2015



2015/16 Final Financial Plan and Budget

Decision to approval The Governing Body is asked to:- • Approve the 2015/16 Final Financial Plan and Budget Summary of key changes from Interim Financial Plan and Budget There have been the following key changes between the Plan and Budget, with further details provided in the section below:

• National tariff efficiency was reduced from 3.8% to 3.5%. The CCG received c£500k funding to compensate.

• The CCG’s request to drawdown 0.2% of its surplus (£432k) was not approved by NHS England, as the CCG is >5% above its allocation target. Therefore, the CCG’s headroom has had to be used to support the Mental Health non-recurrent investments the draw-down would have supported. In addition, this has meant that the CCG’s planned surplus has increased to 1.2%

• There has been a national directive for the CCG to increase its non-elective activity commissioning by 2% (c£500k). The CCG’s headroom has had to be utilised to support this change.

• Due to the above changes, the CCG has now committed all of its headroom (non-recurrent funding to support transition), but its contingency of 0.5% (£1.1m) remains uncommitted.

• Some of the figures have been updated to reflect year end out-turn (e.g. cost pressures, budgets) and the outcome of contract negotiations (e.g. interim support to IW NHS Trust)

Key financial targets & Table 1: 2015/16 Key Planning Assumptions • Achievement of a 1.2% Income & Expenditure (I&E) surplus (on total allocation): was 1% Source and application of funding

• New paragraph added: The Acute contract values have been calculated using the 2015/16 payment by results (PbR) tariffs and forecasting the likely demand for services. With the national tariff not being agreed, providers were given 2 options on tariff prices and had until the 4th March to decide. The 2 options were:

• DTR (Default tariff roll-over) tariff prices unchanged from 2014/15 (no inflation or efficiencies) but providers will not be eligible for CQUINS.

• ETO (Enhanced tariff option) inflation of 1.9% and efficiencies of 3.5% with CQUINS available.

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• NHS England has been working with NHS Clinical Commissioners to identify the impact at CCG level of the recent ETO/DTR decisions made by providers. This follows the recent letter to CCGs notifying them that NHS England was making available a further £150m of resources to commissioners to meet these pressures. As a result the CCG has received a non-recurrent allocation of £595k in our 2015/16 allocations (ref 5).

• The non-recurrent figure of £2,550k (ref 6) shown in the funding section of Table 2 below is the return of the 2014/15 surplus – was £2,530k.

• Reference to a £432k surplus draw-down (in relation to utilising an underspend incurred last

year against the national risk pool for Continuing Healthcare Retrospective claims) has been removed, as this was not approved by NHS England, as the CCG is more than 5% over its allocation target.

• Tariff efficiency, inflation and price changes increase expenditure on healthcare contracts by

£2,124k (ref,9,10,11). Demographic change leads to an increase of £2,133k (ref 14) – was £1,982k and £1,235k. Increase in demographic change is mostly due to the national directive to add in 2% non-elective activity.

• As in 2014/15, to give stability whilst the Isle of Wight Health and Social Care system integrates services, the CCG will keep community and mental health contracts at their current funding levels, by off-setting the tariff deflation of £1,298k (ref 12) with an equivalent investment – was £1,406k. The reduction is due to a national change in tariff deflation, from 3.8% to 3.5%.

• Cost pressures of £1,303k (ref 15) will be funded by the CCG. This relates to Mainland Acute SLA activity (£665k), high cost placements (£350k) and high cost drugs (£200k) – was total £1,328k; Continuing Healthcare £315k, high cost placements £383k, high cost drugs £630k. Change due to revised forecasts.

• 2015/16 Quality, Innovation, Productivity and Prevention (QIPP) plans will recurrently save

£3,363k (1.6%) (ref 16). Further information regarding QIPP is provided later in this document.

• £849k (ref 19) service development investment, such as Mental Health and Community

Services and in line with national planning guidance – was £1,444k. The majority of this reduction because there is no longer a Better Care Fund performance fund.

• £5,100k (ref 24) which is likely to predominantly be interim support for provider contracts – was £5,500k. The initial figure was only an estimate.

• Table 2: Summary Draft Source & Application of Funds 2015/16 – updated to reflect the

changes highlighted above. The key changes, in addition to the above are: allocation of £595k non-recurrent funding to support the change in tariff deflation; removal of £432k non-recurrent drawdown request, which was unsuccessful.

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• Table 3: Summary 2015/16 Final Budgets – 2014/15 budgets in the table are now as at Month 12, rather than Month 10

• Better Care Fund – the revised figures are awaiting formal sign-off, by the Health & Wellbeing Board

• Better Care Fund: wording has been updated to: following a national directive, the CCG has been required to build into its planning a non-elective increase of 2%. The revised figures show that we are now anticipating an increase of 1.8% from calendar year 2014 to 2015. Our original submission was aiming for a -1.5% reduction. However taking into account the information below which demonstrates that we have already made significant reductions in non-elective admissions, not least a -3.1% reduction in 14/15, we do not believe that we will experience a 1.8% increase. With the service delivery plans we have put in place, we are aiming for zero growth - the Interim Plan stated a reduction of 0.3%.

• Table 6: Overview of non-elective activity: has been updated to reflect the above changes

• Better Care Fund – as the updated non-elective figures do not show a reduction in activity, there is no performance fund for the BCF

• Appendix 2 contains the final version of the 2015/16 Operational Plan Executive Summary

• A further breakdown of the Better Care Fund budget has been provided in Appendix 3

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Introduction This financial plan has been developed in line with the CCG’s Strategy and Operational Plan. It reflects the following guidance and policies that are currently in place:- • National Planning Guidance 2015/16 – Forward View into Action: Planning for 2015/16 • Isle of Wight CCG Commissioning Intentions 2015/16 • NHS Mandate (incorporating NHS Outcomes framework, NHS Constitution) • Isle of Wight Joint Strategic Needs Assessment (JSNA) The expenditure budgets reflect the outcome of discussions and negotiations with the CCG’s provider organisations. The purpose of this paper is to inform the Audit Committee of the financial allocation for 2015/16 and how this is planned to be utilised. The Audit Committee is asked to recommend for approval to the Governing Body, the interim expenditure budgets for 2015/16 and to agree the proposed financial assumptions. Key financial targets The current NHS financial regime includes a number of statutory and other key requirements that will be delivered by this financial plan: • Achievement of a 1.2% Income & Expenditure (I&E) surplus (on total allocation) • Management within an agreed cash limit • 1% non-recurrent headroom, to support transformational change • 0.5% contingency (minimum) • Manage within running cost allocation Key financial assumptions The allocations have been received in conjunction with the publication of “Five Year Forward View” and “Forward View into Action: Planning for 2015/16”. The documents set out the national agenda for efficiency, productivity and reform. To provide further information on how the CCG will be delivering the Five Year Forward View, the Executive Summary of the draft 2015/16 Operational Plan is attached as Appendix 2. Table 1 below shows the assumptions that have been used in developing the plan. Table 1: 2015/16 Key Planning Assumptions Assumption 2015/16 Comparison

2014/15 I&E surplus (mandatory) 1.2% 1.0% Non-recurrent headroom (mandatory) 1.0% 2.5% Contingency (mandatory) 0.5% 0.5% CQUIN (mandatory)* 2.5% 2.5%

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Assumption 2015/16 Comparison 2014/15

Population growth 1.6% 1.5% Efficiency requirements 3.8% 4.0% Inflationary uplift Acute 3.0% 2.8% Inflationary uplift Non Acute 2.2% 2.2% Prescribing inflation 8.0% 8.0% Continuing care growth 3.0% 3.0%

*the level of CQUINs is still under discussion at a national level, but CCG have been told to plan in the interim on the basis of 2.5% Source and application of funding References are given in the section below to where the figures appear in Table 2 Summary Draft Source & Application of Funds 2015/16 The CCG has received a recurrent increase to its programme allocation of £3,821k (1.7%) (ref 2) and a reduction in its running cost allocation of £357k (10%). It should be noted that the programme increase includes £1,071k (ref 19) for system resilience funding and therefore, the growth received net of this is 1.4%. There was a national requirement for a 10% reduction in CCG running costs. The Acute contract values have been calculated using the 2015/16 payment by results (PbR) tariffs and forecasting the likely demand for services. With the national tariff not being agreed, providers were given 2 options on tariff prices and had until the 4th March to decide. The 2 options were:

• DTR (Default tariff roll-over) tariff prices unchanged from 2014/15 (no inflation or efficiencies) but providers will not be eligible for CQUINS.

• ETO (Enhanced tariff option) inflation of 1.9% and efficiencies of 3.5% with CQUINS available.

NHS England has been working with NHS Clinical Commissioners to identify the impact at CCG level of the recent ETO/DTR decisions made by providers. This follows the recent letter to CCGs notifying them that NHS England was making available a further £150m of resources to commissioners to meet these pressures. As a result the CCG has received a non-recurrent allocation of £595k in our 2015/16 allocations (ref 5). The non-recurrent figure of £2,550k (ref 6) shown in the funding section of Table 2 below is the return of the 2014/15 surplus Tariff efficiency, inflation and price changes increase expenditure on healthcare contracts by £2,124k (ref,9,10,11). Demographic change leads to an increase of £2,133k (ref 14). As in 2014/15, to give stability whilst the Isle of Wight Health and Social Care system integrates services, the CCG will keep community and mental health contracts at their current funding levels, by off-setting the tariff deflation of £1,298k (ref 12) with an equivalent investment. This is shown in Table 2 as “protection of contracts”.

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Cost pressures of £1,303k (ref 15) will be funded by the CCG. This relates to Mainland Acute SLA activity (£665k), high cost placements (£350k) and high cost drugs (£200k). 2015/16 Quality, Innovation, Productivity and Prevention (QIPP) plans will recurrently save £3,363k (1.6%) (ref 16). Further information regarding QIPP is provided later in this document. The CCG plans to make investments of £10,057k (4.8%), £4,557k (2.2%) of this is recurrent investment. The types of investments are as follows:

• £823k (ref 13) recurrent adjustment to the IW NHS Trust Mental Health contract, following a joint contract re-basing exercise

• £1,071k (ref 20) recurrent allocation has been given to the CCG for system resilience • £1,219k (ref 17) QIPP investment (details in appendix 1) • £849k (ref 19) service development investment, such as Mental Health and Community

Services and in line with national planning guidance • £5,100k (ref 24) which is likely to predominantly be interim support for provider

contracts In line with national planning requirements, a contingency of 0.5% (£1,050k) (ref 20) will be held to manage in-year risk. Non-recurrent headroom of 1% (£2,008k) (ref 21) has been identified and in line with national planning requirements, it will be used to support expenditure relating to transition or transformation. The CCG plans to use £795k (see Table 4) for non-recurrent QIPP investment schemes and £245k for the contribution it is required to make to the national CHC “Closing the Gap” risk pool. It should be noted that, despite having closed almost 100% of the Isle of Wight claims and therefore having an insignificant level of cost risk remaining, the CCG is still required to make a full contribution. Table 2: Summary Draft Source & Application of Funds 2015/16 ` 2015/16

Recurrent Non-

Recurrent Total Ref £'000 £'000 £'000 Funding Programme Allocation 1 196,935 196,935 Growth funding 2 3,821 3,821

Running Cost Allocation 3 3,121 3,121 S256 Social Care Funding 4 3,513 3,513 ETO/DTR Funding 5 595 595 Winter Funding - Ambulance 49 49 Previous Year surplus 6 2,550 2,550 Total Funding 207,390 3,194 210,584 0 Expenditure Baseline Expenditure 7 (192,141) 1,000 (191,141)

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` 2015/16

Recurrent Non-

Recurrent Total Ref £'000 £'000 £'000 Island Premium 8 5,388 5,388 Tariff Efficiency 9 4,668 4,668 Tariff Inflation 10 (6,581) (6,581)

Price & Casemix Changes 11 (211) (211) Protection of contracts 12 (1,298) (1,298) Mental Health Capita costs 13 (823) (823) Demographic Change 14 (2,133) (2,133) Cost Pressures 15 (1,303) (1,303) QIPP Savings 16 3,363 3,363 QIPP Investments 17 (1,219) (1,219) Social Care 18 (3,513) (3,513) Investments 19 (849) 0 (849) Operational Resilience 20 (1,071) (49) (1,120) Contingency 21 (1,053) (1,053) Non Recurrent Headroom 22 (2,007) (2,007) Running Costs 23 (3,121) (3,121) Total Expenditure (200,843) (2,109) (202,952) 4,400 700 5,100 Total surplus/deficit 6,547 1,085 7,632 Target surplus/deficit 2,532 2,532

Surplus above Plan 5,100 Interim support (Island Premium) 24 (4,400) (700) (5,100) Adjusted Surplus 2,147 (2,147) 0

Funding allocations The recurrent baseline allocation given to the CCG for 2015/16 was announced in December at £200,756 (including growth at 1.7% of £3,821k) for programme (healthcare). As stated above, it should be noted that the growth allocation included £1,071k for system resilience funding, so the actual level of growth was 1.4%. The revised allocation leaves the CCG £31m (18%) above its allocation target. In addition to the programme funding allocation, the CCG has an allocation of £3,121k, for running costs which is a reduction to last year’s allocation of £357k (10%). In 2014/15 the running costs were based on £25 per head of population. This has now reduced to £21.98 per head of population. NHS England will also be delegating the GMS IT budget to the CCG to manage on its behalf. This allocation will be ring-fenced.

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Income and expenditure summary Table 3 below provides an overview of the 2015/16 interim budgets at service level. Generally, there is less investment in acute services and more in community and primary care services, which is in line with the Island’s Health and Social Care vision of reducing/avoiding hospital admissions through enhanced support in community and primary care settings. Table 3: Summary 2015/16 Final Budgets

Summary of budgets 2015/16 2015/16 2014/15*

Comments on movements £’000 £’000

Acute services 92,348 92,925 Less system resilience funding in 15/16 Out of Hours 2,426 2,464 14/15 higher level of activity

Mental Health/LD services 23,307 22,331 15/16 SLA cost re-based, increase in high cost placements, investments

Community services 28,558 24,852 15/16 social care funding (£3.3m), investments Continuing care services 11,033 10,921 Increase in number & complexity Children’s services 1,210 1,142 Increase in high cost placements Prescribing/ Enhanced services 32,713 31,610 Increase in cost Corporate costs 4,937 5,004 All staff & (non-healthcare) non-pay costs Contingency 1,053 0 0.5% national planning guidance Headroom 2,008 1,300 1.0% national planning guidance

Other expenditure 8,460 11,307 Growth for Comm/MH SLAs (£700k), investments schemes not yet commenced (£2.7m), Interim support for contracts (£5.1m)

Total expenditure 208,052 203,855 Surplus 2,532 2,050 1.2% national planning guidance Allocation 210,584 205,905

*2014/15 budgets as at Month 12 Quality Innovation Productivity & Prevention (QIPP) Programme The CCG has a 2015/16 QIPP savings plan of £3,531k. To support the delivery of the savings, investment of £2,014k is required. Non-recurrent investment is being supported through headroom. This year’s QIPP investment programme will support the delivery of savings in future years. An overview of the schemes is provided in Table 4 below and the further detail is attached in Appendix 1.

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Table 4: 2015/16 QIPP Plans

2015/16 QIPP Plans

PLAN AREA

Rec Savings

£000

Rec Investment

£000

Total £000

Non Rec Savings

£000

Non Rec Investment

£000

Total £000

Total Savings

£000

Total Investment

£000

Net £000

Frail Older People 0 0 0 0 0 0 0 0 0 Long Term Conditions 0 0 0 0 0 0 0 0 0 Planned Care 200 (10) 190 0 (30) (30) 200 (40) 160 Unscheduled Care 1,245 (1,084) 161 168 0 168 1,413 (1,084) 329 Mental Health 128 (105) 23 0 (356) (356) 128 (461) (333) Children & Young People 0 (20) (20) 0 0 0 0 (20) (20) Medicines Management 1,790 0 1,790 0 0 0 1,790 0 1,790 Running Costs 0 0 0 0 (250) (250) 0 (250) (250) Primary Care 0 0 0 0 (158) (158) - (158) (158)

TOTAL 3,363 (1,219) 2,144 168 (795) (627) 3,531 (2,014) (1,518)

Better Care Fund As directed in the national planning guidance, for 2015/16 the CCG will be providing £3,513k funding to Isle of Wight Council for support for Social Care. This funding has been provided to Social Care in previous years by the NHS via a section 256 agreement and is now part of the Better Care Fund, which creates a pooled budget (via a Section 75 agreement) between the Isle of Wight Council and the CCG. The fund will be managed by the newly formed Joint Adult Commissioning Board, which consists of Executives and Senior Managers from each organisation. The schemes within the fund are existing schemes. Over time, the joint commissioners will work together to review and, where necessary, re-design services to ensure they meet the needs of our population and achieve value for money. Table 5 below provides an overview of the Better Care Fund for 2015/16. Table 5: 2015/16 Better Care Fund

Area of spend

Baseline funding

IW Council IW CCG Total

S256 Proposed Proposed BCF Proposal

£’000 £’000 £’000 £’000 Mental Health reablement 147 461 1,392 2,000 Crisis response 598 406 762 1,766 Rehabilitation/reablement 765 2,711 3,774 7,250 Elderly integrated locality teams 0 495 5,518 6,013 Enhanced hospital discharge 1,808 0 1,501 3,309 Supptg info, advice & self mgt 100 6 0 106

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Area of spend

Baseline funding

IW Council IW CCG Total

S256 Proposed Proposed BCF Proposal

Carers 95 0 291 386 Care Act 0 786 0 786 Local area co-ordination 0 400 0 400 Total 3,513 5,265 13,238 22,016

One of the aims of more integrated care delivered through the Better Care Fund is a reduction in non-elective admissions. Following a national directive, the CCG has been required to build into its planning a non-elective increase of 2%. The revised figures show that we are now anticipating an increase of 1.8% from calendar year 2014 to 2015. Our original submission was aiming for a -1.5% reduction. However taking into account the information below which demonstrates that we have already made significant reductions in non-elective admissions, not least a -3.1% reduction in 14/15, we do not believe that we will experience a 1.8% increase. With the service delivery plans we have put in place, we are aiming for 0.3% growth. Table 6: Overview of non-elective activity

2011/12 2012/13 2013/14 2014/15 2015/16

Emergency Spells G&A 11,608 12,009 11,299 11,178 11,397

% Change 3.5% -5.9% -1.1% 2.0% As the revised figures shown a non-elective activity increase above 14/15 figures there will not be a BCF performance fund, which is the funding associated with the elective reduction. Cash The CCG will be provided with an annual cash limit within which the CCG must remain. As the vast majority of CCG business relates to contracts, the majority of cash expenditure is known and will flow in equal 12ths. However, the CCG’s Better Care Fund annual contribution (£13.5m) will be paid into the Isle of Wight Council in April. Capital The CCG does not have any assets on its balance sheet and has no plans to purchase any capital assets during 2015/16. A £3.5m bid against the NHS England Capital Scheme for 2015/16 and 2016/17 has been made by the CCG, on behalf of the Island’s Health and Social Care System, for the development of the three Locality Hubs. The capital will be granted to partner organisations, who will create and own new

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assets or enhance their current assets. The bid is under consideration by NHS England, who may identify alternative routes to fund this scheme. Financial risk and mitigation An overview of the CCG’s key financial risks and their mitigations is provided in Table 7 below. Table 7: 2015/16 Key Financial Risks

Risks Details/mitigation 1 Ability to manage & control activity Set clear activity levels within contracts; fixed financial

envelope for IW NHS Trust; monthly SLA meetings to performance manage; use contingency or re-prioritisation of investments

3 Ability to influence in performance targets

Set clear CQUINs & performance manage through monthly SLA meetings

4 Delivery of QIPP schemes Clear delivery plans, based on robust activity modelling, with monthly review through CCG performance review meetings & SLA meetings with the providers

5 Changes in policy Horizon scanning to identify, use of reserves to finance 6 Ability to fund all planned investments CCG surplus drawdown request (£432k) may not be

approved by NHS England. In this event, investments would need to be pre-prioritised.

7 Ability to manage cost pressures Potential cost pressures around the following areas have been identified: mainland activity, increased high cost placements, increased continuing healthcare activity, higher prescribing inflation, high cost drugs, NHS England does not fund the impact of zero tariff efficiency. These have been estimated to be up to £2.6m. All budgets will be closely monitored & actions taken wherever possible to mitigate the issue. If necessary, the contingency of £1.1m will be deployed & investments using the CCG headroom (£2m) would be delayed.

Financial governance The CCG has considered its requirement to establish robust financial and corporate governance arrangements. There are several key policy and procedure documents that the CCG has adopted, the key ones being: • Constitution • Standing Orders and Standing Financial instructions • Prime financial procedure documents • Scheme of Delegation To ensure that the CCG meets its obligation to account for public funding, the SBS Integrated Single Financial Environment (ISFE) ledger system is used and a scheme of delegation for authorisation of all expenditure has been embedded within the system.

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Committees of the board are in place to seek assurance that the organisational governance is sound and assurance can be placed on the mechanisms in place. This will be done predominantly through the Audit and Quality and Patient Safety committees. Alignment with providers To ensure that the Isle of Wight health system remains financially sustainable, the CCG works closely with the Isle of Wight NHS Trust and Isle of Wight Council, on a monthly basis and during the annual planning cycle, to maintain consistent financial assumptions. Commissioning Intentions The CCG’s 2015/16 commissioning intentions comply with the “Forward View into Action” planning guidance and have been shared with the main provider, Isle of Wight NHS Trust. Contract and payment process For 2015/16 the CCG will be using the NHS standard contract and complying with the Payment by Results framework. Arrangements with NHS South Commissioning Support Unit The CCG will continue with its Service Level Agreement to receive support services from NHS South Commissioning Support Unit for 15/16. The capability and capacity of the CSU to provide the range of services agreed is critical to the delivery of the financial strategy. To ensure that services are delivered to the expected level and standard, the CSU has assigned an Account Director and Account Manager to work with the CCG and the CCG’s Chief Finance Officer and Head of Performance and Contracting are members of the CSU’s Leadership Team (User Board), which meets monthly. In a joint exercise with the other Wessex CCGs a review of the service specifications and costing methodology has taken place. As a result of the updated costing methodology, which has been reviewed and approved by all of the CCG’s Chief Finance Officers, we have a potential cost future cost pressure in excess of £100k. During 2015/16 we will therefore be reviewing the services provided, alongside the rest of the CCG running costs, to ensure that they are both affordable and represent best value for money. Loretta Outhwaite Chief Finance Officer

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Appendix 1: Overview of 2015/16 QIPP Programme

1.1 Overview The CCG has a number of schemes that can be described as QIPP Plans. These vary from small savings on pathway changes, e.g. unbundling cardiology pathways in relation to echocardiograms to the major system transformation projects such as the development of new models of care and the MLAFL programme. They are in various stages of development. Some from previous years are near completion, for other the detailed plans such as for the new model of care have yet to be developed. Depending on the size of the change, a project plan may or may not be in place and bigger schemes have programme plans. The following sets out some of the key projects and programmes that can be defined under QIPP.

1.2 Transformation of Hospital Services • Safe and Sustainable services – The CCG is starting a major review of the acute services

to ensure that they are clinically sustainable and financially viable to be provided on the Island. In this first year, reviews will be undertaken of haematology services, urology services, cancer services and paediatric services. This work will also link with the cost base exercise being undertaken within the Trust to identify which services are not financially viable at national tariff payment and therefore need to attract a premium if delivered on an Island.

1.3 Transformation of Urgent Care • Fully integrated Communications Hub – The IOW already has an effective

Communications Hub which combines 111, 999, hospital switchboard, patient transport, single point of access for rehabilitation services and district nursing services, Wight care alarms. A project is now underway to scope extending this further to bring together a health single point of contact with the IOW Council main call centre. The aim is to streamline systems, improve efficiency, increase resilience and deliver savings across all three IOW partner organisations.

• A&E and Primary Care Management of Urgent Care – This is an overall programme of work which will review how to ensure the most cost effective model of care delivering the Keogh recommendations for urgent care. The CCG is currently contributing significant additional funds over tariff for A&E services, paying for the Walk In Centre. The IOW Walk In Centre is co-located with the Emergency department. The CCG has also commissioned an Acute GP service, which triages GP referrals and is co-located with the medical assessment unit. In primary care, GP’s are funded for the minor injuries LES and are also struggling to deliver primary care urgent care as well as managing long term conditions and complex needs. An Urgent Care Strategy will be consulted on in April 2015 and a programme plan will be developed to implement the agreed preferred models of care.

1.4 Transformation of Community Services • If the model of health and social care delivery is to change on the Island to ensure

clinically and financially sustainable services, the community services need to develop at pace to enable more people to remain fit and well and be independent at home. The MLAFL programme has been instrumental to the implementation of change and the next phase of this will be shortly agreed between the partners, building on the development

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of integrated locality teams, across health, social care and the voluntary sector. This will develop into the new model of care and the preferred option for the Island of a Multispecialty Community Provider.

As part of the work to implement transformation a number of projects are running in tandem: • Review of rehabilitation and reablement services with the view to integrating across

health and social care and being part of the locality teams. • Pilot extension to crisis response services. • Improved End of Life Care to ensure preferred place of death is supported and there is

sufficient capacity to offer choice. • Market development to ensure increased capacity in nursing homes and the domiciliary

market and a focus on supporting nursing and residential homes to develop their capability to take more people with complex needs.

• Continuation of the prevention, self-help and self-management programmes. Building on community assets and supporting people to support themselves.

1.5 Transforming Mental Health Services In mental health there are a number of interrelated projects which will support better access and delivery of the new constitution targets, improve quality of treatment and outcomes for individuals and will start to deliver parity of esteem. • Community Mental Health Services – A review and redesign of community mental health

services is nearing completion, to ensure delivery is in line with agreed service specifications for payment by clusters. As part of this work there is a specific focus on NICE compliant pathway redesign for eating disorder and psychosis to ensure faster access to diagnosis and that the community mental health support services are supporting people in their recovery and to live independent lives.

• Mental Health Crisis Response – An overall analysis is being undertaken of the gap of current provision against the Crisis Concordat Action Plan. This will inform further actions but will include continuation of street triage Operation Serenity and ensuring the crisis home treatment team is delivering required outcomes.

• Mental Health Reablement – This has been a major QIPP project for the past two years and is nearing completion. The service has been redesigned to enable greater community support and integrated services with the Council including adult social care, supporting people and housing.

• Liaison Psychiatry – The IOW has a small psychiatric liaison team in the acute hospital. This is being redesigned in order to give more support to people who present at A&E and if admitted to acute hospital care are supported through their journey to discharge. The preferred model is Rapid Assessment, Interface and Discharge (RAID).

1.6 Transforming Dementia Care Considerable work has been undertaken to transform dementia services, with an improved dementia care pathway, improved diagnosis rates and dementia friendly communities. The community dementia service has been developed and the inpatient assessment and treatment centre unit moved to St. Mary’s. Two parts of the pathway are not delivering the outcomes required and two further pieces of work are proposed: • Ensuring the community dementia support team is fit for purpose to support people

wherever they live. • Option appraisal of alternative models for inpatient provision.

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Getting the community support service right first is critical to determine the demand for the inpatient limit. The new community model has been agreed and will be implemented over the next few months and then a major piece of work will commence on the inpatient provision.

1.7 Transforming Primary Care A vision and strategy for primary care is being developed to ensure primary care is in a position to lead the new model of provision in the future. There are a number of different projects that interrelate to transform the current services: • Improving IT to ensure integrated records, electronic prescribing and electronic referrals. • Workforce development through exploring more creative ways of delivery to meet

demand and improve access. • Development of the Primary Care Collaborative and a prime provider model. • Supporting primary care to be in a position where they are a leading component of the

new integrated care locality teams. • Ensuring primary care urgent access is improved as part of the overall urgent care

reconfiguration.

1.8 Medicines Management The focus of medicines management is cost-effective, high quality prescribing. The Medicines Management team support GP practices with prescribing advice, script switch and drug changes to cost-effective alternatives and incentivising GPs to undertake additional activity. The team are also working on reducing costs from high cost drugs that have lost, or are losing, patent.

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Appendix 2: Operational Plan 2015/16 – Executive Summary

ISLE OF WIGHT OPERATIONAL PLAN 2015/16 EXECUTIVE SUMMARY

Submission 14th May 2015

2 INTRODUCTION

The Operational Plan 2015/161 sets out how the CCG will deliver its strategic priorities and objectives within the resources it has available. The Operational Plan also takes account of new national requirements as published in the Five Year Forward View particularly in relation to the emphasis on prevention and the development of new models of care. The IOW Operational Plan 2015/16 should be read alongside the IOW Clinical Commissioning Strategy2 and the IOW CCG Delivery Plan3, which sets out actions and milestones for delivery. There are a number of key themes that run through all our plans – improving quality and patient experience, clinical and financial sustainability, meeting nationally required targets and improving health outcomes. The IOW health and social care system faces major financial challenges. The IOW NHS Trust and the IOW Council are both forecasting significant financial gaps and have substantial savings programmes. The IOW CCG has received the lowest level of growth nationally at 1.4% for 2015/16, despite increasing demands of an elderly population. This is due to its distance from the financial target allocation. The CCG will meets its financial targets in 2015/16 but historically the CCG has given additional financial support to both the Trust and Adult Social Care and is now not able to do so to the same level. This will have significant impact across the system. To support the financial risks in 2015/16 the CCG has, as per the national planning guidance, an uncommitted contingency of 0.5% £1,050K. Prior to deploying investments the CCG will also review its financial forecast to ensure affordability. The IOW system in recognising these pressures has produced the Five Year Health and Social Care Vision (2013)4 of ‘Person centred, coordinated health and social care’ which gives a commitment to work closely together to transform services. The plans for the IOW system are therefore closely aligned and there is excellent understanding of the issues and pressures which each organisation faces and the system as a whole. Long term, the IOW health and social care system is committed to achieving sustainable service delivery. A key element of the new models of care (Vanguard) will be ensuring affordability. The CCG is working closely with the Trust to establish costs at service level and to develop a robust cost model to understand the affordability of different models of care delivery and hence support decision making. Alongside this, the CCG will continue to work with NHS England to understand the negative impact of the CCG funding formula on the Island’s allocation and identify solutions.

2 KEY COMMISSIONING INTENTIONS

1 IOW CCG Operational Plan 2015/6 2 IOW Clinical Commissioning Strategy 2014-2019 3 IOW CCG Delivery Plan 2015-2017 4 Isle of Wight Health and Social Care Vision (2013)

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The CCG Commissioning Intentions underpin the delivery of the Strategy and new requirements that have emerged since the Strategy was written.5 This is an ambitious programme of work across a number of areas. Vanguard The IOW system has been successful in becoming a vanguard site. This means the IOW system will receive additional funds and support to enable us to progress faster with our vision for integrated services. All of our key commissioning intentions as set out in below will continue, but we will be aiming to support the development of a new provider model for the Island, which builds on the integrated Trust to include social care and some elements of primary care while shifting the focus and delivery from acute to community care. It will also, through new contracting models such as the use of alliance contracts, ensure that all incentives and required outcomes are aligned across contracts in order to ensure all providers are clearly delivering services with the same goals. We anticipate that the BCF will grow rapidly over the next year as greater integrated commissioning grows to lead the integrated provision. Transforming Community Services – The model of service provision on the Island needs to change to enable more people to be supported in their communities and to remain fit, well and independent at home. We need to see an accelerated shift from acute care into jointly provided community provision. Integral to this is the ongoing development of integrated locality teams, improved and integrated rehabilitation and reablement services, a more joined up approach to working with care homes and the voluntary sector and improved end of life care. Transforming Urgent Care – There are two major programmes. Firstly, work has commenced on scoping an extension to the remit of the Integrated Communications Hub. This will further streamline access to health and council services and increase the efficiency and resilience of the current 999/111 services. These are high cost services for the Island when benchmarked against other areas due to diseconomies of scale. Secondly, we are about to start on a programme of work which is identified in our Urgent Care Strategy6 to both improve access to primary care, urgent care and improve pathways, but to also reduce the current costs. Transforming Hospital Care – The need to ensure safe and sustainable acute clinical services and a planned shift of some services to more community settings will mean the acute hospital sector could look very different in five years’ time. Increasing expectations, more robust guidance on standards required and difficulties in attracting clinicians to some specialities, will impact on what can be safely provided in a small district general hospital. A number of service reviews will commence in 2015/16 to consider the future implications of service delivery on an Island in this context. These will include haematology, urology, cancer and paediatrics. Transforming Mental Health Services – There is a major programme of work underway to transform mental health services to improve outcomes and support people better in the community. The work streams are very interrelated and include improving crisis response, mental health reablement and improved community mental health services. As part of this work a number of care pathways are being improved and refined. Transforming Dementia Services – This is being undertaken in two parts. Firstly, reconfiguration of the existing community support services to enable more people to be cared for and managed in their place of residence. Secondly, reprovision of the assessment and treatment unit and an option appraisal of the alternatives. Transforming Primary Care – A new vision and strategy is being co-created with primary care which will see it become part of integrated locality teams. In order to enable this to happen, the CCG

5 Section 6 of the CCG Operational Plan 2015/16 and relevant sections of the Delivery Plan 2015-17 6 Urgent Care Strategy – Draft for SRG prior to consultation

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will be working to support improved premises and IT systems, and in particular upgrading the existing clinical systems used in primary care. We are also actively supporting the continuing development of the formal federation of member GP practices (One Wight Health), as well as engaging in workforce development and reconfiguration particularly looking at using alternative professionals to support GPs. Primary Care is also an integral part of the transforming urgent care and dementia workstreams. Transforming Prevention – The CCG is committed to working with Public Health who are leading this agenda7, supporting improved health outcomes and reduction in inequalities. A clearer strategy is required for prevention and priorities include:- An Integrated Health Improvement Service which will provide lifestyle support across a range of risk factors and which will take a whole family approach; and Locality Area Coordinators who support individuals to utilise the resources available in their communities to lead more healthy and fulfilling lives. 3 DELIVERING PRIORITIES The delivery priorities can be divided into two areas – the enablers and the service changes. The enablers are set out below and the service changes are set out above in the key commissioning intentions. A number of key system challenges are also the enablers. The aim will be to ensure being a Vanguard will enable significant support in these areas. The integrated record is essential to effective working. There are significant workforce issues to be addressed in terms of culture of, workforce redesign and capacity. New models of care also mean the estate will look different in three years’ time. All of these programmes have commenced and will be workstreams within the vanguard process.

Enablers

Area Objective Priorities Joint Commissioning (Joint Adult Commissioning Board, JACB)

To agree joint priorities across CCG, adult social care and public health and maximise efficiency and capacity in the delivery of the key commissioning work programmes.

• Market Management • Further development of

integrated locality provision

• Mental health services • Prevention, early

intervention , self help and self management

• Voluntary sector commissioning

• Carers • Making hospital

discharge work effectively Better Care Fund To maximise use of resources

across health and social care and ensure delivery of the key programmes of work.

• Pooled budget in place by April 2015

• Delivery of the programmes of work

Primary Care Co-commissioning

To ensure primary care development is integrated into the wider health and social care transformation agenda.

• Support the development of the prime provider model

• Support changes to ways of working including use of IT and reprocurement

7 CCG Operational Plan 2015/16 – Appendix 3 and Section 4

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Area Objective Priorities of the GP IT system

• Enable primary care to be an integrated part and lead locality development

My Life A Full Life Programme

To support the delivery of the five year vision and integrated provision. Operational Delivery of the Vanguard Model.

• Support the development of the new model of care with integrated provision across acute, primary care, community health services and alliances with the voluntary sector and care home sector

IM&T To develop an IOW health and social care system IM&T strategy by December 2015. Develop a plan to deliver an integrated electronic record across health and social care.

• Ensure Information Governance across partners

• IM&T strategy agreed • Integration of Community

health, mental health and adult social care records

• New primary care system across all practices

• Interface between all health and social care systems

Estates To develop an IOW health and social care system estates strategy

• Community Health Partnerships

• Estates strategy agreed • Wight Life Partnership in

working together on strategy development.

Finance To develop an IOW health and social care system financial strategy.

• Finance strategy agreed • IOW NHS Trust cost

base review completed, to support future strategy development.

• Include Island system’s response to the CCG allocation distance from target.

4 PERFORMANCE While the CCG has generally performed well in 2014/15 and is making steady progress on improving most of its outcome measures8, the CCG performance has deteriorated in the achievement of the National Constitution targets for Referral to Treatment (RTT) and A&E four hour waits. Due to capacity issues on the Island the two 2 key constitutional targets will not be achieved in the first quarter of 2015/16. It is estimated that the A&E position will be 92% on average for the first quarter and the RTT non admitted targets will not be achieved until July 2015 as patients on the back log waiting list will be treated in turn. Plans are in place to move the current rehabilitation unit into vacant space within one of the Island’s nursing homes during June. This will release additional

8 IOW CCG Operational Plan – Appendix 2

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capacity within the IOW NHS Trust. It is anticipated that the targets will be achieved for the second quarter. Referral to Treatment – During 2014/15 activity at the IOW NHS Trust has been below planned levels for inpatient elective patients but above for day cases. Some of this is due to a switch between elective and day cases, some is due to non-elective pressures in the system, and bed capacity issues leading to less elective capacity. The CCG has taken a much more robust approach to capacity planning for 2015/16.9 An action plan has been developed which includes securing capacity from independent sector providers, promoting choice, reviewing pathways.10 Existing patients on the waiting list are also being offered the opportunity to transfer to another provider. However in order to meet forecast demand there is a delicate balance between improving access for Island residents, while giving choice if patients prefer to wait to receive Island services. The CCG is commissioning an additional 4.4% level of activity on plan outturn, to ensure RTT will be achieved. A&E Targets –The A&E target wasn’t achieved in 2014/15. The analysis of the performance has shown that it is not demand that has increased significantly but that the flow through the hospital is causing delays. The loss of 50 care home beds due to a CQC enforcement notice has had a significant impact and has increased delayed discharges and subsequent patient flow problems. The System Resilience Group (SRG) has refreshed its action plan11 to ensure the focus is on the key priorities to both support further prevention, reduction of non-elective admissions, improve patient flow in the hospital and facilitate discharge. Another key component of resilience is improving independent sector capacity and capability in particularly nursing homes and increasing domiciliary care provision. 5 WHOLE SYSTEM VIEW The CCG takes a whole system view to achieving outcomes and performance. The CCG liaises with lead commissioners in Wessex and the Commissioning Support Unit to ensure demand by IOW residents for off Island care is accounted for in plans. The national directive to increase non-elective admissions by an additional 2% has meant remodelling this activity in the demand plan. Contracts were agreed with the IOW NHS Trust based on the original modelling assumptions. A contract variation will now need to be agreed and until this is agreed there is a variation of an additional 178 spells in the CCG plans. Figure 1: Planning changes for non-elective admissions – all providers 2015/16.

9 IOW CCG Operational Plan – Section 5 - Access 10 RTT Action Plan 11 System Resilience Action Plan

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6 THE BETTER CARE FUND One of the aims of more integrated care delivered through the Better Care Fund is a reduction in non-elective admissions.12 The updated demand modelling for non-electives has had an impact on the figures in the original Better Care Fund submission (September 2014). The latest figures show that the CCG is now anticipating an increase of 1.8% from calendar year 2014 to 2015. Our original submission indicated an ambition of -1.5% reduction in calendar year 2015. This is therefore a 3.3% variation to the original submission. The Case for Change ambition set out in the original BCF submission demonstrated that the health economy was expected to achieve a total 5% reduction in non-elective admissions over the calendar years 2014 and 2015 against the year 2013. Achievement in 2014 has been in excess of expectations at -4.21% which was predicted to be -3.6%. Given the ageing population growth and the fact that Quarter 4 2013/14 appears to have been an unpredictably low activity quarter, it would therefore be unreliable to base 2014/15 forecast at the same level in predicting the outcome for 2015. This is despite the impact of QIPP schemes in containing growth and managing need arising from increasing acuity. The overall planned reduction over the two years has therefore been adjusted to -2.5% against the calendar year (2013), with 2015 showing the slight increase of 1.8% compared to an unusually low year in 2014. The BCF does have schemes that will reduce demand but it has not been possible to quantify them at this stage and put into QIPP plans. It is therefore anticipated that the BCF position should be better than predicted with current modelling. 7 DELIVERY AND ASSURANCE The CCG has a number of robust assurance processes13 to monitor performance which range from Governing Body reports to individual staff objectives. The delivery of key strategic priorities and financial and performance targets is a ‘thread’ which runs through the organisation.

Governing Body Clinical Executive Commissioning teams High level performance report bi-monthly Governing Assurance

Detailed performance report monthly

Annual individual objectives Individual supervision weekly/biweekly

12 IOW Operational Plan – Section 5.4 13 Operational Plan – Section 10

1.2% 2.0%

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Governing Body Clinical Executive Commissioning teams Framework Audit Committee reports bi-monthly

Delivery Plan (including QIPP) Report Quarterly

Team work plans Team performance review meetings monthly

Quality and Patient Safety Committee reports monthly

Clinical Effectiveness Committee reports bi-monthly

Review of detailed performance and contractual reports monthly includes monthly QIPP plans

Clinical Quality Review meetings monthly

Delivery of the system enablers (section 3) will be monitored through the Vanguard governance structure, which will include the system’s Health and Social Care Integration Group (monthly meetings). The vanguard governance structure will build on that already in place for the My Life A Full Life Programme and has yet to be finalised.

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Governing Body

Audit Committee Summary Minutes 21 May 2015 & 27 May 2015

Sponsor: Fredrick Psyk – Lay Advisor, Governance

Summary of issue: Summary of the Audit Committee Minutes 21 May 2015 and 27 May 2015.

Action required/ recommendation: To note the summary of the Audit Committee.

Principle risks: There are no principle risks relating to this paper.

Other committees where this has been considered: This document has not been considered at any other committee.

Financial /resource implications: There are no financial or resource implications relating to this paper.

Legal implications/ impact: There are no legal implications or impact relating to this paper.

Public involvement /action taken: There is no public involvement or action taken to this paper.


The Committee remains cognisant of equality and diversity issues in all matters it considers.

Author of Report: Minutes recorded by: Rebecca Berryman, Governance Support Officer.

Date of Paper: June 2015



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For the attention of the Governing Body – Summary of the Audit Committee 21 May 2015. Apex House, St Cross Business Park, Newport: The committee reviewed the progress with the preparation of the annual report and accounts and reviewed a draft copy of the annual report and accounts. Apart from a small number of actions (all of which have subsequently been closed) the committee were happy to recommend that the governing body approves the annual report and accounts.

For the attention of the Governing Body – Summary of the Audit Committee 27 May 2015. Apex House, St Cross Business Park, Newport: The committee was inquorate at this meeting and as such no decisions were made. The chair however reviewed completion of all actions for the completion of the annual report and accounts following the meeting held on May 21st and received no material concerns from the work of external auditors and the internal auditors and no other concerns were raised. Therefore it was confirmed that the decision made at the May 21st meeting should stand and therefore recommended that the governing body approve the 2014/2015 annual report and accounts.

The meeting subsequently reviewed a number of progress reports and noted suggested actions for the committee to consider at their next meeting.

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Governing Body

Quality and Patient Safety Committee Summary 7 May 2015

Sponsor: Ian Reckless – Secondary Care Doctor

Summary of issue: Summary of the Quality and Patient Safety Committee Minutes 7 May 2015.

Action required/ recommendation: To note the summary of the Quality and Patient Safety Committee.


Other committees where this has been considered: This document has not been considered at any other committee.

Financial /resource implications: There are no financial or resource implications relating to this paper.



A member of Healthwatch is a member of QPSC. These minute form part of the public record of events.


The Committee remains cognisant of equality and diversity issues in all matters it considers.

Author of Report: Minutes recorded by: Rebecca Berryman, Governance Support Officer.

Date of Paper: May 2015



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For the attention of the Governing Body - Summary of the Quality and Patient Safety Committee 7.5.15 Apex House, St Cross Business Park, Newport:

QPSC noted that the role of named GP for children’s safeguarding currently remains vacant.

The number of pressure ulcers across the health economy remains a concern.

QSPC discussed the IOW NHS Trust’s escalation procedure (and red and black alerts in particular). QSPC sought further information as to the frequency with which such status alerts were declared.

The draft Quality Account from IOW NHS Trust was tabled at the meeting and the Chair agreed to review the document on behalf of QPSC.

New Never Event Guidance from NHS England was discussed.

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Clinical Executive

Minutes of the Clinical Executive 2 July 2015


Summary of issue: Minutes of the Clinical Executive.

Action required/ recommendation: To note the minutes of the Clinical Executive.



There are no other committees where this has been considered.


There are no financial or resource implications relating to this paper, other than the matters raised in the meeting.



There has been no public involvement or action taken in relation to this paper.


Author of Paper: Rebecca Berryman, Governance Support Officer




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Clinical Executive 16 April 2015

Minutes of the Clinical Commissioning Group (CCG) Clinical Executive held on 21 May 2015 at 12:30 at Block A, The APEX, St Cross Business Park

PRESENT: Helen Shields (HS) – Chief Officer (Chair) Anitha Ande (AA) – Clinical Executive Gillian Baker (GB) – Deputy Chief Officer Dr Benjamin Browne (BB) – Clinical Executive Dr Peter Coleman (PC) – Clinical Executive

Rida Elkheir (RE) – Associate Director of Public Health Dr Joanna Hesse (JH) – CCG Executive Dr David Isaac (DI) – CCG Executive Loretta Kinsella (LK) – Interim Director of Quality and Clinical Services Dr Michele Legg (ML) – Clinical Executive Loretta Outhwaite (LO) – Chief Finance Officer Dr John Rivers (JR) – CCG Chairman

IN ATTENDANCE: Alison Geddes (AG) – Urgent Care and Community Commissioning Manager (Item 6) Steve Rowe (SR) – Secondary Care Hospital Commissioning Manager (Item 7) Dr Mark Pugh (MP) – Executive Medical Director (IOW NHS Trust) (Item 15)

MINUTED BY: Rebecca Berryman (RB) – Governance Support Officer

15-018 Apologies for Absence No apologies for absence were received. 15-019 Declarations of Interest

The Declaration of Clinical Executive Members was agreed as accurate, with no changes.

15-020

Minutes of the last Clinical Executive meeting The minutes of the last meeting on the 16 April 2015 were agreed as an accurate record.

15-021

Matters Arising i. Schedule of Actions from the CCG Executive 16 April 2015

For the attention of the Governing Body:

• Positive discussions and agreement with mainland private provider to provide effective capacity. They will also fund the transport costs.

• Approved: - Business case to support Hepatitis C pathway - Rehabilitation consultation paper - Delivery plan 2015/2016 - Amendments to the Better Care Fund

• Noted following feedback the CCG’s response to the Quality Account for the Isle of Wight NHS Trust and Earl Mountbatten Hospice.

• GMS IT procurement to progressing well with three provider presentation having taken place.

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The Clinical Executive received the Schedule of Actions from the CCG Clinical Executive meeting on the 16 April 2015, noting the following comments: • 14-106 – Education Health and Care Plans (EHC) – schedule of actions to be updated to clarify

what EHC stands for. • 14-188 – IOW NHS Trust (IOWNHST) Bed Capacity – the bed capacity report has been recently

received. It was highlighted that positive discussions with mainland private providers were taking place, and transport to the mainland would be funded. Communication and engagement with the public and primary care is key, as the back log of elective patients continues to be high.

• 14-211 – Safeguarding Threshold Tool – LK has discussed Primary Care needs in relation to the Safeguarding Threshold Tool with the Local Safeguarding Adults Board (LSAB). It was agreed to close this action.

• 14-234 – 18 Week Referral to Treatment (RTT) Access Policy – JH confirmed that she had reviewed the policy and it is in the final stages of completion. It was agreed to close this action.

• 15-005 – KPMG – left the Island after the 2 day My Life a Full Life powered by Vanguard site visit. It was agreed this action could be closed.

• 15-009 – CQUIN Information – has been circulated, action closed. • 15-012 – Operational Plan approval at Health and Wellbeing Board – GB confirmed Steve

Stubbings, Chair of the Health and Wellbeing Board had taken Chairman’s action and approved the Operational Plan.

The Clinical Executive received the Schedule of Actions. 15-022 Chief Officer and Chair Update

JR and HS gave a verbal update in relation to the two day My Life a Full Life powered by Vanguard Visit. Overall the visit was very successful and a positive response was received from the New Models of Care team. HS commented that a communications message is to go out to staff across all health and social care organisations, and a press release to the public. JH thanked all those involved for all their hard work in the lead up and during the two day site visit.

The Clinical Executive noted the Chief Officer and Chair update. 15-023

Hepatitis C The Clinical Executive received paper CE15-016 Hepatitis C, presented by SR. It was highlighted that it was planned, subject to funding, that the implementation of the local Hepatitis C pathway for the Isle of Wight patients will include the provision of a local nurse specialist clinic based on the Isle of Wight for patients who have a positive diagnosis of Hepatitis C. The Clinical Executive was asked to approve the release of the previously agreed investment funds of £10k to implement a locally developed integrated Hepatitis C pathway from June 2015.

The Clinical Executive approved the release of previously agreed investment funds (£10k) to implement a locally developed integrated Hepatitis C pathway from June 2015.

15-024 Rehabilitation Consultation Paper

The Clinical Executive received paper CE15-017 Rehabilitation Consultation Paper, presented by AG. It was highlighted that rehabilitation had been discussed in detail at the Clinical Executive

3

Seminar and this was the result of those conversations. The Consultation to integrate existing rehabilitation and reablement services would be shared with contractors, the IOWNHST, Local Authority, Autism Diagnostic Centre (ADRC), as well as charities to include Headway, Red Cross and Age UK. It was agreed that it was important for the two teams to interrelate. It was requested that this was made clear on the rehabilitation proposed pathway on page 8. It was also requested that a glossary of terms was included within the consultation. The next steps were for the feedback to be presented to the Clinical Executive in July and a business case to the August Clinical Executive meeting.

The Clinical Executive approved the Rehabilitation Consultation paper, subject to the ammendments discussed.

15-025 Policy Recommendation 003: The Use of Partial Knee Arthroplasty in patients with

Osteoarthritis of Knee The Clinical Executive paper CE15-018 Policy Recommendation 003: The Use of Partial Knee Arthroplasty in patients with Osteoarthritis of Knee, presented by HS. JH queried how the policy related to the Island and how it could be ensured that patients receive the service. HS confirmed that his had been through the SHIP Priorities Committee, however it would be useful for Linda Rann, Head of Secondary Care Hospital Services to review the activity and the impact it has to commissioning. She suggested that this should be the way forward for all policy recommendations to have a Commissioner’s summary to accompany the policy.

The Clinical Executive recommended for approval to the Governing Body Policy Recommendation 003: The Use of Partial Knee Arthroplasty in patients with Osteoarthritis of Knee.

ACTION: GB to request Linda Rann reviews the activity and impact on commissioning for Policy

Recommendation 003: The Use of Partial Knee Arthroplasty in patients with Osteoarthritis of Knee. All policy recommendations to have a Commissioner’s summary to accompany the policy.

GB

GB

15-026 Quality Accounts

Isle of Wight NHS Trust The Clinical Executive received paper CE15-019 Isle of Wight NHS Trust Quality Account presented by LK. LK highlighted that feedback she had received was that the document was not public facing and it was very acute focussed, not mentioning all the services provided by the Trust. GB commented that within the Chairman’s statement Poppy Ward was referred to, it was requested that LK fed back in the CCG’s response that it was made explicit that Poppy Ward was an interim measure to relieve pressure on the health and social care system.

The Clinical Executive noted the Isle of Wight NHS Trust’s Quality Account. ACTION: LK to feed back in the CCG’s response to the IOWNHST Quality Account that Poppy Ward was

an interim measure to relieve pressure on the health and social care system. LK

15-027 Earl Mountbatten Hospice

The Clinical Executive received paper CE15-020 Earl Mountbatten Hospice (EMH) Quality

4

Account, presented by LK. It was felt that the account was public facing, with good presentation. It was agreed that the CCG’s final response for both the IOWNHST and EMH Quality Accounts were shared with the Clinical Executive.

The Clinical Executive noted the Earl Mountbatten Hospice Quality Account. ACTION: LK to share the CCG’s final response for both the IOWNHST and EMH Quality Accounts with

the Clinical Executive. LK

15-028 Performance Report

The Clinical Executive received paper CE15-021 Performance Report, presented by LO. The report highlighted the following: • Pressure Ulcers – for both the hospital and community still continue to be high. Discussion

took place regarding the Locality teams requiring some strategic direction in relation to Pressure Ulcers.

• C Difficile – a further 6 cases were reported for March, two of these cases have been reported at the IOWNHST. Discussion took place regarding C.Difficile education, particularly in Primary Care and Residential/Nursing Homes.

• Accident and Emergency (A&E) Performance – the target for A&E breaches of 4 hour waits was missed in March.

• 18 Week RTT – the target for admitted continued to be missed in March. The Island is a significant outlier.

• Slips Trips and Falls – figures for March demonstrated an increase. It was queried if the CCG had figures for falls in Nursing/Residential homes. It was confirmed they did not.

LK highlighted that after a recent audit looking at root cause analysis (RCA) (excluding pressure ulcers) that out of 20 Serious Incidents Requiring Investigation (SIRIs) only two had a doctor’s involvement in the completion of the RCA. HS requested that in future, section 2 of the Performance Report was not printed, but circulated to the Clinical Executive for information.

The Clinical Executive noted the Performance Report 15-029 Contracts Report

The Clinical Executive received paper CE15-022 Contracts Report, presented by LO. It was reported that a quarterly review takes place to look at contracts that are expiring. The CCG currently has 120 providers and 219 contracts.

The Clinical Executive noted the Contracts Report. 15-030 Delivery Plan 15/16

The Clinical Executive received paper CE15-023, Delivery Plan 15/16 presented by GB. The Delivery Plan sets out how the CCG strategy will be delivered over the next 2 years. The document includes the key performance metrics, the QIPP plans for savings and investments and the milestone to deliver the strategy. It was noted that the Delivery Plan was ambitious and in light of My Life a Full Life powered by Vanguard priorities were likely to change. It was confirmed that the Delivery Plan is an internal CCG document.

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GB confirmed that there would be quarterly update reports. These reports would also reflect other work that has been undertaken.

The Clinical Executive approved the Delivery Plan. 15-031 Operational Plan

The Clinical Executive received paper CE15-024, Operational Plan presented by GB. The Operational Plan was formally approved in April 2015 however due to national directives to increase non-elective admission by 2% within plans; sections of the Operational Plan were required to be updated to reflect the directive. It was discussed that clarity was required in relation to the Chair of the Health and Wellbeing Board, as there had been some recent changes.

The Clinical Executive recommended for approval to the Governing Body the final Operational Plan.

ACTION: Clarity to be sought regarding the Chair of the Health and Wellbeing Board. HS/

GB 15-032 Better Care Fund Update

The Clinical Executive received paper CE15-025 Better Care Fund Update, presented by GB. As a result of the national directive to increase non-elective admissions within plans, the BCF non elective admissions target needed to be revised to reflect this.

The Clinical Executive approved the ammendments to the Better Care Fund. 15-033 NHS Support for Social Care Quarter 4 Report

The Clinical Executive received paper CE15-026 NHS Support for Social Care Q4, presented by GB. There was £428k of slippage within the NHS Support for Social Care funding. It was agreed that £359k of this would be used to support the Care Act. As agreed with the Local Authority £69k was carried forward to 2015/16.

The Clinical Executive noted the NHS Support for Social Care Q4 Report. 15-034 Budget Update

LO confirmed that the budget update would come to the June 2015 meeting.

ACTION: Budget Update to come to the June 2015 Clinical Executive. LO 15-035 Information Management and Technology

The Clinical Executive received a verbal Information Management and Technology update from LO. CCG IT – the IT Strategy across the whole health system is going to go ahead. A working group will take this forward. The CCG HQ’s IT is going to be reviewed as there are still concerns with the current service provider. Information Governance – LO will circulate the year end IG report to the Clinical Executive. It was confirmed that LK is the Caldicott Guardian. JR will act as Deputy Caldicott Guardian.

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GMS IT – 3 provider presentations for the GP Clinical System has now taken place. This is progressing well. It was requested that an email was circulated to GPs to give them an update on the progress and next steps regarding the procurement. The Windows 7 and Office 10 upgrade is progressing.

The Clinical Executive noted the Information Management and Technology update. ACTION: LO to circulate the year end IG Report to the Clinical Executive.

Email to be circulated to GP’s to update them on the next steps regarding the procurement of the new GP Clinical System.

LO LO/CM

15-036 Procurement Decisions

There were no new procurement decisions. However GB highlighted that in light of My Life a Full Life powered by Vanguard a decision needed to be made with regard to procurement decisions in the future, it was agreed for a paper to go to the Clinical Executive in June.

ACTION: A paper regarding the future of procurement decisions to go to the Clinical Executive in June. LO 15-037 Risk Register

The Clinical Executive received paper CE15-027 Risk Register. A summary will be presented to the Governing Body. It was agreed that a detailed discussion would take place at the next meeting.

The Clinical Executive noted the Risk Register. 15-038 Beyond Boundaries Update

MP attended to give an update on the IOWNHST’s Beyond Boundaries strategy. Discussion took place regarding the clinical sustainability of medical specialities on the Island.

The Clinical Executive noted the Beyond Boundaries Update. 15-039 Notes of Sub-Committees

The Clinical Executive received the following minutes: • Contract Monitoring and Service Review Meeting 21.4.15 • CQRM Minutes 20.3.15 • April and May 2015 Locality Minutes • Joint Adult Commissioning Board Minutes 1.4.15 & 6.5.15 • SHIP 8 Priorities Committee Minutes 22.1.15 • Clinical Effectiveness Minutes 23.4.15

The Clinical Executive noted the Sub-Committee minutes. 15-040 Any Other Business

RE queried where SIRIs relating to suicides should be reported within the CCG. LK confirmed that they should be directed to the Quality Team at the CCG, where all unexpected deaths are reviewed.

15-041 Date of Next Meeting: Thursday 18 June 2015 12:30–15:30 Block A, The Apex – Carisbrooke

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Room.

Circulation: Members In attendance: For Information (Agenda): Benjamin Browne – CCG Executive Peter Coleman – CCG Executive Rida Elkheir – Associate Director of Public Health Joanna Hesse – CCG Executive David Isaac – CCG Executive Loretta Kinsella – Interim Director of Quality and Clinical Services Michele Legg – CCG Executive Loretta Outhwaite – Chief Finance Officer John Rivers – CCG Executive Helen Shields – Chief Officer (Chair)

Gillian Baker Rebecca Berryman (notes)

Rebecca Wastall For Information (Minutes): Matthew Leek, CCG Commissioning Finance Mgr Shaun Sweatman, CCG Commissioning Finance Mgr Linda Rann, Eleanor Roddick, Sue Lightfoot, Rachael Hayes, Dawn Berryman - Heads of Commissioning, Andy Brandham, Deputy Head of Medicine’s Management, Caroline Morris – Head of Corporate Business, Rebecca Wastall – Deputy Chief Finance Officer

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governing body agenda thursday, 2 july 2015, …...5.1 governing body assurance framework hs gb1 5...

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