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SUTTON CLINICAL COMMISSIONING GROUP

GOVERNING BODY

Wednesday 6th September 2017

PART I: 2:00pm–4:00pm

Meeting Room 1,

Priory Crescent,

Sutton, SM3 8LR

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SUTTON CLINICAL COMMISSIONING GROUP

GOVERNING BODY

Wednesday 6 September 2017

(Part 1, 2:00pm-4.00pm, Part 2, 4.15pm-5.00pm)

Meeting Room 1, Priory Crescent, Cheam, Sutton SM3 8LR

AGENDA - PART I

Chair: Dr Jeffrey Croucher

Report Author Presented by ENC

WELCOME AND INTRODUCTIONS

1. Welcome and Apologies for Absence

Dr Jeffrey

Croucher

2. Venue Safety Announcement

Dr Jeffrey

Croucher 01

3. Register of Declared Interests

Governance Body members are asked to declare if

their entry upon the Register of Declared Interests

(attached) is not a full, accurate and current

statement of any interests held.

Jane

Walker

Dr Jeffrey

Croucher 02

4. Minutes of previous meeting

To approve the minutes of the Sutton Clinical

Commissioning Group Governing Body meeting held

on 5 July 2017.

Jane

Walker

Dr Jeffrey

Croucher 03

5. Matters Arising

To review any matters arising and the action log

following the meeting held on 5 July 2017.

Jane

Walker

Dr Jeffrey Croucher

04

FOR PRESENTATION

6. Vanguard – external evaluation

Mary Hopper /

Viccie Nelson /

Dr Clare O’Sullivan

05

FOR APPROVAL

7. End of Life Care Strategy

Mary Hopper / Jane Pettifer

/ Dr Clare O’Sullivan 06

FOR DISCUSSION

8. Sutton CCG 2016/17 Improvement & Assessment

Framework Rating

Sean Morgan 07

9. Performance and Quality Report

Sean Morgan /

Mary Hopper 08

10. Finance Report 17/18 - Month 4

Geoff Price 09

11. QIPP Report

Sean Morgan 10

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Report Author Presented by ENC

12. Board Assurance Framework

Geoff Price

11

13. Chief Clinical Officer’s update

Dr Chris Elliott Verbal

14. STP Update

Sarah Blow 12

FOR INFORMATION

15. Approved Minutes of the Executive Committee of

the Sutton CCG Governing Body

• Executive Committee: 28.6.17, 12.7.17, 26.7.17,

9.8.17

Dr Jeffrey

Croucher 13 a-d

16. Questions from the Public

Members of the public can submit questions relating to the

agenda if raised with the Chair 48 hours prior to the

meeting. The Chair will make every effort to ensure

questions are responded to at the meeting however there

may be occasions where time constraints preclude this. If

a question cannot be answered at the meeting, or a fuller

response is required, a written reply will be sent as soon

as possible.

Dr Jeffrey

Croucher

ANY OTHER BUSINESS AND CLOSE

17. Any Other Business

18. Meeting Close

19. Date of Next Meeting

The Sutton Clinical Commissioning Group Governing

Body meets bi-monthly on Wednesday afternoons.

The usual start time will be 2.00pm, with occasional

need to extend the meeting time.

The next meeting will take place on Wednesday 1

November 2017, 2.00pm, at Priory Crescent, Cheam,

Sutton SM3 8LR.

Closure of Part I To resolve that the public now be excluded from the meeting, on the basis that publicity would be prejudicial to the

public interest by reason of the confidential nature of the business to be conducted in the second part of the agenda. A

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MEETING ROOM 1 SAFETY NOTICE

PRIORY CRESCENT

For the purpose of this safety notice the wall on which the screen is situated is

deemed to be the front

The emergency exit is marked and is to the left of the room

The toilets are in the front of the room to the left of the screen

A Fire alarm is not scheduled during this meeting

The fire alarm is a continuous single tone and if it does sound we should all leave the building

by the emergency exit

The emergency assembly point is on the footpaths out on Priory Crescent

Please do not block the access for emergency vehicles

If you are aware of anyone with a sight or physical impairment please offer them assistance

No one should re-enter the building unless the Fire Marshall (IN HIGH VISBILITY JACKET)

declares it safe to do so

Screen

Entrance /

Alternative exit

Toilets

Entrance /

Emergency Exit

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Register of Interests

NHS Sutton CCG’s Register of Interests are made publicly available at the Governing Body meetings of the CCG and can be found at

http://www.suttonccg.nhs.uk/News-Publications/publications/Key%20publications/DECLARATIONS%20OF%20INTEREST%20-%20January%202016.pdf

The Register is maintained by the Head of Corporate Governance. The Register is constructed in line with the CCG’s Constitution and Conflicts of Interest

Policy which can be found at

http://www.suttonccg.nhs.uk/News-Publications/publications/Key%20publications/GB%20Approved%20SCCG%20Conflicts%20Of%20Interest%20Policy.pdf

The Register contains details of all members of the CCG’s formal committees and the Governing Body itself. The interests of those individuals that are in

attendance only will be captured in the minutes of the meeting concerned.

Name Position Held Declaration of Interest Membership Date

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Pippa Barber Governing Body – Independent Nurse

Director THF Health Limited

Non-Executive Director at Kent Community NHS Foundation Trust (as from 01/12/16).

✓ ✓ ✓ ✓ (23.11.16)

Gillian Bennett Patient Reference Group (Participating Observer)

Representative for the Grove Road GP Surgery on the Patients’ Representative Group

Shareholdings in AstraZeneca.

✓ Membership to be confirmed - Non-Voting Member

Sally Brearley Lay Member – Patient & Public Engagement and Chair of the Quality Committee

National Nursing Research Unit, Kings College. London - Visiting fellow

Member, NHS England Clinical Priorities Advisory Group

Chair, NHS England London Region Health in the Justice System Patient and Public Voice

✓ ✓ ✓ ✓ (07.12.16)

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Reviewed: 31 August 2017 Jane Walker, Head of Corporate Governance


Reviewed

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Fellow in Patient and Public Involvement, Faculty of Health, Education and Social Care, Kingston University and St George's University of London.

Member of the South London Health Innovation Network Musculoskeletal Advisory Board

Patient representative, NHS 11 Futures/Digital Urgent Care Board.

Annette Brown Healthwatch representative

No interests to declare. ✓

Dr Robert Calverley

Wallington Locality Lead

GP partner at Manor Practice (1.11.16)

Member of Sutton GP Services Ltd

GP Trainer.

✓ Commenced 01.09.16 (26.04.17)

Dr Jonathan Cockbain

GP Board Member Carshalton Locality Lead

GP Partner – Chesser GP Practice


Wife employed by Sutton College working as ESOL tutor.

✓ ✓ ✓ Updated 12.01.17 (Commenced on Exec 01.11.16)

Dr Jeffrey Croucher

Clinical Chair GP Partner at Benhill and Belmont GP Centre

Member of the Remuneration Committee of Sutton GP Federation

Benhill and Belmont GP Centre is a Member of the Sutton GP Federation

Wife is a Consultant Gynaecologist/Infertility services at Epsom and St Helier’s NHS Trust and is Clinical Director for Women’s Health

✓ ✓ ✓ Commenced Role as Chair 10.7.17

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Reviewed

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Received a research grant from the Health Innovation Network in 2015/2016 for Musculoskeletal clinical services in Sutton

LMC representative for Sutton LMC

Project Lead for the Belmont surgery, in developing the new Benhill and Belmont GP Centre

GP Trainer and occasionally supervise OOH shifts in SELDOC for GP Trainees.

Dr Chris Elliott Chief Clinical Officer

Sutton Healthcare Services - Director

Member of SWL STP Executive Committee

Locum GP.

✓ ✓ ✓ ✓ (21.09.16) Updated 12.04.17

Dr Simon Elliott Independent GP Advisor

No interests to declare. ✓

Susan Gibbin Lay Member - Performance

Director – Susan Gibbin Consultancy Ltd

Corporate consultancy support to Carnall Farrar, Strategic Health and Care Consultancy

Trustee and Board member of the Bourne Education Trust

Chair of Governors – Downs Way School, Oxted.

✓ ✓ Commenced 01.05.17

Mary Hopper Director of Quality No interests to declare. ✓ ✓ (21.09.16)

Dr Senthooran Kathirgama Kanthan

Sutton and Cheam Locality Lead

GP Partner Well Court Surgery


GP Tutor St George's University of London.

✓ (26.09.16)

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Sean Morgan Director of Performance & Delivery

No interests to declare. ✓ Commenced 03.07.17

Dr Dino Pardhanani

GP Board Member GP Partner - Mulgrave Road. ✓ ✓ ✓

Geoff Price Chief Finance Officer

Daughter working in a nursing post with Epsom and St Helier NHS Trust at Epsom hospital.

✓ ✓ ✓ ✓ ✓ (17.03.17)

Dr Les Ross Lay Member – Secondary Care Consultant

No interests to declare. ✓ ✓ ✓ ✓ ✓ ✓ (21.09.16)

Paul Sarfaty Lay Member – Governance and Audit, Vice Chair and Chair of the Audit Committee

Feughside Limited – Director and Shareholder

Consultancy through Feughside Limited. ✓ ✓ ✓ ✓ ✓ ✓ ✓

(05.10.16)

Dr Roshni Scott GP Executive Member


GP Partner - Dr Scott & Partners

Husband- clinical director planned care Merton CCG (includes MOT).

Husband to join partnership - Dr Scott & Partners (01.04.17)

✓ ✓ (20.07.17)

Karol Selvey Primary Care Nurse Board Member

Partner at The Old Court House - Dr Grice & Partners

Member of Sutton GP Services Ltd.

✓ ✓ ✓ (01.10.16)

Lucie Waters Managing Director No interests to declare. ✓ ✓ ✓ ✓ ✓ Commenced 01.04.17

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David Williams Chair - Healthwatch (Participating Observer)

Member of Old Court House Surgery Patient Participation Group

Chair, Patient Reference Group

Healthwatch Sutton Chair

Appearances on Radio St Helier on behalf of Healthwatch Sutton

Son is a Planning Officer with the London Borough of Sutton.

✓ Non-Voting Member

Clare Wilson Deputy Chief Operating Officer (Interim)

Director/Owner Chamberlain Partners Ltd. ✓ Commenced 03.10.16 (10.01.17)

No longer a member of a formal committee and/or the Governing Body and removed from the Register:


Reviewed

Dr Brendan Hudson

Clinical Chair Principal of The Grove Practice, 83 Grove Road, Sutton, SM1 2DB

Practice is a member of Sutton GP Services Limited (GP Federation)

From time to time raised money for Royal Marsden Hospital Cancer Charity and St Raphael’s Hospice

Past Councillor and Mayor (2008/9) of London Borough of Sutton

✓ ✓ ✓ Updated 26.09.16 (new DoI form completed) Stepped down 10.7.17

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Reviewed

SWL Commissioning Collaborative - As Chair of the CCG member of the clinical board and governance committee. Joint clinical lead for the children and young person workstream.

Helen Bailey Director of Delivery (interim)

Director/Owner Wayside Health & Care Ltd. ✓ Commenced 03.10.16 (09.01.17) No longer Director 3.7.17

Dr Nicola Lang Board Member - Director of Public Health

Director of Public Health – London Borough of Sutton

Offender health work with NHS England on offender-related issues

Director of Public Health Lead for Offender Health, London ADPH

Director of Public Health Lead for Drugs and Alcohol.

✓ ✓ Left Sutton CCG 1 July 2017

Sian Hopkinson Director of Performance & Primary Care

No interests to declare. ✓ No longer a member of the Exec

Jonathan Bates Chief Operating Officer

No interests to declare. ✓ ✓ ✓ ✓ ✓ Left Sutton CCG 31.03.17

Dr Chris Keers GP Executive Member

GP - Wrythe Green Surgery

Member - SELDOC

Practice is a Member of SW London Primary Care Research Network


GP Trainer.

✓ Resigned as an Exec member - last meeting 28.09.16

Dr Ashraful Mirza

Carshalton Locality Lead

GP Partner Faccini House Surgery

Sutton GP Services Ltd

Member of Sutton GP Services Ltd.

✓ Resigned as an Exec member 01.11.16

Dr Farhan Rabbani

Wallington Locality Lead

GP Partner Wallington Medical Centre

Board Director of SELDOC ✓ No longer a

member of the Exec

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Reviewed


Director of Sutton GP Services Ltd.

01.09.16

Dr Lindsey Roberts

Local Medical Committee (Participating Observer)

Salaried GP Wallington Family Practice

Lead with in practice for anticoagulation service and IUCD/implant service.

My husband is a consultant cardiac surgeon working for UCLH

Director of Roberts Medical Limited.

✓ No longer a member of GB (confirmed 01.02.17)

Sue Roostan Director of Commissioning

No interests to declare. ✓ Left Sutton CCG 30.09.16

Hilary Smith Patient Reference Group Rep

No interests to declare. ✓ No longer a member of the QC

Dr Mark Wells GP Executive Member

Practice is a Member of SW London Primary Care Research Network

GP - Wrythe Green Surgery

Member of Sutton GP Services.

✓ On sabbatical for 3 months from 01.01.17

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MINUTES OF THE SUTTON CLINICAL COMMISSIONING GROUP

GOVERNING BODY

Wednesday 5 July 2017, 2:00 – 4:00pm Meeting Room 1, Priory Crescent

Present:

Pippa Barber PB Governing Body Member - Independent Nurse

Dr Chris Elliott CE Chief Clinical Officer

Susan Gibbin SG Lay Member – Performance

Dr Dino Pardhanani DP Clinician/GP Board Member

Geoffrey Price GP Chief Finance Officer

Dr Les Ross LR Governing Body Member - Secondary Care Consultant

Paul Sarfaty PS Vice Chair, Lay Member - Governance & Audit

Karol Selvey KS Nurse Practitioner

Lucie Waters LW Managing Director

Participating Observers:

David Williams DW Healthwatch Sutton Director

In Attendance:

Helen Bailey HB Director of Delivery (Interim)

Mary Hopper MH Director of Quality

Sean Morgan SM Director of Performance & Delivery

Clare Wilson CW Deputy Chief Operating Officer (Interim)

Jane Walker JW Head of Corporate Governance

Member of the Public:

Kim Tolley KM General Medical Council

Apologies:

Gillian Bennett GB Patient Reference Group

Sally Brearley SB Lay Member - Patient & Public Involvement

Dr Jonathan Cockbain JC Clinician/GP Board Member

Dr Brendan Hudson BH Clinical Chair

Welcome & Introduction

1. Welcome and Apologies In the absence of BH, PS informed members that he would be chairing the meeting and welcomed all present to the Sutton Clinical Commissioning Group (CCG) Governing Body meeting. It was also noted in his absence that this would have been Dr Hudson’s last meeting as Clinical Chair following his resignation. PS thanked BH on behalf of the Governing Body for all his hard work and commitment at Sutton CCG and wished him all the very best for the future.

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LW also thanked HB for all her hard work in the role of Interim Director of Delivery and welcomed her successor, Sean Morgan into the substantive role of Director of Performance and Delivery. Apologies were noted as detailed above.

2. Venue Safety Announcement PS informed the meeting of all necessary procedures and facilities.

3. Register of Declared Interests PS requested that the Governing Body members to declare if their entry upon the Register of Declared Interests, attached to the agenda, was not a full, accurate and current statement of any interests held. It was noted that a completed declarations form had now been received from SG and would be included on the Register of Declared Interests prior to the next meeting. There were no further declarations made by members of the Governing Body.

JW

4. Minutes of previous meeting The minutes of the Sutton CCG Governing Body meeting held on 3 May 2017, were agreed as an accurate record.

5. Matters Arising & Action Log Action Log The Governing Body received verbal updates on a number of actions. It was agreed to revise the action log and submitted to the next meeting of the Governing Body.

JW

For Presentation

6. Local Transformation Board

LW gave a presentation to the Governing Body on the

development of Local Transformation Boards.

The SW London Sustainability and Transformation Plan (STP)

footprint contains four local geographies, of which Sutton

(including Epsom and St Helier Universities NHS Trust) is one.

The STP has asked for the development of Local Transformation

Boards across local stakeholders to deliver key priorities for the

local and wider STP system:

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Focus on the local ‘bottom up’ initiatives that will deliver

real transformational change across partners in a local

health and care economy;

Progress the development and delivery of key STP

initiatives

Track progress against STP trajectories

Consider how best to develop an ‘accountable care’ model

for the people of Sutton

LW stated that the development of the Sutton Local

Transformation Board (LTB) was being undertaken with partners

to establish the right governance, work streams and capacity to

take forward our shared priorities at pace. The final shape of the

LTB will be subject to finalisation of those discussions.

Governing Body members noted the following key points:

The need to ensure a high level of engagement

Recruitment and retention of staff by working in a more

holistic way

The need to work differently as the system was not

currently financially sustainable

Epsom and St Helier Universities NHS Trust were

committed to this work

LW agreed to keep the Governing Body updated with the

development of a LTB.

Items for Approval

7. Effective Commissioning Initiative (ECI) re-alignment

process across South West London

HB presented a report which described the proposed process to

align clinical thresholds listed in the Effective Commissioning

Initiative policy and the revision of the compliance monitoring

mechanisms to underpin this.

HB explained that some procedures had different clinical

thresholds in South West London and some required clarification

to ensure effective implementation and consistent access to

services. It was also noted that some challenging clinical

thresholds would remain outside of the scope of this work.

The process described within the report was supported by the

South West London Committees in Common and the South West

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London Clinical Board.

On 6 April 2017 the SWL Committees in Common (CiC) agreed

that SWL CCGs would work in collaboration to deliver version 2.0

of the SWL ECI policy, ensuring alignment of existing clinical

thresholds and common processes to monitor compliance.

The SWL Clinical Board held a workshop on the 20 April 2017 to

define the processes surrounding the alignment of the clinical

thresholds for CiC ratification. The workshop generated

considerable appetite for refinement and alignment of clinical

thresholds as well as streamlining compliance monitoring

processes.

The scope of the realignment process includes the 59 clinical

thresholds currently listed in the SWL ECI policy and considers a

limited number of new thresholds that are deemed high priority

and can be fast tracked, such as those being novated from NHS

England specialist commissioning to CCGs like bariatric surgery

in 2017/18.

It will also examine and refine the compliance processes

supporting the effective implementation of the ECI policy.

HB confirmed that SWL Clinical Chairs will send the final version

of 2.0 to the CiC in October 2017 for final ratification for all six

CCGs with a proposed ‘go-live’ date of 1 December 2017

Recommendation(s):

The Governing Body approved the Effective Commissioning

Initiative Re-alignment process across South West London.

8. Appointment of Sutton CCG Clinical Chair

CE presented a paper which informed the Governing Body on the

selection process and appointment of a new Sutton CCG Clinical

Chair following notification from Dr Brendan Hudson of his wish

to step down as from July 2017.

CE confirmed that only one application was received from Dr

Jeffrey Croucher, Benhill & Belmont GP Centre Sutton.

Unfortunately due to annual leave Dr Croucher was unable to

attend the Governing Body meeting.

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Following support by practices at the Plenary and

recommendation by the Board selection panel, both held on 22

June 2017, the Governing Body were asked to approve the

appointment of Dr Jeffrey Croucher to the role of Sutton CCG

Clinical Chair.

Recommendation(s):

The Governing Body approved the appointment of Dr Jeffrey

Croucher to the role of Sutton CCG Clinical Chair.

Items for Discussion

9. Improving Access to Psychological Therapies (IAPT)

Recovery Plan

CW presented a paper which explained that as part of the CCGs

contractual management of the UPLIFT service of which IAPT

was a part, a performance notice had been issued to SWL St

Georges University NHS Foundation Trust (StG).

This was to ensure an action plan, included within the papers,

was put in place to bring Sutton CCG recovery and access rates

up to the national standard.

CW confirmed that since the action plan had been put into place

the CCG had now achieved the rates for April and May.

CW also stated that there was a need to look at the case for

additional funding to meet the new targets for 17/18 and 18/19.

This would be discussed at the July Executive Committee

meeting.

CW agreed to look into the issues raised by members of the

Governing Body around the number of patient calls not being

answered and patients preferring one-to-one sessions rather than

group sessions.

Recommendation(s):

The Governing Body noted the action plan.

CW

10. Performance & Quality Report

HB presented the performance and quality report which provided

the Governing Body with feedback on the performance of the

CCG and the providers from whom it commissions services.

HB stated that the structure and content of the report had been

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subject to discussion and review by members of the Executive

Committee and Quality Committee over the last couple of months

and feedback from each of these has been integrated into this

month’s report. Work would continue to improve the presentation

now performance posts have been recruited to.

Recommendation(s):

The Governing Body noted the report.

11. Finance Report 17/18 – Month 2 GP presented the finance report. The CCG submitted its month 02 position to NHS England on 09 and 12 June 2017. The CCG was reporting on plan at month 02 year to date and full year

forecast. It was noted that the year to date plan was for a deficit

given QIPP savings profiling. The full year forecast assumes full

QIPP delivery.

Acute spend was reported on plan in the absence of complete

and accurate information from acute providers at this time and in

the absence of any information to the contrary. CHC is reported

on plan (a high risk area) in the absence of any information to the

contrary. Primary care is also reported on plan in the absence of

any information to the contrary. Appendix 1 shows the summary

overall position; note that as this time the only significant contract

not agreed for 2017/18 is the Royal Marsden Hospital where

there is disagreement over critical care costs.

Recommendation(s):


12. QIPP Report

HB presented the QIPP report at month 12. Key points noted included:

QIPP schemes were identified at the beginning of the financial year to the value of £6.5m

The CCG was currently reporting an outturn for 2016-17 of £6.338m savings against that target

This equates to 98.1% of the total

This means that we currently have a QIPP gap of £162k HB highlighted successes which included:

Prescribing

Medicines optimisation

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Kinesis

MSK direction to service Those areas which failed to hit target included respiratory & diabetes and ECI implementation. Work was currently being undertaken to look at the lessons learnt. Recommendation(s):


13. Board Assurance Framework

GP introduced the Governing Body Assurance Framework (GBAF) stating that one additional risk had been added to the GBAF since the last meeting. Whilst risk 1024, relating to gaps in primary care workforce, was

not strictly speaking a CCG risk (in the same way the workforce

issues in the acute and community sectors is not), it is highlighted

as it has implications for the quality of primary care and therefore

is an area of concern for the CCG.

Recommendation(s):


Items for Information

14. Improving Access to Psychological Therapies (IAPT) Annual Report The Governing Body noted the report which provided information of the Primary Care Mental Health Services within Sutton and the work undertaken to provide a broad range of support to the people of Sutton.

15. Final Annual Accounts & Annual Report 2016/17 The Governing Boy noted that these had now been uploaded and were accessible via the Sutton CCG website.

16. Approved Minutes of Committees of the Executive Committee of Sutton CCG Governing Body The Governing Body received and noted the approved minutes of the Executive Committee meetings dated 26.4.17, 10.5.17, 24.5.17 and 14.6.17.

Recommendation(s):

The Governing Body noted the minutes.

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17. Questions from the public The attached Appendix 1 provides answers to the questions

raised prior to the Governing Body meeting.

Any Other Business and Close

18. Any other business There was no further business to discuss.

19. Meeting close PS closed the meeting at 4:00pm.

20. Date of next meeting The next meeting of the Sutton CCG Governing Body, held in public, would take place on Wednesday 6 September 2017, 2:00pm at Sutton CCG, Priory Crescent, Sutton SM3 8LR.

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Appendix 1

Responses to questions received from members of the public at the Governing

Body meeting held on 5 July 2017

Question 1

It’s often been suggested that Right Care Commissioning for Value packs which

identifies outliers in spend and outcomes should be used as a first point of reference

when considering local transformation plans. Given that nearly £2m savings in

gastroenterology admissions has been identified as a potential saving, would Sutton

CCG board agree that this should be a priority? I’m in contact with the clinical teams

at St Helier, Kingston and St George’s and they are open to talks about how to make

this happen.

Answer

The CCG has utilised the Right Care Commissioning for Value packs as a principal

source of information for the development of our local transformation and Quality,

Innovation, Prevention and Productivity (QIPP) plans. The potential opportunity for

Sutton relating to gastrointestinal admissions is over £1m and this area is being

actively explored, including with Epsom and St Helier University Hospitals NHS

Trust. The underlying reasons for any variance from the peer group of similar CCGs

can be complex and multifactorial. The work is reviewing a number of aspects of the

pathways resulting in gastrointestinal admissions, both for diagnosis and elective

and emergency admission. This work is still at quite an early stage.

Question 2

If a local transformation in gastro planned care was agreed, would it be a good idea

to consider linking in to the experiences of other local health economies going

through the same process. For example, I’m taking part in Croydon CCG’s

Transforming Planned Care work stream in digestive diseases and the initial meeting

took place a couple of weeks ago. Similarly I have been making contact with other

CCGs around the country to learn from their experiences. Would this be of any

interest?

Answer

The CCG is liaising with the other CCGs in South West London to share good

practice and to align our transformation plans where we can, as the work is part of

the overall South West London Sustainability and Transformation Plan (STP). In

developing our plans in depth we are drawing on experience from across the NHS

and we are always pleased to draw on any experience of how transformation and

service redesign has been implemented elsewhere.

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Question 3

At the Sutton Health and Wellbeing Board Meeting on Monday 19th June, following Lucie Water's presentation about the Local Transformation Board, a recurring theme in the ensuing discussion was the importance of engaging with the public, ensuring that local residents' views are heard and represented regarding the 'transformational change' described. The Sutton Local Transformation Board had a Workshop planned for the following day, and I would like to ask if any progress was made then, or in any other meetings, on exactly what form this important consultation of the public will take?

Answer

The Sutton LTB has met once and at that meeting it was agreed that a

communications and engagement plan should be developed with local health watch

and Sutton CVS, who were at the meeting, and also local authority and NHS

communications and engagement professionals. This plan will ensure that

engagement happens with local stakeholders and patient representatives and if

significant changes were to be proposed then public consultation would of course

take place with advice from the Overview and Scrutiny committee. This plan will also

set out systems and processes to communicate the vision and work for this new

health and care partnership.

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Sutton CCG Governing Body - Matters Arising /Action Points from previous meetings.

Date Item Title and Action Required Lead Comments Status

1 March 2017 8 Governance arrangement for SWL

Lucie Waters

To produce a summary version of the governance arrangements for wider circulation.

Once work to confirm

arrangements is complete,

SWL Programme Office

have confirmed a summary

version will be produced.

Updated: 30 August 17

Summary version still being

worked through

1 March 2017 11 Performance and Quality Report Helen Bailey/ Mary Hopper

Quality Committee to discuss and shape the information that would wish to see within the report going forward. To incorporate patient feedback and complaints within the community section of the report.

This will be a priority for the

Director of Delivery once in

post (3 July 2017).

Updated: 30 August 17

Ongoing

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Report to the Sutton Clinical Commissioning Group

Governing Body

Date of Meeting: 6th September 2017

Agenda No: 6 ATTACHMENTS: 5 a&b

Title of Document: Evaluation of Sutton Homes of Care Vanguard End

of Year report, 20 July 2017

Purpose of Report:

To provide an independent

evaluation of the impact of the

Vanguard

Report Authors:

SQW and SCIE

Lead Director:

Mary Hopper

Executive Summary: Please see the report for the executive summary

Key sections for particular note (paragraph/page), areas of concern etc: Please see the overview slides prepared by the Vanguard Team

Recommendation(s):

The Quality Committee is asked to note the findings.

Committees which have previously discussed/agreed the report:

Vanguard Steering Group

Financial Implications:

None

Other Implications:

None

Equality Impact Assessment:

Not applicable

Information Privacy Issues:

Not applicable

Communication Plan:

The report and infographic will be uploaded onto the Vanguard publications web

page; a short piece will be put in the news section and it will be put on Twitter.

Additionally, the New Care Model team is circulating via its communication

department.

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Overview of the External Evaluation Report

Sutton CCG Quality Committee

17 August 2017

Sutton Homes of Care Vanguard Programme

1

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Background to the evaluation

• NHS England’s New Care Models Team includes an evaluation team which is

responsible for comprehensively evaluating the vanguards

• NHS England has required all vanguards to commission external evaluations of

their programmes. These are called the local evaluations.

• NHS England has also commissioned an independent evaluation of the NCM

programme, and is carrying out its own national evaluation

• It gave all Enhanced Health in Care Home Vanguards £70,000 for local

evaluations for 2016/17 and has given Sutton Vanguard the same amount for

2017/18

• In August 2016, the Sutton Vanguard commissioned SQW and SCIE through a

competitive procurement exercise to carry out its evaluation

• SQW and SCIE have been reporting each month to the Vanguard’s Steering

Group on evaluation design and progress of work

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Overall impact of the Programme

• This slide deck focuses on the outcomes of the external evaluation, however ongoing

internal and national (New Care Model) evaluation has taken place throughout the

programme; all confirming positive impact of the programme.

• Overall the impact from 2013/14 to 2017/18 to date, taking account of bed changes has

been:

- a 20% reduction in Non-Elective admissions for CCG homes

- 6% reduction across all Sutton homes in LAS incidents

- £205,928 less cost of medications in total (Sept 15 to May 17)

- Reduction in hospital Length Of Stay of up to 4.8 days

- 33% reduction in pressure ulcer rates

- 4% reduction in falls rates

- 49% reduction in medication error rates

- 82% nursing home and 91% of residential home residents with an EoLC

plan have achieved their preferred place of death

• Additionally, resident, family and care staff feedback has been positive; there has been an

improvement in genuine partnership and collaborative working (across sector) enabling

more joined-up services; enhanced communication across health and social care.

• The success of the programme has led to article publications, presentations at national

conferences, VIP visits, TV publicity and contribution to national toolkits.

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The independent evaluation: points to note

• SQW and SCIE have produced a comprehensive and detailed report of their

work and the Vanguard’s position

• A key point is that they have measured net change for the economic analysis

and outcome metrics from when Vanguard status was awarded in March 2015

up until December 2016 as this was when data was available for the end of year

report

• The report does make clear that activities to support care homes were being

carried out before Vanguard status was awarded and it presents year on year

changes in key metrics since 2013/14

• The report has a conclusion and lessons section which finishes with: “sufficient

attention needs to be devoted to accurately monitoring activity as it happens

such that subsequent evaluation can be as meaningful and helpful as possible.”

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5

Quotes from the independent evaluation report

• There is evidence of “some systemic change for care home residents of Sutton:

999 calls, A&E attendances, non-elective admissions and the length of stay

have fallen.”

• “Crucially, there is some reason to believe that the Vanguard has played a part

in delivering this change. Both the quantitative and qualitative evidence support

this.”

• “Change has largely occurred in nursing homes rather than residential homes,

and attribution to the Vanguard is evident only for nursing homes.”

• “Overall the Vanguard saved £466,282 in 2016/17… Achievement of net savings

will depend on maintaining or continuing to reduce activity levels such as non-

elective admissions without such high levels of programme funding.”

• “In these circumstances, which are mainly outside of local control, the current

direction of travel in Sutton is encouraging.”

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Next steps of the independent evaluation

• SQW and SCIE have begun the second year of evaluation

• They will:

• Analyse the full year of data to understand if there are differences to the

part-year data, particularly important as in quarter four our data shows an

impact on some outcome metrics for residential homes

• Build a logic model for this year’s programme

• Collect qualitative and quantitative data and information, similar to last year

but includes the new initiatives, with a particular focus on subjective

improvements such as enhanced communication, partnership and resident

experience

• Report progress and findings to the Vanguard Steering Group, with a final

report being presented in March 2018

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Governing Body


Agenda No: 7. ENCLOSURE: 6 a&b

Title of Document:

Sutton’s Joint End of Life Strategy

Purpose of Report:

Approval

Report Authors:

Lola Triumph, Clinical Project Support

Lead Director:

Mary Hopper

Executive Summary:

Sutton’s Joint End of Life Care Strategy set out a vision for end of life care that aims

to meet the palliative care needs of those thought to be in the last stage of life to

enable them to live as well as possible until they die.

The strategy builds on its predecessor Merton and Sutton End of Life Care Strategy

that was published in 2011.

The new strategy aligns itself with the recommendations of the National Palliative

and End of Life Care Partnership - Ambitions for Palliative and End of Life Care: A

national framework for local action 2015-2020 that includes six ‘ambitions’ –

principles for how care for those nearing death should be delivered at local level and

eight principles which are the foundations to build and realise the ambitions. The six

ambitions are:

Ambition One: Each person is seen as an individual

Ambition Two: Each person gets fair access to care

Ambition Three: Maximising comfort and wellbeing

Ambition Four: Care is coordinated

Ambition Five: All staff are prepared to care

Ambition Six: Each community is prepared to help

The priorities described in section 6.3 have been structured around statements that

describe the six ambitions from the point of view of a person nearing the end of life

and local themes that commissioners and providers including voluntary sector

organisations think we need to focus on in the next three years to bring the ambitions

to reality.

The End of Life Care Strategy Working Group which representative from key

strategic partners and stakeholders will oversee the operational delivery of the

strategy including the High Level Implementation Plan described in section 6.4.

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The Group is chaired by Mary Hopper, Director of Quality.

Key issues to note are:

The whole report

Recommendation:

The Sutton Clinical Commissioning Group Governing Body is asked to approve

Sutton’s Joint End of Life Care Strategy.


Quality Committee – 17th August 2017

Executive Committee – 23rd August 2017


There is likely to be financial implications arising from the implementation of the

Strategy. Detailed business case and financial modelling will be undertaken to

determine the following:

Level of new investment in the proposed local health and social care 24/7 End

of Life Care Hub that will support care coordination, care planning and care

delivery from 1 April 2018.

Impact of Sutton Care Home Vanguard funding which will cease in March

2018.


The Equality Impact Assessment for the End of Life Care Strategy was approved by Yasmin Mahmood, Equality, Diversity and Inclusion Manager NEL Commissioning Support on 11 August 2017.

Information Privacy Issues: N/A

Communication Plan:

The Sutton End of Life Care Strategy Group will be responsible for communication

and engagement with service users, voluntary sector organisations, faith and

communities groups through the forums facilitated by Sutton Centre for the Voluntary

Sector (SCVS).

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Sutton’s Joint End of Life Care Strategy September 2017 Page 1 of 50

Sutton’s Joint End of Life Care Strategy for

Adults and Young People

2017 to 2020

‘I can make the last stage of my life as good as possible because everyone works

together confidently, honestly and consistently to help me and the people who are

important to me, including my carer(s)’

September 2017

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Contents

Foreword ...................................................................................................................................................... 3

Strategic Partners and Stakeholders ...................................................................................................... 4

End of Life Care Strategy on a page ....................................................................................................... 6

1. Introduction .......................................................................................................................................... 7

2. Background ......................................................................................................................................... 8

3. National Policy Context ................................................................................................................... 10

4. Sutton: The Local Context .............................................................................................................. 14

5. People, Public and Provider Perspectives ................................................................................... 23

6. Our Priorities for 2017 - 2020 ......................................................................................................... 26

Appendix A: Review of Priorities in 2011 and Progress to Date ....................................................... 34

Appendix B: Review of Sutton’s position against the Ambitions for Palliative and End of Life

Care: a national framework for local action 2015 – 2020................................................................... 40

Acknowledgements .................................................................................................................................. 47

References and Other Useful Sources of Information ........................................................................ 49

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Foreword

Everyone deserves to receive high quality, compassionate care at the end of their life and as such end of life care is a priority for Sutton CCG. Sutton’s Joint End of Life Care Strategy set out a vision for end of life care that aims to meet the palliative care needs of those thought to be in the last stage of life to enable them to live as well as possible until they die. Our vision is to structure end of life care services in a way that provides care and support that is needed by people, their family member, friend and/or carer during this time of life. This strategy builds on its predecessor Merton and Sutton End of Life Care Strategy that was published in 2011. Since this time we have made significant progress and implemented new models of care for end of life care services. The new strategy aligns itself with the recommendations of the National Palliative and

End of Life Care Partnership - Ambitions for Palliative and End of Life Care: A national

framework for local action 2015 - 2020. The national framework for action sets out six

‘ambitions’ – principles for how care for those nearing death should be delivered at local

level and eight principles which are the foundations to build and realise the ambitions.

Responsibility for implementing the ambitions of the new national framework spans the commissioner and provider spectrum, putting onus not just on Clinical Commissioning Groups (CCGs), but on providers, NHS England, Public Health England, local authorities and third sector organisations to take action, monitor progress and influence change. Acknowledging this challenge, the refreshed strategy sets the direction of travel for the next three years. We will seek to facilitate a compassionate approach to dying, raise awareness of dying through engagement with local communities, religious and faith groups in Sutton. We recognise that improving end of life care is a joint responsibility, involving a variety of organisations across health, social care, communities and the voluntary sector. Therefore our main priority will be to build on existing partnerships and create new relationships to drive up quality of care.

Lucie Waters, Managing Director of NHS Sutton CCG

Claire O Sullivan, Clinical Lead for End of Life Care, NHS Sutton CCG

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Strategic Partners and Stakeholders

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End of Life Care Strategy on a page Sutton’s Joint End of Life Care Strategy plan on a page for 2017 to 2020

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By April 2018 we will: 1. Commission a local health and social care 24/7 End of Life Care Hub to support information/advice, assessment, care coordination,

information exchange, care planning and care delivery. 2. Promote choice and personalised care for those dying and their families in acute and community settings through the offer of personal

health budgets 3. Review use of Coordinate my Care across acute and community health and social care settings and its ability to achieve the shared

records by scoping other electronic integrated records and links across Sutton 4. Ensure good understanding of different religions, cultures and norms of communities especially in relation to end of life care and death

By April 2019 we will: 5. Develop local information packs for End of Life Care services and available support 6. Promote engagement with faith groups, cultural communities as well as diverse organisations that support people with life shortening

illnesses and those managing the difficulties of older people 7. Promote spirituality in end of life care to raise awareness and ensure people’s beliefs and wishes are respected and supported 8. Develop an information sharing protocol that will enable and support Sutton multiagency approach to End of Life Care, care planning

and shared records 9. Review care homes and acute sector staff access to local end of life care training and development opportunities. 10. Review funding arrangement for the hospital specialist palliative care team at Epsom and St Helier. 11. Commission hospital discharge planning to include identification of individuals requiring Continuing Healthcare End of Life Care Fast

Track 12. Establish routine collection of person centered outcome measures as part of contractual arrangement with services 13. Provide support to young people, adults and their family/carer who are bereaved 14. Improve identification of individuals presenting with non-malignant diseases such as renal, respiratory and circulatory diseases both in

acute and community settings. 15. Ensure the End of Life Care Co-ordination Hub collect local data such as demographic data, activity, demand, service use, inequalities to

compliment national datasets and provide an evidence base for commissioning services, workforce development and education 16. Develop a coordinated approach to events during Dying Matters week

By April 2020 we will: 17. Ensure that people recorded on Coordinate my Care have a multi-agency care management plan and are proactively case managed to

prevent unnecessary hospital admission. 18. Ensure that an identified named key worker is responsible for overseeing the individual’s end of life journey. 19. Promote the development of a multiagency End of Life Care framework that will support unpaid family carers, support workers and

professional staff working with individuals at the end of their life 20. Promote cultural shift including engagement with social services and other agencies through joint acute and community projects.

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1. Introduction

Sutton’s Joint End of Life Care Strategy builds on the previous three year Merton and Sutton End of Life Care Strategy (2011) that took account of the national End of Life Care Strategy: Promoting High Quality Care for All Adults at the End of Life, published by the Department of Health (2008). The vision and objectives of this strategy has been framed around recommendations from the National Palliative and End of Life Care Partnership ambitions framework, which builds on the 2008 Department of Health (DH) Strategy for End of Life Care. This strategy is underpinned by the principle of an active and compassionate approach to end of life that ensures respect and dignity for people, their family and carers. It builds on existing partnership and stakeholder involvement in shaping the delivery of end of life care services in Sutton. Through the refreshed strategy we acknowledge the importance of current collaborative arrangements between statutory, community and voluntary sector agencies and recognises that going forward these arrangements need to be strengthened further. The improvement in service delivery that is expected from this strategy will require ownership and leadership from across the system in partnership with individuals, carers, families and others that are important to them. The strategy will be implemented through the new Sutton Local Transformation Board, Sutton Health and Wellbeing Board and the South West London Sustainability Transformation Plan (STP) Programme Board (see Section 6.1).

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2. Background

2.1. Definition of End of Life Care The Sutton’s Joint End of Life Care Strategy will adopt the General Medical Council’s definition for End of Life Care. The General Medical Council (2010) has defined End of Life as described below. The National Institute for Health and Care Excellence adopted the same definition in their Quality Standard for End of Life Care for Adults which was published in 2011. Source: General Medical Council. 2010. Treatment and care towards the end of life: good practice in

decision making. Can be accessed here: http://www.gmc-uk.org/End_of_life.pdf_32486688.pdf

2.2. Scope of this Strategy The scope of Sutton’s Joint End of Life Care Strategy includes:

Adults aged 18 and over who are dying

Adults affected by someone close to them dying

Children who are affected by someone close to them dying

Young people who are transitioning from children to adult services This strategy does not cover:

Neonates, children and young people aged 0 to 17 who are dying

Sutton CCG is committed to delivering recommendations of the National Institute for Health and Care Excellence Guidance (2016) End of life care for infants, children and young people with life limiting conditions: planning and management. The guidance recommends that children and young people with life-limiting conditions should be cared for by a defined multidisciplinary team which include a specialist paediatric palliative team and a named medical specialist who leads on and coordinates the child or young person’s care.

An individual is approaching the end of life when they are likely to die within the next 12 months. This includes people whose death is imminent (expected within a few hours or days) and those with:

advanced, progressive, incurable conditions

general frailty and co-existing conditions that mean they are expected to die within 12 months

existing conditions if they are at risk of dying from a sudden acute crisis in their condition

life-threatening acute conditions caused by sudden catastrophic events

Sutton will be using a broad definition of End of Life Care which describes the process of care through dying, death and bereavement of people who are likely to die in the next year, their families and carers.

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Through a separate workstream, Sutton CCG will work with specialist paediatric teams, social care and other relevant agencies to ensure that the end of life care needs of neonates, children and young people are met through a comprehensive model of palliative care for children and young people.

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3. National Policy Context

3.1. Department of Health End of Life Care Strategy: Promoting High Quality Care for All Adults at the End of Life (2008)

The aim of this strategy was to “make a step change in access to high quality care for all people approaching the end of life” (DH 2008:10). The strategy identified 12 key areas, listed below, together with associated actions and recommendations.

Raising the profile

Strategic commissioning

Identifying people approaching the end of life

Care planning

Coordination of care

Rapid access to care

Delivery of high quality services in all locations

Last days of life and care after death

Involving and supporting carers

Education and training and continuing professional development

Measurement and research

Funding The Department of Health’s Strategy highlighted the need to consider the entirety of the patient journey.

3.2. National Institute for Health and Care Excellence (NICE) Quality

Standard for End of Life Care for Adults (2011)

This NICE quality standard defines clinical best practice within this topic area and covers all settings and services in which care is provided by health and social care staff to all adults approaching the end of life. It does not cover condition-specific management and care or the clinical management of specific physical symptoms. The quality standard for end of life care for adults requires that services are commissioned from and coordinated across all relevant agencies, including specialist palliative care provisions as well as the voluntary sector and encompasses the whole end of life care pathway. An integrated approach to provision of services is fundamental to the delivery of high quality care to people approaching the end of life and their families and carers. The standard includes specific, concise quality statements, of which there are 16 relating to the areas listed below.

Identification

Communication and Information

Assessment, Care Planning and Review

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Holistic Support

Coordinated Care

Urgent Care

Specialist Palliative Care

Care in the Last Days of Life

Care After Death

Workforce

3.3. Actions for End of Life Care: 2014-16

The National Palliative and End of Life Care Partnership, made up of statutory bodies including NHS England, the Association of Directors of Adult Social Services, charities and groups representing patients and professionals, developed a framework for action. The action plan outline plans to improve the care for people of all ages; people living with and dying from all conditions and those that need additional specialist help and advice. The document is one component of a wider ambition to develop a vision for end of life care beyond 2015. To work in partnership with all those in health and social care and ensure that living and dying well is the focus of end of life care, wherever it occurs. The framework is aimed at health, social care and community leaders. It builds on the Department of Health’s 2008 Strategy for End of Life Care and responds to an increased emphasis on local decision making in the delivery of palliative and end of life care services since the introduction of the Health and Social Care Act 2012

3.4. One Chance to Get It Right (2014)

The Leadership Alliance for the Care of Dying People (LACDP), which was established following an independent review of the Liverpool Care Pathway for the Dying Patient (LCP), published ‘One chance to get it right’ in June 2014. This focuses on care in the last days of life using 5 priorities of care:

Recognise This possibility is recognised and communicated clearly, decisions made and actions are taken in accordance with the person’s needs and wishes, and these are regularly reviewed and decisions revised accordingly;

Communicate Sensitive communication takes place between staff and the dying person, and those identified as important to them;

Involve The dying person, and those identified as important to them, are involved in decisions about treatment and care to the extent that the dying person wants;

Support The needs of families and others identified as important to the dying person are actively explored, respected and met as far as possible;

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Plan & Do An individual plan of care, which includes food and drink, symptom control and psychological, social and spiritual support, is agreed, co-ordinated and delivered with compassion.

3.5. The Ambitions for Palliative and End of Life Care: A National Framework for Local Action 2015 - 2020 (2015)

The National Palliative and End of Life Care Partnership, made up of statutory bodies including Public Health England, NHS England, the Association of Adult Social Services, charities and groups representing patients and professionals has developed a framework for action in making palliative and end of life care a priority at local level. It is aimed at local health and social care and community leaders. It builds on the Department of Health’s 2008 Strategy for End of Life Care and responds to an increased emphasis on local decision making in the delivery of palliative and end of life care services since the introduction of the Health and Social Care Act 2012.

The national framework for action sets out six ‘ambitions’ – principles for how care for those nearing death should be delivered at local level:

each person is seen as an individual;

each person gets fair access to care;

maximising comfort and wellbeing;

care is coordinated;

all staff are prepared to care;

each community is prepared to help. The framework identifies measures such as personalised care planning and shared electronic records that are needed to realise each of the six ambitions, and calls on Clinical Commissioning Groups, Local Authorities and Health and Wellbeing Boards to designate a lead organisation on palliative and end of life care and to work collaboratively to bring people together to publish local action plans based on population based needs assessments. Ambitions for End of Life Care: www.endoflifecareambitions.org.uk

3.6. The Choice in End of Life Care Programme Board’s What’s important to me (2015)

In February 2015 the Choice in End of Life Care Board published a Review of Choice in End of Life outlining clear recommendations for a national choice offer to be in place by 2020, alongside increasing the coverage of coordinating systems to 100% by 2018 and ensuring that 24/7 out of hospital care is in place by 2019. It also sets out the need for work to continue on outcome and experience measures and suggests that social care at the end of life should be free. It recommends that additional spending is identified to enable this in the next spending review. In addition, the House of Commons Health Committee published their final report with respect to end of life care in March 2015, in which they focus on the need for providers

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to ensure they have a model in place to deliver the approach set out in ‘One Chance to Get it Right’. They also make a call to the Government to set out plans to enable sustainable hospice care, suggest that social care at the end of life should be free and that there needs to be focus going forward on outcome measures.

3.7. NICE Guidance Care of Dying Adults in the Last Days of Life (2015)

Published in December 2015, the NICE guidance covers the clinical care of adults (18 years and over) who are dying during the last 2 to 3 days of life. It aimed to improve care for people by communicating respectfully and involving them, and the people important to them, in decisions and by maintaining their comfort and dignity. The guideline covers how to manage common symptoms without causing unacceptable side effects and maintain hydration in the last days of life. It is notable that artificial nutrition is not discussed. The NICE guideline includes recommendations on:

recognising when people are entering the last few days of life;

communicating and shared decision-making;

clinically assisted hydration;

medicines for managing pain, breathlessness, nausea and vomiting, anxiety, delirium, agitation, and noisy respiratory secretions;

anticipatory prescribing.

3.8. Every Moment Counts, National Voices (2015)

The narrative for ‘person-centred coordinated care’ produced for NHS England by National Voices in 2015, in conjunction with its partners, sets out critical outcomes and success factors in end of life care, support and treatment, from the perspective of the people who need that care, and their carers, families and those close to them. These include honest discussion and the chance to plan, work to achieve individual goals and quality life and death, and for the people who are important at the centre of my support, physical, emotional, spiritual and practical needs and responsive, timely support day and night.

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4. Sutton: The Local Context

4.1. The demography of Sutton

The population of Sutton is approximately 202,220 (2016 resident population estimate) and a registered GP list size of 191,670. This is predicted to rise to 223,000 by 2024. Sutton’s population is also aging with the percentage of over 65 predicted to increase by 19.7% by 2024. Similarly the population aged over 75 is expected to increase by 29.1% by 2024, a higher percentage than for London (26.1%), but less than the 33.9% projected increase for England. The London Borough of Sutton is split into eighteen wards. Within each ward are smaller geographical areas called Lower Super Output Areas (LSOAs). The following figure profiles where our older people were living at the time of the 2011 census by LSOA.

Key Population

0 to 169

170 to 199

200 to 239

240 to 279

280 and over

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Some of the key demographic characteristics of Sutton’s population presented in the borough’s Joint Strategic Needs Assessment are described below:

The resident population of Sutton is approximately 202,220 with a registered GP list size of 191,670. This resident population is predicted to rise to 223,000 by 2024.

The Office for National Statistics (ONS) 2014 sub-national population projections estimate that between 2014 and 2024 Sutton’s population is projected to increase by 12.7%. This is similar to London (13.7%) and higher than for England (7.5%). Over this time the population of young people aged 0 to 19 is expected to increase by 16.6% in Sutton, higher than the average for London (14.8%) and England (7.8%). This will have implications for children’s services.

The 2011 census indicated that Sutton had become more ethnically diverse over the last ten years; around 79% of people living in Sutton are white, compared to nationally (85%) and London (60%). 12% of the population was from the Asian or Asian British ethnic groups (compared to 18% in London) in 2011.

In the 2011 Census 58.4% of people living in Sutton reported their religion as Christian compared to 48.4% in London and 59.4% nationally. The next biggest group were those that reported ‘no religion’ (24.6%). After this, the next most commonly specified religions were Hindu (4.2%) and Muslim (4.1%)

In Sutton, cancer remains the biggest single cause of death in under 75 year olds, and the proportion of cancer deaths slightly decreased over the last five years. Over the same time, the proportion of deaths from circulatory disease also reduced, but there was an increase in the number of deaths.

(Source: JSNA 2017)

Sutton’s demography has impact in terms of planning for End of Life Care services.

There is an expectation that there will be an increase in people aged over 65 and 75 by

2024. It is anticipated that the greater number of older people will result in multi

comorbidities and the need for better coordination of resources to support individuals

approaching the last year of their life.

The diversity of population characteristics in Sutton means that commissioners and providers should have a good understanding of different religions, cultures and norms of communities especially in relation to end of life care and death.

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4.2. End of Life Care Profile for Sutton

In 2016, 1,527 Sutton residents died. The majority of these deaths occurred in adults

over the age of 75 with the higher proportion above the age of 85 following a period of

chronic illness. Figure 1 profiles the percentage of deaths by age band.

Figure 1

The End of Life Care Monitoring Information for Sutton has highlighted the following points regarding deaths at home trends for Sutton compared to London and England, and at GP Locality Level:

The percentage of deaths at home for Sutton is significantly higher than London and similar to England (See Figure 2).

NHS Sutton’s 25 GP Practices are structured around three localities – Carshalton (8 practices), Sutton and Cheam (10 Practices) and Wallington (7 Practices).There are differences in the proportion of home deaths between the localities with the highest proportion in Sutton and Cheam locality (see Figure 3). The differences between localities with the highest proportion of home deaths in Sutton and Cheam could be explained by the large number of care homes in this part of the borough.

(Source: London Borough of Sutton Public Health Department)

0 to 64 15%

65 to 74 15%

75 to 84 28%

85 and above 42%

Percentage of deaths by age group Source: Sutton residents, 2016

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Figure 2

Figure 3

4.3. Merton and Sutton End of Life Care Strategy (2011)

We are proud of the new service developments and models of care for end of life care services that have been accomplished since the implementation of the Merton and Sutton End of Life Care Strategy (2011). Detailed update have been provided in Appendix A. Some of the significant achievements are highlighted below.

0

5

10

15

20

25

30

35

40

45

50

2010/1

1 Q

4 -

…

2011/1

2 Q

1 -

…

2011/1

2 Q

2 -

…

2011/1

2 Q

3 -

…

2011/1

2 Q

4 -

…

2012/1

3 Q

1 -

…

2012/1

3 Q

2 -

…

2012/1

3 Q

3 -

…

2012/1

3 Q

4 -

…

2013/1

4 Q

1 -

…

2013/1

4 Q

2 -

…

2013/1

4 Q

3 -

…

Q4 2

013/1

4 -

…

2014/1

5 Q

1 -

…

2014/1

5 Q

2 -

…

2014/1

5 Q

3 -

…

2014/1

5 Q

4 -

…

2015/1

6 Q

1 -

…

2015/1

6 Q

2 -

…

2015/1

6 Q

3 -

…

Perc

en

tag

e

Percentage of deaths occurring in usual residence between Q4 2010/11 and Q2 2016/17

Source: Public Health England

NHS Sutton

London

England

0

10

20

30

40

50

60

20

10

/11

Q1

- 20

10

/11

Q4

20

10

/11

Q2

- 20

11

/12

Q1

20

10

/11

Q3

- 20

11

/12

Q2

20

10

/11

Q4

- 20

11

/12

Q3

20

11

/12

Q1

- 20

11

/12

Q4

20

11

/12

Q2

- 20

12

/13

Q1

20

11

/12

Q3

- 20

12

/13

Q2

20

11

/12

Q4

- 20

12

/13

Q3

20

12

/13

Q1

- 20

12

/13

Q4

20

12

/13

Q2

- 20

13

/14

Q1

20

12

/13

Q3

- 20

13

/14

Q2

20

12

/13

Q4

- 20

13

/14

Q3

20

13

/14

Q1

- 20

13

/14

Q4

20

13

/14

Q2

- 20

14

/15

Q1

20

13

/14

Q3

- 20

14

/15

Q2

20

13

/14

Q4

- 20

14

/15

Q3

20

14

/15

Q1

- 20

14

/15

Q4

20

14

/15

Q2

- 20

15

/16

Q1

20

14

/15

Q3

- 20

15

/16

Q2

20

14

/15

Q4

- 20

15

/16

Q3

20

15

/16

Q1

- 20

15

/16

Q4

20

15

/16

Q2

- 20

16

/17

Q1

20

15

/16

Q3

- 20

16

/17

Q2

20

15

/16

Q4

- 20

16

/17

Q3

20

16

/17

Q1

- 20

16

/17

Q4

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2 m

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Percentage of deaths that take place at home, by Locality NB: Home deaths are classified as those in a person's home, plus care home deaths

Source: Primary Care Mortality Database

% Carshalton home deaths % Wallington home deaths % Sutton and Cheam home deaths

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Coordinate my Care 21. Sutton CCG remains one of the highest users of Coordinate my Care in

London. Coordinate my Care, our chosen Electronic Palliative Care Coordination Systems (EPaCCs) allows healthcare professionals such as London Ambulance Service, NHS 111, GP Out of Hours and Accident and Emergency Services to electronically record people's wishes and ensures their personalised urgent care plan is available 24/7 to all those who care for them.

Preferred place of Death

22. Deaths at home for Sutton is significantly higher than London. The proportion of deaths that occur in people’s home is considered to be an indicator of the quality of end of life care provision.

New models of care and service developments

23. Sutton CCG achieved vanguard status for Enhanced Health in Care Homes (see point 4.6).

24. We commissioned a team of End of Life Care Specialist Nurses for our nursing homes to support the homes with identification and advance care planning and to facilitate end of life care within the home and attend GP multidisciplinary meetings

25. There is increased identification of people with a learning disability, dementia and non - cancer diagnosis entering the last year of life.

26. We commissioned a selection of targeted community pharmacies to provide urgent provision of palliative care drugs to support prescribing of anticipatory medicines and dispensing of this Out of Hours.

27. Hospice @ Home is delivered by St Raphael’s Hospice to support individuals in the last three months of life at home, in care and residential homes to prevent unwanted admissions to hospital and provide support to carers

28. Acute sector Commissioning for Quality and Innovation in 2011/12 to 2013/14 focused on early identification of patients with cancer and non-malignant conditions at end of life and supporting earlier end of life care discussions.

Workforce development 29. There is a comprehensive end of life care training and education package for

GPs, care home staff, community nurses and other professionals.

Service developments from the previous strategy that we are seeking to further strengthen and prioritise in Sutton’s Joint End of Life Care Strategy include:

Appointment of the organisation that will coordinate end of life services across Sutton

Ongoing commitment to ensure that specialist nurses continue to support care homes with the identification and advance care planning for people in the last days of their life.

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Ongoing commitment to implementing the preferred place of death

Extending the use of Coordinate my Care to non-health organisations

Further engagement with voluntary sector organisations, community groups and Faith Leaders regarding access to end of life care services for their communities.

Explore opportunities for using Commissioning for Quality and Innovation to embed best practice and end of life care priorities within the acute sector.

4.4. End of Life Care Services

End of life care is delivered by a range of professionals and services. Care coordination and joint working across the local healthcare economy underpin the close working relationship between providers of end of life care services in Sutton.

Figure 4

Outlined below are details of providers of palliative and end of life care that are commissioned by Sutton CCG.

People, family and

their carer (s)

Community

nurse

Consultant

Allied

healthcare

professional

Community

pharmacy

GP

Voluntary

sector

Care home

staff/home

carers

Social

care

Ambulance

Service

Hospice

Specialist

nurse

Hospice

@ Home

Public

health

Caring Support

at Night in the

Home

Bereavement

services

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Sutton General Practices Primary Care End of Life Care Enhanced Service This service is commissioned to provide primary care based End of Life Care Enhanced Service which includes identification of people entering the last phase of life; discussion and development of advance care plans and if there is consent, uploading of care plans to Coordinate my Care. The service includes regular multidisciplinary (MDT) meetings to discuss the needs of the individual, coordination of care and completion of After Death Audits. GP Practice clinicians are also required to attend recognised End of Life Care education and training event. Sutton Community Health Services Community Nursing Service This service is commissioned to be delivered 24/7 365 days a year to support individuals, their carers and families in their own homes and care homes. The service include ongoing holistic assessment of the person’s condition, pain management, symptom control and nursing care for palliative care patients and work in conjunction with providers that offer specialist end of life and palliative care services. The community nurses work closely with specialist palliative care services to ensure a coordinated approach to care delivery. Supportive Home Care Team The Supportive Care Home Team support nursing home staff in the identification of residents entering the last year of life, supporting them to understand and develop advance care plans. This work is now part of the Vanguard programme which is now being rolled out across residential and learning disability homes. Marie Curie The service is commissioned to provide care overnight to individuals in their own home (including a residential setting). This service can be requested by Community Nursing Service or St Raphael’s Hospice. Support is provided by qualified nurses or healthcare assistants depending on the care needs of the individual. St Georges Hospitals University NHS Foundation Trust End of Life Fast Track Discharge Service This service is commissioned at St George’s Hospital jointly with Wandsworth and Merton CCGs to support Sutton residents. The aim is to facilitate timely discharge of Fast Track cases from hospital for people in the last days of life so that they can return home or to their preferred place of care such as care home or hospice if this is their wish. St Raphael’s Hospice Inpatient Hospice Care The service is commissioned to deliver a variety of End of Life Care services which includes 24 hour specialist inpatient beds; outpatients services, home service community palliative care service which is delivered by clinical nurse specialists and a

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community consultant who provide symptom control and advice to enable people to remain comfortable and independent at home Epsom and St Helier NHS Trust Acute Palliative Care Service The service is commissioned to provide acute palliative care services. The service includes 24/7 access to palliative medical team, seven day 09.00 to 17:00 access to Clinical Nurse Specialist and daily ward rounds.

4.5. Sutton CCG Fully Funded NHS Continuing Healthcare Sutton CCG is responsible for ensuring that people with ongoing care needs are assessed against the National Framework for Fully Funded NHS Continuing Healthcare to establish when Sutton CCG needs to take full responsibility for their care needs. The National Framework for Continuing care (revised November 2012) includes a Fast Track Tool which allows healthcare professionals to refer individuals who are considered to be entering the final stages of their life with a rapidly deteriorating condition and are eligible to receive a fully funded care package for nursing home placements and domiciliary care services which is commissioned by Sutton CCG on behalf of the NHS. Individuals are cared for in their preferred place of care or in their own home by commissioned domiciliary care agencies, community nursing service with access to St Raphael’s Hospice and Marie Curie Services.

4.6. Sutton Care Home Vanguard

Sutton has been working with care homes since 2014, to improve the residents’ health outcomes and quality of life. This work was formally recognised by NHS England in April 2015 when Vanguard status was awarded. The programme has been given annual funding which will cease in March 2018. Sutton Homes of Care is one of six Enhanced Health in Care Home Vanguards across England where we are working to improve the quality of life, healthcare and health planning for people living in care homes. The combined work of the 6 care home Vanguards resulted in the development of the enhanced health in care homes framework which includes a focus on High Quality End of Life Care through improved integration of services and coordination of care. The programme has enhanced end of life care for residents of care homes, all of whom have the same entitlement to high-quality holistic health and social care as those living in their own homes and those in hospital. Close partnership working between care home staff, the Supportive Home Care Team and primary care has significantly increased the number of residents who have a Coordinate my Care record and advanced care plan. Over 60% of nursing home residents and 30% of residential homes residents have a Coordinate my Care record (Performance data Quarter 4 2016/2017). There is still further progress to be made as hospital data shows that the number of hospital deaths of residents from nursing homes is increasing and from residential homes is decreasing.

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4.7. Dementia and End of Life Care We have embarked on a comprehensive training and education programme that is equipping GPs and care home staff to identify people in the early and end stage of dementia. The training programme include information on specific care issues for individuals with end stage dementia, pain assessment in dementia and advance care planning in advanced dementia. In line with NICE Supporting People with Dementia and their Carers (2006), palliative care will be available to people with dementia from the time they are diagnosed until the end of life. We will ensure that dementia care incorporate a palliative care approach from the time of diagnosis until death. The aim is to support the quality of life of people with dementia and to enable them to die with dignity and in the place of their choosing, while also supporting carers during their bereavement, which may both anticipate and follow death.

4.8. End of Life Care for Young People in Transition to Adult Services

Transition planning must continue to take place even during times of uncertainty and as a young person approaches the last stage of their life. Every effort must be made to ensure that the young person’s death takes place according to their wishes and in their place of choice wherever possible. This may be home, hospital, hospice or other residential setting. The young person may still be attending school or college and their place of education should continue to be involved and kept informed. We are committed to working in collaboration with voluntary sector, health and social care organisations to develop a joint approach to care planning and care provision for young people entering the last stage of their life.

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5. People, Public and Provider Perspectives We are committed to hearing the voices of peoples in order to find out what is working well and identify areas for development. We intend to work with providers to ensure feedback from people who are approaching the end of life, carers and family members is captured in a sensitive and meaningful way to support continual improvement in the services.

5.1. National Survey of Bereaved People (Voices) In the 2015 National Survey of Bereaved People (VOICES), the majority of people who reported where they would like to die expressed a preference to die at home (Office of National Statistics 2015) although often this does not become a reality. Therefore, the proportion of deaths that occur in people’s homes is considered to be one indicator of the quality of End of Life Care provision.

The VOICES survey asks respondents if the person who died had expressed a preference for where they would like to die and asked to state where this was (for instance, at home, in a hospice etc.). Out of the 7,561 responses to this question, the majority believed the deceased had wanted to die at home (81%), 8% said they wanted to die in a hospice, 7% in a care home, 3% in hospital and 1% somewhere else.

In Sutton, we have seen an increase in people who die at home or their usual place of residence such as a care home. Recent data shows that the percentage of deaths at home for Sutton is significantly higher than London and in line with England (see Figure 2).

5.2. The Role of Family and Friend Carers

Sutton Carers Centre supports unpaid Carers, adults and children, who live, work or go

to school in the London Borough of Sutton. They provide advice, information and

emotional support, help with benefit forms and/or accessing funds, counselling, breaks

e.g. complementary therapies, support groups, and much more. Much of this work is

funded jointly by London Borough of Sutton and Sutton CCG as part of their

commitment to supporting the wellbeing of Carers and their families at all stages of life.

The important role and contribution of unpaid Carers to end of life care deserve our

respect and recognition. We must ensure that unpaid Carers of all ages continue to

receive advice, information and training, as well as access to breaks and emotional

support, so that they are equipped to care for family members during their last days.

We also want to hear the opinions of unpaid Carers and empower them to influence the

local End of Life Care agenda. We intend to agree a process that will enable Carers to

contribute to planning and provide regular feedback to commissioners and providers on

the quality of End of Life Care services.

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5.3. The Role of the Voluntary and Community Sector (VCS)

We are committed to strengthening existing partnership with voluntary sector

organisations, faith and communities groups through the forums facilitated by Sutton

Centre for the Voluntary Sector (SCVS), a membership organisation that supports,

develops and promotes the voluntary sector in the London Borough of Sutton. We

believe that by investing time and resources in building strong relationships, we will be

in a position to jointly deliver maximum benefit to individuals, families and Carers going

through the dying experience and bereavement.

We will achieve this by ensuring that relevant local health and social care organisations

are aware of the end of life care support available from all partners in the statutory,

community and the voluntary sector. We also will listen to stakeholders’ ongoing

opinions about what works well and what needs to be developed to deliver this strategy.

Working with the VCS, we aim not only to develop these organisational relationships but

also increase our reach into the community so that the experiences of many diverse

groups and individuals will help improve end of life care.

In particular, we will work with partners such as Sutton’s Information and Advice

Service, ‘ALPS’ (Advice Link Partnership Sutton), funded by London Borough of Sutton

as well as several independent sources, to provide training to frontline workers who

inform and advise families as well as colleagues. This includes supporting paid workers

as well as volunteers to develop the confidence to have difficult conversations with

individuals and their family members going through the dying experience.

5.4. Feedback from End of Life Care Engagement Events and Workshops

The following strategic partners and stakeholders have contributed to the development

of Sutton’s Joint End of Life Care Strategy:

NHS Sutton Clinical Commissioning Group

Age UK

SLDUC Ltd, The Vocare Group

Epsom and St Helier University Hospitals NHS Trust

London Ambulance Service

London Borough of Sutton

Marie Curie

St Raphael’s Hospice

Sutton Carers’ Centre

Sutton Community Health Services, Community Division of The Royal Marsden NHS Foundation Trust

Sutton Centre for the Voluntary Sector End of Life Care building Sutton Strategy workshop that was held on the 20th of September 2016 involved key strategic partners and a wider group of colleagues from relevant agencies across Sutton. The workshop identified cross cutting themes and requirement that will support better identification, assessment, care coordination, service delivery, Last Days and After Death.

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On the 4th of July 2017 and 2nd of August 2017, Sutton End of Life Care Strategy Working Group whose membership include the key strategic partners reviewed Sutton’s position against recommendations in the Ambitions for Palliative and End of Life Care: a national framework for local action 2015 to 2020. Feedback and key messages from the workshops have guided the development of priorities outlined in Section 6.3. Appendix B includes detailed information on the review.

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6. Our Priorities for 2017 - 2020

6.1. Leadership and Governance

The End of Life Care Strategy Working Group will be responsible for the operational delivery of Sutton’s Joint End of Life Care Strategy. The Group is chaired by Mary Hopper, Director of Quality at Sutton CCG. The Group will report to the new Sutton Local Transformation Board and Health and Wellbeing Board ( see Figure 5), with links to commissioners and providers’

Organisational Boards and Management Leadership Teams.

Figure 5

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6.2. South West London Sustainability and Transformation Plan End of Life Care Priorities

South West London Sustainability and Transformation Plan is a collaboration between all the NHS commissioners and providers in south west London, working with our six local authorities and GP Federations. It sets out how commissioners and providers across the south west London could transform health and care services, so that local people receive the high quality care they rightfully expect, now and in years to come. The End of Life Care priorities of the South West London Sustainability and Transformation Plan include:

Delivering the right care in the right place Helping people nearing the end of their life to die where they choose

Getting end of life care right Proactively identify patients who should be receiving palliative care to

ensure that all people at the end of their life have high quality and compassionate care.

Train staff across the health system to help people at the end of their life, their families and carers, plan and proactively manage their care.

Promote Coordinate my Care across south west London to ensure that important information about people at the end of their life and their preferences for the care they wish to receive is recorded and known.

Roll out the implementation of the national cancer vanguard to improve access to high quality palliative and round the clock end of life care

Evidence across south west London indicate that health and social care services are not meeting the needs or preferences of people at the end of their lives in south west London.

(Source: South West London Five Year Forward Plan, October 2016)

6.3. Sutton’s End of Life Care Priorities We have structured our priorities for 2017 to 2020 around statements that describe the six ambitions in the Ambitions for Palliative and End of Life Care: a national framework or local action 2015 to 2020 from the point of view of a person nearing the end of life and local themes that people, commissioners and providers think we need to focus on in the next three years to bring the ambitions to reality.

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Ambition One: Each person is seen as an individual I, and the people important to me, have opportunities to have an honest, informed and timely conversations and to know that I might die soon. I am asked what matters most to me. Those who care for me know that and work with me to do what’s possible.

Sutton’s Priority Key Performance Indicator Theme

Improve identification of individuals presenting with non-malignant diseases such as renal, respiratory and circulatory diseases both in acute and community settings.

Commission hospital discharge planning to include identification of individuals requiring Continuing Healthcare End of Life Care Fast Track

Extend current Supportive Care Home service to include council funded sheltered accommodation

Promote choice and personalised care for those dying and their families in acute and community settings through the offer of personal health budgets

Ensure good understanding of different religions, cultures and norms of communities especially in relation to end of life care and death.

Increase identification of individuals entering the last stage of their life

Increase the use of Advance Care Plans

Increase identification of individuals presenting with non-malignant diseases

Increase the number of individuals identified through Continuing Healthcare End of Life Care Fast Track

Identification

Assessment

Ambition Two: Each person gets fair access to care I live in a society where I get good end of life care regardless of who I am, where I live or the circumstances of my life


Promote engagement with faith groups, cultural communities as well as diverse organisations that support people with life shortening illnesses and those managing the difficulties of older people

Increase in patients registered on GPs palliative care register

Reduction in deaths in hospital for people at the end of life whose preferred place of care

Positive Dying Experience

Community Engagement

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Ensure that patients recorded on Coordinate my Care have a multi-agency care management plan and are proactively case managed to prevent unnecessary hospital admission

Ensure that an identified named key worker is responsible for overseeing the individual’s end of life journey

is in the community

Increase the number of people able to die in their usual place of residences through the delivery of advance care planning

Care Coordination

Ambition Three: Maximising comfort and wellbeing My care is regularly reviewed and every effort is made for me to have the support, care and treatment that might be needed to help me to be as comfortable and as free from distress as possible


Review access to end of life care pain control related to different care settings

Ensure that domiciliary and social care providers are trained to recognise and acknowledge the physical, psychological, emotional, social or spiritual distress of an individual at the end of life to facilitate timely access to appropriate End of Life Care services

Increase in satisfaction of bereaved families


Ambition Four: Care is coordinated I get the right help at the right time from the right people. I have a team around me who know my needs and my plans and work together to help me achieve them. I can always reach someone who will listen and respond at any time of the day or nigh


Commission a local health and social care 24/7 End of Life Care Hub to support information/advice, assessment, care coordination, information exchange, care planning, training and care delivery.

Ensure the End of Life Care Co-ordination Hub collect local data such as demographic data, activity,

Reduction in emergency admissions to hospital for people who are approaching the end of life their life as a result of better management of care packages

Reduction in number of hospital bed days of patients wishing to die at home

Care Coordination


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demand, service use, inequalities to compliment national datasets and provide an evidence base for commissioning services, workforce development and education

Develop local information packs for End of Life Care services and available support

Develop hand held care plans for patients to keep at home or take to GP and hospital appointments

Review use of Coordinate My Care across acute and community health and social care settings and its ability to achieve the shared records by scoping other electronic integrated records and links across Sutton

Develop an information sharing protocol that will enable and support Sutton multiagency approach for End of Life Care, care planning and shared records

Reduction in emergency admissions of people who are approaching the end of their lives from Care Homes

Ambition Five: All staff are prepared to care Wherever I am, health and care staff bring empathy, skills and expertise and give me competent, confident and compassionate care.


Review care home staff’s access to local end of life care training and development opportunities.

Review acute sector workforce access to local end of life care training and development opportunities.

Establish a systematic approach to collecting service user feedback including patient and carer satisfaction in a meaning way in acute and community settings

Increase number of care home staff, unpaid carers, community and voluntary sectors staff accessing training in end of life care.

Workforce development

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Establish routine collection of person centred outcome measures as part of contractual arrangement with services

Support the development of a multiagency End of Life Care framework that will support unpaid family carers, support workers and professional staff working with individuals at the end of their life

Ensure that the End of Life Care Co-ordination Hub develops a model of care that reassures individuals and their families that a peaceful death can be achieved in their own environment

Review funding arrangement for the hospital specialist palliative care team at Epsom and St Helier.

Ambition Six: Each community is prepared to help I live in a community where everybody recognises that we all have a role to play in supporting each other in times of crisis and loss. People are ready, willing and confident to have conversations about living and dying well and to support each other in emotional and practical ways.


Promote cultural shift through the joint delivery of secondary care, social care, faith groups, carers support and voluntary sector organisations

Develop a coordinated approach to events during Dying Matters week

Increase in satisfaction of bereaved families 30. Positive Dying Experience

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6.4. High Level Implementation Plan

This section describes the High Level Implementation Plan and deadline for priorities in

the End of Life Care Strategy. In order to deliver this strategy and realise the benefits for

individuals, their family and carers, a more detailed implementation plan will be

developed by the Sutton End of Life Care Strategy Working Group. The plan will work

to ensure best use of the existing resources, building on what has been done to date

and where necessary develop specific project mandate(s) to take collaborative

improvement work forward.

Organisations that are represented on the Sutton End of Life Care Strategy Working

Group will be asked to describe how they will contribute to the implementation of the

strategic priorities.

By April 2018 we will:

1. Commission a local health and social care 24/7 End of Life Care Hub to support

information/advice, assessment, care coordination, information exchange, care planning and care delivery.

2. Promote choice and personalised care for those dying and their families in acute and community settings through the offer of personal health budgets.

3. Review use of Coordinate my Care across acute and community health and social care settings and its ability to achieve the shared records by scoping other electronic integrated records and links across Sutton.

4. Ensure good understanding of different religions, cultures and norms of communities especially in relation to end of life care and death.

By April 2019 we will:

5. Develop local information packs for end of life care services and available support.

6. Promote engagement with faith groups, cultural communities as well as diverse

organisations that support people with life shortening illnesses and those managing the difficulties of older people.

7. Promote spirituality in end of life care to raise awareness and ensure people’s

beliefs and wishes are respected and supported.

8. Develop an information sharing protocol that will enable and support Sutton

multiagency approach to end of life care, care planning and shared records.

9. Review care homes and acute sector staff access to local end of life care training and development opportunities.

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10. Review funding arrangement for the hospital specialist palliative care team at Epsom and St Helier.

11. Commission hospital discharge planning to include identification of individuals

requiring Continuing Healthcare End of Life Care Fast Track.

12. Establish routine collection of person centered outcome measures as part of

contractual arrangement with services.

13. Provide support to young people, adults and their family/carer who are bereaved.

14. Improve identification of individuals presenting with non-malignant diseases such

as renal, respiratory and circulatory diseases both in acute and community settings.

15. Ensure the End of Life Care Co-ordination Hub collect local data such as

demographic data, activity, demand, service use, inequalities to compliment national datasets and provide an evidence base for commissioning services, workforce development and education.

16. Develop a coordinated approach to events during Dying Matters week.

By April 2020 we will

17. Ensure that people recorded on Coordinate my Care have a multi-agency care management plan and are proactively case managed to prevent unnecessary hospital admission.

18. Ensure that an identified named key worker is responsible for overseeing the individual’s end of life journey.

19. Promote the development of a multiagency End of Life Care framework that will

support unpaid family carers, support workers and professional staff working with individuals at the end of their life.

20. Promote cultural shift including engagement with social services and other

agencies through joint acute and community projects.

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Appendix A: Review of Priorities in 2011 and Progress to

Date This section provides an overview of the commitments set out in the 2011 Merton and Sutton End of Life Care Strategy and outlines the progress that has been made since its publication.

1. Raising the Profile

Commitments in the 2011 Strategy:

To promote the profile of end of life care through the local Health and Wellbeing Boards in Merton and Sutton, and to work with partner organisations including social care and the third sector.

To continue to work with local communities to raise awareness, particularly faith and other spiritual groups and organisations.

To promote choice in end of life care services so that people are better informed about what services are available to them.

Progress since 2011:

People are increasingly offered the opportunity to have a Coordinate my Care record which provides an opportunity to discuss and document choice.

Coordinate my Care monthly data overview for NHS Sutton CCG data for June 2017 reported that there are 1445 peoples with a recorded date of death on Coordinate my Care. Of these, 1194 had a place of death recorded, of whom 918 had explicitly expressed a preferred place of death (some had no preference, or were too unwell for the discussion). Overall 73% of peoples have died in their preferred place where peoples have a Coordinate my Care record, 20% die in hospital. However, nationally, 47% die in hospital.

Invitations to events about end of life care have been extended to Faith Leaders in order to share information about access to end of life care services for their communities.

The hospice, community services and palliative care teams in the acute sector have actively engaged with Dying Matters Week in May each year to inform the public about their choices for end of life care and available services/resources.

The Supportive Home Care Team have worked with care home staff and GPs to identify residents who are entering last year of their life. Care plans are recorded and shared on Coordinate my Care.

2. Strategic Commissioning


The Sutton and Merton End of Life Care Network, a strategic stakeholder group, will continue to ensure plans are implemented and links are made to relevant workstreams.

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To utilise the Marie Curie ‘Delivering Choice’ methodology/systems approach to ascertain end of life care gaps and unmet needs.


We will continued to support the end of life care network across Merton and Sutton bringing together strategic partners to develop improvements in end of life care services.

The strategic commissioning arrangement for end of life care has extended to the South West London Sustainability Transformation Plan platform.

3. Identifying People Approaching the End of Life

Commitment in the 2011 strategy:

To continue to implement, embed and sustain symptom assessment tools (i.e. Gold Standards Framework prognostic indicators) and knowledge and skills of symptom management with all professionals working with an individual in the last year of life in all clinical settings.

To consider the implications of ‘The Route to Success in End of Life Care: Achieving Quality for People with Learning Disabilities’ published by the identifying how well prepared providers are to manage the end of life care needs of people with learning disabilities, appropriate pathways and policies, and ensuring staff are aware of the guide.


Increased the identification of patients with non-cancer diagnosis for those accessing advance care planning and Coordinate my Care records.

Symptom Assessment Tools training as part of the Sutton Community Health Team work with care homes

Learning Disability Pilot as part of Vanguard work, yet to be validated.

4. Care Planning

Commitment in the 2011 Strategy:

To implement, embed and sustain Advance Care Planning across community and acute settings


Commissioned a Local Enhanced Service for end of life care which is delivered by general practice to increase advance care planning and to facilitate people’s preferences for care at the end of their life.

Commissioned a team of End of Life Care Specialist Nurses for our nursing homes to support the homes with identification and advance care planning and to facilitate end of life care within the home and attend GP multidisciplinary meetings

Development of agreed last days of life care plan for use in care homes, own homes in collaboration with the St Raphael’s Hospice.

5. Coordination of Care


To continue to encourage and support staff to offer Coordinate my Care records to patients in all settings

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To look to develop a provider to coordinate end of life care services across Sutton and Merton


Implemented a pilot an Electronic Palliative Care Coordination System currently Coordinate my Care.

GP Practices, ambulance service, hospices and Epsom and St Helier University Hospitals NHS Trust use coordinate my care to upload an individual’s wishes and preferences. Sutton CCG remains one of the highest users of Coordinate my Care in London. There are future plans to extend to other end of life care providers.

A Community Consultant in Palliative care has been appointed at St Raphael’s Hospice.

Implemented Fast Track process within the acute trust to facilitate discharge in a timely manner for peoples nearing the final stages of life.

Equipment service has been commissioned to respond urgently if needed

Commissioned a selection of targeted community pharmacies to provide urgent provision of palliative care drugs to support prescribing of anticipatory medicines and dispensing of this Out of Hours.

Appointment of the organisation that will coordinate end of life services across Sutton is outstanding. This remains a priority.

6. Rapid Access to Care

Commitments in the Rapid Access to Care:

To continue implementing preferred place of care, which will lead to reduced length of hospital stay, through extension of the Coordinate my Care and Hospice @ Home schemes to patients with a non-malignant diagnosis


Hospice @ Home is delivered by St Raphael’s Hospice to support individuals in the last three months of life at home in care and /or residential homes to prevent unwanted admissions to hospital and provide support to carers.

Sutton CCG’s Coordinate my Care data for June 2017, included recorded diagnoses for Cancer 43.6% and for Non-Cancer 56.4%

7. Delivery of high quality in all locations

Commitment in the 2011 strategy:

To ensure the remaining 30% of care (nursing) homes that have yet to undertake the Gold Standard Framework in Care (nursing) homes programme achieve this, and to sustain those care (nursing) homes that have completed the programme to maintain it.

To extend and implement the Gold Standard Framework and other best practice in primary care by seeking to employ a Macmillan GP and introducing a Local Enhanced Service.

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Priority moved away from Gold Standard Framework with the development of the Supportive Care Home Team.

The Supportive Care Home Team provide bespoke End of Life Care training to care homes. The training is based on National Priorities of Care and underpinned by clinical role modelling of good End of Life Care practice.

Macmillan GP has been appointed to deliver Macmillan’s priority regarding cancer prevention and screening uptake. The Macmillan GP service does not directly support end of life care.

8. Dementia Care


To promote the development of expertise in end of life dementia care


In 2012, an End of Life Care and End Stage Dementia Project delivered the following: A training package for GPs which included identification of the end stage of

dementia, information on specific care issues for individuals with end stage dementia , pain assessment in dementia and advance care planning in advanced dementia

A pilot training package for care homes which consisted of general

dementia training including identification of advanced dementia, pain assessment in dementia and advance care planning

9. Last Days of Life and Care After Death


To ensure that widespread use of the Liverpool Care Pathway continues through a focus on a multi-disciplinary team meetings and working.


Since the cessation of the Liverpool Care Pathway, the acute sector follows the principles of One Chance to Get it Right (DH, 2015) in order to provide good quality care in the last hours and days of life.

Development of individualised care plan for people in the dying phase has been adapted from St Raphael’s Hospice documentation for use in care homes and community nursing.

10. Involving and Supporting Carers


To seek feedback and undertake bereavement research, using the ‘Voices’ questionnaire

To review the bereavement support to look at both face-to-face support and telephone advice


Bereavement support is available from the Community Mental Health Team

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11. Education and Training and Continuing Professional Development


To focus training on communication skills, symptoms control, psychological care and /or bereavement care, and spiritual care, ensuring this is in place for all professionals working with patients and clients in the last year of life.

To continue to identify best practice locally and also implement any new national best practice, as it is published.


St Raphael’s RCN accredited care home training programme was delivered from 2011 to 2014 to support improved end of life care knowledge and skills. The training was well attended by all grades of staff and feedback from participants was very positive.

There is informal end of life care support from specialist end of life nursing teams, GPs and Sutton Care Home Provider Network Forum

Formal training in end of life care for MDT staff groups is available for staff in the acute sector.

Secured funding from Health Education South London (HESL) to deliver training programme for syringe pump management in nursing homes. The training was supported by the Vanguard programme and delivered jointly by the Supportive Care Home Team and St Raphael’s Hospice, This programme delivered training to 58 nurses from Sutton nursing homes and established a 24/7 pathway of support for the use of syringe pumps.

Education and Training is a requirement of the local enhanced service contract for end of life care.

12. Measurement and research


To undertake research into symptom assessment and control, exploring the use of validated tools, such as the Palliative Care Outcomes score and/or another tool called SPARC

To progress the development of a pain diary, and, to ensure that psychological and spiritual dimensions of pain are incorporated into pain assessment


Sutton CCG remains committed to learning from effective models of care and good practice in symptom assessment using validating tools and methodologies

Care homes are taught about pain assessment tools for people with dementia. There is a pain assessment tool (DISDAT) for people with learning disability.

13. Funding


To utilise the Commissioning Support for London economic modelling tool (or similar) when ready, in order to understand the size of the acute end of life care population and associated costs

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A review that was undertaken by a Darzi Fellow on end of life care in Sutton reported that the per-patient cost of hospital, emergency and unplanned care is £2,324 to £2,467 lower for Co-ordinate my Care patients. The net impact is that average treatment costs for Co-ordinate my Care patients are £1,350 to £2,102 lower than for non-Coordinate my Care patients in the 6 months prior to death. The report did not look at the increasing costs of social care or the impact on primary care and community services as these are block contracts.

14. Commissioning for Quality and Innovation


To use the acute Commissioning for Quality and Innovation scheme as a mechanism to improve care for patients approaching the end of life in hospitals by increasing the number of patients being placed on end of life registers and having the opportunity to undergo discussions regarding preferred priorities for care.

To use the community services Commissioning for Quality and Innovation scheme to improve end of life for people with an increase in the number of people approaching the end of life having an advanced care plan and dying in their preferred place.


Sutton CCG has achieved vanguard status for enhanced health in care homes. This includes facilitation of high standard of end of life care.

Acute sector Commissioning for Quality and Innovation in 2011/12 to 2013/14 focused on early identification of patients with cancer and non-malignant conditions at end of life and supporting earlier end of life care discussions.

15. Value for Money Scheme


To develop a scheme to assess and ensure end of life care services are value for money, which will aim to improve quality whilst reducing the reliance on acute hospital beds.


As described above, in 2013, a Darzi Fellow review indicated that the per-patient cost of hospital, emergency and unplanned care is £2,324 - £2,467 lower for Co-ordinate my Care patients. The net impact is that average treatment costs for Co-ordinate my Care patients are £1,350 to £2,102 lower than for non-Coordinate my Care patients in the 6 months prior to death.

Sutton will seek to test out different models of care in the coming years to support reducing reliance on acute hospital beds.

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Appendix B: Review of Sutton’s position against the

Ambitions for Palliative and End of Life Care: a national

framework for local action 2015 – 2020 Ambition One: Each person is seen as an individual I, and the people important to me, have opportunities to have an honest, informed and timely conversations and to know that I might die soon. I am asked what matters most to me. Those who care for me know that and work with me to do what’s possible.

National Picture:

Having our personal needs and wishes ignored or overridden is a deeply rooted fear for those who are dying, their families, and the many people who are carers, as well as those who have been bereaved.

We know that much about recognising dying and impending death is uncertain and challenging. However, timely identification and honesty where there is uncertainty is key to the quality of care – all else follows.

We know that despite the difficulty that can be associated with talking about death, people want repeated opportunities to consider whether to engage in such honest conversations about their future.

We know that people want to be involved in their care, and should be given all the information, advice and support they need to make decisions about it.

We know that with effort, collaboration and system leadership health and social care can be designed around the wishes of the person approaching death.

We know that asking, recording and working to support choices requires those who lead organisations and the care professionals who work in them to be innovative in how to enable choices to be met, particularly within resource constraint.

Sutton’s response:

There are established organisational approaches to supporting individuals during the last year of their life in both acute and community settings.

GP Practices are commissioned to identify patients and offer advance care plan in the last year of their life. Individuals information is uploaded into Coordinate my Care with consent from the individual and/or their family.

There are local arrangements for identifying and supporting care home residents who are entering the last year of life.

There are arrangements in place to support care home staff with training and awareness of end of life care processes.

St Raphael’s Hospice and nursing home teams have shared end of life care plan.

Sutton care homes receive support from the Royal Marsden Supportive Care Home Team on end of life care plans for their residents.

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Training for Fast Track applications in both the acute and community setting for healthcare professionals has improved the effectiveness of the assessments, timely informed decision making and commissioning of required care.

Case management is provided by community nursing for those individuals cared for at home.

Gaps:

There is no agreed multi-agency approach for care planning and shared records

Staff, in acute and community settings, do not necessary have access to available local training because of capacity and time constraint issues

Information governance can be a barrier. Voluntary sector organisations do not always have access to information on the people they are caring for.

Ambition Two: Each person gets fair access to care I live in a society where I get good end of life care regardless of who I am, where I live or the circumstances of my life

National Picture:

People from black and ethnic and minority (BAME) communities and deprived areas report a poorer quality of end of life care, similarly those who are living with non-malignant illnesses, people living in more deprived areas, the homeless or imprisoned and those who are more vulnerable.

The quality of end of life care is poorer and harder to access for people who live in very rural or other isolated areas.

There remain unacceptable inequities and inequalities in access to palliative and end of life care particularly for those with learning disabilities, dementia and non-malignant long term conditions.

There are unacceptable variations in aspects of palliative and end of life care such as access to pain control, related to different care settings


The ethnic profile in Sutton is projected to change with the borough becoming increasingly more diverse. The increase in diversity is likely to be seen in the wards of Wandle Valley, Sutton Central, Belmont and Carshalton South therefore services will be tailored to meet the culturally needs diversity of the population.

Sutton wards in the most deprived quintile currently have a lower volume of deaths at home reported therefore commissioned services need to target these wards regarding service provision

The Royal Marsden NHS Foundation Trust Supportive Care Home Service currently support nursing care homes staff in the identification of residents with learning disability and dementia entering the last year of life and supporting them to understand and develop advance care plans. They also provide training for the staff. This work is now part of the Vanguard programme which

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is now being rolled out across residential and learning disability homes. There are 20 Nursing Homes, 11 residential homes and 50 learning disability homes in Sutton.

Under the Memorandum of Agreement between Sutton Council and Sutton CCG, the Sutton Public Health Department provides regular monitoring information on end of life care.

Jigsaw4u provides (currently funded by Macmillan Cancer Support) counselling to children and families with life limiting conditions. Funding ends on 31 March 2018

Gaps:

There is no local agreement on the current reach of palliative and of life care services across different diseases, social and ethnic groups.

There is no arrangement in place for early identification and raising awareness of social care funded carers who work with individuals with life limiting conditions.

Person centered outcome measures are not used uniformly across Sutton.

There is lack of End of Life Care data such as demography, activity, demand, service use and inequalities to compliment national datasets, provide evidence base for commissioning services, workforce development and education.

Service user engagement is not embedded in local arrangements for end of life care.

No clear engagement plan with faith groups, cultural communities as well as diverse organisations that support people with life shortening illnesses and those managing the difficulties of older people

Lack of awareness of what support St Raphael’s Hospice can offer to people from multicultural communities.

Ambition Three: Maximising comfort and wellbeing My care is regularly reviewed and every effort is made for me to have the support, care and treatment that might be needed to help me to be as comfortable and as free from distress as possible

National Picture:

Many people approaching death are fearful of being in pain or distress. Dying and death can be powerful sources of emotional turmoil, social isolation and spiritual or existential distress.

We know that distress from pain and symptoms can be relieved with expert palliative care and that inadequate and misguided clinical interventions are features of patients’ and their families’ poor experiences.

We know that access to good and early palliative care can improve outcomes for life expectancy as well as improve the quality of life.

A comfortable death can help those who are bereaved to adjust to their loss in

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ways that secure their future health and wellbeing.


There is recognised approach to anticipatory prescribing for symptoms that may present at the end of life.

Sutton CCG commissions specialist palliative care pharmacies to dispense end of life medications during and out of hours.

Through the Sutton vanguard programme, qualified nurses working within the care home setting have received training on set up of syringe drivers for management of pain control.

Gaps:

Lack of support to raise awareness and recognition by domiciliary and social

care providers regarding the physical, psychological, emotional, social or

spiritual distress of individuals entering the end of stages of their life.

There is need for education regarding frequency of use and prescribing for symptoms that may present at the end of life in both acute and community services.

The End of Life Care workforce needs to have access to all locally supported symptom management guidelines.

There needs to be clarity on how to access rehabilitation services for people approaching the end of life.

Ambition Four: Care is coordinated I get the right help at the right time from the right people. I have a team around me who know my needs and my plans and work together to help me achieve them. I can always reach someone who will listen and respond at any time of the day or nigh

National Picture:

Fragmented and disjointed care is a source of frustration and anxiety for the dying person and for all those important to them

Carers often testify to the difficulties of multiple professionals and organisations working with little awareness of each other. This lack of coordination causes significant distress.

Poor communication and a failure to share information about the dying person is a recurrent failing when care is not good enough.

We have to find a way to provide the social care that people need regardless of financial circumstances.

We know that 24/7 expert palliative and end of life care services need to be available and that their availability around the clock is key to building a system of high quality care.

We know that access and trust in the services available in the community are crucial to sustaining care outside of hospitals – most people’s preferred

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environment


There is 24 hour access to specialist symptom control advice and support for those nearing end of life through Marie Curie, St Raphael’s Hospice and the Royal Marsden Sutton Community Health Service.

The hospital specialist palliative care team at Epsom and St Helier provides 24/7 service to inpatients.

Befriending service is available through the hospice

Gaps:

There is a lack of care coordination across Sutton with currently no single point of access and/or hub for information and advice; assessment, care coordination, information exchange, care planning and service delivery.

Fragmented services also means that data and/or information is held in silos, leading to poor oversight and understanding of services, workforce development and educational requirements.

Specialist palliative care team in hospital are not directly funded for 2017/18 as Sutton CCG has Payment by Result contract (previously indirectly funded through block contract agreement).

Providers have reported that communication is a big issue. Planning, communication and sharing of information should be a key priority.

Information is not routinely shared with the voluntary sector

Do Not Attempt Resuscitation (DNAR) status does not follow when patients are discharged home.

Lack of funding for End of Life Care training for volunteers and/or staff

Integration with social care requires improvement.

There is no locally agreed information pack on end of life care for individuals, their family and carers.

Everyone matters – we need to recognise cultural differences

Ambition Five: All staff are prepared to care Wherever I am, health and care staff bring empathy, skills and expertise and give me competent, confident and compassionate care.

National Picture:

Caring for the dying, looking after the bodies of the dead and supporting people facing loss and grief, before and after death, is difficult and distressing. It challenges the resilience and fortitude of those working in end of life care.

Most health and care staff look after people who are nearing death, so if care is to improve they must be trained in those aspects of end of life care that are appropriate to their role

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Too often the employers of health and care professionals have not acted systematically to help their staff avoid the debilitating effects of burn out, avoidance or helplessness resulting from lack of education, training and support.

Staff can only provide compassionate care when they are cared for themselves and must be supported to sustain their compassion so that they can remain resilient, and use their empathy and apply their professional values every time

We know that good pain and symptom management benefits both the dying and those who spend time with them.

If we are to make deaths at home more achievable, we know that we have to do more to ensure sufficient support for those paid carers who may be vital to sustaining the viability of care at home


There is a strong and clearly defined clinical leadership for palliative and end of life care across agencies involved in the delivery of End of Life Care. The new strategy will explore future opportunities for joint working and accountability across agencies.

Gaps:

Lack of coordination of end of life care service delivery and education across Sutton.

No coordinated end of life care education framework in place for all Sutton.

We need individual held care plan that is flexible to meet the needs of the population groups.

No single point of referral or key worker approach to the delivery of end of life

care in Sutton.

Ambition Six: Each community is prepared to help I live in a community where everybody recognises that we all have a role to play in supporting each other in times of crisis and loss. People are ready, willing and confident to have conversations about living and dying well and to support each other in emotional and practical ways.

National Picture:

Dying, death and bereavement are not primarily health and social care events; they affect every aspect of people’s lives and experience.

Dying and bereaved people often feel disconnected or isolated from their communities and networks of support.

Despite some real progress and the growing reach and impact of the Dying Matters Coalition there remains a continued need to address and dissolve the taboo that many people feel when it comes to talking about dying, death and bereavement and facing up to their own mortality and that of the people important to them

There are ways to foster and support compassionate communities and to put end

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of life care at the heart of community health and wellbeing.

Supporting and working with communities, to develop their capacity to play a significant role in supporting individuals and those important to them, at the end of life and through bereavement, can help achieve the best outcomes for those with pressing needs

Volunteers are a significant resource in creating good end of life care and must be valued more highly and used more effectively


There is annual promotion of Dying Matters week in hospital and hospice

GPs via key performance indicators are encouraged to identify and offer advanced care plans

What to expect booklets are available from GP Practice, palliative care/specialist palliative care teams and commissioners.

There is evidence of multiagency working and good engagement among acute and community service providers.

St Raphael Hospice provides advice and supports the voluntary sector including carers

Gaps:

Lack of Sutton wide collaborative working and approach to the Dying Matters campaign week

Community engagement is not prioritised

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Acknowledgements

We would like to thanks colleagues who have helped to develop this strategy and also

professionals, volunteers and groups who are committed to delivering quality end of life

care for the people of Sutton.

Mary Hopper Director of Quality, NHS Sutton Clinical Commissioning Group

Alison Navarro Chief Executive, Sutton Centre for the Voluntary Sector (SCVS)

Lynne Brown Team Manager Hospital Pathway /START, London Borough of Sutton

Clare Ridsdill- Smith Head of Public Health Integration, London Borough of Sutton

Anna-Marie Stevens Nurse Consultant, The Royal Marsden NHS Foundation Trust

Gail Linehan Director of Care Services and Strategy Development, St Raphael’s Hospice

Caroline Betts Clinical Services Manager, St Raphael's Hospice

Caroline Pollington Care Home Vanguard Nurse Clinical Lead, NHS Sutton Clinical Commissioning Group

Christine Harger Quality Assurance Manager (Care Homes and Older People), NHS Sutton Clinical Commissioning Group

Clare O'Sullivan Clinical Lead for End of Life Care, NHS Sutton Clinical Commissioning Group

Debbie Lindon-Taylor Clinical Nurse Director, The Royal Marsden NHS Foundation Trust

Jane Begley Assistant Clinical Support Manager, 111 provider, SLDUC Ltd, The Vocare Group

Jane Pettifer Head of Continuing Care, NHS Sutton Clinical Commissioning Group

Lynne MacInnes Clinical Nurse Manager, SWL Nursing Service, Marie Curie

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Rachael Chapman Divisional Business and Service Development Manager, Marie Curie

Sally Middleton Specialty Doctor in Palliative Medicine, SAS Tutor, Epsom and St Helier University Hospitals NHS Trust

Victoria Wright Operations Director, Age Uk

Rachael MacLeod Chief Executive, Sutton Carers Centre (Carers Trust Network Partner)

Alison Navarro Chief Executive, Sutton Centre for the Voluntary Sector (SCVS)

Corrine Campion Clinical Nurse Specialist, The Royal Marsden NHS Foundation Trust

Lucy McCulloch Evaluation Lead Care Home Vanguard, NHS Sutton Clinical Commissioning Group

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References and Other Useful Sources of Information

Documents which have been referenced /referred to in this strategy document

General Medical Council (GMC) (2010). Treatment and care towards the end of life: good practice in decision making. London: GMC. Available at: www.gmc-uk.org/static/documents/content/Treatment_and_care_ towards_the_end_of_life_-_English_0914.pdf (accessed on 6 August 2017).

Department of Health (2008). End of Life Care Strategy: Promoting high quality care for all adults at the end of life. London: HMSO. Available at: https://www.gov.uk/ government/publications/end-of-life-care-strategy-promoting-high-quality-carefor-adults-at-the-end-of-their-life (accessed on 6 August 2017).

NICE National Institute for Health and Care Excellence (NICE) (2011 modified 2013). Quality standard for end of life care for adults. NICE Quality Standard 13. London: NICE. Available at: www.nice.org.uk/guidance/qs13 (accessed on 6 August 2017).

NHS England (2014). Actions for End of Life Care: 2014-16. London: NHS England. Available at: www.england.nhs.uk/wp-content/uploads/2014/11/actions-eolc.pdf (accessed on 6 August 2017).

Department of Health (2015). One Chance to Get it Right: One Year On Report: An overview of progress on commitments made in Once Chance to Get it Right: the system wide response to the Independent Review of the Liverpool Care Pathway. London: Department of Health 2015. Available at: www.gov.uk/government/uploads/system/uploads/attachment_data/file/450391/One_chance_-_one_year_on_acc.pdf (accessed on 6 August 2017)

The Choice in End of Life Care Programme Board (2015). What’s important to me. A Review of Choice in End of Life Care. The Choice in End of Life Care Programme Board: London. Available at: www.gov.uk/government/publications/choice-in-end-oflife-care (accessed on 6 August 2017)

The National Palliative and End of Life Care Partnership. 2015. Ambitions for Palliative and End of Life Care: A national framework for local action 2015-2020.Available at: http://endoflifecareambitions.org.uk/wp-content/uploads/2015/09/Ambitions-for-Palliative-and-End-of-Life-Care.pdf (accessed on 6 August 2017)

Office of National Statistics (2015). National Survey of Bereaved People (VOICES), 2014. London: ONS. Available at: www.ons.gov.uk/ons/dcp171778_409870.pdf (accessed on 6 August 2017)

The Sutton Joint Strategic Needs Assessment (JSNA). Available at: https://data.sutton.gov.uk/sutton_jsna/ (accessed on 6 August 2017) National Institute for Health and Care Excellence Guidance (2016) End of life care for infants, children and young people with life limiting conditions: planning and management. London: NICE. Available at: https://www.nice.org.uk/guidance/ng61/evidence/appendix-l-pdf-2728081265 (accessed on 28 August 2017)

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NICE Supporting People with Dementia and their Carers (2006). London: NICE. Available at at https://www.nice.org.uk/guidance/cg42/resources/supporting-people-with-dementia-and-their-carers-pdf-252703220677 ( accessed on 29 August 2017)

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Report to the Sutton Clinical Commissioning Group Governing Body

Date of Meeting: 6 September 2017

Agenda No: 8 ENCLOSURE: 7 a&b

Title of Document:

CCG Improvement and Assessment

Framework Rating for 2016/17

Purpose of Report:

To Note

Report Authors:

Sean Morgan, Director of Performance

and Delivery

Lead Director:


and Delivery

Executive Summary:

The report provides a summary of the NHS England Improvement and Assessment

Framework rating for Sutton CCG for the year 2016/17.

Sutton was rated ‘Good’ which is an improvement on the previous year.

The rating is based on 60 KPIs across four domains. The report highlights those

areas on which the CCG scored significantly above average and also those areas

where the score was lower than average. For the latter an indication is given on the

issues to focus on this year to improve performance. The report highlights some

risks relating to performance in 2017/18 which may impact on this year’s rating.

Alongside the overall CCG rating all CCGs were also assessed against three of the

six national clinical priorities, the ratings for Sutton were:

Cancer - Good

Dementia - Outstanding

Mental health - Requires improvement

The report includes a description of the factors resulting in these ratings and gives a

steer on the areas requiring further improvement.

Recommendation:

The Governing Body is asked to:

NOTE the annual CCG ratings and agree the areas of focus for improvement

plans for the current year as suggested


There is no direct impact.

Some of the issues which need improvement may require additional investment to

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support improved performance, although the intention initially is that an improvement

plan for each area would work to existing budgets.


Much of the data used in the IAF ratings is aggregate performance data and is

therefore not amenable to a specific equality impact assessment. To the extent

that this is possible for individual issues an assessment will be undertaken as part

of the improvement plans.

Equality / Human Rights / Privacy impact analysis

Not directly applicable.

Risk Mitigating actions

The CCG has limited resources to take

on additional work beyond the existing

agreed priorities, and therefore may not

be in a position to resource all the work

required to improve performance.

Some of the factors impacting on the

national KPIs may be either largely

outside the influence of the CCG or may

be amenable to influence only over the

long term and therefore it may not be

possible to effect any significant

improvement during 2017/18.

NHS England may change the IAF

rating methodology.

Any area requiring significant additional

resource to effect improvement will be

highlighted to Management Team and

Executive Committee.

Partnership working including through

the Health and Well Being Board and

Local Transformation Board.

Liaison with NHS England during the

year to gain early insight into any likely

change to the methodology.

Governance and reporting

(list committees, groups, other bodies in your CCG or other CCGs that have

discussed the paper)

Committee name Date discussed Outcome

Executive Committee 09/08/17

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1. Background

NHS England published the annual ratings for CCGs on 21 July 2017, Sutton’s

overall rating was ‘Good’, which is an improvement of one category from the

‘Requires Improvement’ rating for the previous year. The categories are:

outstanding, good, requires improvement or inadequate.

The overall rating was derived from a calculation as follows:

Quality of leadership: 25%

Finance management: 25% (the assessment was on financial outturn only,

not plan)

The remaining performance and outcome measures: 50%

Alongside the overall CCG rating all CCGs were also assessed against three of

the six national clinical priorities, the ratings for Sutton were:

Cancer - Good



Assessments for diabetes, learning disabilities and maternity (the other three

national clinical priorities) are expected to follow later in the

year.

The report includes a description of the factors resulting in these ratings and

gives a steer on the areas requiring further improvement.

2. IAF Methodology

2.1 Summary of the Assessment

For 2016/17 NHS England introduced a new CCG Improvement and

Assessment Framework. The new framework is intended to align with NHS

England’s Mandate from the Department of Health and with the planning

guidance

NHS England noted in its formal letter confirming the 2016/17 rating that the

CCG had been rated as ‘Green’ for leadership, and that there was a broadly

strong set of stakeholder responses in the 2017 CCG 360° Stakeholder Survey.

NHS England noted that “the CCG responded well to NHS England feedback,

CCG Improvement and Assessment Framework (IAF) Rating for 2016/17

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strengthening the leadership team to provide more robust provider activity and

performance monitoring and intervention.”

However, NHS England highlighted three issues from the 360° Stakeholder

Survey where the score declined notably from the previous year:

To what extent, if at all, would you say your CCG/CCG has contributed to

wider discussions through local groups?

Overall, to what extent, if at all, do you feel you have been engaged by the

CCG over the past 12 months?

The leadership of the CCG has the necessary blend of skills and experience

A recommendation is that the CCG’s plans for public engagement be reviewed

and well publicized.

NHS England confirmed an overall finance rating for Sutton CCG of ‘Green’, with

the CCG successfully delivering its planned £1.2m surplus, and QIPP delivery of

£6.2m (96% of plan).

NHS England stated that “the system must be commended for the very strong

performance across 2016/17” on the 95% A&E standard. Also “the RTT and

Cancer 2 week wait standards have been met consistently every month for your

patients”.

NHS England highlighted IAPT recovery as an area of concern (the recovery

rate was 46.67% for the rolling Quarter Ending March 2017). However, it should

be noted that performance since April has improved considerably and the 50%

target is now being achieved.

2.2 IAF Indicators

The IAF framework includes 60 indicators. All indicators were given a score of 0

(low) to 2 (high). Comparative performance was made either against a national

standard for those indicators where there is one, or otherwise against the England

mean value.

The indicators are presented by theme (better health, better care, sustainability,

well-led) but separate ratings are not calculated for these themes.

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Of the 60 KPIs assessed the CCG performance was in the top quartile of CCGs

nationally for 11 indicators and in the lowest quartile for 6 indicators, which are set

out below with the time period covered by the dataset shown in parentheses:

Key Areas of Strength -

Performance in Top Quartile

Key Areas of Challenge -

Performance in Lowest Quartile

101a - Maternal smoking at delivery

(2016-17 Q3)

104a - Injuries from falls in people aged

65 and over (2016-17 Q3)

122b – Cancer 62 days of referral to

treatment (2016-17 Q4)

108a – Quality of life for carers (March

2016)

122d – Cancer patient experience

(2015)

125b – Experience of maternity services

(2015)

123e – Mental Health out-of-area

placements (2016-17 Q4)

125c – Choices in maternity services

(2015)

124a – Learning Disability reliance on

specialist inpatient care (2016-17 Q4)

127f – Hospital bed use following

emergency admission (2016-17 Q3)

124b – Learning Disability annual health

check (2015-16)

128d – Primary care workforce

(September 2016)

125a – Neonatal mortality and stillbirths

(2015)

127a – Delivery of an integrated urgent

care service (January 2017)

127c - A&E admission, transfer and

discharge within 4 hours (March 2017)

127e - Delayed transfers of care per

100,000 population (March 2017)

129a – 18 week RTT (March 2017)

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3. Issues Highlighted from the Ratings KPIs

This section highlights the areas where Sutton scored well and also where

performance was scored as low (i.e. a 0 out of 2). Where performance was in the

lowest quartile it also sets out what improvements would be needed to improve

the score. Finally, it considers any risks or concerns about the 2017/18

assessment, including KPIs where performance was close to the lowest quartile or

is at risk of being scored in the bottom category for this year.

KPIs where Sutton scores well above and well below national average

U P P E R Q U A R T I L E P E R F O R M A N C E

Maternal smoking at delivery - 6.6%

People with urgent GP referral having 1st definitive treatment for cancer within 62 days - 87%

(above the 85% standard) Cancer patient experience - score of 8.9 was the second highest score in London

MH out-of-area placements LD reliance on inpatient care (N.B. assessed across SWL)

LD annual health checks - 46.9%

Neonatal mortality and stillbirths per 1000 births - 4.7 (the 3rd lowest rate in London) Delivery of an integrated urgent care service A&E patients admitted transferred or discharged within 4 hours - 95.5% (the only CCG in London

to have achieved the 95% standard) Delayed transfers of care per 100,000 population - 4.4 (the 4th lowest rate in London) 18 weeks RTT - 93.3% (above the 92% national standard)

L O W E S T Q U A R T I L E P E R F O R M A N C E

Injuries from falls in people aged 65 and over per 100,000 population

Falls are the largest cause of emergency hospital admissions for older people. The risk

of falls increases with age and the risk is also increased for older people in residential

care. This indicator is a proxy for adherence to the NICE clinical standard for post fall

assessment and prevention and of how the NHS, public health and social care are

working together to reduce the risk of falls. Sutton had the highest rate of injuries from

falls for people aged >65 in London and the 12st highest in England. Performance

against this indicator is dependent on quality of coding at acute trusts. CCGs with large

activity flows to specific acute trusts show similar performance, including ourselves and

Merton CCG.

Quality of life for carers

This indicator is based on responses to a question in the GP Patient Survey, asking

carers to rate their health state at the time. The score was the equal second lowest in

London

Experience of maternity services

This is a measure based on responses to questions in the 2015 CQC national

maternity survey to look at reported user experience across the maternity pathway,

and with regards to choice, information, confidence in staff and clinical care. The

indicator is a composite value, calculated as the average of six survey questions.

Sutton’s composite score was the lowest in South London, and 12th lowest in the

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country. Epsom & St. Helier survey responses for these questions were average or

slightly better, and at present the CCG doesn’t have the raw data to analyse why the

CCG responses were so poor (this data has been requested from NHS England).

Choices of maternity services

This is a second measure from the 2015 national maternity survey, specifically looking

at choices offered to mothers throughout the care pathway, again an average of

responses to six questions. This was the 3rd lowest score in London. The survey

responses for Epsom and St Helier for the six questions were above average other

than for the question “thinking about your care during labour were you involved enough

in decisions about your care”, although even on this question the responses were not

amongst the lowest. As with the overall patient experience KPI, with the information

we have it isn’t possible to analyse where the Sutton mothers responding to this survey

had their baby.

Hospital bed use following emergency admission

The indicator calculates the total bed days following emergency admission per 1000

population, adjusted for age, gender and need. The presumption for the use of this

indicator is that areas with lower rates of emergency bed days are likely to have

services in place which support people to remain independent and support timely

discharge if they do have to be admitted to hospital. The rate was the 5th highest in

London Primary care workforce

This indicator is based on the number of GPs and practice nurses (full-time equivalent)

per 1000 weighted patients. This is partly a London-wide issue, over half of the London

CCGs were in the national bottom quartile

Looking Ahead – Opportunities and Risks in 2017/18 O P P O R T U N I T I E S ?

Injuries from falls in people aged >65

A review of Sutton's falls services against best practice was undertaken last year by a

specialist project manager. The conclusion was that Sutton currently commissions all

the elements required for an optimal falls service however this was not being delivered

in line with the service specification for Community Services. The issue was addressed

through the contract management route to ensure that patients receive the full benefit

of the CCGs commissioned service, it is now timely to review whether the outcome

have improved as intended, or whether further improvements can be made.

We are working with falls prevention champions in care homes, which should reduce

falls causing harm in those settings.

Quality of life for carers

The CCG has not had a specific lead on carers support for some time, and

opportunities for a review of the service offer for carers will form part of the Sutton

Health and Care work as well as through the BCF.

Experience and Choices in Maternity Services

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In addition to the monthly national Friends and Family Test E&SH uses PALS and

Picker Maternity Survey and the Maternity Voices Partnership (previously MSLC)

undertake maternity experience surveys and walk the patch to receive on-going

feedback to inform service development.

The SWL Local Maternity System is one of the seven Maternity Choice and

Personalisation Pioneers involved in the development and testing of Personal

Maternity Care Budgets and improving choice and personalisation in maternity

services across SW London

E&SH offers mothers choice of obstetric-led labour ward, birth centre or home birth on

both sites, with individualised birth planning with consultant midwives and home birth

lead as required

Hospital bed use following emergency admission

The BCF programme supports reduced emergency admissions and length of stay

The business case for Sutton and Health and Care is focused on reduced emergency

admissions and lower LoS through better integrated care, a more joined-up reactive

care model and a new service model for proactive care.

Primary care workforce

There are gaps in the primary care workforce both in terms of GPs and nurses. A

significant number of GPs and nurses are at or approaching retirement age, leaving a

risk that Sutton will experience primary care staff shortages. A number of actions are

being taking including:

Membership of the SWL wide workforce initiative

Monitoring and review at Primary Care Programme Board

Inclusion of workforce as priority in the Primary care strategy

There are some KPIs on which Sutton scored in the middle band and where there is an

opportunity to aim to move to the highest band performance:

Diabetes patients who achieved all of the NICE-recommended treatment targets

The performance of 40.2% was just below the threshold for the top rating.

There is considerable variation across GP practices, which the Diabetes work

programme is addressing

Anti-microbial resistance: appropriate prescribing of antibiotics in primary care

Sutton was one of just 6 CCGs in London not in the top banding.

Mental health – crisis care and liaison psychiatry

The reported compliance for Q4 may have under-reported the true level of

performance, see below (although this specific national return has been dis-continued).

Dementia care planning and post-diagnostic support

The performance of 80.1% was just below the threshold for the top rating. This relates

to the QOF indicator on patients having a face-to-face review of their care plan at least

every 12 months.

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R I S K S O R C O N C E R N S ?

There are a number of KPIs where there is a risk of either Sutton falling behind much of the

country and scoring a lower rating for 2017/18, or where the thresholds may well

increase and a broadly static performance may result in a lower score.

Diabetes patients diagnosed less than a year attending a structured education course

The data period included was 2014, and Sutton’s performance of 4.9% was above the

threshold for the lowest score (which was c. 1.5%), but that is likely to increase in

future.

This is being mitigated through the Diabetes work plan

Utilisation of the NHS e-Referral system

Sutton’s performance of 16.9% was relatively low, but was not scored in the lowest

category, given the 80% target for this year it is likely that a step up in performance will

be needed to continue to score in the middle banding.

There is SWL-wide work underway, and Epsom and St Helier has an implementation

group with commissioner input. This work will require significant additional focus to

deliver the step up to the national target expected.

IAPT Recovery

The performance of 46% was just fractionally above the bottom score threshold.

Performance in 2017/18 to date has been much improved and above the 50%

standard, which needs to be maintained alongside the increase in access which is

nationally mandated.

LD – annual health check

Sutton’s performance of 46.9% was enough to score in the top band, but was close to

the threshold (c. 44%) and it is likely that performance will need to improve to maintain

this score.

18 week RTT

The threshold for the highest banding was c. 93% (i.e. above the 92% national

standard) and whilst Sutton achieved this level of performance in 2016/17 there are

considerable risks to this being maintained this year.

This issue comes under the Planned Care Delivery Board with respect to Epsom and

St Helier, although there are risks relating to other providers.

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3.2 Assessments for Three Clinical Priorities

Dementia

Sutton was rated ‘Outstanding’, and whilst performance on the two KPIs was

positive the rating methodology worked favourably for Sutton’s combination of

performance, neither KPI was actually scored in the top banding in the overall

IAF assessment, and the weighting was greater for higher performance on the

care planning and post diagnostic support KPI. Some CCGs are doing better on

both KPIs and therefore Sutton should aim to improve further.

Cancer

Sutton was rated ‘Good’, primarily due to the very positive score on the cancer

patient experience survey, the other three KPIs were close to the national

average. Both the diagnosis of cancer at an early stage and one-year survival

KPIs are on an upward trajectory.

9.2%

↑3.4%

↓

2015 08 2017 03

Ou

tsta

nd

ing

De

me

nti

a

126a

126b

↑

↓Dementia post

diagnostic support

Dementia

diagnosis rate68.3%

6 8 .5% 1

59 .3 %

8 0 .1% 1

80.1%

76 .8 % 2014-15 2015-16

122b

122c

Ca

nc

er

122d

↓ 2015 2015

Go

od

8 .9 1 ↑8.9 0.0%

↑

↓

↑

↓

20.5%

One-year survival

from all cancers

Cancer patient

experience

8 .9

Cancer 62 days of

referral to

treatment (based on

16-17 Q1 to Q4)

20.0%

↓↑8.0%

122a

13-14 Q1 16-17 Q4

2012

1999 2014

2015

6 9 .8 %

8 9 .7%

70 .6 % 1

70.6%

6 2 .6 %

52 .0 % 1

52.0%

3 1.5%

Cancers

diagnosed at early

stage

1

87.0%

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Mental Health

Sutton was rated ‘Requires Improvement’.

Although the IAPT recovery rate is marked as ‘red’ in the national clinical priority

dashboard in fact the performance was scored in the middle banding in the

overall IAF rating.

The Children and Young People’s score of 45% was mainly due to the CCG’s

annual financial return showing that the CAMHS allocation of £404k had not been

fully invested, as the return declared growth in spend of £330k. This was based

on a new breakdown of the block contract values by service line for both ‘16/17

and ‘15/16, which had an element of estimation to it. This return will need to be

reviewed with this in mind for ‘1718.

The Crisis Resolution and Liaison Psychiatry score of 75% could have been

higher (and would have been if based on the self-assessment returns made in

previous quarters), as the Q4 return stated that the CCG was ‘not compliant’ in

two areas where in fact with hindsight a more positive assessment might have

been made. A more robust governance process for all national returns is being

put into effect across the CCG.

123c

123d

123e

IAPT recovery rate 51.5% 1

46.0%

3 6 .4 %

71.2%

EIP 2 week referral

MH - CYP mental

health

MH - Crisis care

and liaison

2017 03

16-17 Q1 16-17 Q4

16-17 Q1 16-17 Q4

8 5.0 %

3 5.0 %

8 5.0 %

2015 03 2017 01

2016 11

Me

nta

l H

ea

lth

12

3a

12

3b

6 8 .6 %

0.0%

↑↓

Req

uir

es i

mp

rovem

en

t

1

45.0%

75.0%

↓

71.2 % 1

↓

MH - OAP

↑↓

15.1%

2.6%

↑

16-17 Q1 16-17 Q4

No ca lculation poss ible

due to lack of z-scores

75.0 %

10 0 % 1

1

100%

10 0 %





↑↓50.0%

10.0%

↑

from the KLOE tab

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4. Conclusion

The CCG had a positive year in 2016/17 which was reflected in the annual IAF

assessment and in NHS England’s feedback. This is down to the successful

work of the CCG’s clinical commissioners and staff and the performance of our

local providers.

The report highlights the areas which require attention to improve performance

and also notes the risks with respect to the 2017/18 assessment. The Executive

Committee is asked to note the annual assessment and the priority areas

highlighted. Future Performance and Quality Reports will track progress on the

IAF KPIs and the associated actions.

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Appendix A IAF Scorecard 2016/17

NHS Sutton CCG

Better Health Period CCG Peers England Trend Better Care Period CCG Peers England Trend

R 101a n/d Maternal smoking at delivery 16-17 Q3 6.6% 4/11 45/209 R 121a n/a High quality care - acute 16-17 Q4 56 6/11 134/209

R 102a n/d % 10-11 classified overweight /obese12/13 to 14/15 32.3% 6/11 92/209 R 121b n/a High quality care - primary care16-17 Q4 64 3/11 116/209

R 103a n/d Patients who achieved NICE targets2015-16 40.2% 6/11 79/209 R 121c n/a High quality care - adult social care16-17 Q4 61 6/11 84/209

R 103b n/d Attendance of structured education course2014 4.9% 5/11 105/209 R 122a n/d Cancers diagnosed at early stage2015 52.0% 6/11 107/209

R 104a ✘ Injuries from falls in people 65yrs +16-17 Q3 2,790 11/11 199/209 R 122b n/d Cancer 62 days of referral to treatment16-17 Q4 87.0% 5/11 33/209

R 105a n/a Utilisation of the NHS e-referral2017 03 16.9% 10/11 #DIV/0! R 122c n/d One-year survival from all cancers2014 70.6% 6/11 72/209

R 105b n/a Personal health budgets 16-17 Q4 13 3/11 88/209 122d ✔ Cancer patient experience 2015 8.9 1/11 8/209

R 105c n/a % of deaths in hospital 16-17 Q2 48.7% 9/11 97/209 R 123a n/d IAPT recovery rate 2017 01 46.0% 7/11 157/209

105d n/d LTC feeling supported 2016 03 62.9% 8/11 139/209 R 123b ✔ EIP 2 week referral 2017 03 71.2% 7/11 141/209

R 106a n/d Inequality Chronic - ACS 16-17 Q3 988 8/11 123/209 R 123c n/a MH - CYP mental health 16-17 Q4 45% 8/11 132/209

R 106b ✘ Inequality - UCS 16-17 Q3 2,265 9/11 149/209 R 123d n/a MH - Crisis care and liaison 16-17 Q4 75.0% 5/11 86/209

R 107a ✘ AMR: appropriate prescribing2017 02 1.07 7/11 96/209 R 123e n/a MH - OAP 16-17 Q4 100.0% 1/11 1/209

R 107b ✘ AMR: Broad spectrum prescribing2017 02 8.7% 3/11 104/209 R 124a n/d LD - reliance on specialist IP care16-17 Q4 38 2/11 21/209

108a n/a Quality of l ife of carers 2016 03 0.77 11/11 183/209 124b n/d LD - annual health check 2015-16 46.9% 1/11 30/209

Sustainability Period CCG Peers England Trend R 125a n/d Neonatal mortality and stil lbirths2015 4.7 2/11 27/209

R 141a n/a Financial plan 2016 Red 7/11 141/209 125b n/a Experience of maternity services2015 73.4 11/11 198/209

R 141b n/a In-year financial performance16-17 Q4 Green 1/11 141/209 125c n/a Choices in maternity services 2015 61.8 9/11 174/209

R 142a n/a Improvement area: Outcomes 16-17 Q3 ########### 1/11 1/209 R 126a n/a Dementia diagnosis rate 2017 03 68.3% 5/11 95/209

R 142b n/a Improvement area: Expenditure16-17 Q3 ########### 1/11 1/209 126b n/d Dementia post diagnostic support2015-16 80.1% 3/11 65/209

R 143a n/a New models of care 16-17 Q4 Y #VALUE! R 127a n/a Delivery of an integrated urgent care service2017 01 7 1/11 1/209

R 144a n/a Local digital roadmap in place16-17 Q4 Y #VALUE! R 127b n/d Emergency admissions for UCS conditions16-17 Q3 2,806 8/11 154/209

R 144b n/a Digital interactions 16-17 Q4 60.5% 6/11 129/209 R 127c n/d A&E admission, transfer, discharge within 4 hours2017 03 95.5% 1/11 22/209

R 145a n/a SEP in place 2016-17 Y ###### #VALUE! R 127e ✔ Delayed transfers of care per 100,000 population2017 03 4.4 1/11 14/209

Well Led Period CCG Peers England Trend R 127f n/d Hospital bed use following emerg admission16-17 Q3 574.8 8/11 174/209

R 161a n/a STP 2016-17 Green 1/11 1/209 R 128a n/d Management of LTCs 16-17 Q3 880 6/11 101/209

R 162a n/a Probity and corporate governance16-17 Q4 Fully Compliant 1/11 1/209 R 128b n/d Patient experience of GP services2016 03 86.7% 1/11 80/209

R 163a n/a Staff engagement index 2016 3.79 8/11 105/209 R 128c n/a Primary care access 2017 03 0.0% 8/11 115/209

R 163b n/a Progress against WRES 2016 0.18 8/11 190/209 R 128d n/d Primary care workforce 2016 09 0.87 4/11 159/209

R 164a n/a Working relationship effectiveness16-17 68.45 5/11 101/209 R 129a ✔ 18 week RTT 2017 03 93.3% 2/11 47/209

R 165a n/a Quality of CCG leadership 16-17 Q4 Green 1/11 31/209 R 130a n/a 7 DS - achievement of standards2016-17 0.0% 1/11 #N/A

Key R 131a n/a People eligible for standard NHS CHC16-17 Q3 38.8 5/11 123/209

Worst quartile in England Best quartile in England

Interquartile range

Good

from the KLOE tab

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Governing Body



Title of Document:

Performance and Quality Report

Purpose of Report:

For discussion

Report Authors:

Richard Simon, Performance Assurance

Manager


and Delivery

Mary Hopper, Director of Quality

Lead Director:


and Delivery

Mary Hopper, Director of Quality

Executive Summary:

This report is to inform and provide assurance to the Governing Body about the

performance, quality and safety of service provision commissioned by NHS Sutton

CCG.

There has been a significant improvement in the IAPT recovery rate in 2017/18 Q1

and the 50% national target has been achieved in each of the first three months of

the year. The access standard has also been met over Q1, although further

increases in access numbers are required to deliver the trajectory required of all

CCGs by NHS England.

The ED maximum 4-hour wait standard was not achieved in April or May and whilst it

was achieved in June performance has been close to the 95% standard and during

the summer months a step up in performance would normally be expected.

The CCG continues to achieve the referral to treatment maximum 18 week wait

standard (albeit that St. George’s is not submitting national performance data due to

ongoing data quality issues). However, Epsom and St. Helier is not achieving the

standard partly due to consultant sickness absence in a number of specialties.

Recovery plans are in place, although it will take some months for the backlog to be

cleared sufficiently in some specialties for the standard to be met.

The CCG is consistently achieving the maximum 6 week wait for diagnostics

standard.

EN

C 0

8

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of 3

The CCG is consistently achieving the cancer waiting time standards, However,

there was a dip in performance in June on the 62-day maximum wait standard for

urgent GP referral to treatment, with performance fractionally below the standard at

84.8%, with 5 patients waiting beyond the standard out of 33 patients in total, 2 of

which had complex diagnoses.

Epsom and St Helier continues to miss their dementia assessment rate targets and

also the number of VTE assessments. Monitoring of this required improvement is

undertaken through contract arrangements.

The stroke clinical network recently visited the Epsom and St Helier and found the

Trust to be compliant with the required standards.

Some of the Community Service KPIs are not being consistently achieved including

for access times and reporting of outcomes notifications. Some demand and

capacity modelling has been undertaken and us being reviewed by the service.

The format of the report is in development. The intention is to utilise a standard

SWL-wide suite of dashboards for all the main performance standards, incorporating

a pan-SWL commentary. The first draft of this SWL level report is included on pages

31-41 of the attached full report. Alongside this suite of SWL pages we will be

including a high level performance summary for the CCG and the CCG content on

quality and also the performance information relating to community services.


The CCG was rated as ‘Good’ in the 2016/17 annual ratings by NHS England, and

performance on the NHS Constitution standards remains broadly satisfactory.

However, there are risks relating to performance on the A&E 4-hour maximum wait

standard looking ahead as the current performance is only just over the 95%

standard, and performance on the 18-week maximum wait from referral to treatment

standard is also only just over target.

Recommendation:


REVIEW the Performance and Quality Report


Executive Committee meeting on 23 August


There is no direct impact.

Some of the issues which need improvement may require additional investment to

support improved performance, although there are no specific recommendations for

investment beyond existing budgets at this point in time.

EN

C 0

8

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of 3


The CCG is committed to monitoring the compliance with the Equality duty of the

providers from whom we commission services. This is done through the quality and

contracting process.

The performance and quality data used in the report is aggregate data and

commissioners do not routinely receive patient level data. These datasets are often

therefore not amenable to a specific equality impact assessment. To the extent that

this is possible for individual issues an assessment will be undertaken as part of the

root cause analysis process and in the production of improvement plans.


The performance and quality data used in the report is almost all aggregate data and

commissioners do not routinely receive patient level data, and any individual level

data (e.g. on healthcare associated infections) is anonymised.

Communication Plan:

N/A

EN

C 0

8

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PERFORMANCE AND QUALITY REPORT

21 August 2017

1

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2

Table of Contents

Section 1: Introduction

Section 2: CCG Performance Highlight Report

Section 3: Acute, Community, Mental Health Trust , IUC & LAS Performance

Section 4: SWL Performance

Section 5: Quality Premium

Appendix 1: Month 3 CCG NHS Constitution Standards Appendix 2: Month 2 Sutton Community Health Services performance dashboard

3

Slide No.

4-5

6-30

31-41

42

43-44

47-50 Appendix 3: Month 3 SWL & St Georges Mental Health Trust performance dashboard 45-46

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1. Introduction

This report is to inform and provide assurance to the Governing Body on the the performance, quality and safety of service provision commissioned by NHS Sutton CCG. Performance is generally reported up to Month 3 (June 2017) unless otherwise stated.

This report has been reviewed and updated to provide a more integrated view of performance and quality across Sutton CCG (section 2) and at each of the main providers from whom Sutton CCG commissions services (section 3). Each section includes an over view of:

• Constitutional Performance standards

• Quality Standards

The report includes an assessment of the current level of performance for key standards and other measures by exception i.e. where standards are currently not being achieved. The report provides a summary of the issues identified and the actions being taken to address these.

3

Key Performance & Quality Messages:

A&E 4 hour maximum wait has been achieved in the year to date, although emergency pressures have been

significant and performance has remained close to the 95% standard.

Performance against referral to treatment time (RTT) target continues to be achieved at aggregate level.

Sutton CCG has met 6 of the 8 CWT Standards for June 2017/18, including the 14 day standard for first

appointment, but not the 62-day standard for first treatment following urgent GP referral.

The Improving Access to Psychological Therapies National recovery rate has been consistently met since April

2017 and reached 60.4% at Month 3.

e-RS utilisation remains significantly below the national average (54%) with current performance for July static at

17%, and clearly the 80% target for the end of Q2 will not be acheived. This now requires greater prioritisation

within the CCG and GP practices.

Healthcare Acquired Infection rate is within the threshold for C. Difficile and there have been no cases of MRSA

bloodstream infections for Sutton CCG patients.

Dementia diagnosis rate has also continued to exceed the national standard in Q1, at 73.6% in June.

Issues that have been discussed at the regular quality meetings with providers are outlined to highlight the level of

challenge and scrutiny that occurs through these discussions with information on how any themes or trends are

being identified and associated actions taken.

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2. CCG Performance Highlight Report This section of the report provides a highlight report on the current performance of key performance and quality indicators which are used to assess

the CCG against NHS Constitution and local standards. Full details for all standards are included in appendix 1.

4

Performance Standards

Performance

Indicator

Period Target Current

Performance

Previous

Period

Trend (2016/17 – 2017/18) Comment Action

Referral to

Treatment (RTT)

Patients on

non-emergency

pathways wait

no more than 18

weeks Jun-17 92% 92.0% 92.9%

Sutton CCG achieved the incomplete standard in June with an

outcome of 92.05%. However, it should be noted this figure

does not include data from St Georges who ceased reporting of

RTT data in June in order to improve data quality and accuracy

of the PTL.

Performance for CCG patients was not achieved at Epsom & St

Helier with an outcome of 91.8%, down from 92.8% in May.

Actions are in place

within Epsom and St

Helier, these are

outlined in the provider

section of this report. CCG

Responsible

Lead: Sean

Morgan

52 week

breaches

Referral to

treatment (RTT)

incomplete

pathways

greater than 52

weeks

Jun -17 0 3 2

Sutton CCG had three patients waiting over 52 weeks in June,

one each at Guy’s & St. Thomas’, Surrey & Sussex and King’s

College Hospital.

The patient at Guy’s & St. Thomas’ was under Dermatology but

the Trust reported this referral was received from Epsom & St.

Helier at week 53. Surgery for this patient is planned for

10/08/17 and an assessment for clinical harm has taken place,

with none found.

Surrey and Sussex Healthcare Trust reported that the General

Surgery patient who breached 52 weeks in June subsequently

had their pathway stopped in July. Additionally the Trust

explained that this was a complex pathway, involving multiple

diagnostics and shared care between Gastroenterologists and

Colorectal Surgeons.

The 52 week breach at King’s in June was a patient under T&O.

The patient was admitted and treated 19/07/17 having had a

TCI cancelled 30/06/17 due to the Surgeon being on leave. The

trust reported that the patient declined a TCI offered for

16/06/17.

CCG

Responsible

Lead: Sean

Morgan

Diagnostic

waits

Patients waiting

less than 6

weeks Jun-17 99.0% 99.6% 99.4%

The CCG achieved the 6 week waits diagnostic standard, with

performance of 99.6% in June, up from 99.42 % in May (14

breaches out of 3,544 procedures).

CCG

Responsible

Lead: Sean

Morgan

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2. CCG Performance Highlight Report (contd.)

5


Performance

Indicator


Performance

Previous

Period

Trend (2016/17 – 2017/18)

Comment Action

Dementia diagnosis

rate

Jun-17 67% 73.6% 73.0%

Performance is now consistently

achieving the target

CCG Responsible

Lead: Corinna White

62-day cancer

waiting standard

From urgent GP

referral for suspected

cancer to first

treatment Jun-17 85% 84.8%

91.1%

Sutton CCG has met 6 of the 8 CWT

Standards for June (M3) 2017/18.

The CCG did not achieve 31 day

subsequent surgery and 62 day GP

urgent

62 day GP urgent: The CCG did not

achieve the standard with 84.8% due

to 5 breaches out of 33 seen. 5

breaches, 1 at ESTH for delay in work

up, 4 shared between ESTH and

RMH 2x delay in work up 2x complex

diagnostics

31 day subsequent surgery: The CCG

did not achieve the standard with

81.8% due to 2 breaches out of 11

seen. 1 breach was at SGH due to

capacity and 1 breach at RMH due to

capacity.

Patients treated after day 100: There

were three 100+ day patient

breach for Sutton CCG in June

(M3) 2017/18 1 at ESTH for delay in

work up and 2 shared between ESTH

and RMH 1x delay in workup 1x

complex diagnostics

● To address late referrals/ ITTs, SLF are

monitoring trusts’ referrals to the treating trust by

day 38. Weekly calls between trusts to agree

referral/ITT dates are being undertaken and 38

day performance is being monitored on weekly

performance calls with the CSU. Trusts are also

developing reports to show 38 day breach

reasons.

● SWL Trusts have been asked to develop

trajectories to achieve the 38Day ITT to RMH by

23.08.17

● RMH is developing a trajectory to improve

performance on 62 Day pathway for all internal

patients.

● (3TP) 3 trust pathways are being monitored

through SLF and NHSE London are collating

data on 3TP’s

● Head & Neck pathway for SW London is being

reviewed by TCST.

CCG Responsible

Lead: Sarah Raheem

e-RS (electronic

Referral System)

utilisation Jul-17

80%

by end

Q2

17%

(provisional

data)

17%

(provisional

data)

To add

1st Outpatient utilisation date for July

indicates that the CCG maintained

June’s position at 17%. The national

average for England in July was 54%

The figures for June and July are

provisional.

Epsom & St. Helier has an e-RS implementation

group to which the CCG now attends. Further

work to refine a CCG delivery plan for e-RS is

now required, and some external support is

available.

It is clear that the 80% target for the end of Q2

will not be achieved and action to improve

utilisation will require greater prioritisation by the

CCG and GP practices

CCG Responsible

Lead: Sarah Raheem

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3. Acute, Community and Mental Health Provider Performance

3.1 Acute - Epsom and St. Helier University Hospitals NHS Trust

6


Performance

Indicator


Performance

Previous

Period


Access

standards for

A&E

Patients wait no

more than four

hours Jun-17 95% 95.0% 95.7%

ESTH achieved the A&E standard with a

Trust-wide outcome of 95.02% for June,

down slightly from 95.6% in May. The Trust

has achieved the target every month since

February 2017.

July performance at the Trust was 95.2% for

All Types and 95.04% for Type1

attendances.

Individual site level performance at Epsom

was 94.8%. St. Helier site level performance

was 95.5% for All type

There has been a dip in performance in

August, and a targeted piece of in depth

analysis is being undertaken between the

CCG, NELCSU and the Trust to consider

the reasons for this including any

unexpected issues with acuity of patients

with recommendations to be brought to

the A&E Delivery Board.

A task and finish group is being

established to look at the issue of

redirection of patients who could be

navigated to alternative services to A&E,

to ensure that all pathways are being

utilised.

CCG

Responsible

Lead: Clare

Wilson

Referral to

Treatment (RTT)

Patients on

non-emergency

pathways wait

no more than 18

weeks

Jun-17 92% 91.0% 91.5%

ESTH did not meet RTT Incomplete standard

at Trust level in June with an outcome of

91.01% (2,459 breaches for 27,344

incomplete pathways). This is a decline in

performance by 0.50% as compared with

May. This outcome means the Trust did not

meet the Performance Trajectory of 91.40%

for June-17, as was outlined in the operating

plan submission. The total number of Trust

incomplete breaches in June (2,459) was an

increase by 169 from 2,290 in May. This

month on month increase in breaches

spanned across several specialties but was

driven by breaches in ENT, Other, Neurology

, General Surgery, Dermatology and

Gastroenterology.

Over-all the majority of breaches continue to

occur in T&O (441) and Gynaecology (358).

However, whilst T&O saw an improved

performance (up 0.41%) and Gynaecology

saw a worsened performance (down 0.21%),

both specialties saw a month on month

reduction in the number of breaches (-5 in

T&O and -7 in Gynaecology).

The Trust has experienced a variety of

workforce issues impacting on available

capacity across a number of specialties,

which has resulted in a backlog building

up which will take some time to clear.

Theatre allocation has been reviewed

across both sites and an action plan has

been put in place

CCG

Responsible

Lead: Sean

Morgan

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3.1 Acute - Epsom and St. Helier University Hospitals NHS Trust (contd.)

Epsom & St Helier Hospital Trust 18 week RTT (incomplete Pathways) performance by speciality

The table below shows 18 week performance for Epsom and St Helier Trust split by speciality. Figures for June 17 show that the Trust continues to

be below target for Cardiology*, Thoracic Medicine, Geriatric Medicine, ENT, Neurology, General Surgery, Gastroenterology, T&O, Plastic Surgery,

Urology Gynaecology, and Oral Surgery. In June the Trust did not meet the standard in Plastic Surgery which had been met since October 16.

of 208


8


Performance Indicator Period Target Current

Performance

Previous

Period


62-day cancer

waiting standard

From urgent GP

referral for

suspected cancer to

first treatment

Jun-17 85% 85.5% 83.3% The Trust achieved the target in June

CCG Responsible

Lead: Sarah Raheem

Diagnostic waits

Patients waiting less

than 6 weeks Jun-17 99% 99.7% -

The Trust achieved the standard in June.

The standard was not met for Urodynamics and

Cystoscopy, however, there were only 2 breaches for

Urodynamics out of 118 patients waiting.

CCG Responsible

Lead: Sean Morgan

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9

Quality Indicator Period Target Current

Performance

Trend Issue Action Risk

Owner

HSMR (Hospital Standardised

Mortality Ratio): Ratio of the

observed to the expected

number of deaths, multiplied

by 100.

Mar-17 - 78.5

HSMR decreased in

March with the relative risk

ratio significantly below

the national average of

78.5

Medical

director Trust

SHMI (Summary Hospital

Mortality Indicator): Ratio of

the observed to the expected

number of deaths

Q3 16-17 - 0.95

Year to Dec 2016 SHMI

was 0.95, compared to

0.96 for the previous

reporting period (to Sept

2016). Remains within

expectations. The Trust is

30th in the list of 135

Trusts.

Medical

director

Trust

Time spent on stroke unit:

80% of patients spending at

least 90% of their time in the

stoke unit

May-17 80%

83.3%

(Epsom) 63.6% Trust total in May.

The Epsom site continues

to achieve the target

Medical

director

Trust 40.0%

(St. Helier )

Quality Standards

Safe and Effective: Improve patient safety and reduce avoidable harm

Key Messages

Further assurance on Dementia assessment and referral rate are being sought at the September CQRG meeting, as the assessment rate

target is not being achieved

The CCG continues to monitor closely the Trust’s infection prevention and control action plans and has begun work with the Trust to reduce

the incidence of E coli

The data included in this section of the report is taken from the Trust’s June 2017 Integrated Performance Report

There has been a decline in the proportion of inpatient stay that patients spend on a stroke unit. Further assurance has been asked from the

trust on this issue. The Stroke clinical network visited the Trust earlier this year and found the trust to be compliant across all clinical quality

indicators.

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10


Performance


Owner

Risk Assessment Dementia Trust reporting under review

Risk Assessment VTE:

Proportion of patients

assessed on admission for

Venous Thromboembolism

(VTE) risk.

May-17 95%

94.1%

(Total

Admission)

Improvement seen in

May, although

performance still below

target.

Risk assessment is

done using the clinical

risk assessment criteria

described in the national

tool. Ongoing weekly

monitoring by speciality.

Medical

director

Trust

Serious incidents: Serious

incidents requiring

investigation (SIRI) during the

period

Jun-17 - 5 6 incidents were reported in May 17.

Medical

director

Trust

Never Events Jun- 17 Zero

tolerance 1

A wrong site surgery SI

was reported in June.

Medical

director

Trust

Quality Standards


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11


Performance


Owner

MRSA Jun-17 zero

tolerance 0

There were no cases

reported in June.

Medical

director

Trust

C.Diff Jun-17

39 cases

(15.9 per

100,000 bed

days)

2 cases

(9.2 per

100,000 bed

days)

There were 7 cases in

June of which 2

were trust apportioned.

(Year to date 9 trust

apportioned cases). Both

cases highlighted good

staff awareness of

diarrhoea management as

stool samples were

obtained promptly and

ward staff contacted

Infection Control for

advice.

However, in both cases

single room unavailability

meant the patient was not

isolated in a single room

until positive result known.

Both reviews showed

more development is

needed in implementing

robust systems for

delivering pre-meal

hand hygiene and

ensuring doors to single

rooms are kept closed

or a valid reason

documented on the risk

assessment.

Medical

director

Trust

E.Coli Jun-17 -

3 cases

(Trust

apportioned)

23 total cases

The national

requirement to

reduce E.coli blood

stream infection has

been released and

the same strategy

will be used to

reduce MSSA blood

stream infections. A

joint reduction plan

will be agreed

between Epsom & St

Helier Trust, the

CCGs and the

Council

Quality Standards

Infection Prevention and Control

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12

Quality Standards

Maternity


Performance

Trend Issue Action Risk Owner

1:1 care by

a midwife in

labour Jun-17

95% (internal

Trust Target

97.8% (St Helier)

99.5% Trust wide

performance for

May 1:1 care in labour in

line with target and quality

indicator. This includes

babies born before arrival,

which is why the target is

not 100%.

Medical

director Trust

96.2% (Epsom)

C-sections: % of

caesarean

sections

out of total births Jun-17 < 27%

27.2% (St Helier

Trust wide performance

30.5% for June, above

London average for the

month.

Emergency CS 19.2%. Audit of all

emergency CS in Epsom to be

completed in July. Action plan will be

developed in line with key themes

emerging. Fetal monitoring teaching

and case review weekly sessions are

in place

Medical

director Trust

35.3% (Epsom)

Birth centre

births as a % of

total births Jue-17 20%

20.1% (St Helier)

-

19.0% Trust wide

performance for June

and 17.2% for Q1.

There has been a

significant increase at

Epsom which is a great

achievement with one

midwife allocated.

Medical

director Trust

35.3% (Epsom)

PPH : % of

deliveries with

severe post

partum

haemorrhage

(PPH) greater

than

1500 mls

Jun-17 < 3%

3.1% (St Helier)

3.2% Trust wide

performance for June,

above the local average

of 3.19%.

Ongoing PPH work:

● Carbotocin agreed for caesarean

sections

●On-going training in the assessment

of blood loss and weighing of swabs

with PDM drive | Use of instruments

and clinical supervision for Doctors

● Ongoing audit and review of

cases

● Fetal pillow for second stage

caesarean sections

Medical

director Trust

3.2% (Epsom)

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13


Performance


Owner

FFT: Inpatients: Recommended

Score

Jun-17

95%

(Internal

target)

92.2%

The response rate for

inpatients has decreased

in June and is now below

the London average (as of

April 2017).

The Trust have recently re-

introduced the postcard response

option to help improvement in this

area - a review of response

methods has shown a steady

decline in the number of

responses since postcards were

phased out.

Medical

director

Trust

FFT: A&E: Recommend Score Jun-17

95%

(Internal

target)

84.0%

The ‘recommend’ score

for A&E has improved this

month - while still below

Trust target, it is now in-

line with the London

average.

Medical

director

Trust

FFT: Maternity: Recommended

Score

June-17

95%

(Internal

target

98.5%

The response rate for

Maternity (births only) has

decreased by almost 5%

and is now significantly

below the London

average.

This will be an area for focus in

the coming months, working in

partnership with the Maternity

leadership team. It is worth noting

that the "not recommend" score

for Maternity is now

0%.

Medical

director

Trust

Complaints: % complaints responded to within the agreed timescale

June-17 100% 32.0%

Challenges in complaints

response continue,

Progress is being made within the

Divisions with high levels of

engagement and design of the

new process underway which

includes dedicated named

complaints support person for

each Division. For two weeks in

July, the teams delivered higher

than average responses (15 each

week).

Medical

director

Trust

Quality Standards

Caring and responsive: Patient experience

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14

Quality Standards

Well led/Resources: Workforce


Performance


Owner

Vacancies: difference

between the establishment

and the staff In post as a %

of establishment

Jun-17 10% 16.7%

Vacancy rate has reduced by 0.2%

compared to May. This continues the

anticipated gradual reduction in rate

with cost improvement plans and

adjusted staffing targets to meet

service demand.

HR

director

Trust

Sickness : Calculated using

the staff in post (FTE) days

lost due to absence

Jun-17 3.8% 3.64%

June's sickness absence rate is

3.64%. This is a 0.3% decrease on

May and within the 3.8% threshold. At

present for 2017-18 the Trust is on

target to achieve a lower 12 month

rolling rate than 16/17.

HR

director

Trust

Turnover: 12 month average

of leavers against

FTE. (training Doctors are

excluded)

Jun-17 12% 14.9%

Turnover has reduced by 0.2%

compared to May (refreshed).

Directorates with the highest 12

month turnover are Strategy at

23.1%, POD 21.3% and Clinical

Services 19.4%. The lowest is Renal

at 9.3%

HR

director

Trust

Mandatory training (MAST) Jun-17 95% 86.5%

-

The Trust has exceeded the target for

Infection Control at 97.4%, Manual

Handling 97% and Safeguarding

Adults 96.7%. Information

Governance is currently at 24% and

below the incremental target for June.

IG training is now classroom based

only, which will affect the rate

adversely.

HR

director

Trust

of 208

3.1 Acute – St. George’s University Hospital NHS Foundation Trust

15


Performance

Indicator


Performance

Previous

Period


Access

standards for

A&E

Patients wait no

more than four

hours Jun-17 95% 92.2% 89.7%

The Trust performance was 92.17% in June,

up from 89.68% in May for All Types A&E

attendances. This is above the operating

plan target of 92.0% for the month.

July performance was 89.8%, down from

92.17% in June, and the Trust has not

achieved the operating plan target of 93.3%

for the month of July.

At the start of the month there were high

attendances and high volumes of LAS

conveyances with a high volume of Resus

work indicating a high acuity of attendance.

The closure of Dolby ward (24 beds)

continued to place pressure on medical beds,

and allocation of appropriate beds

contributed to breaches.

Surges from 7pm – midnight continued

The second week of the month saw

performance decline markedly, and evening

surges continued with medical admissions

remaining higher than expected for the time

of year.

● The Trust has highlighted in it’s June

exception report a physical capacity

issue, and is undertaking joint

investigation work into ED processes in

the Trust flow programme.

● Initial assessment area has been

expanded with a focus on streaming

patients through the most clinically

appropriate flow (primary care, urgency

care or ambulatory pathway)

● Plans are being developed to increase

medical ambulatory provision (from 6

trolleys & 1 chair to 12 trolleys 15 chairs)

and ED streaming rates (through increase

in Rapid Assessment and Treatment area

and scope).

● Recruitment is in progress to fill

vacancies and there is an upcoming

nurse recruitment programme.

● Weekly “Communications Cell” in place

to review the previous weeks

performance, share lessons learned and

agree actions,

CCG

Responsible

Lead: Clare

Wilson

Referral to

Treatment (RTT)

Patients on

non-emergency

pathways wait

no more than 18

weeks

18 week data currently not being reported by the Trust due to data quality issues. A recovery programme is in

place with governance in place with commissioners and regulators.

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3.1 Acute – St. George’s University Hospital NHS Foundation Trust

16


Performance

Indicator


Performance

Previous

Period


62-day cancer

waiting

standard

From urgent GP

referral for

suspected

cancer to first

treatment

June-17 85% 85.4% 87.5%

The Trust is now consistently achieving the

target

CCG

Responsible

Lead: Sarah

Raheem

Diagnostic

waits

Patients waiting

less than 6

weeks

Jun-17

99% 97.4%

96.7%

Long waits are within Audiology,

Urodynamics and Endoscopy predominantly

at the Queen Mary’s Roehampton site with

the driver in Endoscopy linked to vacancies.

Recovery has been seen within non-obstetric

ultrasound.

Head and Neck – demand and capacity

analysis completed and core session

have been increased.

Urodynamcs – additional clinics to clear

the backlog and provide additional on-

going capacity

Endoscopy - additional capacity

provided through waiting list initiatives.

Recruitment on-going to staff two

additional rooms. Re-centralisation of

management at the QMH site and offering

STG capacity to help recover the position

The expected timescale for recovery of

the target is Sept 17.

CCG

Responsible

Lead: Sean

Morgan

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3.1 Acute – St. George’s University Hospital NHS Foundation Trust (contd.)

17


Performance


Owner

HSMR (Hospital Standardised

Mortality Ratio): Ratio of the

observed to the expected

number of deaths, multiplied

by 100.

May-17 - 81.3 -

Latest HSRM and SHMI

data for the Trust shows

the mortality rate remains

lower than expected for

the Trusts’ casemix when

benchmarked against

national comparators

Medical

director

Trust

SHMI (Summary Hospital

Mortality Indicator): Ratio of

the observed to the expected

number of deaths

May-17 - 0.84 -

Medical

director

Trust

Risk Assessment VTE:

Proportion of patients assessed

on admission for Venous

Thromboembolism (VTE) risk.

May-17 95% 96.2% -

Medical

director

Trust


incidents requiring

investigation (SIRI) during the

period

May-17 - 6 -

Medical

director

Trust

Never Events May-17 Zero

tolerance 0 -

Medical

director

Trust

Quality Standards


Key Messages

Wandsworth CCG continues to be the lead commissioner for St George’s Sutton CCG invited St George’s to attend the July Quality Committee. This provided an opportunity for the CCG to seek assurance on a number of

quality issues in outpatients and work that was being undertaken to address a number of other issues The data included in this section of the report is taken from the Trust’s June 2017 Integrated Performance Report

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18


Performance


Owner

MRSA May-17 Zero

tolerance 0 -

There were zero patients

who acquired an MRSA

Bacteraemia in May, with 2

incidents reported in June.

On review of the 2 MRSA cases

in June, whilst there were no

obvious lapses in care there

was learning for departments

regarding screening and

documentation. The policy for

screening will be updated and a

detailed review of all the MRSA

cases is currently under way.

Medical

director

Trust

C.Diff May-17 31 cases 1 case -

Investigation of the

Clostridium Difficile case

reported has shown no

lapses in care.

Root cause analysis is

undertaken for each case to

ensure that any opportunities

for learning are captured and

appropriate actions taken to

prevent similar avoidable

infections in the future

Medical

director

Trust

E.Coli May-17 - 2 cases -

Medical

director

Trust

Quality Standards

Infection Prevention and Control

Quality Standards

Maternity


Performance

Trend Issue Action Risk Owner

C-sections: % of caesarean sections out of total births May-17 28% 29.1%

-

C-Section-the service is

reviewing the data and

completing an internal

audit of practice and data

validation

Medical

director

Trust

of 208


19


Performance


Owner

FFT: Inpatients: Recommended

Score May-17 Local 97.0% -

The FTT score for

inpatients remain above

local target 97% in May

Medical

director

Trust

FFT: A&E: Recommend Score May-17 Local 83.0% -

The FTT score has

decreased slightly from

85% in April to 83% in

May

The ED management team are

reviewing the results from the FFT

survey for the last quarter to

determine any themes for

improvement.

Review of staffing model to

ensure response nurse available

to support high volume areas and

minimise delays for patients

Medical

director

Trust

FFT: Maternity: Recommended

Score (Deliveries)

May-17 Local 100% -

The FTT score for

inpatients is above local

target however

improvement work to

increase number of

patients responding is

required

Medical

director

Trust


May-17 _ 76% -

Medical

director

Trust

Quality Standards

Caring and responsive: Patient experience

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20

Quality Standards

Well led/Resources: Workforce


Performance


Owner

Vacancies: difference between the establishment and the staff In post as a % of establishment

May-17 10% 17% - Vacancy Rate across all staff

group has increased to 17%

HR

director

Trust

Sickness : Calculated using the staff in post (FTE) days lost due to absence

May-17 3% 3.4% - Sickness has decreased to

3.4%

HR

director

Trust

Turnover: 12 month average of leavers against FTE. (training Doctors are excluded)

May-17 10% 19.1% -

Turnover has remained at

19.1% for all staff groups

Junior doctors are excluded

from the reported figures.

HR

director

Trust

Mandatory training (MAST) May-17 - 87.0% -

MAST figures for May were

recorded at 87% which is an

improvement

HR

director

Trust

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21

3.2 Community – Sutton Community Health Services (Royal Marsden NHS Foundation Trust)


Performance

Indicator

Period Target

/Threshold

Current

Performance

Previous

Period

Trend (2016/17 – 2017/18)

To be included in future reports

Comment Action

Number of routine

therapy referrals

offered an

assessment within

30 working days of

acceptance May-17 75.0% 30.2% 39.7% -

Children's Services:

Reduced staff capacity due to staff sickness, maternity

leave and partial cover is impacting on availability of

appointments.

● Average waits are monitored by

RMSC, while the 30 day target is not

being met the average waiting time for

1st appointment is better than 18

weeks,

● 0.5 WTE of OT Health Maternity

leave and 2.0 WTE Speech and

Language Therapy (SALT) maternity

cover was recruited in May

● Demand and capacity modelling

exercise on-going. RMCS are currently

reviewing the first cut modelling which

has been undertaken.

CCG Responsible

Lead: Sharron

Bawden

Percentage of

outcomes

notifications after

each episode of

care May-17 90.0% 60.0% 91.7% -

Performance reduced in May from 91.7% to 60% with 6

of the 15 patients breaching. This is being reviewed by

the service manager to ensure outcomes notifications

are sent following every episode of care.

The CCG is decommissioning Podiatry

Surgery as part of Community

Services as there is no surgeon or

theatre capacity. Patients will be

reviewed by Podiatry team and

referred to ESH for surgery. CCG Responsible

Lead: Sharron

Bawden

For patients not

discharged within 6

months following

the contact

Assessment, the

Management Plan

is reviewed

May-17 80% 67.4% 88.2%

-

5 of the 12 patients breached from continence and 1 of

1 patient from pulmonary rehab. For the one breach in

pulmonary rehab the patient attended the assessment

but did not attend the subsequence classes but was

discharged from the caseload.

Service Manager to ensure reviews

are completed at planned intervals.

CCG Responsible

Lead: Sharron

Bawden

The KPIs reported in this sections of the report are reported by exception only. The latest data available is for May 2017, for this period there are

four KPIs assessed as “red” and seven as “amber”. Please note that the following section includes commentary on only the amber assessed KPIs

where there was a change in performance from the April position. The current performance for all measures is provided in appendix 2.

Underperforming services

Children's OT Health 8.0%

Children’s Physiotherapy 30.0%

Children’s SALT 22.9%


Podiatric Surgery 60%


Continence 58.3%

Pulmonary Rehab 0%

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22



Performance

Indicator

Period Target

/Threshold

Current

Performance

Previous

Period

Trend (2016/17 – 2017/18)

To be included in future reports

Comment Action

Percentage of

priority referrals

seen within 10

working days of

acceptance of

referral

May-17 90% 52.9% 69.5% -

In May 204 patients were triaged under the priority

pathway, 108 were not seen within the target. There was

a 42% increase in the number of referral s from the

previous month.

● A review of the number of priority

appointments held in clinics is

underway.

Service manager to review slot

availability (routine and priority) to

determine if other factors are

effecting performance. CCG Responsible

Lead: Sharron

Bawden

Percentage of

routine referrals

offered an

appointment within

20 working days of

acceptance of

referral

May-17 90% 83.4% 85.5%

-

Adult Dietetics:

41 patient breached the 20 standard. 32 patients were

on the back log for May for domiciliary visits. Following

intensive assessment weeks in May and June the back

log is expected to reduce.

Of not the Adult Dietetics service became fully staffed in

May.

Adult Speech and Language Therapy:

3 of the 11 routine patients breached the standard.

Reduced staff from mid-May reduced clinical capacity. 1

WTE SALT is vacant and is due to be recruited to at the

start of August.

Community Neuro-Therapy Team (CNTT):

Waiting list project commenced at the start of May where

EDS supported CNTT by completing the triage of all

patients. The service saw 44 patients in May with 37

breaching the standard, of note the number of patients

seen was significantly higher in May compared to April

(12 patients seen).

Podiatry:

The service has made progress against this KPI however

the new MSK pathway is impacting on performance.

Adult Dietetics:

● use of back staff to offer additional

sessions over the next 2-3 months to

help eradicate the backlog by

September.

● continue to prioritise the most at

risk patients

● complete demand/capacity

exercise

Adult Speech and Language

Therapy:

● focused effort on recruitment of

permanent staff

● continue to prioritise high priority

patients

Community Neuro-Therapy Team

(CNTT):

● continue with waiting list project

and review demand/ capacity

analysis. Feedback to Contract

Monitoring in October.

Podiatry:

● pathway review between MSK &

Podiatry underway to understand the

reporting issue regarding clock stop

from first clinical interface within the

MSK and Podiatry services. CCG Responsible

Lead: Sharron

Bawden


Adult Dietetics 35.9%

Adult Speech & Language Therapy (SALT) 72.7%

Continence 57.4%

Diabetes tier III 31.4%

CNTT (Community Neuro Therapy Team) 15.9%

Podiatric Surgery 20.0%

Podiatry 24.7%


MSK 69.5%

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23


Quality Indicator Period Threshold Current

Performance


Owner

Never Events May-17 Zero

tolerance 0


incidents requiring

investigation (SIRI) during

the period

May-17 - 0

Vacancies: difference between the establishment and the staff In post as a % of establishment

May-17 - 19.1%

The Director of Nursing

from RMH will be

attending the Sutton

CCG quality committee

in August where further

assurance will be sought

as to staff vacancies

and associated actions

Sickness : Calculated using the staff in post (FTE) days lost due to absence

May-17 - 3.0%

Mandatory training (MAST)

May-17 - 93.4%


May-17 _ 3 (100%)

Quality Standards

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24

3.3 Mental Health – South West London and St George's Mental Health NHS Trust


Performance

Indicator


Performance

Previous

Period


CPA 7 day follow

up Q1-

17/18 95% 98.5% 98.1%

The Trust is consistently meeting the

standard..

CCG Responsible

Lead: Adrian Davey

Percentage of

people experiencing

a first episode of

psychosis treated

with a NICE

approved care

package within two

weeks of referral

Jun-17 50% 87.5% 100% Please note data for April 17 was not

published by NHS England.

CCG Responsible

Lead: Adrian Davey

98.81% 99.40% 98.89% 98.11% 98.46%

2016-17

Q1

2016-17

Q2

2017-18

Q1

2016-17

Q3

2016-17

Q4

The key KPIs and quality metrics are provided in this section of the report. The current performance for all measures is provided in appendix 3.

Quality Indicator Period Threshold Current

Performance


Owner

% of eligible staff receiving adult

safeguarding training (L1) Jun-17 95% 91.3% -

% of eligible staff receiving child safeguarding training (L2

Jun-17 95% 93.9% -

% of eligible staff receiving child safeguarding training (L3

Jun-17 95% 75.4% -

Patient experience: % of community patients saying overall experience of care was good, very good or excellent

Jun-17 - 71.9% -


Jun-17 100% 22 (52.4%) -

Quality Standards

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25

3.3 Mental Health – IAPT (Sutton Uplift)


Performance

Indicator


Performance

Previous

Period


IAPT Access: The

number of people

entering IAPT first

treatment

Jun-17

4.2%

(target

for Q1)

351

(303 people

needed to

access service

(rolling

quarter) to

meet target

373

Sutton has met the required

trajectory of 4.2% for Q1

17/18.

• Continued marketing and outreach to a range of

community groups. Well-being team able to do this

work.

• Silver Cloud, a new on-line provision, has been

implemented and will help engage more people and

more quickly.

• Focus on engaging those with low-level symptoms

by providing one-off well-being workshops.

• Introduction of new Step 3 group programme, (which

has been successful in Richmond).

CCG Responsible

Lead: Corinna

White

IAPT recovery rate

Jun-17 50% 60.4% 55.2%

Sutton CCG has met the

national IAPT Recovery target

(50%) across all 3 months in

Q1 17/18.

• Symptom reviews each treatment session following

a further team training session

• Reviewing non-recovered clients in supervision

toward the end of treatment and adjust treatment

where recovery may be met

• Improve Mental health cluster allocation via triage

supervision and training CCG Responsible

Lead: Corinna

White

IAPT Waiting times;

% who received

their first treatment

within 6 weeks

Jun-17

75% 98.3% 98.5%

Sutton CCG is meeting the 6

and 18 weeks waiting time

standard. However, the

increase in numbers needed

to meet the increased national

access target will have an

impact on meeting recovery

and WTs. Currently there is a

build up of delays in the

pathway between first and

second appointments.

• Re-balancing of capacity to address the backlog

• Close monitoring

• Implementation of Silver Cloud.

IAPT Waiting times;

% who received

their first treatment

within 18 weeks

95% 100% 100%

CCG Responsible

Lead: Corinna

White

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26

3.3 Mental Health – IAPT (Sutton Uplift)

Quality Standards


Performance


Owner

Never Events Q1 17/18 Zero

tolerance 0 -

Serious incidents Q1 17/18 - 0 -


Q1 17/18 - No complaints -

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27

3.4 – Integrated Urgent Care (111 & GP Out of Hours)

Vocare’s staff attrition following a restructure of their employment contracts continues to challenge their rota-fill, along with high call demand,

leading to poor call answering performance. The performance measures are more focused on time to answer the call rather than outcomes or

referral rates and it is possible that pressure on the staff to close calls may be leading to patients being directed to services such as Ambulance,

A&E and GP OoHs rather than other locally commissioned services in the community. Sutton CCG has asked for actual (anonymised) call data

to be provided so the CCG can assess onward referral patterns.

Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17

Calls Offered 1739 25753 25218 32250 30129 25067 26963 30957 29913 26795

Forecast calls offered 1612 23723 23074 32364 32381 26186 27093 29706 28463 24594

Abandoned calls (>30 sec) 88 645 297 689 348 477 498 831 851 715

Abandoned calls % 5.3% 2.6% 1.2% 2.2% 1.2% 2.0% 1.9% 2.7% 2.9% 2.7%

Calls Answered 1587 24506 24372 30929 29209 23984 25719 29416 28369 25410

Calls answered in 60 sec 1468 22011 22586 27570 27468 21405 22655 25649 23891 21637

as a % of calls answered 92.5% 89.8% 92.7% 89.1% 94.0% 89.2% 88.1% 87.2% 84.2% 85.2%

Pathways Triage 1353 19988 19567 24154 22778 18579 20035 23111 22316 19874

as % of calls answered 85.3% 81.6% 80.3% 78.1% 78.0% 77.5% 77.9% 78.6% 78.7% 78.2%

Ambulance Dispatch 198 2862 2961 3222 2924 2107 2279 2402 2425 2173

as % of calls triaged 14.6% 14.3% 15.1% 13.3% 12.8% 11.3% 11.4% 10.4% 11.3% 10.9%

Recommended to all call A&E 131 1904 1857 2212 2338 1910 2127 2307 2451 2302

as % of calls triaged 9.7% 9.5% 9.5% 9.2% 10.3% 10.3% 10.6% 10.0% 11.0% 11.6%

NHS 111 South West London - Activity & Performance Monthly

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Performance Performance Performance

4 Patient Safety

Patient's registered GP to receive report of all frequent users (who present for

treatment more than 8 times a month) by 08:00 the next working day following 8th

visit

100% 100% 100%

5Time taken for call back to

HCP

Calls to be returned to an HCP caller must commence within 20 minutes of the call

being received 87.27% 94.35% 92.00%

6Telephone Clinical

Assessment (20 mins)

Clinical assessment by telephone advice for urgent calls must commence within 20

minutes of the Initial call from HCP being completed or the case being received

from a 111service. Note that where a case has been received from a 111 service

commissioners consider that Initial Definitive Clinical Assessment as defined in

NQR 8 has taken place.

93.24% 93.53% 93.33%

7Telephone Clinical

Assessment (60 Mins)

Clinical assessment by telephone advice for routine call backs must commence

within 60 minutes of the initial call from HCP being completed or the case being

received from a 111 service. Note that where a case has been received from a 111

service commissioners consider that Initial Definitive Clinical Assessment as

87.59% 95.04% 91.78%

9Telephone Clinical


Clinical assessment by telephone advice for routine call backs must commence

within 60 minutes of the initial call being received from a 111 service for all

dispositions mapped to 2 hour92.93% 95.98% 92.90%

10Telephone Clinical


Clinical assessment by telephone advice for non-routine call backs must

commence within 240 minutes of the initial call being received from a 111 service

for all dispositions mapped to 4 hour.

95.45% 96.55% 96%

13 Service provision All primary care base sessions appropriately and adequately clinically and non

clinically staffed and all sessions for the measurement period are completed100% 100% 100%

Apr-17 May-17 Jun-17

SOUTH WEST LONDON IUC: KEY PERFORMANCE INDICATORS

KPI

Ref

Quality and

Performance

Indicators

Quality and Performance Indicator(s)

28

3.4 – Integrated Urgent Care (111 & GP Out of Hours)

The GP OOH service was not compliant in KPIs for telephone clinical assessment (NQR6, NQR7 and NQR9), call back to a health care

professional (NQR5).

During June, there was partial compliance for urgent calls at 93.3%, and health care professional 92.0%. Routine 1 hour clinical assessment

was partially compliant 91.8% and within 2 hours 92.9%.

50% of all activity presenting in OOHs has a priority of 2 hours or less, this profile does not match the tender activity profile resulting in service

demand issues.

A workshop is planned to review GP OOH activity and consider the role of GP telephone re-triage of some 111 Pathway disposition codes.

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29

3.4 Integrated Urgent Care (111 & GP Out of Hours)


Performance


Owner

Never Events June-17 Zero tolerance 0 -

There were no

never events or

serious incidents

in June 17

Serious Incidents

Jun-17 - 0

Complaints received Jun-17 _ 3

Learning outcomes to date:

● Patient perception – focus on

reading DoS instructions and

reporting any issues where

found.

● Communication – individual

feedback ongoing where audit

indicates a communication issue

● Weekly comms to highlight

revised / new pathways and

SOPs e.g. lab results / under 5s

● A weekly meeting has been set

up with Vocare / SELDOC to

specifically go through complaints

/ incidents

● There is a need to develop an

improved escalation process

where complaints involve multiple

providers

Quality Standards

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30

3.5 London Ambulance Trust

Performance Standards Performance

Indicator


Performance

Previous

Period


Ambulance Red 1

(8-minute response) Jun-17 75.0% 73.3% 73.1%

Although LAS aggregate performance

was below the standard in June, the

performance relating to incidents in

Sutton was above the standard, and

has been in the year-to-date

CCG Responsible

Lead: Clare Wilson

Ambulance Red 2

(8-minute response)

Jun-17 75.0% 69.7% 79.4%

Although LAS aggregate performance

was below the standard in June, the

performance relating to incidents in

Sutton was above the standard, and

has been in the year-to-date

CCG Responsible

Lead: Clare Wilson

Along with colleagues in SWL the CCG has plans in place to reduce demand on LAS and as a result improve performance. The CCG’s current

schemes are outlined below:

Sutton Vanguard: Sutton homes of Care Vanguard Programme continues into 2017/18 with increasing spread of good practice across all

Sutton CCG care homes. Through the Vanguard Programme there is a sustained reduction in conveyance from nursing homes and it is

anticipated a 5% reduction in conveyance will be achieved in 2017/18 with the roll out of the programme to residential homes in 2017/18. This is

within the context of anticipated growth with additional care homes opening in 2017 increasing care home bed capacity within Sutton

GP Education programme re LAS HCP guidance with Audit on Guidance adherence: To improve awareness of LAS Guidance on HCP

calls 2% reduction identified

Sutton Health and Care: Focus on creating an integrated, multi-disciplinary service delivered in the home and the community to prevent

hospital admissions and reduce conveyances by LAS.

Category ‘A’ call activity in Sutton was almost exactly on plan for April and May, although was 4.6% above plan in June

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Croydon CCG- A&E performance at CHS is affected by current ED refurbishment, embedding of new UCC arrangements, MH breaches and Medical staffing. RTT is affected primarily by performance at Kings College hospital. Diagnostics continues to be affected by performance at CHS primarily echocardiography. The trust is revising the recovery plan which is expected to be received on 21.07.17. Croydon CCG consistently meets the 2WW cancer target.

Sutton CCG- continues to achieve RTT, Diagnostics and Cancer targets. In terms of A&E, the CCGS main provider ESTH has had performance above 93% for the last 14 months and achieved the A&E target of 95% for 9 of these months.

Kingston CCG- consistently achieves performance in RTT, Diagnostics and Cancer. However, performance on A&E has been under target for 1617. A revised operating plan trajectory for A&E has been agreed with NHSI which aims to achieve 95% in March 2018. The main drivers for ED performance continue to be the continued availability of middle grade staff.

Richmond CCG- has consistently achieved RTT. However, performance on Diagnostics and Cancer was not achieved in May. Diagnostics performance was 98.51% (43 breaches out of 2,871 pathways, with the majority occurring at Kingston Hospital and SGH.)The CCG failed to meet 2ww all cancers and 2ww breast symptomatic targets. 2WW was driven by breaches at Chelsea and Westminster hospital and SGH. Breast symptomatic was not achieved due to 7 breaches out of 92 patients, 5 of which were due to patient choice.

Merton CCG- performance on cancer has been affected by issues with 2WW dermatology at SGH. RTT performance does not include RTT figures from SGH which has not been reporting since June 2016. The non compliance in May reported figure is due in part to performance at ESTH. While ESTH performance was 91.51% in May it is above trajectory of 91.30% for May.

Wandsworth CCG- The main drivers identified for the ED performance at SGH are related to evening surges, increased acuity. accessing Gen Med beds due to the closure of Dolby Ward (24 beds).RTT performance is affected by the non reporting of RTT data by SGH. As a result Chelsea and Westminster have the biggest impact on CCG reported performance. Diagnostic performance is affected by SGH which has capacity issues in several modalities. There are plans in place to recover performance by the end of July. Cancer performance has been affected by the dermatology issues at SGH.

A&E- All Types (RAG rated against Plan. National threshold is 95%)

Cancer- 2 Week Wait (RAG rated against Plan. National threshold is 93%)

Narrative

18 Week RTT - Incomplete Pathways (RAG Rated Against Plan. National Threshold is 93%)

Diagnostics- Over 6 Weeks (RAG Rated Against Plan. National Threshold is 1%)

Period: Report Date:

May 2017 1st August 2017

CCG May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17

Croydon 92.22% 93.49% 93.17% 92.99% 88.47% 85.83% 87.48% 84.81% 84.92% 85.21% 86.54% 88.54% 90.80%

Plan 94.59% 94.99% 96.50% 95.00% 93.39% 92.89% 95.19% 94.99% 94.70% 94.70% 94.70% 93.30% 95.64%

Kingston 92.62% 92.54% 94.09% 92.14% 92.91% 90.75% 89.38% 87.28% 84.39% 88.31% 91.24% 91.14% 89.95%

Plan 93.40% 90.30% 95.00% 95.20% 94.30% 95.00% 95.00% 95.00% 93.50% 94.10% 95.10% 88.00% 90.00%

Merton 93.37% 93.97% 94.21% 93.60% 93.53% 93.76% 93.35% 90.10% 88.38% 91.34% 90.95% 91.71% 91.35%

Plan Merton CCG is not a Co-ordinating Commissioner and no Plan was submitted to NHSE

Richmond 94.79% 94.76% 95.70% 94.43% 94.39% 93.07% 92.30% 90.70% 88.87% 91.73% 93.17% 93.71% 92.75%

Plan Richmond CCG is not a Co-ordinating Commissioner and no Plan was submitted to NHSE

Sutton 93.37% 94.56% 94.06% 95.85% 96.62% 96.80% 95.23% 93.49% 93.75% 94.58% 95.54% 94.60% 94.98%

Plan 95.01% 95.01% 95.01% 95.01% 95.01% 95.01% 95.01% 95.01% 95.01% 95.01% 95.01% 95.70% 95.52%

Wandsworth 93.99% 94.21% 94.45% 93.20% 92.66% 92.01% 91.96% 88.91% 86.87% 90.44% 89.94% 91.64% 90.63%

Plan 90.20% 91.48% 91.42% 92.78% 92.97% 92.56% 92.61% 91.47% 92.64% 92.14% 92.24% 89.39% 91.03%


Croydon 96.60% 96.94% 98.42% 96.84% 96.50% 96.15% 97.84% 95.44% 93.68% 96.67% 98.03% 97.23% 96.41%

Plan 93.11% 93.09% 93.09% 93.08% 93.01% 93.06% 93.06% 93.04% 93.09% 93.02% 93.03% 93.08% 93.00%

Kingston 97.26% 99.22% 97.52% 98.68% 97.54% 98.32% 98.07% 99.22% 99.17% 97.80% 99.78% 98.37% 99.31%

Plan 93.09% 93.22% 93.16% 93.22% 93.22% 93.16% 93.22% 93.09% 93.22% 93.09% 93.05% 93.15% 93.11%

Merton 89.84% 95.03% 95.82% 94.94% 95.07% 94.93% 90.66% 95.15% 90.41% 92.88% 89.02% 85.68% 84.98%

Plan 93.08% 93.03% 93.07% 93.15% 93.12% 93.07% 93.07% 93.00% 93.15% 93.11% 93.10% 93.22% 93.19%

Richmond 94.55% 92.54% 95.10% 95.49% 93.58% 95.82% 96.73% 94.77% 95.21% 96.19% 96.25% 91.97% 92.46%

Plan 93.03% 93.03% 93.03% 93.03% 93.03% 93.03% 93.03% 93.03% 93.03% 93.03% 93.03% 93.10% 93.01%

Sutton 95.95% 94.82% 95.92% 94.44% 93.58% 95.32% 97.86% 98.40% 96.17% 99.02% 95.47% 95.06% 93.78%

Plan 93.18% 93.18% 93.18% 93.18% 93.18% 93.18% 93.18% 93.18% 93.18% 93.18% 93.18% 93.11% 93.08%

Wandsworth 87.64% 90.72% 93.65% 94.48% 94.00% 92.77% 86.94% 93.52% 88.41% 88.45% 88.01% 78.81% 79.40%

Plan 93.05% 93.04% 93.03% 93.04% 93.04% 93.03% 93.04% 93.05% 93.03% 93.05% 93.08% 93.02% 93.08%


Croydon 92.61% 92.71% 92.26% 92.06% 91.88% 91.83% 91.70% 90.81% 90.93% 90.91% 91.46% 91.22% 91.70%

Plan 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.01% 92.00% 92.00% 90.75% 90.76%

Kingston 94.43% 95.08% 95.41% 94.49% 93.66% 94.10% 93.89% 94.18% 94.03% 94.35% 94.52% 94.21% 94.18%

Plan 93.00% 93.00% 93.01% 93.00% 93.00% 93.01% 93.01% 93.01% 93.00% 93.00% 93.01% 92.01% 92.00%

Merton 92.21% 92.86% 92.38% 91.95% 91.79% 92.22% 92.59% 91.55% 91.89% 92.26% 92.56% 91.74% 91.97%

Plan 90.90% 90.94% 91.05% 91.40% 91.54% 91.67% 91.88% 92.00% 92.04% 92.15% 92.41% 91.97% 91.97%

Richmond 94.27% 93.50% 93.31% 92.39% 91.97% 92.16% 92.84% 92.83% 92.97% 92.93% 93.14% 92.42% 93.53%

Plan 94.87% 94.87% 94.87% 94.87% 94.87% 94.87% 94.87% 94.87% 94.87% 94.87% 94.87% 92.03% 92.03%

Sutton 92.81% 93.04% 92.86% 92.27% 92.69% 92.85% 92.82% 92.48% 92.54% 93.13% 93.30% 92.91% 92.99%

Plan 92.15% 92.15% 92.15% 92.15% 92.15% 92.15% 92.15% 92.15% 92.15% 92.15% 92.15% 91.87% 91.88%

Wandsworth 91.99% 91.19% 91.48% 91.14% 90.96% 90.55% 90.21% 89.32% 90.72% 91.36% 90.67% 89.90% 90.36%

Plan 90.65% 90.79% 91.13% 91.30% 91.46% 91.79% 91.81% 91.96% 91.95% 92.08% 92.39% 92.04% 92.01%


Croydon 2.85% 3.88% 3.19% 2.29% 0.99% 0.50% 0.33% 0.68% 0.91% 2.42% 3.81% 5.75% 5.40%

Plan 1.00% 0.98% 0.99% 1.00% 0.99% 1.00% 0.99% 1.00% 0.99% 0.99% 0.99% 0.94% 0.97%

Kingston 0.13% 0.26% 0.45% 0.16% 0.26% 0.23% 0.36% 1.16% 0.86% 0.96% 0.81% 1.32% 1.51%

Plan 0.89% 0.88% 0.87% 0.87% 0.89% 0.88% 0.87% 0.87% 0.89% 0.88% 0.87% 0.99% 0.98%

Merton 0.68% 1.03% 0.94% 0.86% 0.71% 0.99% 0.64% 3.38% 2.78% 1.74% 1.59% 2.03% 1.68%

Plan 0.99% 0.99% 0.99% 0.99% 0.99% 0.99% 0.99% 0.99% 0.99% 0.99% 0.99% 0.92% 0.86%

Richmond 0.84% 0.66% 0.96% 0.80% 0.59% 0.57% 0.57% 0.76% 0.84% 0.63% 1.28% 2.23% 1.49%

Plan 0.92% 0.92% 0.92% 0.92% 0.92% 0.92% 0.92% 0.92% 0.92% 0.92% 0.92% 0.86% 0.86%

Sutton 0.74% 1.00% 1.18% 0.75% 0.65% 0.62% 0.57% 7.05% 0.77% 0.45% 0.30% 0.52% 0.58%

Plan 0.98% 0.98% 0.98% 0.98% 0.98% 0.98% 0.98% 0.98% 0.98% 0.98% 0.98% 0.89% 0.90%

Wandsworth 0.88% 0.69% 0.93% 0.66% 0.70% 0.72% 0.60% 1.69% 3.28% 1.93% 2.42% 3.51% 2.70%

Plan 0.99% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 0.99% 1.00% 0.99% 1.00% 1.00% 1.00%

1

4. SWL Performance - Constitutional Standards

of 208

May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17

CARDIOLOGY 95.0% 93.7% 94.0% 93.5% 93.7% 94.4% 95.3% 94.4% 95.5% 94.8% 94.6% 93.8% 93.6%

CARDIOTHORACIC SURGERY 77.7% 83.7% 81.1% 81.1% 80.7% 84.6% 85.5% 84.8% 91.1% 92.4% 86.6% 77.2% 75.0%

DERMATOLOGY 95.7% 96.0% 96.4% 95.9% 95.7% 94.6% 93.9% 92.3% 92.7% 94.4% 94.6% 94.3% 95.7%

ENT 86.7% 91.1% 90.5% 89.3% 87.8% 88.0% 87.7% 86.7% 87.8% 87.1% 87.4% 88.5% 89.1%

GASTROENTEROLOGY 92.4% 93.8% 93.8% 92.7% 93.7% 93.8% 94.6% 94.3% 94.6% 94.8% 95.4% 94.1% 94.6%

GENERAL MEDICINE 94.1% 93.5% 94.6% 94.8% 95.8% 97.0% 97.3% 96.9% 97.6% 96.5% 96.1% 95.3% 97.1%

GENERAL SURGERY 90.2% 89.1% 90.6% 91.7% 91.4% 91.1% 90.2% 90.0% 90.2% 90.0% 89.1% 89.0% 89.7%

GERIATRIC MEDICINE 98.7% 98.7% 97.9% 97.2% 97.0% 95.6% 97.2% 97.0% 97.2% 97.5% 98.8% 97.1% 98.9%

GYNAECOLOGY 91.6% 90.8% 90.4% 90.6% 90.6% 90.4% 90.6% 89.9% 89.7% 90.5% 90.0% 89.0% 89.2%

NEUROLOGY 95.1% 94.4% 92.4% 90.9% 91.0% 91.1% 91.5% 92.6% 92.7% 93.4% 94.4% 92.8% 92.5%

NEUROSURGERY 88.1% 75.5% 76.3% 72.5% 73.6% 77.8% 81.4% 81.0% 83.8% 80.4% 83.2% 84.1% 85.0%

OPHTHALMOLOGY 97.9% 97.1% 97.0% 96.4% 95.6% 95.6% 95.6% 95.5% 95.9% 95.5% 95.6% 94.2% 94.0%

ORAL SURGERY 97.7% 50.0% 0.0% - - - - 100.0% - 100.0% 100.0% 100.0% -

OTHER 94.2% 93.1% 92.7% 91.6% 92.2% 92.3% 92.5% 92.1% 92.3% 92.8% 93.7% 93.2% 93.5%

PLASTIC SURGERY 86.3% 90.5% 90.1% 88.7% 89.7% 90.9% 91.8% 91.0% 90.5% 90.2% 88.3% 88.0% 88.7%

RHEUMATOLOGY 97.7% 98.0% 97.9% 96.7% 96.7% 96.4% 97.1% 96.5% 96.5% 96.1% 96.4% 96.3% 96.0%

THORACIC MEDICINE 97.0% 96.9% 97.0% 97.4% 96.1% 97.4% 97.0% 97.3% 97.1% 97.5% 97.6% 97.1% 97.6%

TRAUMA & ORTHOPAEDICS 88.0% 88.9% 88.7% 87.8% 88.1% 88.5% 88.0% 86.6% 86.6% 87.1% 86.7% 87.4% 87.7%

UROLOGY 92.3% 92.6% 92.2% 90.9% 91.0% 91.1% 90.3% 90.1% 91.1% 91.7% 91.2% 90.8% 92.1%

Total 92.8% 93.0% 92.8% 92.0% 92.1% 92.2% 92.2% 91.6% 91.9% 92.2% 92.4% 91.9% 92.3%

RTT- By Trust

RTT- By Specialty

CHS - CHS met the RTT standard overall in May with an outcome of 92.24% in May 2017, however performance in T&O, Gynae, Oral surgery and ENT were below 92% largely due to reported capacity issues. T&O was the lowest performing specialty in month with an outcome of 77.5% at Trust level. Epsom and St Helier -RTT performance was not achieved in April and May with performances below the national target. However, at Trust level May’s performance was above the operating plan trajectory of 91.30% for the month. The majority of breaches continue to occur in T&O and Gynaecology. Kingston Hospital - has continued to achieve the RTT target, which was achieved every month in 1617. Performance in May was 94.67%. . However, ENT, Ophthalmology, Oral Surgery and General surgery did not achieve the target in month. SGH - suspended reporting on RTT in July 2016 and a recovery plan put in place. In terms of non-achieving specialities, with the highest numbers of breaches at SWL level in May were T&O 948, Oral Surgery 702, Gynae 600 and ENT 509 patients. 52 Week Waits CCG level - there were 16 CCG patients reported nationally waiting over 52 Weeks for treatment in May, down from 19 in April. In terms of Providers 7 breaches occurred at KCH, 4 at Imperial, 2 at EPSH, 1 each at RMH and GSTT. Provider level - There were 4 reported 52 week breaches for SWL providers (at Trust level) in May. However, it should be noted that this figure does not include the patients waiting over 52 weeks at SGH (350 patients as at 14.07.17).

Narrative

RTT- Incomplete Pathways

52 Week RTT by SWL Providers

Key Actions

Action Narrative Owner Due

Specialty recovery plan at CHS for RTT.

While CHS achieves the RTT target overall, the Trust has reported at monitoring meetings with the CCG and CSU that they are focusing on backlog reduction in non achieving specialities.

KCH RTT recovery trajectory

The trajectory for 17/18 shows the Trust aiming to achieve 78.98% by March 2018. The trust is looking at bringing in an additional validation resource over the next 3 months. The trust will also continue to look into insourcing providers in order to utilise additional capacity

SGH SGH suspended RTT reporting in July 2016 and a recovery plan put in place. However following a recent report in waiting list management at Queen Mary site the Trust has decided to refresh the overall plan and look at the overall governance structure for the recovery programme. The Trust is currently able to locally report a validated position for patients waiting over 52 weeks.


Lead LDU: Named Lead:

May 2017 1st August 2017 Merton and Wandsworth John Atherton


CHS 94.42% 93.36% 92.56% 92.33% 92.28% 92.54% 92.80% 92.06% 92.03% 92.04% 92.14% 92.01% 92.24%

ESTH 92.04% 91.47% 91.49% 90.51% 90.62% 91.37% 91.45% 90.52% 90.94% 91.40% 92.01% 91.24% 91.51%

KHFT 96.88% 96.39% 96.49% 95.77% 95.42% 95.44% 95.20% 95.02% 94.80% 95.04% 95.11% 94.63% 94.67%

SGH 90.40%

RMH 96.28% 96.03% 95.29% 95.52% 95.95% 96.82% 96.76% 96.51% 96.82% 97.01% 96.58% 95.83% 96.73%


STG’s 4 0 0 0 0 0 0 0 0 0 0 0 0

CHS 1 0 3 2 2 1 0 0 0 0 0 0 0

KHFT 0 0 0 0 0 0 0 0 0 0 1 0 1

ESH 0 0 0 0 0 1 0 0 0 0 1 1 2

RMH 4 4 4 2 0 0 2 1 1 1 2 2 1

BMI - SHIRLEY

OAKS

HOSPITAL 0 0 0 0 0 0 0 0 0 0 0 0 0

ASPEN -

PARKSIDE

HOSPITAL 0 0 0 0 0 0 0 0 1 0 0 0 0

Total 9 4 7 4 2 2 2 1 2 1 4 3 4

2

4. SWL Performance - Referral to treatment

of 208

SWL Diagnostics Waiting List and Performance

Diagnostic Wait Performance

St. George’s did not achieve the 6 Week standard with an outcome of 96.7% (248 breaches out of 7,442 waits) in May. The majority of the breaches occurred in Non Obstetric Ultrasound (71), Audiology assessments (50), Gastroscopy (33) and Urodynamics (31). Performance in Urodynamics specifically was extremely challenged in May, with an outcome of 24.4% (31 Breaches for 41 waits). The position is driven by the performance of Echocardiography at CHS, contributing 347 of the 349 breaches reported in May. The breaches are due to the loss of physiology staff in the Cardiology department earlier in the year due to changes in the IR35 rules. The Trust had plans in place to recruit staff from abroad, but one member failed to show up. Recently another echo cardiographer has gone on emergency leave. In addition the service relocated to Croydon Heart centre to improve patient experience, however performance was affected in the move. ESTH and Kingston Hospitals consistently achieve the diagnostic target. At CCG level, Kingston CCG did not achieve the target due to breaches at SGH and ESTH, while Richmond CCG was due to breaches at Kingston hospital and SGH. Merton CCG and Wandsworth CCG performance was affected by SGH.

Narrative

SWL Diagnostics > 6 Weeks Wait

SWL Diagnostics Waiting List and Performance (By Provider)

Key Actions


CHS The Trust had planned to recover by the end of August. However, this is now in the process of being updated and a revised trajectory is expected from the Trust this week (21.07.17) .

SGH Recovery Plans in place to recover the target Plan to achieve target in July



May 2017 1st August 2017 Merton and Wandsworth John Atherton


CHS 97.30% 96.21% 96.98% 97.73% 99.19% 99.65% 99.93% 99.62% 99.79% 97.50% 96.01% 93.79% 94.37%

ESTH 99.47% 99.11% 99.07% 99.14% 99.56% 99.35% 99.63% 94.65% 99.29% 99.78% 99.87% 99.73% 99.72%

KHFT 99.97% 99.95% 99.70% 100.0% 99.78% 99.84% 99.54% 99.27% 99.68% 99.73% 99.79% 99.27% 99.27%

SGH 99.34% 99.01% 99.22% 99.16% 99.11% 99.17% 99.29% 97.81% 94.94% 97.22% 97.10% 95.87% 96.67%

TOTAL 98.90% 98.40% 98.63% 98.91% 99.38% 99.45% 99.59% 97.53% 98.08% 98.46% 98.12% 97.05% 97.39%

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

Rate

AUDIOLOGY_ASSESSMENTS 99.4% 99.8% 99.0% 99.9% 97.8% 99.0% 99.8% 99.7% 99.8% 99.8% 98.6% 96.1% 95.1% 2/6

BARIUM_ENEMA 100% 100% 100% 100% 100% 100% 100% - 100% 100% 100% 100% 100% 1/1

COLONOSCOPY 99.1% 98.7% 99.4% 99.3% 98.7% 99.0% 99.2% 96.9% 93.5% 96.8% 96.4% 97.3% 97.4% 1/6

CT 99.6% 99.8% 99.8% 99.9% 99.9% 99.8% 99.9% 99.6% 99.5% 99.9% 99.7% 99.6% 99.6% 6/6

CYSTOSCOPY 96.2% 97.1% 94.5% 96.4% 94.1% 94.5% 92.7% 87.1% 91.2% 93.2% 93.2% 87.9% 90.9% 0/6

DEXA_SCAN 99.6% 100% 99.8% 100% 99.6% 100% 100% 100% 100% 100% 100% 100% 100% 6/6

ECHOCARDIOGRAPHY 91.8% 87.3% 90.9% 92.8% 98.1% 99.6% 99.9% 99.9% 99.9% 92.6% 90.1% 83.3% 79.6% 1/6

ELECTROPHYSIOLOGY - 100% 66.7% - 100% 50.0% 100% 100% 100% 90.9% 77.8% 100% 87.5% 4/5

FLEXI_SIGMOIDOSCOPY 99.2% 98.2% 98.9% 98.7% 99.0% 97.8% 99.0% 93.4% 89.5% 94.5% 96.9% 97.9% 99.5% 4/6

GASTROSCOPY 98.5% 98.6% 98.9% 99.3% 99.2% 98.4% 98.8% 96.7% 96.8% 98.5% 98.1% 94.2% 95.3% 1/6

MRI 99.5% 98.9% 98.9% 98.9% 99.2% 99.4% 99.3% 99.3% 97.2% 98.5% 98.9% 98.9% 99.4% 5/6

NON_OBSTETRIC_ULTRASOUND 99.4% 99.7% 99.5% 99.7% 99.9% 99.8% 99.8% 96.6% 99.2% 99.5% 99.1% 98.8% 99.2% 4/6

PERIPHERAL_NEUROPHYS 99.5% 98.8% 96.4% 97.5% 98.3% 99.4% 99.6% 100% 99.5% 100% 100% 99.2% 98.3% 3/6

SLEEP_STUDIES 91.5% 81.0% 80.6% 94.0% 95.2% 96.4% 100% 97.1% 94.3% 100% 98.4% 98.1% 97.4% 4/6

URODYNAMICS 95.0% 92.3% 90.9% 93.8% 91.1% 91.5% 96.6% 96.2% 96.6% 96.3% 88.3% 86.5% 77.1% 0/6

Grand Total 98.6% 98.2% 98.3% 98.8% 99.3% 99.4% 99.5% 97.7% 98.4% 98.6% 97.9% 96.9% 97.2%


NHS CROYDON CCG 97.1% 96.1% 96.8% 97.7% 99.0% 99.5% 99.7% 99.3% 99.1% 97.6% 96.2% 94.2% 94.6%

NHS KINGSTON CCG 99.9% 99.7% 99.5% 99.8% 99.7% 99.8% 99.6% 98.8% 99.1% 99.5% 99.2% 98.7% 98.5%

NHS MERTON CCG 99.3% 99.0% 99.1% 99.1% 99.3% 99.0% 99.4% 96.6% 97.2% 98.4% 98.4% 98.0% 98.3%

NHS RICHMOND CCG 99.2% 99.3% 99.0% 99.2% 99.4% 99.4% 99.4% 99.2% 99.2% 99.5% 98.7% 97.8% 98.5%

NHS SUTTON CCG 99.3% 99.0% 98.8% 99.3% 99.4% 99.4% 99.4% 93.0% 99.2% 99.5% 99.7% 99.5% 99.4%

NHS WANDSWORTH CCG 99.1% 99.3% 99.1% 99.3% 99.3% 99.3% 99.4% 98.3% 96.7% 98.2% 97.6% 96.5% 97.3%

Total 98.6% 98.2% 98.3% 98.8% 99.3% 99.4% 99.5% 97.7% 98.4% 98.6% 97.9% 96.92% 97.24%

3

4. SWL Performance - Diagnostics

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2 Week Wait

2 Week Wait By Tumour Site

SGH did not achieve 2ww all cancer standard in May making it the fifth consecutive month the Trust missed the 93% target. The two main causes or non-achievement of the 2 week standard have been inadequate administrative capacity for processing referrals to book appointments and the oversight of the capacity and demand required for the 2WW standard. The Trust has also not achieved the 2 WW Breast symptoms target. All South West London Providers with the exception of The Royal Marsden achieved the 62 Day target in May. At The Royal Marsden the 62 day target was not achieved in May 17 due to the number of late referrals, however the Trust treated 100% of all internal patients within 62 days in May. On the 62 day GP referral pathway London achieved 79.1% for 62 day GP referral in May, while SWL providers acheived 87.3%. At CCG level the 2 Week wait standard was not achieved at Merton CCG (85%), Richmond CCG(92.5%) and Wandsworth CCG (79.4%). At CCG level the 62-day urgent referral was not achieved at Croydon CCG (81.6%), Merton CCG (82.1%) and Wandsworth CCG (73.3%).

Narrative

62 Day Wait

62 Day Wait by Tumour Site

Key Actions


SGH 2 Week Waits and 2 Week Breast symptoms

The Trust has submitted a Recovery Action Plan to Commissioners and NHSI for 2WW performance and the 2WW breast standard. This plan is currently being worked through.

2WW attendances by Day 7

Each Provider has plans in place to continue to meet this target throughout 2017/18. All providers are conducting quarterly reviews of 2ww referrals to better understand patient choice, any GP practice found not to be compliant in giving clear communication will be offered further guidance.



May 2017 1st August 2017 Alliance Maggie Lam (Laura Morrison)


CHS 97.24% 97.06% 98.98% 97.01% 96.81% 96.47% 98.40% 95.73% 93.74% 97.33% 98.66% 98.15% 97.08%

ESTH 95.67% 95.01% 96.03% 93.99% 93.95% 94.66% 96.72% 97.97% 96.15% 97.85% 95.95% 93.33% 94.74%

KHFT 97.81% 98.91% 97.57% 98.44% 98.30% 98.83% 98.51% 99.11% 98.54% 97.96% 99.35% 99.05% 99.41%

SGH 87.29% 90.02% 93.11% 94.30% 94.22% 93.15% 85.71% 93.27% 87.90% 87.94% 86.00% 75.44% 76.64%

RMH 90.37% 96.55% 97.89% 96.07% 98.25% 98.21% 98.70% 99.16% 97.74% 97.36% 98.03% 97.77% 96.55%

Total SWL 93.61% 95.01% 96.48% 95.83% 95.94% 95.76% 94.62% 96.62% 93.84% 95.11% 94.86% 90.84% 91.09%


Brain/Central Nervous System 92.9% 100.0% 100.0% 100.0% 100.0% 95.8% 95.8% 100.0% 92.9% 100.0% 99.1% 90.9% 96.3%

Breast 95.6% 96.0% 97.7% 97.3% 98.6% 98.1% 97.7% 97.1% 97.6% 96.0% 96.5% 94.8% 92.9%

Childrens 100.0% 100.0% 94.1% 100.0% 96.2% 100.0% 84.6% 100.0% 100.0% 100.0% 98.6% 87.5% 96.0%

Gynaecological 90.6% 97.8% 94.7% 95.3% 93.8% 95.9% 96.8% 98.4% 91.7% 93.7% 96.4% 89.4% 89.9%

Haematological 95.4% 95.5% 95.2% 96.1% 98.0% 98.3% 95.1% 100.0% 100.0% 98.3% 97.9% 88.0% 98.6%

Head & Neck 92.5% 95.2% 95.8% 95.4% 92.8% 95.6% 97.8% 97.3% 98.7% 98.5% 97.4% 94.2% 93.5%

Lower Gastrointestinal 95.2% 93.6% 96.2% 95.0% 93.9% 92.9% 94.6% 92.7% 87.6% 94.1% 94.4% 89.6% 91.8%

Lung 97.2% 94.1% 96.8% 95.5% 96.7% 96.4% 99.1% 99.0% 99.2% 100.0% 99.0% 98.4% 94.4%

Other 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% - 100.0% 100.0% 100.0%

Sarcoma 59.0% 96.6% 100.0% 94.1% 91.3% 100.0% 100.0% 100.0% 96.8% 92.3% 96.0% 100.0% 97.3%

Skin 92.8% 93.2% 95.4% 95.6% 94.8% 93.0% 85.0% 92.6% 87.7% 88.1% 85.2% 79.7% 80.7%

Testicular 100.0% 100.0% 100.0% 100.0% 95.2% 100.0% 100.0% 100.0% 94.7% 100.0% 96.3% 83.3% 95.0%

Upper Gastrointestinal 93.6% 91.5% 95.8% 95.0% 92.6% 94.7% 94.9% 94.7% 91.1% 97.8% 95.4% 92.8% 95.1%

Urological (excluding testicular) 93.5% 96.7% 97.3% 95.9% 96.1% 97.6% 99.0% 97.5% 97.5% 98.1% 97.8% 97.7% 95.2%

Grand Total 93.5% 94.7% 96.2% 95.8% 95.1% 95.3% 94.2% 95.7% 93.1% 94.7% 94.3% 90.4% 90.4%

Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17

Brain/Central Nervous System 100.0% - - - - - - - - - - 100.0% - -

Breast 96.8% 95.9% 100.0% 91.9% 87.9% 97.1% 100.0% 100.0% 97.5% 100.0% 100.0% 97.6% 96.8% 100.0%

Childrens - - 100.0% - 100.0% - - - - - - - 100.0% -

Gynaecological 92.9% 75.0% 64.3% 85.7% 66.7% 47.1% 70.6% 91.7% 88.9% 75.0% 88.9% 62.5% 86.7% 76.9%

Haematological 90.0% 90.9% 94.1% 100.0% 100.0% 94.1% 100.0% 94.7% 81.8% 87.5% 85.7% 100.0% 100.0% 71.4%

Head & Neck 100.0% 60.0% 37.5% 54.5% 55.6% 71.4% 75.0% 42.9% 80.0% 58.3% 41.7% 71.4% 55.6% 61.5%

Lower Gastrointestinal 78.9% 77.3% 66.7% 87.0% 96.3% 82.1% 78.6% 78.3% 85.0% 81.3% 75.0% 75.0% 86.7% 92.3%

Lung 81.3% 68.8% 66.7% 76.9% 94.7% 100.0% 76.5% 75.0% 83.3% 69.2% 86.7% 61.5% 91.7% 73.3%

Other 100.0% - 0.0% 100.0% - 66.7% 100.0% 25.0% 50.0% 100.0% 100.0% - 50.0% 0.0%

Sarcoma 0.0% 50.0% 50.0% 80.0% 50.0% 100.0% 0.0% 0.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Skin 93.9% 96.3% 95.9% 100.0% 95.1% 95.2% 97.8% 93.0% 100.0% 100.0% 95.7% 96.2% 97.7% 98.0%

Upper Gastrointestinal 88.2% 64.3% 66.7% 63.6% 57.1% 60.0% 53.8% 58.8% 81.8% 30.8% 83.3% 92.9% 81.3% 66.7%

Urological (inc. testicular) 84.0% 76.6% 84.6% 85.7% 92.9% 87.0% 89.7% 83.0% 79.7% 83.6% 84.1% 88.1% 88.4% 80.6%

Grand Total 88.0% 81.8% 83.0% 87.0% 88.0% 86.1% 87.4% 83.8% 87.4% 83.8% 86.4% 88.7% 90.0% 85.3%

245

85.3%

70%

75%

80%

85%

90%

95%

100%

0

50

100

150

200

250


Pe

rfo

rman

ce

Tota

l Tre

ate

d

Total Treated Performance Target

4

4. SWL Performance - Cancer

of 208

Monthly counts of MRSA bacteraemia (Zero Threshold)

Monthly counts of C. difficile infection patients aged 2 & over - Trust Apportioned only

Narrative

Mixed Sex Breaches

To be provided from next month

Friends and Family

Key Actions


To be provided from next month



May 2017 1st August 2017 TBC TBC


CHS 0 0 0 1 0 0 0 0 0 0 0 0 0

ESTH 3 0 0 1 0 1 1 0 0 0 0 1 1

KHFT 0 0 0 0 0 0 1 0 1 1 0 2 0

SGH 0 0 0 0 0 1 0 0 0 1 0 2 0

RMH 0 0 0 1 0 0 0 0 0 0 0 0 0

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

4

2017/18

Target May-16 Jun-16 Jul-16 Aug-16

Sep-

16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17

CHS 16 2 2 1 1 0 1 0 2 3 0 1 2 1

ESTH TBC 4 6 1 3 4 2 1 1 5 1 2 1 6

KHFT TBC 2 0 2 1 2 1 1 0 5 1 1 1 1

SGH 31 2 2 2 2 3 6 4 4 3 4 3 1 1

RMH 31 3 3 6 5 3 2 4 4 3 1 8 5 5

Total SWL

4. SWL Performance - Quality

of 208

4. SWL Performance - DTOC

DTOC- SWL Days By Category

DTOC- SWL Delayed Days by Responsible Organisation (all Providers)

Croydon- 854 day. Social Care Responsible for 310. NHS responsible for 544. Kingston- 447 days. Social Care Responsible for 64. NHS responsible for 375. No blame 8 days. Richmond- 578 days. Social Care Responsible for 192. NHS responsible for 380. No blame 6 days. Wandsworth- 574 days. Social Care Responsible for 223. NHS responsible for 173. No blame 2 days. Merton- 327 days. Social Care Responsible for 173. NHS responsible for 117. No blame 37 days. Sutton- 218 days. Social Care Responsible for 113. NHS responsible for 105. Generally levels of DToCs are low, Sutton consistently has one of the lowest rates in London. Some pressures on social care packages has been seen in July, which has been escalated with Adult Social Care

Narrative

DTOC- Days by Local Authority

DTOC- SWL Delayed Days by Reason (May 2017)

Key Actions




May 2017 1st August 2017 TBC TBC

DTOC Days Per 100,00 population to be

included next month. This is measured as part

of the NHSE IAF framework but can be

calculated provisionally locally,

5

of 208

4. SWL Performance - A&E

A&E Performance -v- Attendance

A&E Performance By Type

While performance was not achieved at SWL level in May, ESTH trust met the target with an outcome of 95.56%. The other providers did not meet their operating plan trajectories in month. Provisional data for June shows that ESTH achieved the target in month. SGH The provisional figure for June’s performance is 92.12% meaning that the Trust has achieved it’s operating plan target of 92.0% for the month. The Trust reported that breaches were due to; High acuity presentations and high attendances, evening surges and the closure of Dolby ward which has reduced the bed base by 24. Provisional figures indicate that Kingston Hospital’s performance in June was 90.17% against an operation plan trajectory of 92.0%.The issues reported by the Trust driving the breaches were mainly related to: Staffing shortages in the ED – specifically an inability to recruit middle-grade doctors at registrar level, ED, specialty and capacity breaches. The provisional figure for June’s performance at CHS is 90.58% against an operating trajectory of 96.6%. The Trust reported that breaches were due to delays in assessing and treating Mental health attendances, surges in attendances and staff sickness. On occasion there have been problems accessing beds in SLAM.

Narrative

A&E Attendance by Type

A&E Performance By Site

Key Actions


Croydon Healthcare Services

Actions to address the recovery are part of the Emergency Care programme plan monitored via the ED Delivery board.

Current trajectory 95% in March 18

Kingston Hospital The Trust implemented new UCC arrangements in April and these continue to bed into the system. The current A&E works are affecting performance due to the availability of space. The trust reviews forecasted activity weekly, identifies surges and plans to mitigate them. Escalation process in place.

Current trajectory shows 96.6% in June 17

St Georges Hospital The Trust has highlighted that physical space is inadequate to tolerate current surges and is and is undertaking joint investigation work into ED processes and Trust flow programme. There are plans to increase medical ambulatory provision and recruitment is in progress to fill vacancies including a nurse recruitment programme.

Current trajectory shows 95.0% Feb 18



April 2017 1st August 2017 Sutton Sean Morgan

Provider A&E Type Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17

Croydon

Croydon UH - T1

88.0% 88.9% 91.4% 91.3% 89.3% 84.5% 80.4% 83.1% 77.3% 78.4% 76.5% 79.7% 77.8% 85.0% 80.7%

Urgent Care Centre - T2/T3

97.9% 98.7% 99.1% 98.3% 99.2% 93.7% 92.3% 94.3% 97.8% 97.3% 97.3% 96.1% 96.9% 96.5% 98.4%

Epsom & St. Helier

Epsom - T1 94.0% 91.4% 95.5% 93.3% 96.8% 97.3% 97.9% 94.0% 94.9% 94.7% 93.7% 97.3% 97.2% 95.6% 96.1%

St Helier - T1

95.4% 94.4% 93.8% 94.2% 95.6% 97.1% 97.2% 96.3% 93.2% 94.0% 95.9% 95.5% 93.7% 95.5% 94.0%

Sutton - T2/T3

100.0% 100.0% 99.8% 99.6% 99.6% 100.0% 100.0% 100.0% 100.0% 100.0% 99.6% 99.1% 98.8% 99.8% 100.0%

Kingston

Kingston - T1

94.5% 91.4% 91.0% 93.1% 90.3% 91.4% 88.5% 86.7% 84.6% 80.7% 85.6% 89.8% 90.6% 87.8% 89.0%

Kingston REU - T2/T3

99.9% 99.0% 99.8% 99.8% 100.0% 99.9% 99.4% 98.8% 100.0% 100.0% 100.0% 99.7% 100.0% 100.0% 99.9%

St George's

Q Mary Roe'ton - T2/T3

100.0% 99.9% 100.0% 99.7% 100.0% 100.0% 96.4% 97.1% 99.9% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

St George's - T1

88.6% 92.9% 93.3% 93.8% 91.9% 91.2% 92.4% 92.8% 88.0% 85.2% 89.6% 87.6% 88.8% 88.6% 91.3%

SWL TOTAL 92.7% 93.1% 93.9% 94.1% 93.5% 92.8% 91.7% 91.5% 88.9% 87.5% 89.7% 90.6% 90.7% 91.5% 92.0%

6

of 208

2,166

1,642

2,209

1,400

1,000

1,500

2,000

2,500

3,000 CHS KUFT STG's ESH

4. SWL Performance - LAS

LAS Attendance by Provider

LAS 30 Minute Breaches By Provider

• CHS has developed a plan to improve LAS Handovers focusing on optimising ED layout, standardising core processes, ensuring surge periods are recognised early and managed and managing full queue situations effectively. • Kingston has got a 4 bed bay dedicated to LAS off load • ESH have got LAS handover processes in place; however, the high numbers in December and January were due to bed capacity, high acuity and patient flow issues affecting the ability to offload.

Narrative

LAS patient handover within 15 minutes

LAS 60 Minute Breaches By Provider

Key Actions




April 2017 1st August 2017 Merton and Wandsworth Fergus Keegan

The above graph shows LAS attendances only. Some sites will also have conveyances from SECAMB.

Data is validated breaches only

38% 50% 48% 47% 46%

0%

20%

40%

60%

80%

100%


CHS KUH SGH ESH SWL Target

108

19

72 74

0

50

100

150

200CHS KUH SGH ESH

2

5 3

10

0

10

20

30


CHS KUH SGH STHData is validated breaches only

7

of 208

19.6% 20.1% 20.1% 19.6% 19.9% 19.7%

22.4% 23.6% 24.0%

22.2%

24.3% 24.4% 23.8% 24.0% 19.6% 20.3% 20.7%

19.8% 20.4% 21.2%

27.7% 28.4%

25.4% 25.4% 26.1% 26.5%

24.2% 24.0%

London - Transfer to Clinician

SWL - Transfer to Clinician

4. SWL Performance - 111

% Calls Leading to Ambulance Call Out & % Transferred to Clinician

(The indicators have been taken from the national suite of 111 KPIs as they were felt to be most pertinent. Feedback is welcome on any suggested substitutions. )

Performance within SWL the % of calls transferred clinicians is the same as London. Activity continues to be above the commissioned levels, which has resulted in under-performance against many key metrics.

Narrative

% Transferred to Clinical Advisor

111 Dispositions (Outcomes)- Top 3

Key Actions


CQC CQC visit in progress (early August). Key reflections will take place at the end of August.

End of August

Capacity and Demand The

Contract Lead Commissioners are still considering whether Sutton CCG or the Alliance will lead on the contract moving forwards.



April 2017 1st August 2017 Sutton Sean Morgan

5.6% 5.3% 5.8% 5.9% 5.4% 5.6%

11.7% 12.1% 10.4% 10.0%

8.8% 8.9% 8.2% 8.9% 8.2% 8.0% 8.8% 8.7% 8.8% 8.5% 9.9% 10.2% 9.8% 9.9%

9.2% 9.1% 8.6% 9.1%


London - Ambu Dispatched SWL - Ambu Dispatched


Croydon 1,241 1,298 1,260 1,285 1,272 1,083 Vocare commenced providing the SWL Service in October 2016

Kingston & Richmond 1,031 1,204 1,062 1,102 1,014 968

Sutton & Merton 1,249 1,387 1,236 1,341 1,205 1,093

Wandsworth 1,034 1,188 1,035 1,109 1,097 899

Vocare 532 6,776 6,926 7,861 7,430 6,249 6,812 7,117 6,800

SWL 4,555 5,077 4,593 4,837 4,588 4,575 6,776 6,926 7,861 7,430 6,249 6,812 7,117 6800

London 26,639 29,125 26,050 27,452 25,859 24,956 31,145 32,376 40,634 36,727 32,841 35,531 36,406 36,778

5.6% 5.3% 5.8% 5.9% 5.4% 5.6% 11.7% 12.1% 10.4% 10.0% 8.8% 8.9% 8.2% 8.9%

7.7% 8.1% 8.5% 8.1% 8.0% 8.5%

7.8% 7.6% 7.2% 8.0% 8.0% 8.3% 7.8% 8.6%

47.3% 47.3%

47.6% 45.6%

45.9% 46.0%

45.3% 45.4%

46.0% 44.8%

45.5% 44.4%

46.6% 45.9%

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000


Ambulance Dispatches Recommended to attend A&E Recommended to attend Primary Care

1.4%

0.7% 0.6% 1.1%

0.6% 0.7% 1.0%

0.7%

1.4% 1.1% 1.1% 1.1% 1.1% 1.3%

2.3%

1.1% 0.8%

1.8%

0.8% 1.2%

2.5%

1.2%

2.1%

1.2%

1.9% 1.8%

2.7% 2.8%


London Abandoned after 30 seconds

SWL - Abandoned after 30 seconds

93% 95% 96% 94% 97% 96% 95% 95% 93% 95% 94% 94% 95% 93%

87%

93% 94% 92%

96% 95%

90% 93%

89%

94%

89% 88% 87% 84% London- Answered in 60 seconds

8

of 208

4. SWL Performance - Mental Health

Estimated Dementia Diagnosis Rate (66.7% threshold)

EIP- % RTT First Episode Psychosis (FEP_ Periods Within 2 Weeks of Referral

Dementia- The SWL Estimated Dementia rate continues to meet the national threshold; however, diagnosis rates in both Croydon and Kingston continue to miss the threshold. CAMHS EIP- The number of referrals on the EIP Pathway continues to be stable, with 75 patients entering treatment in April. 18 Weeks RTT- SWL and STG’s continued to excess the 18W RTT threshold. Mental Health Referrals- MH referrals continue to rise, with higher numbers experienced by Croydon and Wandsworth CCGs.

Narrative

New Mental Health Referrals (Total)

Key Actions




April / May 2017 1st August 2017 Kingston and Richmond Fergus Keegan


Croydon 64.44% 64.65% 65.12% 65.68% 66.42% 66.48% 66.83% 66.80% 66.89% 67.01% 67.42% 66.77% 65.90%

Kingston 62.68% 63.82% 64.20% 64.46% 64.27% 64.14% 64.84% 64.52% 64.58% 63.51% 63.70% 59.31% 59.96%

Merton 73.79% 74.39% 73.73% 73.32% 74.03% 74.09% 73.68% 73.32% 71.66% 71.30% 71.12% 68.60% 68.79%

Richmond 64.38% 65.49% 65.39% 65.69% 64.33% 65.29% 67.35% 67.20% 65.79% 65.69% 66.00% 67.72% 67.75%

Sutton 65.16% 65.16% 65.50% 65.59% 66.51% 67.00% 67.82% 68.21% 67.92% 68.45% 68.26% 73.21% 73.02%

Wandsworth 73.11% 72.95% 73.70% 73.75% 73.43% 75.67% 76.04% 76.47% 76.63% 76.52% 76.90% 71.46% 71.96%

TOTAL 66.90% 67.34% 67.57% 67.77% 67.92% 68.50% 69.14% 69.15% 68.71% 68.61% 68.79% 67.90% 67.85%

2955

1865

1785

1955

1780

3330

800

1300

1800

2300

2800

3300

3800

May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17

Croydon Kingston Merton Richmond Sutton Wandsworth

9


Croydon 0.00% 81.82% 60.00% 83.33% 75.00% 66.67% 75.00% 50.00% 87.50% 88.89% 50.00% 40.00% 50.00%

Kingston 100% 71.43% 60.00% 42.86% 100% 75.00% 100% 100% 83.33% 66.67% 100% 60.00% 70.00%

Merton 50.00% 55.56% 100% 50.00% 50.00% 60.00% 83.33% 100% 100% 100% 66.67% 0.00% 80.00%

Richmond 100% 100% 66.67% 0.00%

100%

66.67% 66.67% 33.33% 0.00% 100% 66.67% 50.00% 80.00%

Sutton 100% 100% 66.67% 50.00% 62.50% 100% 60.00% 66.67% 50.00% 87.50% 60.00%

Data missing 100%

Wandsworth 75.00% 70.00% 66.67% 81.82% 80.00% 100% 61.54% 70.00% 66.67% 100% 54.55%

100.00

% 60.00%

Total 70.83% 79.80% 70.00% 51.33% 77.92% 78.06% 74.42% 70.00% 64.58% 90.51% 66.31% 41.67% 73.33%

of 208

4. SWL Performance - IAPT

% Waited Less than 6 Weeks for Treatment (75% threshold)

Recovery Rate (50% threshold)

Richmond and Sutton CCGs have met all of the thresholds in April 2017. Access continues to be an issue for Croydon, Merton and Wandsworth CCGs, as well as Recovery Rate.

Narrative

% Waited Less than 18 Weeks for Treatment (95% threshold)

Access Rate (1.25% threshold- rises to 1.4% from Q4)

Key Actions


Ensure consistency or reporting (Kingston)

Work has been carried out with the IST to ensure consistency of reporting to NHS Digital. The March 2017 figures reflect the locally reported numbers.

Sylvie Ford

March 2017

Ensure IAPT capacity (Kingston & Sutton)

Work has been carried out to ensure there is sufficient capacity to meet the 16.8% and 19% access targets for 2017-19. The additional funding has been agreed by KCCG, and an action plan has been agreed.

Sylvie Ford

June 2017

Service Mobilisation post-re-procurement (Wandsworth)

The new provider (SWL & St Georges) is continuing to mobilise the service following the recent re-procurement, and plans to only be compliant in quarter 4 2017-18.

Mark Robertson

January 2017

Re-procurement of IAPT service (Croydon)

The CCG is currently undertaking a procurement exercise, with a new IAPT model to be in place form April 2018 onwards. Through the procurement process, the access rate will be reviewed with the successful provider, the CCG currently estimates this will be in region of 14-15% for 2018/19.

Leo Whittaker

October 2017

Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17

Croydon 98.48% 97.10% 97.30% 98.20% 96.00% 95.00% 96.55% 95.45% 94.00% 95.00% 94.00% 92.00% 97.00%

Kingston 100% 95.30% 97.50% 96.60% 95.00% 95.00% 100% 96.77% 95.00% 94.00% 94.00% 95.00% 97.00%

Merton 62.22% 73.90% 85.10% 89.80% 93.00% 94.00% 95.45% 95.83% 94.00% 92.00% 87.00% 89.00% 89.00%

Richmond 96.88% 96.10% 94.20% 97.90% 97.00% 98.00% 96.15% 94.74% 99.00% 98.00% 96.00% 96.00% 96.00%

Sutton 96.43% 95.30% 92.50% 95.00% 96.00% 97.00% 95.24% 95.00% 95.00% 95.00% 97.00% 97.00% 95.00%

Wands. 90.00% 91.90% 92.30% 92.50% 94.00% 93.00% 93.33% 92.86% 93.00% 96.00% 95.00% 95.00% 94.00%


Croydon 98% 100% 99% 100% 99% 100% 100% 100% 100% 100% 100% 100% 100%

Kingston 100% 99% 100% 100% 99% 99% 100% 100% 100% 99% 100% 99% 99.00%

Merton 88.89% 95.80% 96.60% 99.30% 100% 100% 100% 100% 100% 100% 98% 100% 100%

Richmond 100% 100% 99.30% 100% 100% 100% 100% 100% 100% 99% 100% 100% 100%

Sutton 100% 99% 99% 99% 99% 99% 100% 95% 99% 99% 100% 99% 99.00%

Wands. 100% 98.90% 98% 99.30% 100% 99% 100% 98.21% 99% 100% 100% 99% 100%


Croydon 55.00% 48.80% 48.30% 39.70% 45.00% 45.00% 52.00% 48.00% 46.00% 46.00% 44.00% 46.00% 47.00%

Kingston 37.04% 36.60% 42.10% 39.00% 45.00% 45.00% 38.00% 34.00% 49.00% 46.00% 41.00% 55.00% 51.00%

Merton 45.24% 45.10% 41.30% 46.30% 54.00% 49.00% 50.00% 61.00% 52.00% 53.00% 48.00% 56.00% 48.00%

Richmond 55.17% 52.40% 53.20% 58.20% 58.00% 57.00% 61.00% 52.00% 45.00% 57.00% 51.00% 59.00% 70.00%

Sutton 42.31% 48.90% 45.10% 41.20% 46.00% 53.00% 51.00% 46.00% 48.00% 48.00% 49.00% 46.00% 56.00%

Wands. 45.10% 45.30% 46.60% 50.70% 44.00% 36.00% 43.00% 44.00% 39.00% 39.00% 41.00% 42.00% 41.00%


Croydon 1.16% 1.10% 0.80% 0.85% 0.90% 0.73% 0.69% 1.11% 0.86% 1.04% 0.86% 0.59% 0.59%

Kingston 1.13% 1.26% 1.26% 1.16% 1.10% 1.08% 1.60% 1.39% 1.05% 1.31% 1.39% 1.39% 0.92%

Merton 0.85% 0.80% 0.99% 0.83% 0.83% 0.60% 0.41% 0.83% 0.74% 0.93% 1.03% 0.91% 0.50%

Richmond 1.91% 1.53% 1.27% 1.39% 1.53% 1.46% 1.21% 1.27% 0.93% 1.37% 1.34% 1.34% 1.66%

Sutton 1.38% 1.18% 1.13% 1.15% 1.02% 0.64% 0.82% 0.84% 0.51% 0.78% 1.18% 1.71% 1.62%

Wands. 1.52% 1.39% 1.28% 1.35% 1.18% 1.40% 1.20% 1.14% 0.81% 1.23% 0.98% 1.18% 0.93%



April 2017 1st August 2017 Kingston and Richmond Fergus Keegan

10

of 208

42

5. Quality Premium

Quality Premium Measures National Measure 2017-18

Measure

achieved Target

Referral to treatment times (18 weeks Incomplete) (April 2017 to June 2017)* 92.65% Y 92%

A&E waits - All types (April 2017 to May 2017)** 94.80% N 95%

Maximum two month (62-day) wait from urgent GP referral to first definitive treatment

for cancer (April 2017 to May 2017) 90.63% Y 85%

Category A Red 1 ambulance calls (April 2017 to May 2017) 76.38% Y 75%

Local Measure

Mental Health Out of Area Placements (OAPs)

Unknown, as

data

suppressed in

NHS Digital

published

reports due to

small numbers

RightCare Measure: Primary Knee Replacements per 100,000 population To follow

* For the purposes of the quality premium, the percentage of Incomplete pathways within 18 weeks will be calculated by summing the numerators (patients waiting within 18 weeks)

from each month end and then dividing by the sum of all the denominators (patients waiting) from each month end.

**The A&E CCG Quality Premium is based on data mapping from NHSE, derived from HES figures. This calculates what proportion of each provider’s activity can be attributed to a

given CCG. Any activity under 1% is ignored.

of 208

Appendix 1: Month 3 CCG Scorecard NHS Constitution Standards

43

Select CCG

NHS SUTTON CCG

A&

E

Qu

ality

Pre

miu

m

A&E All Types NHS SUTTON CCG 94.56% 94.06% 95.85% 96.62% 96.80% 95.23% 93.49% 93.75% 94.58% 95.54% 94.60% 94.98% 94.80% 95%

18 Weeks RTT Incomplete Pathways NHS SUTTON CCG 93.04% 92.86% 92.27% 92.69% 92.85% 92.82% 92.48% 92.54% 93.13% 93.30% 92.91% 92.99% 92.05% 92.65% 92%

>52 week waits Incomplete NHS SUTTON CCG 0 0 0 0 0 0 0 1 1 1 0 2 3 5 0

> 6 Weeks Diagnostic Waits NHS SUTTON CCG 1.00% 1.18% 0.75% 0.65% 0.62% 0.57% 7.05% 0.77% 0.45% 0.30% 0.52% 0.58% 0.40% 0.50% 1%

2 Week Cancer Wait NHS SUTTON CCG 95.95% 94.82% 95.92% 94.44% 93.58% 95.32% 97.86% 98.40% 96.17% 99.02% 95.47% 95.06% 93.78% 94.35% 93%

2 Week Cancer Wait:

Breast SymptomsNHS SUTTON CCG 100.00% 89.86% 98.46% 96.23% 98.25% 100.00% 96.61% 98.57% 97.10% 97.67% 93.46% 93.15% 91.46% 92.26% 93%

31 day Cancer Wait:

1st definitive treatmentNHS SUTTON CCG 100.00% 100.00% 98.55% 100.00% 95.92% 97.10% 97.10% 98.53% 96.36% 98.51% 100.00% 100.00% 98.48% 0.85% 96%

31 Day Cancer Wait:

Subsequent treatment (Surgery)NHS SUTTON CCG 100.00% 88.89% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 92.31% 100.00% 100.00% 92.86% 100.00% 96.43% 94%

31 Day Cancer Wait:

Subsequent treatment (Chemotherapy)NHS SUTTON CCG 100.00% 94.44% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 94.74% 100.00% 100.00% 100.00% 98%

31 Day Cancer Wait:

Subsequent treatment

(Radiotherapy)

NHS SUTTON CCG 100.00% 96.30% 96.30% 96.30% 100.00% 100.00% 100.00% 93.75% 100.00% 93.75% 88.46% 100.00% 95.45% 97.50% 94%

62 Day Cancer Wait:

GP ReferralNHS SUTTON CCG 93.75% 82.50% 80.95% 82.14% 85.19% 97.14% 86.49% 85.71% 80.00% 88.89% 90.91% 90.00% 91.18% 90.63% 85%

62 Day Cancer Wait:

Screening serviceNHS SUTTON CCG 75.00% 75.00% 100.00% 100.00% 50.00% 100.00% 100.00% 83.33% 100.00% 100.00% 100.00% 85.71% 100.00% 90.91% 90%

62 Day Cancer Wait:

Consultant UpgradeNHS SUTTON CCG 100.00% 100.00% 80.00% 83.33% 50.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 50.00% 100.00% 76.92%

No

thresholds

MRSA reported infections NHS SUTTON CCG 0 0 1 0 1 0 1 0 1 0 0 0 0 Zero tolerance

C. Difficile reported infections NHS SUTTON CCG 3 4 4 6 2 5 4 4 1 4 0 2 2

Mixed Sex Accommodation (MSA)

(Number of breaches)NHS SUTTON CCG 0 0 0 0 0 0 0 0 0 0 0 0 1 1 Zero tolerance

2017-18 Target2017-18

YTD

Jun-172017-18

YTD

Feb-17 Mar-17 Apr-17 May-17

May-17

May-17 Jun-172017-18

YTD2017-18 Target

Theme

Qu

ali

ty

Theme KPI / Measure CCG Dec-16Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Mar-17 Apr-17

Sep-16 Apr-17Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Jan-17

Aug-16

18

We

ek

s

Re

ferr

al

to

tre

atm

en

t

an

d D

iag

no

sti

cs

Ca

nc

er

Wa

its

May-16

Feb-17

KPI / Measure CCG Jun-16 Jul-16

NHS SUTTON CCG

Jul-16 Aug-16 Oct-16Jun-16 2017-18 TargetTheme KPI / Measure CCG

CCG SCORECARD

NHS Constitution Standards

CCG Scorecard PerformanceSummary

NotesCCG GraphsQuality

Premium

of 208

Appendix 1: Month 3 CCG Scorecard NHS Constitution Standards

44

Select CCG

NHS SUTTON CCG

A&

E

Qu

ality

Pre

miu

m






2 Week Cancer Wait:


31 day Cancer Wait:


31 Day Cancer Wait:


31 Day Cancer Wait:


31 Day Cancer Wait:


(Radiotherapy)

NHS SUTTON CCG 100.00% 96.30% 96.30% 96.30% 100.00% 100.00% 100.00% 93.75% 100.00% 93.75% 88.46% 100.00% 95.45% 97.50% 94%

62 Day Cancer Wait:


62 Day Cancer Wait:


62 Day Cancer Wait:


No

thresholds





2017-18 Target2017-18

YTD

Jun-172017-18

YTD


May-17

May-17 Jun-172017-18

YTD2017-18 Target

Theme

Qu

ali

ty




Jan-17

Aug-16

18

We

ek

s

Re

ferr

al

to

tre

atm

en

t

an

d D

iag

no

sti

cs

Ca

nc

er

Wa

its

May-16

Feb-17


NHS SUTTON CCG


CCG SCORECARD




Premium

Select CCG

NHS SUTTON CCG

A&

E

Qu

ality

Pre

miu

m






2 Week Cancer Wait:


31 day Cancer Wait:


31 Day Cancer Wait:


31 Day Cancer Wait:


31 Day Cancer Wait:


(Radiotherapy)

NHS SUTTON CCG 100.00% 96.30% 96.30% 96.30% 100.00% 100.00% 100.00% 93.75% 100.00% 93.75% 88.46% 100.00% 95.45% 97.50% 94%

62 Day Cancer Wait:


62 Day Cancer Wait:


62 Day Cancer Wait:


No

thresholds





2017-18 Target2017-18

YTD

Jun-172017-18

YTD


May-17

May-17 Jun-172017-18

YTD2017-18 Target

Theme

Qu

ali

ty




Jan-17

Aug-16

18

We

ek

s

Re

ferr

al

to

tre

atm

en

t

an

d D

iag

no

sti

cs

Ca

nc

er

Wa

its

May-16

Feb-17


NHS SUTTON CCG


CCG SCORECARD




Premium

of 208

Appendix 2: Month 2 Sutton Community Health Services performance dashboard

45

of 208

Appendix 2: Month 2 Sutton Community Health Services performance dashboard

46

of 208

Appendix 3: Month 3 SWL & St Georges Mental Health Trust performance dashboard

47

Target Month Fractio

n


n

Change

0 0 0 0 No

Change

95% 97.2% 173 /

178

95% 100.0% 22 / 22 Better

92% 95.0% 3014 /

3173

92% 97.0% 605 /

624

No

Change

0 0 0 0 No

Change

99% 99.9% 11362 /

11377

99% 99.9% 2233 /

2235

No

Change

90% 98.0% 11151 /

11377

90% 99.1% 2215 /

2235

No

Change

0 0 0 0 No

Change

50% 68.4% 39 / 57 50% 60.0% 3 / 5

80% 76.0% 367 /

483

80% 76.9% 40 / 52 Worse

80% 85.9% 226 /

263

80% 82.0% 50 / 61 No

Change

90% 94.7% 36 / 38 90% 100.0% 9 / 9 No

Change

90% No

cases

90% No

cases

95% 91.8% 89 / 97 95% 92.3% 12 / 13 Worse

3% 5.0% 393 /

7806

3% 10.8% 106 /

983

Worse

95% 96.8% 8565 /

8850

95% 98.4% 1680 /

1708

No

Change

95% 91.0% 8050 /

8850

95% 92.2% 1574 /

1708

No

Change

0 2 0 1

30% 33.0% 30% N/a

No

Change

Better

South West London and St George's Mental Health NHS Trust

Monthly Contract Schedule Reporting for the Period : June 2017Total

KPI Change

Sutton

National Requirements

National Requirements

N1 Re: EBS1 : Mixed Sex Accomodation Breach No

Change

N2 Re: EBS3 : 7 Day Follow Ups: Proportion of Service Users followed up within 7 calendar days of discharge No

Change

N3 RTT - Incomplete Pathway: Percentage of patients on an incomplete pathway that have been waiting less than 18 weeks (month in arrears,

2 appointment proxy for community services).

No

Change

N4 Re: EBS4 : Zero Tolerance for RTT waits >52 wks: Number of Service Users waiting over 52 weeks for Treatment (2 appointment proxy,

month in arrears)

No

Change

N5 Completion of a valid NHS Number field No

Change

N11 Re: EH4 : EIP : Percentage of Service Users experiencing a first episode of psychosis who commenced a NICE Concordant package of

care within two weeks of referral

Local Requirements

N6 Completion of Mental Health Minimum Data Set ethnicity coding No

Change

N9 Duty of Candour Breach

Access Requirements

L1 Access to services - CMHTs 1: Percentage of patients that were assessed within 28 calendar days of referral. (Non-Urgent Referrals) Worse

L2 Access to services - OPCMHTs 1: Percentage of patients that were assessed within 28 calendar days of referral. (Non-Urgent Referrals) Better

L3 Access to services - CMHTs 2: Percentage of patients that were assessed within 7 calendar days of referral. (Urgent Referrals) Better

L4 Access to services - OPCMHTs 2 :Percentage of patients that were assessed within 7 calendar days of referral. (Urgent Referrals)

L5 Face to face Gatekeeping: Ratio of all informal admissions to the number which are gate-kept by CR/HT service (face to face contacts only) Worse

L6 Delayed transfers of care (DTOCs): DTOCs as a proportion of bed days No

Change

L7 Clustering Extent:Proportion of patients seen face to face at least once and have a valid cluster No

Change

Cluster Requirements

L8 Cluster Timeliness:Proportion of clustered service users that have an in-date cluster No

Change

Serious Incidents

L9 Ensuring timely STEIS investigations: (Submission to Merton CCG) Number of STEIS reports that have not been submitted to Merton CCG

and are overdue (past their 60 day deadlines).

L10 Completeness of STEIS Investigations: Percentage of STEIS Reports where Merton CCG has requested further details

of 208


48


n


n

Change

90% 88.2% 2978 /

3377

90% 92.7% 383 /

413

No

Change

7% 5.5% 28 / 510 7% 6.9% 4 / 58 Worse

14% 10.4% 260 /

2495

14% 10.0% 37 / 369 No

Change

85.0% 82.4% 112 /

136

85.0% 83.3% 15 / 18 Worse

100% 92.2% 47 / 51 100% 92.3% 12 / 13 Better

95% 52.4% 22 / 42 95% 66.7% 4 / 6 Better

100% 77.3% 920 /

1190

100% 80.9% 127 /

157

Better

3% 1.4% 200 /

14074

3% 0.9% 16 /

1833

Better

85% 85.6% 166 /

194

100% 86.0% 357 /

415

100% 90.6% 48 / 53 Better

100% 100.0% 1 / 1

80% 87.6% 9965 /

11377

80% 87.4% 1953 /

2235

No

Change

98% 96.3% 156 /

162

98% 90.9% 20 / 22 Better

100% 100.0% 29 / 29

95% 93.2% 9568 /

10264

95% 92.6% 1060 /

1145

No

Change

50% 71.2% 743 /

1044

50% 75.0% 108 /

144

No

Change

95% 100.0% 873 /

873

95% 100.0% 111 /

111

No

Change

95% 91.3% 1466 /

1606

95% 93.2% 193 /

207

No

Change

95% 93.9% 902 /

961

95% 94.5% 172 /

182

No

Change

95% 75.4% 205 /

272

Total

KPI Change

Sutton

Local Requirements

L11 The proportion of users on CPA with a collaborative crisis plan in place (R6) No

Change

Crisis Care & Readmissions

L12 % of discharges (excluding respite care : incl adult & older people) subject to unplanned readmission within 30 days No

Change

DNA

L13 % DNA 1st appointment No

Change

L14 Follow up after DNA - HTTs: Percentage of HTT clients who have a follow up attempted within 24 hours of DNA Worse

L15 % of complaints acknowledged within 3 working days

Patient Experience & Carers

L16 % of complaints responded to within timescale

L17 % of people on CPA who have had a care review who brought a friend and/or were given the opportunity to bring a friend, relative or advocate

with them.

Better

Worse

L18 Percentage of appointments for patients on CPA that are cancelled by the provider No

Change

L19 Percentage of carers who have been offered a carers assessment No

Change

QL20 % of inpatients where the field to capture learning disability and/or an autistic spectrum disorder (including Asperger's syndrome) is

completed

No

Change

Learning Difficulties / Autism

L32 % of inpatients with an LD/autism ICD10 code have had, at the time of discharge, a CPA (or CTR) within last 26 weeks (or, if not, a date for

the review has been agreed).

Mental & Physical Health

L22 % of trust caseload with smoking status recorded in electronic record No

Change

L23 Ensuring Physical Health for Inpatients: All service users to have a Physical Health Assessment attempted within 48 hours of their

admission.

No

Change

L24 Ensuring Physical Health for Long Stay Inpatients: All inpatient service users to have a physical health assessment every six months (or

more often)

No

Change

Care Planning

L27 Each person on CPA and seen more than once has had their care plan reviewed within 30 days No

Change

L25 % CPA reviews/care plans sent to GPs within 2 weeks No

Change

L26 % of patients on CPA with outcome recorded No

Change

Safeguarding

L28 % of eligible staff shall receive appropriate (as directed by the provider's policy) Adult safeguarding training across the whole organisation

(Level 1)

No

Change

L29a % of eligible staff shall receive appropriate (as directed by the Provider's policy) Children's safeguarding training across the whole

organisation (Level 2)

No

Change

L29b % of eligible staff shall receive appropriate (as directed by the Provider's policy) Children's safeguarding training across the whole

organisation (Level 3)

No

Change

Better

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49


n


n

Change

97% 99.9% 109988

/

110130

97% 100.0% 22887 /

22890

No

Change

95% 95.4% 3113 /

3263

95% 95.7% 398 /

416

No

Change

98% 96.3% 1993 /

2069

98% 96.0% 266 /

277

No

Change

75% 82.9% 3191 /

3847

75% 83.3% 389 /

467

No

Change

100% 75.6% 136 /

180

100% 86.4% 19 / 22 Better

4 1

8 4.7 8 3.3 Better

80% 88.6% 101 /

114

80% 96.6% 28 / 29 Better

90% 95.6% 109 /

114

90% 96.6% 28 / 29 No

Change

95% 89.5% 17 / 19 95% 100.0% 7 / 7 No

Change

95% 100.0% 53 / 53 95% 100.0% 12-Dec Worse

90% 100.0% 103 /

103

90% 100.0% 23 / 23 No

Change

14% 2.9% 3 / 102 14% 8.7% 2 / 23 Worse

14% 8.2% 99 /

1201

14% 9.7% 21 / 216 No

Change

95% 100.0% 2 / 2

95% 100.0% 1 / 1

95% 100.0% 10 / 10 95% 100.0% 4 / 4 No

Change

4 2 4 2 Worse

Total

KPI Change

Sutton

Local Requirements

Data Quality Incl Review

L30 Patient identity data completeness metrics (from the MHSDS): Average percentage completeness of NHS number, date of birth, postcode,

gender, GP and commissioner organisational code

No

Change

L31 Outcome Measure Data Quality: % CPA patients have up to date HoNOS

L33 Ensuring a timely review of service users on CPA: Quarterly Snapshot of Current Caseload No

Change

L34 Service Users on the CPA to have two or more recovery outcome goals recorded on RiO (Promoting recovery orientated practice). No

Change

L35 Delayed & omitted medicines audit result

Pharmacy

Other

L37 The number of episodes of absence without leave (AWOL) for patients detained under the Mental Health Act 1983 on acute wards on

sections 2 and 3

L36 Communication with Primary Care at point of Discharge: All service users to have a discharge summary sent to the GP within 24 hours of

discharge (IP and Daycase Only)

Better

L58 Responses to Referral: Attendance to referral from emergency department within 30 mins

Emergency Response

CAMHS & Related Specialised Related Services

Access

L38 Length of wait time for access to Tier 3 CAMHS (average weeks) Better

L39 % of young people seen within 8 weeks of referral to Tier 3 CAMHS (first assessment) No

Change

L40 % of young people seen within 12 weeks of referral to Tier 3 CAMHS (first assessment) Worse

L41 % of young people referred to CAMHS for an urgent appointment seen within 5 working days (number and percentage) Better

L42 % of young people referred to CAMHS as an emergency seen within 24 hours (number and percentage) Worse

L43 % of Tier 3 triage referrals received by CAMHS from all agencies where the child or young person received a service (defined as one or more

face to face/phone contacts)

No

Change

L44 % DNA 1st appointment No

Change

L45 % DNA follow up appointment No

Change

L46 Percentage of children referred to the Eating Disorder Service for an urgent appointment who are assessed within 5 working days of referral

L47 Percentage of children referred to the Eating Disorder Service for an emergency appointment who are assessed within 24 hours of referral

L48 Percentage of children referred to the CAMHS Tier 3 Eating Disorder Service for a routine appointment who are assessed within 4 weeks of

referral

No

Change

L49 Average length of wait time for access to CAMHS Tier 3 Eating Disorder Service (weeks) Worse

No

Change

Please see separate attachment

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50


n


n

Change

80% 70.0% 7 / 10

12 12 12 9 Worse

90% 44.8% 26 / 58 90% 66.7% 6 / 9 Worse

0 1 0 0

90% 81.5% 53 / 65 90% 75.0% 6 / 8 Worse

90% 93.3% 167 /

179

90% 95.8% 23 / 24 No

Change

90% 92.3% 72 / 78 90% 80.0% 8 / 10 Worse

91.4% 85 / 93 90.0% 9 / 10 Worse

47.4% 9 / 19 66.7% 4 / 6 Worse

71.9% 187 /

260

71.7% 152 /

212

Better

60 42 11

8 1

Total

KPI Change

Sutton

Local Requirements

L50 Percentage of young people referred to the ASD/ADHD Service for a routine appointment who are seen within 8 weeks - Wandsworth CCG Better

L51 Average wait time for access to CAMHS ASD/ADHD Service (weeks) : average over all CCGs Better

L52 Percentage of young people referred to the ASD/ADHD Service for a routine appointment who are seen within 12 weeks - All CCGs No

Change

L53 Number of episodes on adult facilities for patients who are 16-17 years old

CAMHS : Experience and Quality

QL55 % of children and young people in EET

QL56 % Goals set for those interacting with the service more than once

QL54 % Paired Measures

CAMHS : Transformation : CYP-IAPTUS Reported:

Reporting & Information

R4 % of community patients saying that overall their care in the last 12 months was good, very good or excellent No

Change

Patient Experience & Carers

QL57 % of service users who have responded within or to their latest course of treatment; including assessments (e.g. CHI-ESQ)

R3 % of patients feeling safe on an in-patient unit Worse

R5 % of people saying that Mental Health services have definitely or to some extent helped them to achieve their recovery goals.

CAMHS : Crisis

No

Change

No

Change

No

Change

Worse

R8 Number of children attending A&E due to self harming/attempted suicide/alcohol harm/substance misuse

R9 Number of young people assessed through the 136 Suite Worse

R10 Combined both % Paired Measures AND EET Captured

CAMHS : Transformation : CYP-IAPTUS Reported:

R13 Re:Feedback : Qualitative and quantitative service report : based on performance across Q1 and Q2, a lessons learned and performance

report be prepared to reflect upon

R11 % of Assessment Measures used

R12 % of service users who have responded within or to their latest course of treatment; including assessments (e.g. CHI-ESQ)

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Governing Body



Title of Document:

Finance report, M04; Financial Year

2017/18

Purpose of Report:

To Note

Report Authors:

Geoff Price, CFO

Lead Director:

Geoff Price, CFO

Executive Summary:

M04 – Financial Year 2017/18

The CCG reported the M04 position ( the four month to 31 July 2017 and full year forecast ) to NHSE

on 09 August 17.

Key Financials

The CCG is reporting on plan at M04 year to date and full year forecast. Note the year to date plan is

for a deficit given QIPP savings profiling. The full year forecast assumes almost full QIPP delivery and

in reporting the position to NHSE, this and other significant risks facing the CCG have been

highlighted.

The outturn and forecast are based on month 3 acute activity and May prescribing information. The

overall position is set out in appendix 1.

The CCG is recognising a forecast overspend on its acute contracts of £1.3m ( M03 £700k ) and

continuing healthcare budgets of £1.1m ( M03 £700k ). These have been covered by the 0.5%

statutory contingency (reserve), its own internal reserves and some non-recurrent benefits carried

forward from 2016/17. All CCG reserves have been utilised in reporting on plan.

Work is being undertaken on acute hospital spend to ascertain how much of the contract overspend

is due to growth and price changes how much is due to ‘ system’ changes, in particular the changes

in specialist Identification Rules and the introduction of HRG4+ ) both of which went live from 1st

Surplus/(Deficit)

£000

Running costs

£000

Plan YTD (395) 1383

Actual YTD (395) 1383

Full year plan 1245 4115

Full year forecast 1245 4115

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April 2017.

Separately, work is also being undertaken to examine the CHC overspending particularly with

regard to the large increase in LD high cost placement.

Primary care is reported on plan in the absence of any information to the contrary.

Prescribing is reported on plan.

All other commissioned services are reported on plan.

Running costs are reported on plan.

Balance Sheet

The CCG balance sheet as at 31 July is satisfactory in terms of cash, debtor and creditor levels with

all balance sheet KPIs being met.

2017/18 financial plan

The CCG submitted a financial plan of 0.5% in year surplus for 2017/18 ( cumulative 1% ) and that

meets all NHSE business rules. The plan includes significant QIPP savings delivery risk and the focus

of the CCG is to ‘de risk ‘ the plan as far as possible by enhancing existing schemes and adding new

schemes.

In reporting the M04 full year forecast , certain assumptions, particularly around QIPP delivery have

been made. The CCG is currently reviewing QIPP delivery in the context of assessing its full year

forecast which it carries out on an ongoing basis. Whilst every effect is being made to achieve the

financial plan, at this time it is considered that there is a significant risk that the CCG financial plan

for an in year 0.5% surplus will not be met.

Recommendation:

The Executive Committee is asked to:

NOTE the report.


Based on information to date the CCG is currently reporting on plan whilst highlighting the

significant risks faced in meeting the 1718 financial plan.

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July 2017

Plan £000

Actual

Expenditure

before Manual

Accruals £000

Manual

accruals £000

Actual

Expenditure

£000 Variance £000 % Variance Plan £000

Actual

Expenditure

before Manual

Accruals £000

Manual

accruals £000

Actual

Expenditure

£000 Variance £000 % VarianceTotal - 2017/18

Plan £000

Expenditure

£000 Variance £000 % Variance

Programme Resource Limit 23,306 22,856 126 22,982 324 1.4% 90,644 79,709 10,020 89,729 915 1.0% 275,815 270,747 5,068 1.8%

Acute Commissioning

General Acute (inc NCAs) 11,897 11,901 261 12,162 -265 -2.2% 47,586 47,900 126 48,026 -440 -0.9% 142,757 144,077 -1,320 -0.9%

Acute / General Provisions 677 2,031 -1,599 432 245 36.2% 690 2,112 -1,676 436 254 36.8% 2,071 1,303 768 37.1%

Total 12,574 13,932 -1,338 12,594 -20 -0.2% 48,276 50,012 -1,550 48,462 -186 -0.4% 144,828 145,380 -552 -0.4%

Non Acute Commissioning

Mental Health 1,926 1,772 154 1,926 0 0.0% 7,701 6,637 1,064 7,701 0 0.0% 23,102 23,102 0 0.0%

LD BCF 107 107 0 107 0 0.0% 430 430 0 430 0 0.0% 1,290 1,290 0 0.0%

Continuing Care 1,413 1,560 44 1,604 -191 -13.5% 5,476 3,487 2,355 5,842 -366 -6.7% 16,427 17,527 -1,100 -6.7%

Community Services 910 -370 1,182 812 98 10.8% 3,642 1,919 1,625 3,544 98 2.7% 10,927 10,633 294 2.7%

End of Life Care 75 25 50 75 0 0.0% 301 203 98 301 0 0.0% 904 904 0 0.0%

Community BCF 892 892 0 892 0 0.0% 3,567 3,567 0 3,567 0 0.0% 10,701 10,701 0 0.0%

Other 148 319 -171 148 0 0.0% 590 478 112 590 0 0.0% 1,770 1,770 0 0.0%

Total 5,471 4,305 1,259 5,564 -93 -1.7% 21,707 16,721 5,254 21,975 -268 -1.2% 65,121 65,927 -806 -1.2%

Primary Care

Prescribing 2,038 2,006 32 2,038 0 0.0% 8,153 3,763 4,390 8,153 0 0.0% 24,460 24,460 0 0.0%

Primary Care Delegated Commissioning 2,108 2,102 0 2,102 6 0.3% 8,409 8,407 0 8,407 2 0.0% 25,578 25,578 0 0.0%

Locally Commissioned Services 93 85 8 93 0 0.0% 373 56 317 373 0 0.0% 1,120 1,120 0 0.0%

Out of Hours 120 241 -121 120 0 0.0% 479 472 7 479 0 0.0% 1,437 1,437 0 0.0%

Other 87 -251 338 87 0 0.0% 347 -315 662 347 0 0.0% 1,040 1,040 0 0.0%

Total 4,446 4,183 257 4,440 6 0.1% 17,761 12,383 5,376 17,759 2 0.0% 53,635 53,635 0 0.0%

Other Corporate Costs (non RCA)

Other Admin - Non-Running Costs 237 188 49 237 0 0.0% 949 599 350 949 0 0.0% 2,848 2,848 0 0.0%

NHS Property Services re-charge 36 0 36 36 0 0.0% 145 0 145 145 0 0.0% 436 436 0 0.0%

Other Non-pay 110 248 -137 111 -1 -0.9% 438 -6 445 439 -1 -0.2% 1,312 1,312 0 0.0%

Total 383 436 -52 384 -1 -0.3% 1,532 593 940 1,533 -1 -0.1% 4,596 4,596 0 0.0%

Programme Surplus before Reserves 432 0 0 0 432 100.0% 1,368 0 0 0 1,368 100.0% 7,635 1,209 6,426 84.2%

Reserves

Contingency (Minimum 0.5%) 113 0 0 0 113 100.0% 453 0 0 0 453 100.0% 1,358 0 1,358 100.0%

0.5% In-Year Surplus 1 0 0 0 1 100.0% -359 0 0 0 -359 100.0% 1,245 0 1,245 100.0%

0.5% Headroom 0 0 0 0 0 0.0% 0 0 0 0 0 0.0% 1,209 1,209 0 0.0%

Surplus C/Fwd 318 0 0 0 318 100.0% 1,274 0 0 0 1,274 100.0% 3,823 0 3,823 100.0%

Total 432 0 0 0 432 100.0% 1,368 0 0 0 1,368 100.0% 7,635 1,209 6,426 84.2%

Total Application of funds 23,306 22,856 126 22,982 324 1.4% 90,644 79,709 10,020 89,729 915 1.0% 275,815 270,747 5,068 1.8%

Programme Surplus/Deficit 0 0 0 0 0 0.0% 0 0 0 0 0 0.0% 0 0 0 0.0%

Running Cost Allocation 346 410 -64 346 0 0.0% 1,383 1,574 -191 1,383 0 0.0% 4,148 4,148 0 0.0%

Constrained Population 0 0.0%

Running Costs per Head 0.00 0.00 0 0.0%

Running Costs

CCG Running costs 209 273 -64 209 0 0.0% 834 990 -156 834 0 0.0% 2,500 2,500 0 0.0%

CSU Re-charge 137 137 0 137 0 0.0% 549 584 -35 549 0 0.0% 1,648 1,648 0 0.0%

Total 346 410 -64 346 0 0.0% 1,383 1,574 -191 1,383 0 0.0% 4,148 4,148 0 0.0%

Total Running Cost Surplus/Deficit 0 0 0 0 0 0.0% 0 0 0 0 0 0.0% 0 0 0 0.0%

Income & Exp summary 2017/18

2017/18 Total Resources (Prog&RC) 23,652 23,266 62 23,328 324 1.4% 92,027 81,283 9,829 91,112 915 1.0% 279,963 274,895 5,068 1.8%

2017/18 Total Expenditure (Prog &RC) 23,652 23,266 62 23,328 324 1.4% 92,027 81,283 9,829 91,112 915 1.0% 279,963 274,895 5,068 1.8%

Check 0 0 0 0 0 0.0% 0 0 0 0 0 0.0% 0 0 0 0.0%

Apendix 1 - Sutton CCG - I&E Detail

Full Year forecastMonth 4 Year to Date (July 2017)

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Governing Body



Title of Document:

QIPP Report

Purpose of Report:

For discussion

Report Authors:

Richard Simon, Performance Assurance

Manager


and Delivery

Lead Director:


and Delivery

Executive Summary:

This report is to inform and provide assurance to the Governing Body about

delivery of the QIPP Plan for 2017/18.

The CCG has a net QIPP savings plan of £12.6m for 2017/18, which is double the

savings target from last year and considerably in excess of anything the CCG has

previously achieved.

A relatively small, but still significant, element of the QIPP Plan (£747,000) is to

take forward actions suggested by RightCare benchmarking, the Deloitte review

and from a review of the national Menu of Opportunities document where Sutton is

an outlier, with savings profiled to start from September.

Most other QIPP schemes are profiled to deliver savings equally through the year,

although there is an element of backloading of expected savings for both the

Diabetes and Kinesis schemes.

Around 40% of the QIPP target has been built in to budgets and contracts. A

further £1.8m relates to medicines optimisation and there is a reasonable degree

of confidence that it will be delivered, given the successful track record of the team

working with GP practices and other providers. The initial risk assessment of the

QIPP Plan was that c. 25% of the target was at significant risk of not being

delivered (i.e. was ‘red’ rated). The level of risk extends to the whole element of

the QIPP Plan which is not built into internal budgets and provider contracts, which

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totals £5.2m.

In summary, the biggest risk within the QIPP Plan relates to all the schemes which

are intending to reduce non-elective admissions (i.e. the BCF programme, the

Care Homes Vanguard programme, the Diabetes programme and the Respiratory

programme). The mitigate this risk the Management Team is aiming to put more

momentum into the work underway to implement a new approach to proactively

caring for some of the most vulnerable patients including those with multiple long

term conditions, including through the planned Locality Teams development.

There are a number of changes that have been implemented nationally to the

acute dataset (SUS) all for the new financial year, which are impacting on the

ability of all CCGs to accurately track their acute activity in Q1 which also impacts

on tracking of the impact of QIPP schemes on acute demand. For most QIPP

schemes the default position is still reporting performance on plan and on track to

deliver the planned outturn. As further data is available and the impact is clearer

significantly more detail will be included within these reports.

The one QIPP scheme where slippage has been formally reported in Q1 is with

respect of the ECI policy refresh as implementation of the new arrangements for

prior approval at Epsom and St Helier has commenced from 14 August and the

new ECI policy will not be implemented, assuming it is agreed in November, until

Q4 at the earliest. The FOT assumes slippage of £289,000 against the net

£473,000 saving target.


The risk rating of the QIPP Plan at the time it was finalised was that c. 25% of the

savings target was at significant risk of not being delivered (i.e. was ‘red’ rated).

The current assessment is that the level of risk has increased, although due to the

national issues with acute activity data it is difficult to be confident about the Q1

position. As further information becomes available a more robust forecast of the

likely outturn will be made, and will be reported to the next Governing Body

meeting.

Recommendation:


REVIEW the QIPP Report


Executive Committee meeting on 23 August


A small variance at month 3 has been reported to NHS England, due to slippage

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as set out above.

There are significant risks of non-delivery of up to £5.2m savings across all the

schemes that are not built into internal budgets and provider contracts. Mitigating

action is being considered.

If the non-delivery risks occur to any significant extent further action will need to be

agreed by Executive Committee and the Governing Body to rectify the CCG’s

financial position.


The CCG is committed to ensuring compliance with the Equality duty. This is done

through the quality and contracting process, including through an equality impact

assessment as part of any business case that results in a change of access to

services or major redesign of a pathway.


None.

Communication Plan:

Any proposals to redesign patient pathways or change service specifications would

be subject to patient and public engagement in line with the CCG’s normal practice

and NHS England guidance. There are no new proposals made in this report.

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QIPP 2017/18 summary

August 2017

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Summary

2

QIPP CATEGORY 1 PROJ. DESCRIPTION

Savings

Target

(£000s)

Savings FOT

(£000s)

Planned

Net Savings

YTD (£000s)

Actual YTD

(£000s)

savings

assumptions

Project

Costs

YTD

(£000s)

Actual YTD

(£000s)

savings

assumption

s

Planned

Savings

Target

(£000s)

Gross FOT

Savings

(£000s)

FOT Project

Costs

(£'000s)

Net FOT

Savings

(£000s)

Variance

(£000s)

NET FOT

(RAG

RATED)

(£000s)

Acute Services Epsom & St Helier CIPs 2,486 2,486 828 828 - 828 2,486 2,486 - 2,486 - G

Continuing Care Continuing Healthcare 500 500 168 168 - 168 500 500 - 500 - G

Primary Care Prescribing Growth Control 777 777 260 260 - 260 777 777 - 777 - G

Primary Care Medicines Management 887 887 513 513 - 513 887 887 - 887 - G

Mental Health Mental Health SLA 330 330 112 112 - 112 330 330 - 330 - G

Mental Health Mental Health Placements 170 170 56 56 - 56 170 170 - 170 - G

Community Intermediate Care Bed reduction 264 264 88 88 - 88 264 264 - 264 - G

Community Childrens CHC 200 200 66 66 - 66 200 200 - 200 - G

Acute Services CEOV Budget review 210 210 70 70 - 70 210 210 - 210 - G

Other Programme Medicines Management - - (26) - (26) (26) (80) - (80) (80) - G

Acute Services MSK / T&O / Falls Programme 1,330 1,330 214 214 - 214 1,330 1,330 - 1,330 - G

Acute Services Care Homes (Vanguard) - In Contract 396 396 108 108 - 108 396 396 - 396 - A

Acute Services Care Homes (Vanguard) - Not In 598 598 162 162 - 162 598 598 - 598 - A

Acute Services ECI 578 578 93 29 - 29 578 289 - 289 (289) G

Acute Services BCF Programme 1,372 1,372 456 456 - 456 1,372 1,372 - 1,372 - R

Acute Services Right Care 747 747 - - - - 747 747 - 747 - R

Acute Services Acute investments - - (232) - (232) (232) (701) - (701) (701) - G

Acute Services Respiratory Programme 321 321 86 35 - 35 321 321 - 321 - G

Acute Services Diabetes Programme 283 283 45 60 - 60 283 283 - 283 - A

Acute Services Kiniesis Optimisation 300 300 81 62 - 62 300 300 - 300 - A

Acute Services Prostate cancer nurse 15 15 5 3 - 3 15 15 - 15 - A

Acute Services Community Hernia Service 165 165 56 50 - 50 165 150 - 150 (15) A

Acute Services Medicines Audit & Review 215 215 72 72 - 72 215 215 - 215 - A

Other Programme Medicines Audit & Review - - (6) - (6) (6) (20) - (20) (20) - G

Acute Services Unidentified QIPP 1,245 1,245 150 150 - 150 1,245 1,245 - 1,245 - G

PROGRAMME TOTAL (£000s) 13,389 13,389 3,425 3,562 (264) 3,298 12,588 13,085 (801) 12,284 (304)

NET SAVINGS - REFORECASTEDGROSS ORIGINAL

SAVINGS TARGET

The table below provides summary of the current positon for each QIPP scheme. The summary report is to July 2017 using Month 3 actuals and forecast for Month 4. These figures have been used for M4 Financial QIPP reporting submitted to NHSE. A financial RAG rating has also been provided. At Month 4 the CCG is reporting a variance of £304k against a 2017/18 gross savings plan of £13,389k with a forecast outturn of £13,085. A high level summary of each transformational QIPP scheme is provided in the following slides of this report. Please note the scheme summary sheets are in development and in this version are included for illustrative purposes only. Activity numbers and associated costs are subject to revision due to the number of factors impacting on acute activity (SUS) data from April.

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Governing Body


Agenda No: 13 ENCLOSURE: 11a&b

Title of Document: Governing Body

Assurance Framework

Purpose of Report: For Review

Report Authors: Chux Ebenezer, Corporate

Assurance and Risk Manager, NEL CSU

Lead Director: Geoff Price, Chief Financial

Officer

Executive Summary:

The Governing Body Assurance Framework is presented for the Audit Committee to review. Risk 664, 1023, 531 and 1017 remain the highest rated risks for the CCG. 664 - If SWL CCGs fail to deliver the 5 year Strategic Transformation Plan, this may result in the local health economy being unsustainable both clinically and financially. 1023 - Issues with quality of provision of service in relation to GP patient records 531 - If costs for commissioned services exceed the resources available then there is a risk of non-delivery of financial targets and plans 1017 - Primary Care estates not fit for purpose Additional Comment: Corporate risks for August/September 2017 continue to be updated in line with the strategic

objectives of the CCG.


An overview of the Board Assurance Framework is attached to this document for review.

Escalation of risks from the corporate risk register to the Governing Body Assurance Framework No risks have been escalated to the Board Assurance Framework De-escalation of risks from the Governing Body Assurance Framework to the corporate risk register No risks have been de-escalated from the Board Assurance Framework.

Recommendation:

The Governing Body are asked to:

• NOTE the Governing Body Assurance Framework

• REVIEW and make comment ( if any ) on content of BAF

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N/A


As per Strategic Objective 3.


The CCG is committed to monitoring the compliance with the Equality duty of the providers

from whom we commission services. This is done through the quality and contracting

process.


As per Freedom of Information Act 2000

Communication Plan:

As per Freedom of Information Act 2000

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Governing Body Assurance Framework Summary August 2017

Corporate Objectives Principal risks to achievement of objectives Initial Score

Current Score

Target Risk

Score

Date of last

review

Change since

previous review

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Objective 1: Ensure patients are at the heart of decision making, working in partnership with individuals, patient representative groups, families and carers to deliver high quality, accessible services that tackle inequalities and respond to personal need.

534 If engagement with CCG practices inadequate, then there is a risk of a disconnection between the GB and the broader membership

4x3=12 4x2=8 4x2=8 June 2017

Objective 2: Commission high quality cohesive health services for the population of Sutton through joint working between health and social care organisations ensuring patients’ physical, mental and social wellbeing needs are met.

530 If the CCG fails to commission adequate commissioning support services there is a risk that the CCG does not fulfil all of its statutory commissioning functions

4x3=12 4x3=12 4x1=4 June 2017

664 If SWL CCGs fail to deliver the 5 year Strategic Transformation Plan, this may result in the local health economy being unsustainable both clinically and financially.

5x3=15 5x4=20 4x2=8 Apr 2017

677 If Sutton urgent care services are unable to provide sufficient capacity to meet patient demand, this may result in providers failing to meet key quality and performance commissioning expectations

4x4=16 4x3=12 3x2=6 Aug 2016

805 If providers do not meet national and local quality and performance standards, then the CCG population does not have constitutional pledges honoured by providers e.g. Cancer Targets, RTT, HCAIs

5x4=20 4x3=12 4x2=8 July 2017

912 If the CCG does not realise the financial benefits of the BCF programme, then savings will not be available for investment elsewhere in the heath economy and the CCG may not be able to deliver its 5 year strategy in full

4x4=16 3x4=12 3x2=6 May 2017

1023 Issues with quality of provision of service in relation to patient records 4x4=16 4x4=16 4x1=4 July 2017

1020 Financial and quality issues identified with CHC service

3x4=12 4x3=12 3x3=9 June 2017

1024 Gaps in primary care workforce - both GPs and nurses 4x3=12 4x3=12 4x2=8 July 2017

Objective 3: Maintain an efficient and financially stable, local healthcare system by improving primary care and community services and working closely with secondary care to deliver integrated services that bring healthcare into the community.

529 If the CCG's QIPP programmes do not achieve all planned objectives due to the demand for services and complexity of healthcare reconfiguration then there is a risk that the CCG may not be able to realise its cost savings and financial balance

5x4=20 4x3=12 4x2=8 July 2017

531 If costs for commissioned services exceed the resources available then there is a risk of non-delivery of financial targets and plans

5x4=20 4x5=20 3x3=9 June 2017

1017 Primary Care estates not fit for purpose 4x3=12 4x4=16 3x3=9 Aug 2017

Objective 4: Work with the local authority to develop an integrated commissioning framework that supports single, pooled budget for health and social care services with planned and agreed delivery across a range of areas.

803 If the CCG does not align 5 year forward view, Better Care Fund programmes and the Out of Hospital Strategy, as a result of conflicting perspectives, the CCG may fail to develop a locally owned and credible Strategic Plan

4x3=12 4x3=12 3x2=6 June 2017

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The top risks currently facing Sutton CCG, by risk score are:

664 If the CCG fails to reach agreement on hospital configuration across South London, as a result of the SWL Collaborative

Commissioning Strategic Plan being supported, this may mean the CCG is unable to finalise its 5 year strategic plan

1023 Issues with quality of provision of service from Capita PCSE in relation to patient records

531 If costs for commissioned services exceed the resources available then there may be a risk of non-delivery of financial targets of

0.5% surplus

1017 Primary Care estates not fit for purpose

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South West London Sustainability and Transformation Partnership not for onward circulation SWL Programme Update

September 2017

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Introduction

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This report provides an update on the major work programmes across the south west London Sustainability & Transformation Partnership (STP), as of September 2017. This update is the first in a new series of regular reports to CCG Governing Bodies, Local Transformation Boards, Health and Well Being Boards, Trust Boards, Local Authorities and wider stakeholders across SW London. Comments are welcome on the format, content and channels for dissemination for future reports to ensure that this is a robust and useful report. Summary highlights for September: • A refresh of SW London STP strategy is being undertaken in order to ensure we move towards local planning and delivery

to keep people healthy and out of hospital, and to ensure that delivery is centred around the Local Transformation Boards. • Local Transformation Boards (LTB) and new ways of working across Local Delivery Units (LDUs) continue to be embedded

to lead the development and delivery of the local health and care models. • 5 Year Forward View programmes across SW London in Urgent & Emergency Care, Cancer, Primary Care and Mental

Health are beginning to ramp up with delivery plans submitted in June and detailed implementation planning now underway.

• In addition, further work continues in delivering a common approach to Musculo-Skeletal Services (MSK) and Effective Commissioning Initiative across SWL as well as agreeing a delivery plan for Maternity to meet the Better Births recommendations.

• Enabling programmes in Digital, Workforce and Estates are focusing on supporting the transformation required across SW London, including – becoming a national digital exemplar, implementing the Electronic Referral System (ERS), establishing a Local Workforce Action Board and developing common approaches to estates development and monitoring.

• A new approach for Communications and Engagement is to be taken to shift the focus locally into the four Local Transformation Board areas. This will include strengthening engagement with local Healthwatch organisations, Overview and Scrutiny Committees and patient groups.


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• The Sustainability and Transformation Partnership for SW London, which includes the NHS and local authorities is currently refreshing its strategy.

• Since the publication of the SW London STP document in November 2016, we have held a series of public engagement events and more in-depth conversations with our stakeholders. As a result, the STP programme Board is now updating its approach and primary focus.

• We want to strengthen the focus on keeping people healthy. Getting involved earlier, as soon as vulnerable people start to become ill at home. We want to stop people from becoming more unwell and give them the right support at home so that they don’t need to be admitted to hospital. We know that being in hospital can in some cases lead to either a reduction in people’s independence, or even getting an infection. If people do go to hospital, we want to get them home, so they can recover more quickly in their own bed, with the right care and support.

• To achieve this focus on keeping people well, the SW London STP recognises that a local approach works best. The NHS working jointly with Local Authorities and local people within boroughs, will plan care based on people’s health and care needs from local-communities upwards. We want to move the conversation on, to be about planning and delivering care in these four health and care partnership areas:

• Kingston/Richmond

• Sutton

• Croydon

• Merton/Wandsworth

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Refresh of SW London Sustainability & Transformation Partnership (STP) strategy


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• We will also be working with our partners in Surrey, and London borders. By the end of November these health and care systems will have reviewed the feedback from local people over the last 6 months, analysed their local data and identified their challenges. They will then set out how they plan to work together to improve services for local people, and be clinically and financially sustainable into the future.

• We will now take advice from the local stakeholders and build on engagement to date to involve local people in planning services going forward. If any proposals would mean significant change, the statutory organisations would of course consult local people, with advice from our Overview and Scrutiny groups in each area, and our Health Watch partners.

• Since the October 2016 version of the STP was published, NHS leaders have now stated that all hospitals in South West London will continue to be needed in future, but that not all these hospitals will need to provide the same services that they do today.

• In November, we will publish an updated and refreshed strategy document that will consolidate this view and strengthen our major focus on working together in local health and care partnerships, to keep people well and out of hospital.

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Local Transformation Boards (LTB) Update

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Updates on Local Transformation Boards (LTBs)

• LTBs are in place and meeting on a monthly/bi-monthly basis for each local delivery unit (LDU), with core representation at senior clinical and management level from respective CCG, Local Authority, Acute, Community Health, Mental Health, GP Federation/Collaborative, Healthwatch, and Voluntary sector organisations.

• All LTBs have been developing their terms of reference and ways of working.

• The focus of the LTBs have included:

• Croydon: agreeing the out of hospital health and care model business case.

• Sutton: reviewing progress of the development of the health and care model, beginning to look at accountable care system model. Continued work on activity and financial modelling.

• Merton & Wandsworth: reviewing demographic growth analysis, and progress of planned, emergency, and primary care model developments. Continued work on activity and financial modelling.

• Kingston & Richmond: reviewing progress of the development of the health and care model, the LTB workplan, and

initiation of work on how to develop an accountable care system.


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Urgent & Emergency Care

SWL Urgent & Emergency Care Transformation & Delivery Board

• Since April 2017, significant progress has been made to strengthen the leadership and governance for the Urgent & Emergency Care programme across SWL. A&E Delivery Board Chairs (AEDB) were consulted on a draft proposal to establish a SWL Urgent & Emergency Transformation & Delivery Board (UECTDB) which had its first meeting in May and has since met on a monthly basis.

• The Board brings together the AEDB Chairs, Acute Trust Chief Executives, Executive Leads, Clinical Leads and is chaired by Jonathan Bates, Senior Responsible Officer for Urgent Care.

• The Board oversaw the development of the SWL Urgent and Emergency Care(UEC) Delivery Plan which was submitted to NHS England at the end of June. The Board is looking at areas where learning and good practice can be shared and disseminated across local AEDBs and where we can work on improvements that can be addressed collectively across SWL.

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SWL UEC Delivery Plan

The SWL UEC Delivery Plan outlines the priorities for 2017/18-18/19, in line with national and regional expectations to transform urgent & emergency care and get A&E performance back on track.

The priorities include: NHS 111 and 111 Online, GP extended access, Urgent Treatment Centres, ambulance demand management, improving care for the frail elderly, improving hospital flow, Mental Health Crisis Care and Care Homes. Work is underway in all these areas, including:

• A SWL London Ambulance Service (LAS) working group has been in place since May with a focus on demand management across SWL.

• Developing the current 111 Integrated Urgent Care service across SWL to meet the requirement for increased clinical cover by a GP.

• Designation of Urgent Treatment Centres continues, with 3 facilities still to be designated. A further SWL stock-take is to be carried out by the end of Summer.

• A UEC Leads forum is also being set up to support the sharing of learning and also to support and inform a SWL approach where this is appropriate.

• Working with the London Collaborative to build local expertise and local leadership to transform services.


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Cancer Cancer performance across SWL

• Delivery of the 62 day standard across SWL remains strong and above trajectory. There remains challenges for meeting the 2 week waits at St Georges Hospital and there is a possibility that this will impact the 62 day standard into the Autumn.

• The Cancer System Leadership Forum, which includes Trust Operational Leads and CCG Cancer Commissioning Managers, continues to implement the 62 day sustainability programme.

• Work continues across SWL to recover performance against the 6 week standard for diagnostics.

SWL Cancer Delivery Plan

• The SWL STP Cancer programme is working alongside Royal Marsden Partners Cancer Vanguard to deliver improvements to cancer services across SWL and NWL STPs.

• A delivery plan and transformation funding bids were submitted to NHS England in March 17. Transformation funding has now been secured for Early Diagnosis, with further funding for Stratified Follow-up and the Recovery Package is due to be released by the Autumn.

• The SWL Cancer Delivery Group, which includes CCG and Trust Cancer Clinical Leads and Commissioning Managers, previously agreed the major priorities for joint working across SWL including prostate cancer stratified follow-up, improving bowel screening uptake and implementing the recovery package.

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Prostate Cancer Stratified Follow-up • SWL Cancer leads have agreed a clinical pathway and model

for primary care led follow-up for stable prostate cancer patients, building on the pathway already in place in Sutton and Croydon.

• Early engagement with Surrey and London-wide LMCs is in train. They have signalled support for the pathway and work will continue to negotiate consistent pricing.

• A business case and draft service specification has been developed.

• Acute Trusts are reviewing the processes and patient cohort to identify likely activity figures.

• Transformation funding has been agreed and due to be released in the Autumn.

Improving bowel screening uptake • All CCGs continue to drive improvements to bowel screening

with a range of incentive schemes and initiatives in place. • The SWL Cancer Delivery Group is working with RM Partners,

Transforming Cancer Services team and other partners such as Cancer Research UK and the St George’s screening centre to agree a SWL approach for accelerating these improvements through use of the Cancer transformation funding.


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Primary Care

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Primary Care The primary care programme submitted a delivery plan to NHS England in June 2017, this set out our strategy and delivery plan in a number of key areas aligned to the GP Forward View. Achievements from the first three months of the financial year include:

• Working closely with CCG Primary Care Lead colleagues to ensure that each CCG was providing extended general practice access for its patients. Significant progress has been made and now all 6 CCG’s are providing some form of extended access to general practice 8am-8pm, 7 days a week.

A workforce group has been established to support the transformation of primary care and they have completed the following work: • A workforce audit, which was completed by 37 practices across SWL, to understand demand for primary care and how skill

mix could be used to manage demand in new ways. The results will be used to support transformation of the primary care workforce.

• Croydon, Sutton and Wandsworth bids for the clinical pharmacist programme have been successful, with an aim to extend this across SWL in the remaining part of the year.

• The move towards locality working has been supported through workforce modelling, discussions at individual CCGs, and aligning the primary care workstream with other areas of the out of hospital transformation programme.

• To support practices in managing demand, we were successful in securing resource for 3 cohorts of practices to be part of the productive general practice programme. Practices involved will have the opportunity to work with external change and Quality Improvement specialists to support them to become more efficient and release capacity. Learning from the programme will be shared across SWL.

• We have also begun to explore increasing the use of technology in primary care, such as online consultations, and held a roadshow to understand the solutions available in the market. Our patient group is informing this work through discussions about what patients want from technology solutions.


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Mental Health

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Mental Health • The Mental Health programme has moved quickly since April 2017. The programme now has dedicated programme support and

submitted a delivery plan to NHS England at the end of June. The SWL Mental Health Network is overseeing the work to implement this delivery plan.

• Key priorities of the plan include: Children & Adolescent Mental Health Services (CAMHS), perinatal mental health, improving access to psychological therapies (IAPT), community and crisis services, dementia, forensic services and suicide prevention. Ensuring mental health is embedded within the work of each transformation workstream to drive integration of physical and mental health is a theme running throughout the work.

Progress to date includes:

• Developing a service model for community perinatal mental health services across SWL, which would meet best practice guidance set out by Royal College of Psychiatrists. A bid for funding has been produced which will be submitted to the Community Perinatal Mental Health Services Development Fund in September 2017. This service will dramatically improve quality of care offered to women and their families during pregnancy and in the first year after birth.

• St Georges, Croydon, St Helier, and Kingston bids to improve psychiatric liaison services were all successful. From April 2018, all SWL acute hospitals will be compliant with “Core 24” standards, improving the care for people with mental health needs presenting at A&E.

• SWL work to support the London-wide agenda around Health Based Places of Safety is ongoing; testing the case for change and options locally, ahead of London wide pre-consultation engagement beginning in autumn 2017.

• The South London Mental Health Partnership (made up of SWLStG, SLaM and Oxleas) have successfully bid to pilot new models of care for adult forensic and Children & Adolescent Mental Health Services (CAMHS). These new models of care aim to transform the pathways, ensuring high quality care is available locally and that investment is used efficiently across the whole pathway.

• Work is underway across SWL to produce local suicide prevention plans, which will be complete by end of December 2017. Plans will draw on local and national best practice and identify things that should be done once across SWL e.g. work with the transport and river networks.


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Integrated Community Care

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• SWL is delivering the transformation of community based services through our four Local Delivery Units. This work is driven and overseen by the Local Transformation Boards (LTBs)

• LTBs are in the process of developing their models of care, setting out how they will improve and develop integrated community based care. This work involves developing the narrative plans, as well as modelling the activity and financial impact of the plans

• Whilst the work is being driven locally, there are a number of common areas of priority across the four LTBs. These include: integrated locality teams, intermediate care and crisis response, enhancing health in care homes, and end of life care

• Progress to date from the LTBs includes:

• Implementation of pilots to test new care models and ways of working, for example:

o Multi-disciplinary GP practice huddles are being assessed in Croydon, to form the basis for new ways of working in integrated locality teams.

o Multi-disciplinary working, including health clinics for older people, are being assessed in Kingston and Richmond.

o Community health and social care teams are being brought together in Sutton’s Wallington locality

o Work is underway across SWL to share learning from the Sutton Care Home Vanguard to implement the best practice interventions across the rest of SWL.

o Work continues across SWL to embed the best practice in end of life care including identifying priority areas for joint working across SWL.

• These examples of new ways of working across community based teams will drive the further development and refining of LTB plans, with learning being shared across SWL.

• A tool has been developed which will support LTBs to understand the activity and financial impact of their plans for integrated community care.


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Planned care The 6 SWL CCGs have agreed joint investment in Medicines Optimisation, including initiatives to:

• Get better value for money for high cost drugs prescribed in secondary care by working with hospital colleagues to optimise high cost drug pathways and improve the procurement of high cost drugs.

• Get better value for money from our primary care drug spend by supporting patients with their self care where approriate and working with prescribers to reduce prescribing of items which are less cost effective

• Support care homes to reduce the significant waste of prescription items which are paid for from primary care prescribing budgets

• Support patients and carers to take control of their care and their medicines by reducing over-ordering of items which are not needed and may, for example, expire before they are needed, checking prescription items before leaving their community pharmacy and training GP practice staff on the prescription reordering process

• Work with specialist colleagues to reduce the variation and price differences we have across SWL in the products available to patients for Oral Nutritional Supplementation (ONS) , Stoma, Continence and Wound Care.

The 6 CCGs are also working together on the ‘Effective Commissioning Initiative’

• The Effective Commissioning Initiative (ECI) policy contains a list of surgical procedures that are effective treatments only when certain clinical criteria are met. This is to ensure that patients receive the most appropriate care they require and that NHS funds are spent most effectively for the population of SWL.

• CCGs in SWL updated the ECI policy individually and signed these off in their Governing Bodies in Q4 of 2016/17. Although considerable similarities remained variation increased leading to inequality in access to surgical procedures listed in the ECI policy and leading to implementation challenges for providers.

• Variations are being aligned in a new ECI policy for SWL, which is due to be discussed and finalised by the Committee in Common of CCGs on 16 November.

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Planned Care - Musculo-Skeletal (MSK)

Musculo-Skeletal (MSK)

• The output from the Musculo-Skeletal (MSK) workshop in July was for 6 CCGs to agree a shared direction of travel:

• All to achieve an integrated MSK1 Single Point of Access with Triage2 by the end of 2017/18

• For CCGs to work together and achieve as much commonality as possible in terms of specification and delivery

• Work together to identify and look at how to close gaps in the system, for example Pain Management, and also how to support patients to self-manage their condition better.

• This direction of travel was supported by the Clinical Board on 3rd August and a paper on how best to achieve a fully integrated MSK service across SWL is currently being drafted with support from senior clinicians and commissioner planned care leads.

• Work is ongoing to identify more areas in Planned Care where we may wish to undertake work on a SW London basis. Ears Nose and Throat is currently being discussed.

1: Integrated MSK includes Physiotherapy, Pain Management, Rheumatology and Trauma/Orthopaedics 2: Triage in this context is clinical assessment of an inward referral to decide the right treatment


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Maternity

• Since April, the SWL Maternity Network refreshed its terms of reference to become the SWL Local Maternity System (LMS), as required by NHS England in line with the national commitment to deliver the Better Births recommendations for improving maternity services by 2020/21.

• The SWL LMS is led by Ann Morling, Director of Midwifery, CHS and Dr Anu Jacob, SWL Clinical Lead for Maternity. The LMS membership comprises Heads of Midwifery, Obstetric Clinical leads, CCG Maternity Clinical leads, Commissioning Managers, Local Authority, Patient and Public representatives as well as representatives from Obstetric Anaesthesia and Neonatology.

• All Trusts in SWL are piloting “My Maternity Journey in SW London” which provides consistent information on local maternity services, the maternity pathway and supports women to make informed choices about their care. This work is being undertaken as part of the NHS England funded Pioneer for Choice and Personalisation which runs to April 2018.

• Planning is underway to develop a delivery plan for the SWL Local Maternity System to respond to the national maternity review. The delivery plan is due to be submitted to NHS England by October 2017.


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Digital

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SWL Digital Programme • Locally led and supported at a SW London level, we are working hard to build on last year’s first Local Digital

Roadmap. In the last three months we have set in train a number of pan SWL initiatives.

• We have a new whole system SWL Digital & Technology Board with representation from all acute, mental health, primary social and community care partners across SWL

• For 2017/18, we obtained sponsorship at the first SWL leadership conference, to prioritise 3 Digital SWL initiatives: • To pursue support and funding for SWL to become England’s first place based national digital exemplar (GDE) • To deliver the nationally led electronic Referral System (eRS) across primary and secondary care services • To ensure our citizens and patients have access to digital applications that facilitate and support self care and

service signposting.

• Having written and submitted two digital business cases this year, we are going to support all our systems to be connected and extend access and input to shared care records across SWL.


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Workforce

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• The priority since April has been to move from strategic planning to implementation. The joint Local Workforce Action Board (LWAB) with Health Education England has been re-launched with revised membership and a new chair – Kelvin Cheatle, Director of Workforce at Kingston Hospital.

• A delivery plan has been agreed that includes discrete workstreams on Recruitment and Retention and Prevention and Wellbeing plus joint work with the mental health, primary care and UEC programmes to address the workforce issues arising from their plans. Two programme managers have been recruited and commenced work in mid-August.

• Our priorities for the next three months are to:

o Prepare for commissioning of pan-SWL training in Making Every Contact Count and Social Prescribing o Scope employers’ involvement with the Mayor’s Healthy Workplace Charter, encourage new participants, identify

and scale up relevant initiatives to support progress through the stages o Develop an action plan based on the recommendations of the new Recruitment and Retention working group

and commence implementation o Support the Mental Health programme team to develop a local mental health workforce plan as required by the

national plan o Commence scaling up of various local mental and physical health initiatives o Develop workforce plans with remaining STP programmes


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Estates

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• The SWL Estates Board chaired by James Murray, Chief Finance Officer South West London Alliance, continues to meet monthly, bringing together estates leads from all partnership organisations. The SWL estates delivery plan is under consultation and due to be agreed by partners by September.

• SWL estates leads support a strategy to ensure land and property in use across the health and social care system is fit for purpose, accessible and drives value.

• Estate use needs to be assessed and monitored to achieve efficiencies and avoid extra requirement for additional capital investment. SWL estates leads are developing tools and options to support Local Transformation Boards in this process.

• Local Transformation Boards will lead on confirming local estates needs following on from the confirmation of local health and care models from November 2017.

• Bids for a possible autumn allocation of capital are to be prepared by early September. Funding availability is subject to demonstration of proposals which are transformational for services and secure value for money.


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Finance

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• As part of the STP ‘refresh’, top level 2017/18 operating plans are now being modelled at Local Transformation Board level

• LTBs are expected to complete health and care modelling by 30 September 2017

• Growth rates and savings will be reviewed against original STP assumptions

• Updated bids for capital funding to be submitted to NHSI on 11 September 2017: main criteria for assessment will be how transformational schemes are, how they support delivery of the STP and return on investment. Bids need to fully worked up business cases with supporting evidence.

• Financial management at SWL level ongoing: monitoring of QIPP and CIP delivery, SWL financial position and risk, reporting to monthly Finance & Activity Committee and to NHS England and NHS Improvement via regular assurance meetings


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SWL Governance Boards updates

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Update from the STP Programme Board

• STP Programme Board met on 20th July

• Support was given on the proposed future model of the Clinical Board

• Updates on the four national programmes were received; UEC, Primary Care, Cancer and Mental Health

• Health Care Model updates were received from the four Local Transformation Boards

• A draft refreshed narrative and approach to the STP was received by the Board, which outlined the next phase of communications and engagement

• The Board received an update on the Epsom & St Helier estates engagement process

• Support was given to the revised STP Leadership arrangements, a new Quartet arrangement was approved which is the Senior Responsible Officer (Sarah Blow), A Local Authority Representative (Ged Curran), A Provider representative (John Goulston) and a Clinical Chair (Dr Naz Jivani)

• Feedback from the Finance & Activity Committee from 14th July was received

Update from the SWL Clinical Board

• Clinical Board met on 3rd August

• Agreement was reached on the core functions and on the revision membership of the Board

• The Clinical Board gave approval to progress with a standardised approach to MSK across SW London

• A paper was presented on the Epsom & St Helier clinical model, long term estates engagement. The Board acknowledged the paper and supported the principles outlined

• STP Clinical Standards paper with which each SWL acute trust should meet was received and reviewed. The Board gave recommendations on content changes with particular focus on acute medicine and paediatrics

• Mandate was given to a SW London wide ENT approach to modeling, similar to MSK. The first step being a workshop being set up to determine the scope


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Communication and Engagement Planning for the STP

Communications and Engagement

The new Director of Communications, Charlotte Gawne presented at the last STP Board.

• As explained in the presentation at the STP Programme Board, the focus for communications and engagement will now shift locally into the four Local Transformation Board areas.

• We will build on the involvement of Health Watch, Overview and Scrutiny Committees and citizen/ patient representative groups in developing these communications and engagement plans going forward and have already had some helpful conversations with some Health Watch and Community Voluntary Service groups.

• This a good opportunity to re-focus the communications and engagement locally, and think strategically about what outcome we want to achieve from an integrated communications perspective around these areas:

o clinical and staff engagement,

o patient and citizen engagement

o public affairs and stakeholder management

o media, social media and campaigns.


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Summary of current thinking

• A local approach works best for planning health and care

• The best bed is your own bed – lets keep people well and out of hospital

• Care is better when it is centred around a person, not an organisation. Clinicians

and care workers tell us this.

• Likely to mean changes to services locally - we are not proposing to close any

hospitals

• We need to show people how it works better with local examples

• Involving people at local level


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Forward look – Autumn 2017

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SWL Commissioning Intentions 2018/19

• Preparations are now underway for the commissioning and contracting round 2018/19. It has been agreed by Directors of Commissioning that SWL Commissioning Intentions will be developed to reflect the Delivery Plans for Urgent & Emergency Care, Primary Care, Cancer and Mental Health and other local plans agreed this year. SWL Commissioning and Contracting Intentions will be finalised by 30 September

Urgent & Emergency Care

• A&E Delivery Boards are preparing Winter Plans by early September. This includes a number of initiatives such as implementing front-door streaming and improving hospital flow processes including implementing the SAFER bundle.

• There is a national expectation that NHS 111 Online will begin to be implemented during Autumn – Winter. SWL will be expected to implement an online system which will triage symptoms and signpost patients to the most appropriate service.

Cancer

• Continued work to launch projects in early diagnosis, including improving bowel screening uptake.

• Anticipated release of funding during Autumn for stratified follow-up to support primary care led follow-up for prostate cancer.

Maternity

• Delivery Plan against Better Births national maternity review to be further developed through the SWL Local Maternity System and shared with LTBs, ahead of submission to NHSE in by end of October.


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Forward look – Autumn 2017

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Primary Care

• Prepare a bid for the next round of International GP Recruitment, support further bids for the clinical pharmacist programme

• Agree Memorandums of Understanding with practices successfully selected for resilience funding and support any future work required

• Rollout model of 111 direct booking into GP extended access hubs and pilot practices, and implement pilots for redirect from A&E to the hubs

• Engage with practices on primary care at scale, and share learning from the “time for care” initiatives with all practices.

• Locality working – Support planning and implementation of primary care at scale initiatives from interested practices.

Integrated Community Care

• Development of more detailed implementation plans for the full roll out of the out of hospital health and care model across Croydon

• Work to understand the finance and activity impact of developing initiatives e.g.

Setting up of finance and activity groups with senior level finance representation from LTB members to provide oversight and ratification of activity and finance impacts

Development of an activity and financial impact modelling tool by the SWL STP Programme team to support LTBs quantify the impact of their proposed care models in a consistent manner across LTBs

Planned Care

• SWL ECI Policy version 2.0 to be signed off by CCGs in November

• Continued work on MSK model for SWL, and further exploration of the ENT pathway.


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Governing Body


Agenda No: 15 ENCLOSURE: 13a-d

Title of Document: Approved minutes of Committees of the

Sutton CCG Governing Body

Purpose of Report:

For Note

Report Authors:

As per details on each attachment

Lead Director:

As per details on each attachment

Executive Summary: The following minutes are attached for the Governing Body to note:

• Executive Committee: 28.6.17, 12.7.17, 26.7.17, 9.8.17

Due to the timing of meetings, a number of minutes are awaiting approval. These will

be submitted to the September Governing Body meeting.

Recommendation(s):

The Governing Body are asked to:

• NOTE the minutes.

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MINUTES OF

THE SUTTON CLINICAL COMMISSIONING GROUP EXECUTIVE COMMITTEE MEETING

Wednesday 28 June 2017, 2:00 – 3:30

Meeting Room 1, Priory Crescent Present

Dr Chris Elliott CE Chief Clinical Officer / GP - Benhill and Belmont Surgery (Chair)

Dr Robert Calverley FR Wallington Locality Lead

Dr Jonathan Cockbain JC Carshalton Locality Lead

Dr Dino Pardhanani DP QIPP Lead-LCCs and Service Redesign / GP - Mulgrave Road Surgery

Dr Roshni Scott RS QIPP Lead-Medicines Management

Karol Selvey KS QIPP Lead / Nurse Practitioner and Partner - Dr Grice and Partners


In Attendance

Helen Bailey HB Interim Director of Delivery

Sam Green SG Service Redesign Manager


Carolyn Reynolds CR Head of Primary Care Commissioning


Clare Wilson CW Interim Deputy Managing Director

Apologies

Dr Jeff Croucher JJC QIPP Lead – Mental Health



SK Sutton and Cheam Locality Lead

Welcome and Introduction

1. Welcome and Apologies CE welcomed members to the meeting. Apologies of absence were noted as above.

2. Declarations of Interest The Register of Interest was agreed as a correct and accurate record noting the following addition:

- CE declared that he was now a locum GP which needed to be included on the register.

3. To approve the minutes of the Executive Committee meeting 14 June 2017

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The minutes of the meeting held on 14 June 2017 were agreed as an accurate record of the meeting.

4. Matters arising not on the agenda and review of action log from previous meeting The action log was updated and would be submitted to the next meeting of the Executive Committee. Sutton CCG QIPP opportunities identified through the Right Care Programme HB agreed to ask BA to include a timeline on the action plan in

relation to QIPP recovery.

HB

Approval

5. Effective Commissioning Initiative (ECI) policy HB presented a paper which described the process to align clinical thresholds listed in the Effective Commissioning Initiative policy and the revision of the compliance monitoring mechanisms to underpin the process. HB summarised the process which is supported by the South

West London (SWL) Committees in Common and the South

West London Clinical Board.

On 6 April 2017 the SWL Committees in Common (CiC)

agreed that SWL CCGs would work in collaboration to deliver

version 2.0 of the SWL ECI policy, ensuring alignment of

existing clinical thresholds and common processes to monitor

compliance.

The SWL Clinical Board held a workshop on the 20 April 2017

to define the processes surrounding the alignment of the

clinical thresholds for CiC ratification. The workshop

generated considerable appetite for refinement and alignment

of clinical thresholds as well as streamlining compliance

monitoring processes.

The scope of the realignment process includes the 59 clinical

thresholds currently listed in the SWL ECI policy and considers

a limited number of new thresholds that are deemed high

priority and can be fast tracked, such as those being novated

from NHS England specialist commissioning to CCGs like

bariatric surgery in 2017/18.

It will also examine and refine the compliance processes

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supporting the effective implementation of the ECI policy.

HB confirmed that SWL Clinical Chairs will send the final

version of 2.0 to the CiC in October 2017 for final ratification

for all six CCGs with a proposed ‘go-live’ date of 1 December

2017.

It was agreed that there was a need to ensure all GPs, GP

locums, clinicians, nurse practitioners and all relevant practice

staff have access to the policy and understand any changes in

order to be able to communicate with patients.

HB agreed to liaise with colleagues in the primary care team to

discuss how best to disseminate the information.

Recommendation

The Executive Committee approved the ECI realignment

process across SWL.

HB

Update & Discussion

6. Improving Access to Psychological Therapies (IAPT) action plan CW shared the IAPT recovery action plan with members of the executive for information only which describes the work currently being undertaken to provide a broad range of mental health support to the people of Sutton. CW tabled an action plan that was put in place to bring Sutton

CCG recovery and access rates up to the national standard.

This has now achieved the rates for April and May 2017.

CW also stated that there was a need to look at the case for

additional funding to meet the new targets for 17/18 and

18/19. A further paper would be prepared for the July

executive meeting.

After discussion the following key points were raised by

executive members:

In relation to the UPLIFT service there needs to be

some improvement in the second contact made

between the service and patient. A number of patients

‘drop-out’ due to lack of/delayed contact.

Patients are not comfortable with the idea of group

therapy. There needs to be more information to

CW

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patients with regards to these sessions.

Recommendation

The Executive Committee noted the Annual Report and

action plan.

7. Review of Minor Surgery Services in Primary Care

CR attended the meeting and presented a paper of the review

of minor surgery services in primary care.

In common with all London CCGs, Sutton was currently

reviewing the PMS contracts of GP practices. The CCG has

been working closely with the LMC and NHS England to agree

commissioning intentions. The review commenced in

November 2015 but was put on pause by NHSE in early 2016

due to negotiations around the London Offer that the LMC

were not happy with. Negotiations began again in

October/November 2016. The timeline following the pause

was for contracts to be signed and commenced from 1st April

2017. This timeline has now been extended until 1st October

2017.

CR explained that the purpose of bringing the details of the

PMS offer to the executive was for clinical input into the

development of a Minor Surgery Service Specification that

does not overlap with the current Minor Surgery DES or the

Additional Minor Surgery requirements in the GMS/PMS

Contract.

Details of the current position with regard to Minor Surgery in

Sutton are described in the main body of the paper. The

premium attached to this element is £1.20 per head of

capitation and this money could be used to fund another

service in primary care to reduce activity/expenditure

elsewhere in the system if it is felt that minor surgery is already

well covered in primary care.

Following discussion the executive committee agreed that

there was a need to understand what every practice within

Sutton was undertaking by way of minor surgery services. It

was felt that the funding should stay with the PMS Premium

until there was a clear understanding. This decision would

then need to go to the Primary Care Commissioning

Committee for approval.

CR

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Recommendation

The Executive Committee discussed and noted the paper

and requested an audit of minor surgery services within

Sutton practices before taking forward.

8. Performance & Quality report HB presented the report raising a number of key highlights in relation to performance as detailed within the report. It was noted that the June meeting of the Quality Committee had received and discussed the quality section.

The structure and content of the report has been subject to

discussion and review by members of the Executive

Committee and Quality Committee over the last couple of

months and feedback from each of these has been integrated

into this month’s report.

Recommendation

The Executive Committee noted the report.

9. QIPP report SG presented the QIPP report at month 12. Key points noted included:

QIPP schemes were identified at the beginning of the financial year to the value of £6.5m

The CCG was currently reporting an outturn for 2016-17 of £6.338m savings against that target

This equates to 98.1% of the total

This means that we currently have a QIPP gap of £162k

The Executive Committee noted the reported and discussed the issue around training within primary care and the need for the CCG to engage especially around CCG priorities. Recommendation


10.

Finance update – Month 2 (17/18) CE presented the finance report in the absence of GP. It was noted that the CCG reported the month 2 position to NHSE on 9 and 12 June 2017.

The CCG was reporting on plan at month 2 year to date and

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full year forecast.

Recommendation


11. Board Assurance Framework CE presented the Governing Body Assurance Framework. It was noted that there had been an additional risk added to the Board Assurance Framework (Risk 1024) gaps in primary care workforce. It was noted that all risk owners were now actively reviewing and updating their assigned risks. Recommendation


For Information Only

12. Executive Committee Forward Plan The Executive Committee noted the forward plan. CE confirmed that the process of receiving presentations from Clinical Leads would be re-established.

Any Other Business

13. Any Other Business CE confirmed that both the Plenary supported the appointment of Dr Jeff Croucher together with the interview panel. A recommendation of support would be made to the Governing Body on 5 July 2017. CE also thanked Helen Bailey for all her work in the interim role of Director of Delivery. Sean Morgan would commence his substantive role at Director of Delivery and Performance as from 1 July 2017.

Date of Next Meeting

14. The next meeting of the Executive Committee was noted as Wednesday 12 July 2017, 1:00-3:00pm, MR1, Priory Crescent.

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MINUTES OF


Wednesday 12 July 2017, 1:00 – 3:30


Dr Chris Elliott CE Chief Clinical Officer / GP - Benhill and Belmont Surgery (Chair)







In Attendance



Portia Kumalo PK Children & Maternity Commissioner (Interim)


Clare Wilson CW Deputy Managing Director (Interim)

Apologies


Dr Jeff Croucher JJC QIPP Lead – Mental Health




1. Welcome and Apologies CE welcomed members to the meeting and especially welcomed Sean Morgan, Director of Performance & Delivery to his first executive committee meeting. Apologies of absence were noted as above.

2. Declarations of Interest The register of interest was agreed as a correct and accurate record.

3. To approve the minutes of the Executive Committee meeting 28 June 2017 The minutes of the meeting held on 28 June 2017 were agreed as an accurate record of the meeting.

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4. Matters arising not on the agenda and review of action log from previous meeting The action log was updated and would be submitted to the next meeting of the executive committee meeting.

Approval

5. South West London (SWL) CCG’s IT Review

SM presented a paper which provided the executive

committee with details of an IT review looking at requirements

across the 6 SWL CCGs, including supporting increased

collaborative working across the STP Programme and through

the SWL Alliance. A task and finish group was established by

the SWL Alliance Senior Management Team which had

agreed a set of principles and engaged with staff to identify

five top priorities. The task and finish group recommends that

Sutton and the other CCGs adopt the same Cloud based

infrastructure and agile devices as set out in the report.

SM confirmed that the report only related to HQ IT support, no

changes are proposed with respect to GP IT.

SM explained that Sutton was currently reliant on dated and

fragile network infrastructure which carried a high risk of failure

and which would need to be replaced asap to simply maintain

the status quo.

The review recommends a new approach (based on what is

working already at Wandsworth CCG) utilising the Microsoft

Azure Cloud and Office 365 for servers thereby removing the

need to fund the replacement of the local network

infrastructure.

The proposed approach includes use of a single email system

across the SWL CCGs, with a Sutton CCG identity for Sutton

staff, which will involve migrating staff off the current NHS mail

and calendar system.

This approach involves a revenue cost within 17/18 for MS

Office 365 licences of £534 per user, or £37,380. These costs

would then be mitigated elsewhere.

SM confirmed that the current assumption was that the MS

Office 365 licences would not be a revenue pressure for

17/18.

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It was felt that this was the most cost effective solution.

However, there was still a need to work through capital costs

to ensure the best value for money. A number of decisions

will need to be made to reduce the current estimated costs.

The HQ IT support contract with NELCSU will need to be re-

procured in due course, as the current specification and price

are based on management of a local network infrastructure

which will not be required whereas the CCG will want to

access more front line engineer support and training.

SM confirmed that following recent security breaches, NHS

Digital had signed of the proposed Cloud based infrastructure

and was assured it met all the new security requirements.

SM also confirmed that there would be a need to ensure

excellent Wi-Fi access with the possibility of standardising

across SWL.

Recommendation

The executive committee agreed in principle that Sutton

CCG (together with the SWL Alliance CCGs) adopts a

cloud-based ICT service model based on use of Microsoft

Azure and Microsoft Office 365. The executive committee

felt that they would need to discuss further if the financial

predictions changed significantly.

Update & Discussion

6. Feedback from Localities Both SK and JC fed back following recent meetings within the localities. Key items raised and discussed included:

Positive feedback to the 16/17 engagement scheme

Good but varied use of Kinesis by practices with the aim to continue through 17/18

Feedback from integrated locality workshop It was noted that the engagement scheme would need to be agreed at a future meeting of the Primary Care Commissioning Committee.

7. Children’s Commissioning – update

CW introduced PK who was currently working for the CCG as

interim childrens and maternity commissioner.

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The executive committee noted a paper produced in response

to a growing number of individual service issues being raised

over the last 6 months about children’s services.

CW stated that PK had produced an initial summary workplan

which was included within the executive papers that had

highlighted a deficiency in a number of services that are

commissioned from health, education and LA. PK was

currently developing a full action plan to address the issues

that the CCG needs to address over the coming months.

These included:

Neurodevelopment pathway needs review and redesign

Eating disorder pathway needs review and redesign

Paediatric community service commissioned from

ESTH needs redesign and re-specification

Partnership working across all providers and

commissioners must be improved

Children’s SLT/OT/PT services need redesign.

PK confirmed that the CCG was now working more closely

with the LA around the issue children and their families face

when transferring from children to adult services including

issues around age criteria and gaps in service for specific age

groups.

The executive committee felt it was important to ensure that

health, education and LA all understand where each service

sits and who is accountable for what.

It was also noted that the CCG was currently working jointly

with partners to support services relating to children self-harm

and suicides due to recent events.

Recommendation

The executive committee supported and noted the work to

date and requested a further update at the end of August

2017.

CW/

PK

8. Learning Disability (LD) Placements – update LW provided a verbal update on the current situation in relation to the number of Continuing Healthcare (CHC) cases for people with Learning Disability (LD). These are all NHS

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funded in entirety or jointly with the Local Authority (London Borough of Sutton) and the numbers in Sutton CCG have risen significantly in the last year. The spend on this specific patient cohort has increased from £450k in 2014/15 to a projected £4M in 2017/18. LW informed the executive committee that Sutton CCG was seeking an urgent review of the decision making taking into account the statutory responsibilities of health and social services in relation to healthcare need and social need. Two companies had been approached to provide an estimated cost to undertake this review. GP stated that the cost of the review was not in the current CCG budget but was a must do for the organisation. Sutton CCG currently had 44 people with LD who were in

receipt of a full, CHC package of care and 12 joint packages.

Recommendation

The executive committee noted the update and requested

that the outcome of the review be brought back to the

committee once completed.

LW/MH

9. Improving Access to Psychological Therapies (IAPT) – funding proposal CW tabled a paper which answered a number of questions raised by executive committee members at their previous meeting. A subsequent question was raised which CW agreed to answer outside the meeting:

How many repeat attenders over a period of 12 months and the number of associated sessions?

CW also tabled a draft paper on the Sutton Uplift IAPT Increasing Access in line with revised national target:

- As stated in the NHS Five Year Forward view, access

rates for people with mental health conditions including

Depression and Anxiety would increase over that 5 year

period to meet 25% of prevalence.

- From 2017/18 the baseline for the access rate for IAPT

services has been increased from 15% to 16.8%

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meaning that our local service, Sutton Uplift, would

need to see and treat a further 308 per year.

- The service has undertaken a number of transformation

projects around its capacity and demand which has

seen a sustained improvement in both Access and

Recovery.

Although these changes had seen an improvement in these

national targets, in order to maintain this level of service to

take into account the increase, further capacity would need to

be considered.

CW agreed that further work needed to be undertaken to understand the funding required to increase capacity for assessment and treatment to achieve the national target. It was noted that this would generated an additional cost pressure for the CCG. Recommendation

The executive committee noted the update and requested further detail in relation to the funding required.

CW

10.

Finance update – Month 3 (17/18) GP gave a verbal report and confirmed a written report would

be prepared for the next meeting.

The month 3 year to date (ytd) and full year forecast (fyf)

financial returns were due at NHSE today. Prior to the formal

returns there had been the SWL CFOs conference call with

NHSE where NHSE want to understand what will be

submitted.

Sutton CCG (and as GP understands, all SWL CCGs) are

reporting on plan year to date (the 3 months to 30 June) and

full year forecast.

Month 2 acute returns (which inform month 3 reporting) show

a small overspend on contract but with significant variances by

provider. ESH shows an underspend but virtually every other

provider an overspend, particularly at StG, RMH and Guys. It

is very difficult to interpret acute data at this time for a number

of reasons. These include changes to IR rules, the move to

HRG4+, changes to SUS reporting , and how the revised

orthopaedic tariff is operating. The CSU are carrying out work

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to understand the picture but thus will take a few weeks.

In addition to the overspend on contract value there is the

matter of acute QIPP not in contract that must be taken into

account in deriving the overall position and makes the acute

position worse (ie acute actual spend needs to be below

contract value to meet plan).

However given the difficulty in interpreting this early acute data

data just the overspend compared to contract has been

included in the position – an overspend of £700k.

GP also highlighted the cost of LD high costs placements.

These were forecast to be some £700k overplan for the full

year. This does not include a retrospective claim by the LBS

for some#1 million which the CCG is contesting.

The SCCG Managing Director (MD) is initiating a much

needed formal review of LD placements (which may expand

into LD and other continuing healthcare costs) given the

exponential rise in costs in the last few years (around 450k in

1415 to 3 million in 17/18).

All other areas of commissioned services are on plan.

Taken together there is a 1.4 million budget overspend (acute

and LD) and this has been mitigated by the 1.4m (0.5%)

contingency reserve. Thus the CCG has reported on plan but

has highlighted to NHSE the very significant risks of meeting

plan.

The ESH contract for 17/18 has been agreed and will be

signed by the MD shortly.

Recommendation

The executive committee noted the update.


11. Planned Care Working Group minutes – May 2017 The executive committee noted the planned care working group minutes of the 18 May 2017 meeting.

12. Executive Committee Forward Plan The Executive Committee noted the forward plan.

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Any Other Business

13. Any Other Business It was noted that both LW and JC would not be able to attend the next executive committee scheduled for 26 July 2017.

Date of Next Meeting

14. The next meeting of the Executive Committee was noted as Wednesday 26 July 2017, 2:00-3:00pm, MR1, Priory Crescent.

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MINUTES OF


Wednesday 26th July 2017, 2:30–3:30pm



Dr Chris Elliott CE Chief Clinical Officer (Chair)





In Attendance


Apologies









1. Welcome and Apologies CE welcomed members to the meeting. Apologies of absence were noted as above.

2. Declarations of Interest The Register of Interest was agreed as a correct and accurate record.

3. To approve the minutes of the Executive Committee meeting 24 May 2017 The minutes of the meeting held on 12 July 2017 were agreed as an accurate record of the meeting subject to the following minor changes: South West London (SWL) CCG’s IT Review (page 2) SM confirmed that the current assumption was that the MS Office 365 licences would not be a revenue pressure for 17/18 as detailed within the minutes.

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Finance update – month 3 (17/18) (page 7) GP stated that the exponential rise in LD placement costs in the last few years is around 450k in 14/15 to 3 million in 17/18 and not 45K in 14/15 as detailed within the minutes.

4. Matters Arising QIPP Assurance meeting

SM confirmed that he had agreed to produce a brief update

following each monthly QIPP Assurance meeting for

circulation to the Executive Committee, Locality Leads,

Practice Nurse Forum and Practice Managers meeting.

SM

For Discussion

5. 5. Effective Commissioning Initiative policy v.2.0 Following previous updates and approval at both the

Governing Body on 5 July 2017 and Executive Committee on

28 June 2017, SM gave a further update on the process to

align clinical thresholds listed in the Effective Commissioning

Initiative policy (in a new version 2.0) and the revision of the

compliance monitoring mechanisms to underpin this.

Some procedures have different clinical thresholds in South

West London (SWL) and some require clarification to ensure

effective implementation. Three clinically-led task and finish

groups had been established to review the evidence, consider

the current policies in SWL and elsewhere around the country

and make recommendations for a standardised version of the

ECI Policy (v.2.0), to go to the CCG Committees in Common

meeting scheduled for 12 October 2017.

SM confirmed that providers had been made aware that policy

changes would be made in year, so this would not be a

surprise to them.

SM confirmed that DP, clinical lead, was currently reviewing a

number of policies and attending meetings where he had

capacity.

The Executive Committee also noted that the new prior

approval process on the current policy is being rolled out to

Epsom and St Helier with a go live date from 14 August 2017,

with forms being submitted through the Blueteq system for

clinical review by a panel of primary care clinicians.

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SM also confirmed that discussions were being held across

SWL in relation to patient decision aids and the benefits/risks

involved.

Recommendation

The Executive Committee noted progress with the Effective Commissioning Initiative policy v.2.0 development process across South West London, and in particular the arrangements for local clinical input into the process.

Regular Report

6. 6. Finance report – month 3 GP presented a written report following the verbal update

given at the Executive Committee on 12 July 2017.

GP confirmed that the CCG had reported the month 3 position

to NHS England on 12 July 2017.

The CCG was reporting on plan at month 3 year to date and

full year forecast.

Acute spend

GP reported that the month 3 position is based on month 2

acute reporting. There are a number of issues with acute data

at this time which make the month 2 reported results difficult to

interpret. These include the changes in the identification rules

(IR) for specialist services, the effects of HRG4+, the effects of

the change in the orthopaedic tariff, the costs of critical care

and changes in SUS reporting. Given this the CCG has taken

a view on the acute position. This is that the acute outturn is

around £700k over contract value and that QIPP not in

contract will be delivered. There is significant risk around this

view, particularly in terms of QIPP delivery, and this is

highlighted in the financial returns to NHSE. However it is

considered to be an appropriate position to take at this time.

The CSU is and continues to undertake work in clarifying the

acute position, particularly in terms of the impact of the change

in the IR rules.

LD spend

Based on information to date LD placement spend is forecast

to be £700k above plan. This spend has increased

considerably in recent years and has been highlighted in

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previous finance reports. Given this trend, and in response to

even further costs the LA claim should be met by the CCG, the

MD has instigated a formal review of all LD placement costs

met by the CCG and the basis for these.

CHC and LD placements

These costs are currently at or near plan but remain an area of

risk. The review above may well be widened into these areas

given the increase in spend in recent years.

All other areas of CCG commissioned services and running

costs are on plan.

Given the above there is a forecast £1.4m overspend on

budgets ( acute £700k and LD £700k ). In reporting the overall

position on plan the CCG’s 0.5% contingency reserve has

been utilised to cover these overspends and has been

reported to NHSE.

Recommendation

The Executive Committee noted the finance report at

month 3.


7. Executive Committee Forward Plan It was agreed to review and update the forward plan to ensure that there was enough time at the meeting scheduled for Wednesday 23 August 2017, to cover items being submitted to the Governing Body meeting on 6 September 2017.

JW

Any Other Business

8. Any Other Business CE informed members that he had attended a workshop lead by SWL Alliance to identify areas of commissioning that could be done once across SWL. This process was in early stages and CE agreed to keep the Executive Committee updated.

9. Date of Next Meeting The date of the next meeting is scheduled for Tuesday 9th August 2017, 1:00-3:00pm, Priory Crescent.

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MINUTES OF


Wednesday 9 August, 1:00–3:00pm Meeting Room 1, Priory Crescent

Present








In Attendance


Bisi Aiyeleso BA Project Manager (Interim)

Apologies

Dr Robert Calverley RC Wallington Locality Lead


Dr Chris Elliott CE Chief Clinical Officer (Chair)





1. Welcome and Apologies LW welcomed members to the meeting as advised that in CE absence she would be chairing the meeting. Apologies of absence were noted as above. It was noted that the meeting was not quorate and therefore any recommendations made would be emailed out to all members of the executive committee for approval.

JW

2. Declarations of Interest The Register of Interest was agreed as a correct and accurate record.

3. To approve the minutes of the Executive Committee meeting 26 July 2017 The minutes of the meeting held on 26 July 2017 were agreed as an accurate record of the meeting.

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4. Matters Arising & Action Log The action log was reviewed and would be updated prior to the next meeting of the executive committee.

For Approval

5. 5. Head of Programme Management Office (PMO)

SM presented a paper which had previously been discussed

at and was supported by the Management Team .

SM confirmed that the level of QIPP savings planned for

2017/18 (and future years) was a very significant risk for the

CCG. The CCG therefore needed to deliver a QIPP

programme greatly in excess of what had been achieved in

previous years and there was currently a capacity and

capability gap in terms of the skills and competencies required

to oversee the QIPP programme and in terms of providing

expert support to clinical leads and commissioning managers

in delivering their schemes.

The proposal from Management Team was to create a Head

of Programme Management Office (PMO) role to address the

identified risk and enable the Executive Committee and the

Governing Body to have the assurance they would need on

the delivery of the QIPP programme.

The job description attached to the papers described the wide

range of skills and competencies the postholder would bring to

bear on supporting the CCG in delivering on the QIPP

programme, which is an essential must-do.

SM confirmed that this role was not currently being undertaken

efficiently as a whole by the CCG but was being covered by

numerous people undertaking certain key elements.

The post would be advertised externally, with an appointment

in post hopefully by the new year.

LW stated that the role would need to be the ‘brain of the

organisation’ pulling together all the programmes across the

organisation.

Recommendation

The Executive Committee approved the management team recommendation to appoint a Head of PMO role on a permanent basis.

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Due to the meeting not being quorate, approval would be subject to other members agreement.

6. 6. Business case for straight to test pathway for routine

lower gastrointestinal (GI) referrals

BA attended the meeting and presented an outline business

case for straight to test pathway for routine lower

gastrointestinal referrals, which provides details the work

required for the implementation of this project and the potential

savings that could be delivered.

This is in response to the Sutton CCG QIPP plan which

includes a savings target for areas aligned to the opportunities

highlighted within the Commissioning for Value Right Care

toolkit.

Expansion of the straight to test pathway for lower GI referrals

to include routine referrals has been identified as a priority

area within gastroenterology.

The attached business case:

Details the potential options to support the implementation of the pathway through funding provided for the telephone assessment clinics

Details the potential activity that will be managed through the pathway

Details the potential savings that would be delivered from the implementation of the pathway.

Following discussion it was agreed that BA would bring back

to the executive committee further detail on post-scope

pathway and clarity around costings and potential savings.

It was also suggested that this could potentially be a pilot for

other pathways including gynaecology.

Recommendation

The Executive Committee agreed the recommendation to implement a straight to test pathway for lower GI routine referrals with a telephone assessment clinic tariff of between 15 - 20% of the 1st appointment face to face tariff, subject to clarity around costings and potential savings.

BA

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7. 7. Primary Care QIPP

At the end of March 2017, in order to report ability to deliver

financial balance, a number of areas of discretionary spend,

that is money that the CCG spends or is planning to spend

that is not contractually committed were identified and held

back from being invested. One of those areas related to £3 per

head (split over two years) Primary Care transformational

spend. This spend equates to £300k in 2017-18 which as yet

remains unspent.

It was agreed that this decision would be reviewed in year. It

was proposed that the Executive Committee would review

proposals for Primary Care based Transformation QIPP

schemes and should any of them demonstrate the ability to

deliver a savings sum equal to that of the investment proposed

and fulfil the Primary Care transformation criteria,

consideration would be given to releasing the monies to

deliver the scheme and benefit from the associated savings.

Schemes have been proposed from a number of teams within

the CCG which are outlined in this paper.

In reality what is apparent is that whilst there are a number of

areas that in the longer term have significant potential for

delivery of savings, probability of in year savings of equal

value to investment is low in the majority of cases and

confidence is likely to be too low to progress on the basis of

2017-18 return on investment.

HB asked the executive committee to agree that none of the

schemes fit the criteria for releasing the £300K currently being

held back and identify which of the schemes should be

progressed further with a view to future savings in 2018-19

and beyond.

The executive committee discussed and agreed the following:

- Paediatric Primary Care Capacity – further scoping

work required

- DVT Diagnosis in Primary Care – potential to hub via

the Federation

- Wound dressing service – no for now due to workforce

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issues. If we able to use the hub more effectively –

follow-up for next year. Nurse capacity/competency

within the hub raised as an issue – KS agreed to follow-

up.

- Medicines Optimisation review of Patients with Learning

Disabilities and Autism – additional resource would

provide greater resilience within the Medicines

Optimisation team.

- Anticoagulation Pathway Redesign – not a small

project. Another pathway that may benefit from hub

working.

- Minor Eye Conditions Service – Pursue as part of next

year.

- Social Prescribing – need a well-defined criteria –

longer term benefit. Need to decide what is wanted in

Sutton.

LW thanked HB for undertaking the piece of work and

confirmed that SM would take this forward into next year,

starting schemes in year for longer term benefits.

Recommendation

The Executive Committee agreed that none of the

schemes fit the criteria for releasing the £300K currently

being held back and identify which of the schemes should

be progressed further with a view to future savings in

2018-19 and beyond as per the above.


KS

SM

For Update and Discussion

8. 8. Feedback from Localities

SK confirmed that feedback in relation to the 16/17

engagement scheme had been positive with no challenges

received.

All clinical leads would be invited to future locality meetings to

present their work.

LW asked that the outcomes following the localities integrated

workshop be brought back to a future meeting of the executive

committee.

LN

9. 9. 16/17 CCG Improvement & Assessment Framework Rating

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SM presented a report which provided a summary of the NHS

England Improvement and Assessment Framework rating for

Sutton CCG for the year 2016/17.

Sutton was rated ‘Good’ which is an improvement on the

previous year.

The rating was based on 60 KPIs across four domains. The

report highlights those areas on which the CCG scored

significantly above average and also those areas where the

score was lower than average. For the latter an indication was

given on the issues to focus on this year to improve

performance. The report highlights some risks relating to

performance in 2017/18 which may impact on this year’s

rating.

Alongside the overall CCG rating all CCGs were also

assessed against three of the six national clinical priorities, the

ratings for Sutton were:

Cancer - Good



The report includes a description of the factors resulting in

these ratings and gives a steer on the areas requiring further

improvement.

The executive committee noted the report and requested that

further work be undertaken on how the CCG can support

carers more effectively and understand how the funding is

currently being spent through BCF.

Recommendation


SM

10. Improving Access to Psychological Therapies (IAPT) -

extra funding

CW presented a paper which outlined the Sutton’s IAPTs

current performance position and the impact that increased

numbers of people entering treatment will have on

performance. It concludes with a proposal for additional

investment for the service to meet increasing demand.

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Key points to note included:

The IAPT service has seen significant improvements

this year (Q1 17/18) with both the IAPT National

performance targets reaching the standard to date.

However, this improved performance will continue to

put pressure on other parts of the pathway, especially

waiting times and drop-outs rates.

In addition, given the increase in demand seen over the

first two years we will also see an increase in ‘hidden’

waiting times and recovery, as existing capacity will

need to sit at triage and assessment to meet demand,

resulting in reduced capacity to provide treatment.

The increasing demand for more people to be seen and

seen quickly has also impacted on the type of service

offered, with more people receiving lower intensity

support and group work

If we fund the service at the current rate and we fail to

meet the national standard for Access, we have no

recourse with the provider as the contract is set at

16/17 levels.

IAPT is part of our CCG performance dashboard thus

its performance impacts on the CCG’s annual rating.

Given the increase in ‘hidden’ waiting times and the

need to ensure greater access to both low and high

intensity provision and support a 60:40 ratio of that

provision, this paper recommends the service receives

an additional recurrent investment of £129,440 for

17/18.

This will then be built into the contract as a contract

variation.

CW noted previous concerns raised by the executive

committee in relation to waiting times and group therapy.

It was also agreed to ask Corinna White to investigate the

access to the phone referral line, including through‘mystery

shopping’, and to look at the possibility of on-line

appointments.

Recommendation

The Executive Committee noted the report and the additional funding required to increase capacity for assessment and treatment.

CoW

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11. The future of the Community Hernia Service

HB presented a paper on the future of the Community Hernia

Service which opened in February 2015.

HB stated that following a review of the services there was

concerns that the CCG was not maximising value for money

and there was the potential to benefit from partnership working

with ESTH.

HB confirmed that conversations had already taken place with

both the current provider RILA, and ESTH to consider future

arrangements of the service.

CW agreed to take this forward with ESTH via the next

contracting meeting with a view to re-design the pathway and

enter a new contract.

Recommendation

The Executive Committee agreed the proposed way

forward as outlined within the paper and noted the

potential impact on QIPP savings for the CCG.

CW


12. Executive Committee Forward Plan The executive committee noted the forward plan for information.

Any Other Business

13. Any Other Business LW agreed to talk with CE regarding the vacant clinical lead roles following interest by a GP in the mental health clinical lead role which was currently vacant.

LW

14. Date of Next Meeting The date of the next meeting is scheduled for Wednesday 23 August 2017, 1:00-3:00pm, Priory Crescent.

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