meeting llr ccgs’ governing body meetings date tuesday, 12...

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Meeting Title

LLR CCGs’ Governing Body meetings (meetings in common) – held in Public Date Tuesday, 12 May 2020

Meeting no. 3. Time 9:30am – 12:00pm

Chair Prof Azhar Farooqi LC CCG Chair

Venue / Location Via Webex

REF AGENDA ITEM ACTION PRESENTER PAPER TIMING

GBs/20/37 Welcome and Introductions Prof Azhar

Farooqi 9:30am

GBs/20/38

Apologies for Absence: • Leicester City CCG:

o • West Leicestershire CCG:

o • East Leicestershire and Rutland CCG:

o

To receive

Prof Azhar Farooqi

verbal 9:30am

GBs/20/39 Notification of Any Other Business

To receive

Prof Azhar Farooqi verbal 9:30am

GBs/20/40 Declarations of Interest on Agenda Topics To

receive Prof Azhar

Farooqi verbal 9:30am

GBs/20/41 To receive questions from the Public in relation to items on the agenda only

To receive

Prof Azhar Farooqi verbal

9:35am

GBs/20/42

Minutes of the meetings held: • LLR CCGs’ meetings in common 10 March

2020

• Leicester City CCG Governing Body meeting held on 14 April 2020

• West Leicestershire CCG Governing Body meeting held on 14 April 2020

• East Leicestershire and Rutland CCG Governing Body meeting held on 14 April 2020.

To approve

Prof Azhar Farooqi

A1

A2

A3

A4

9:45am

GBs/20/43

Matters arising and actions for the meetings held: • LLR CCGs Governing Body meetings in

common 10 March 2020

• Leicester City CCG Governing Body meeting held on 14 April 2020

• West Leicestershire CCG Governing Body

meeting held on 14 April 2020 • East Leicestershire and Rutland CCG meeting

held on 14 April 2020

To receive

Prof Azhar Farooqi

B1

B2

B3

B4

9:55am

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REF AGENDA ITEM ACTION PRESENTER PAPER TIMING ITEMS FOR DECISION, ACTION AND ESCALATION

GBs/20/44

Report from the LLR CCGs’ Chairs To receive

Dr Ursula Montgomery,

Prof Azhar Farooqi,

Prof Mayur Lakhani

C 10:05am

GBs/20/45 Accountable Officer’s Corporate Report To receive Andy Williams D 10:15am

GBs/20/46 LLR Health response to COVID-19: update

To receive Andy Williams E 10:25am

GBs/20/47 Temporary changes to s117 delegated authority

To approve

Caroline Trevithick F 10:45am

GBs/20/48 Finance Report: Month 12 update To receive Donna Briggs G 10:55am

GBs/20/49 LLR CCGs’ Corporate Performance Report

To receive

Caroline Trevithick H 11:10am

ITEMS FOR INFORMATION

GBs/20/50 Summary report from the Audit Committee meetings in common (March 2020)

To receive

Prof. Jeffrey Knight I 11:25am

GBs/20/51

Summary report from the Primary Care Commissioning Committee meetings in common (to note: meeting in April 2020 was cancelled)

To note For information verbal 11:30am

GBs/20/52 Summary report from the Clinical Reference Group meetings

To receive

Prof Mayur Lakhani J 11:35am

GBs/20/53 Summary report from the Collaborative Commissioning Committee meetings (March and April 2020)

To receive

Prof Mayur Lakhani K 11:40am

GBs/20/54 Summary report from the Integrated Governance and Quality Committee (March and April 2020)

To receive

Warwick Kendrick L 11:45am

GBs/20/55 Summary report from the Performance Finance and Activity Committee (March and April 2020)

To receive Wendy Kerr M 11:50am

ANY OTHER BUSINESS

GBs/20/56 Items of any other business. To

receive Prof Azhar

Farooqi Verbal 11:55am

The next meeting of the LLR CCGs’ Governing Body meetings in common will take place on Tuesday, 14 July 2020, venue to be confirmed.

Prof Azhar

Farooqi Verbal 12:00pm

EXCLUSION OF THE PUBLIC

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REF AGENDA ITEM ACTION PRESENTER PAPER TIMING

In accordance with the provision of Section 1(2) of the Public Bodies (Admissions to Meetings) Act 1960, to exclude representatives of the press and general public from the meeting due to the confidential nature of the business to be transacted.

Blank Page

Paper A1 LLR CCGs Governing Body Meetings

12 May 2020

LEICESTER, LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUPS GOVERNING BODY MEETINGS

Minutes of the LLR CCGs Governing Body Meetings held on

Tuesday 10 March at 9.30am, LOROS Professional Development Centre, Groby Road, Leicester

Present: Leicester, Leicestershire and Rutland CCGs: Mr Andy Williams Chief Executive Ms Caroline Trevithick Executive Director of Nursing, Quality and Performance Ms Sarah Prema Executive Director of Strategy and Planning East Leicestershire and Rutland CCG: Dr Ursula Montgomery Clinical Chair (Chair of meeting) Ms Fiona Barber Deputy Chair and Independent Lay Member Mr Warwick Kendrick Independent Lay Member Mr Clive Wood Independent Lay Member Mrs Donna Briggs Chief Finance Officer and Deputy Managing Director Mr Paul Gibara Chief Commissioning and Performance Officer Mr Tim Sacks Chief Operating Officer Dr Andrew Ahyow Member Practice Representative Dr Nick Glover Member Practice Representative Dr Girish Purohit Member Practice Representative West Leicestershire CCG: Prof Mayur Lakhani Clinical Chair Dr Nick Pulman Clinical Vice Chair Mr Steve Churton Independent Lay Member Ms Wendy Kerr Independent Lay Member Mr Spencer Gay Chief Finance Officer Mr Ian Potter Director of Primary Care Mr Ket Chudasama Director of Performance and Corporate Affairs Ms Yasmin Sidyot Acting Director of Urgent and Emergency Care Ms Tamsin Hooton Director of Service Redesign and Integration Dr Ash Kothari Locality Lead Dr Reema Parwaiz Locality Lead, Hinckley and Bosworth Dr Fahad Rizvi Locality Lead, North Charnwood Dr Nil Sanganee Locality Lead, North West Leicestershire Dr Rowan Sil Locality lead, North West Leicestershire Leicester City CCG: Prof Azhar Farooqi Clinical Chair Mr Nick Carter Independent Lay member Mr Zuffar Haq Independent Lay member Prof Jeffrey Knight Independent Lay member Mrs Michelle Iliffe Director of Finance Mr Richard Morris Director of Operation and Corporate Affairs Ms Chris West Director of Nursing and Quality Dr Matthew Trotter Secondary Care Clinician

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Dr Tony Bentley North and East Health Need Neighbourhood Chair Dr Gopi Boora North and West Health Need Neighbourhood Chair Dr Raj Than Left Shift / Integration Lead In Attendance: Ms Rita Patel Healthwatch Leicester and Leicestershire Mr Jo Johal Healthwatch Leicester and Leicestershire Dr Katherine Packham Public Health Consultant, Leicestershire County Council Mr Sandy McMillan Leicestershire County Council (for item GB/20/26 only) Mrs Daljit K. Bains Head of Corporate Governance and Legal Affairs, ELR CCG Mrs Jayshree Raval Commissioning Collaborative Officer (minutes) Members of the public: Three members of the public were seated in the public gallery.

ITEM DISCUSSION LEAD RESPONSIBLE

B/20/16 Welcome and Introductions Dr Ursula Montgomery welcomed members of the Governing Body and members of the public to the Governing Body meeting.

B/20/17 Apologies for Absences Apologies for absence were received from: East Leicestershire and Rutland CCG:

• Dr Vivek Varakantam, Member Practice Representative West Leicestershire CCG:

• Dr Geoff Hanlon, Locality Lead, North Charnwood • Dr Umar Abdulmajid, Locality Lead, South Charnwood • Dr Mike McHugh, Public Health, Leicestershire County Council • Ms Gillian Adams, Independent Lay Member

Leicester City CCG:

• Dr Sulaxni Nainani, South Health Need Neighbourhood Chair • Dr Avi Prasad, Assistant Clinical Chair • Ivan Browne, Public Health Consultant, Leicester City Council

B/20/18 Notification of Any Other Business Dr Montgomery informed that she had not received any items of business for discussion under any other business.

B/20/19 Declarations of Interest on Agenda Topics All GP members declared an interest in items relating to primary care where a potential conflict may arise and also where there are any items concerning the Leicester, Leicestershire and Rutland Provider Arm where GP members’ are minor shareholders. The conflict was noted and will be managed during the discussions as required, it was also noted that the Register of Interests is published on the CCGs websites detailing declarations made by Governing Body members.

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There were no specific conflicts of interest noted under the items on the agenda. It was RESOLVED to: • RECEIVE the declarations of interest and NOTE the actions being

taken.

B/20/20 To receive questions from the Public in relation to items on the agenda only Dr Montgomery informed that no questions had been received from the members of the public present at the meeting on any of the items on the agenda. It was RESOLVED to: • NOTE that no questions were raised on agenda items from the

public.

B/20/21 Minutes of the LLR CCGs’ meeting in common held on 14 January 2020 (Paper A1) Minutes from the Leicester City CCG Governing Body meeting held on 11 February 2020 (Paper A2) Minutes from the West Leicestershire CCG Governing Body meeting held on 11 February 2020 (Paper A3) Paper A1, LLR CCGs’ meetings in common 14 January 2020 - the minutes of the meeting held on 14 January 2020 were accepted as an accurate record of the meeting subject to: - the finance update on page 7 of the report (B/20/10), first

paragraph, last sentence to remove, “… to help the system achieve balance.”

- page 8 under the finance update, last paragraph - remove: “….however from 2020/21 UHL will be the sole commissioner”.

- Page 9, third paragraph, Dr Tony Bentley advised that this paragraph may need to be rephrased as his comment at the meeting was a general comment and observation about clinical input.

Paper A2, Leicester City CCG (LC CCG) Governing Body meeting - the minutes of the meeting held on 11 February 2020 were accepted as an accurate record of the meeting. Paper A3, West Leicestershire CCG (WL CCG) Governing Body

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meeting - the minutes of the meeting held on 11 February 2020 were accepted as an accurate record of the meeting. Paper A3, East Leicestershire and Rutland CCG (ELR CCG) Governing Body meeting - no CCG specific meeting held since December 2019. It was RESOLVED to: • APPROVE the minutes of the LLR CCGs meeting in common held

on 14 January 2020 subject to amendments noted. • APPROVE the minutes of the LC CCG and WL CCG Governing

Body meetings held on 11 February 2020.

B/20/22 Matters Arising: Update on actions from the meetings held on 10 December 2019 (Papers B1 – B3) The action logs (Paper B1 – B3) were received and the following updates were provided: Paper B1, LLR CCGs meeting in common 14 January 2020: There were no matters arising from the Governing Body meeting held on 14 January 2020. Paper B2, LC CCG: • (LCCCG/20/009) Action was to follow up AF pulse reading being

taken by Home Visiting Service. To be followed up with the Primary care Team and CRG. Dr Bentley confirmed that he has had discussions with Dr Pandya and she is taking the action forward. For the purpose of this meeting the item has been actioned and therefore agreed to be closed. Action closed.

• (LCCCG/20/011): Action was to check if CQC would return to UHL within 12 months to check on areas requiring improvement. Ms Prema confirmed that it does not have to be within 12 months as CQC can visit anytime to check on the required areas. Action closed.

Paper B3, WL CCG: There was no action log received from WL CCG Governing Body meeting held on 11 January 2020. ELR CCG; it was noted that there have been no CCG specific meetings since December 2019. It was RESOLVED to: • RECEIVE the updates provided.

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B/20/23 Report from the LLR CCGs Chairs (Paper C) The report was taken as read and no comments or questions were raised under any sections of the report. It was RESOLVED to: • RECEIVE the updates.

B/20/24 Accountable Officer’s Corporate Report (Paper D)

The purpose of the report is to inform the Governing Body members of the key activities with which the Executive Team and Accountable Officer have been involved in since the last meeting. Mr Williams highlighted that it is great to be able to share a number of good news and good practice with the Governing Body members since the last meeting. The report was taken as read and no comments or questions were raised under this report. It was RESOLVED to: • RECEIVE the report.

B/20/25 LLR Health response to COVID-19 (Paper E) Mrs Sidyot presented the report which outlined some high levels of key aspects. She informed that the LLR Health system is currently prepared for a response to COVID-19. She stated that a collaborative effort between health partners has put in place plans which are in line with the national guidance. Mrs Sidyot highlighted that efforts are currently being focused around protection and containment whilst ensuring that the core services are able to provide business as usual responses to patients health needs, with key actions for health to: • Protect primary care; • Protect the Ambulance service; • Protect the Acute site. She informed that these services are being protected by providing community testing on named sites to ensure patients are deflected away from core services as much as possible so that services are able to provide responses to daily activity. Furthermore Mrs Sidyot explained that LLR CCGs have implemented a command and control procedure which enables coordination of efforts from a health perspective to ensure patients and core services are protected. Mrs Sidyot informed that system wide Health Tactical Coordination Group (HTCG) meetings take place every week and have updates from each service along with Public Health England (PHE) to ensure we have the latest update to plan our responses. Local authority colleagues are also

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represented when required on the HTCG. Dr Montgomery queried if advice to patients was only made available on online NHS 111 or could patients call NHS 111. Mrs Sidyot explained that patients can phone NHS 111 and they will be triaged appropriately according to the symptoms highlighted. Professor Lakhani highlighted the following points stating that:

• As part of safe working, the organisations need to look at smarter ways of working in such times and provided examples of staff working remotely, reviewing the relevance of holding large meetings in public;

• How can the CCGs support GP members by keeping them up-to-date with the changing guidance almost on a daily basis as GP colleagues do not currently feel supported;

• There is a need to establish a pathway where general public who require treatment by case definition but do not necessarily fall under the COVID-19 criteria,

Mr Williams informed that there is clear chain of authority in command who are working towards the published guidance and Ms Trevithick is leading on this work. He added that in terms of internal protocols, there are processes in place and are prepared however the guidance seems to be changing rapidly. Mr Williams asked Mr Sacks what process was being put around the GP support in primary care. Mr Sacks informed that he leading on this area and explained that work is underway with colleagues with regards to collating information in terms of what local availabilities are present for practices as supporting mechanisms for one another. He added that he will share the work as soon as it is completed. Dr Pulman, made a similar comment with regards to practical working with links available for GPs in the CCGs. Furthermore for IM&T group to provide some options which supports smarter ways of working in event of a pandemic. Mr Gibara informed that the work which is being undertaken also includes patients with complex needs and the vulnerable patients and how they can be supported and kept safe during this period. Mr Wood stated that he represents the system-wide Patient and Public Involvement (PPI) group and would look forward to an opportunity to be involved in this piece of work. Mrs Sidyot to liaise with Mr Wood outside of the meeting. Professor Farooqi queried what arrangements are being put in place in terms of maximising bed capacity at UHL where patients are tested positive and require ventilations as well as other arrangements of facilities. Mrs Sidyot explained that they are working on the business continuity plan which is part of the national preparedness which includes reviewing of all areas and putting measures in place. Furthermore Mrs Sidyot added that the team are also working with care providers, domiciliary care and care homes to make sure that

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complex patients and vulnerable patients are protected. Dr Rizvi provided an example of a positive case that had been detected at his practice over the weekend and as a result the practice was deep cleaned on a Sunday. He informed that this practice was open on Monday however it was only consultation by telephone as a precautionary measure. Mr Haq queried if there was capacity within NHS 111 to handle the large volume of calls coming through as not all patients would go on NHS 111 online advice line. Secondly is there any plan to invest further funding into the primary care services to scale them up to deal with these events. Mr Williams informed that currently there is capacity within NHS 111 to handle calls and triage patients appropriately however would have to keep observing the situation in terms of practicalities. Professor Farooqi left the meeting. In terms of investment of funding into primary care services, Mr Williams explained that the regulators have asked the CCGs to collate information around additional workload and requirement of funding, however there is no specific funding allocated at this stage, however work is underway which also addresses ways of managing different situations. Dr Trotter, added from a secondary care perspective stating that the NHS maybe planning for COVID-19 however may not necessarily be looking at the daily workload of the clinicians as there will be a number of patients who may not be able to access the health centres and end up at the hospital where they would require assessment and appropriate treatments. His point was that the planning should include the impact of the events on the clinicians daily work load. Mrs Sidyot explained that this is being reviewed as part of the winter escalation plan and working through the continuity process where patients are being seen via the emergency services and to ensure that these patients are not exposed to COVID-19 areas and hence planning is vital and the tactical group are heading up the actions which fall out of the weekly meetings. In terms of digital solution, Dr Sanganee added that clinical staff who may have to isolate themselves if they are experiencing mild symptoms should have facilities and options to work if they are in a position to continue to work. They should be provided with suitable access in order to improve the speed of delivery. Professor Farooqi re-joined the meeting. Ms Trevithick explained that commissioners and providers are

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working together to ensure that business is as usual whilst putting in measures in place for staff to be able to work from home or other appropriate facilities should the need arises. Dr Than stated that patients are confused in terms of what they should be following with regards to the COVID-19 situation and as a result the practices end up receiving complaints as patients feel they are not getting the service/treatment that they should. His point was that practice staff are already under a lot of pressure with large workload who are then also having to respond to these complaints as well. He asked if there are local protocols and processes in place for practices to refer to. Dr Montgomery suggested that the practices should liaise with their local CCGs for advice on the matter. Professor Farooqi left the meeting. Dr Montgomery brought the discussion to an end and summarised some of the points and comments raised. She stated that:

• It is acknowledged that the advice provided by the government is updated on a daily basis due to the rapid change in the COVID-19 situation:

• Mrs Sidyot to include Mr Wood in the future planning meetings:

• Further guidance is expected from NHS England and NHS Improvement;

• Mr Sacks is leading on the work from the primary care element and working with the practices;

• In terms of further investments, there is no specific allocation at this stage;

• Local communications to be discussed between Mr Morris and the Chairs after the meeting.

It was RESOLVED to:

• RECEIVE the information provided as an overview of an evolving situation.

B/20/27 Finance Report: Month 10 update (Paper G) Mrs Iliffe presented the month 10 position highlighting that there are no major changes to the financial forecast outturn. She informed that as part of the month 10 reporting to NHS England and NHS Improvement, the LLR CCGs submitted a combined forecast of £19.175m in-year deficit. This is a variance of £20.6m against the original plan. Mrs Iliffe highlighted areas of overspend includes, acute services mainly due to NHS providers. She stated that majority of this is UHL’s over-performance position which is impacting across all areas. The remaining pressure is attributable to QIPP non-delivery and the Out of County Providers. Mrs Iliffe informed that all three CCGs are delivering on the Better Payment Practice Code (BPPC) across all four metrics, which means that minimum

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95% payment are done within 30 days both in month and cumulatively for NHS and Non NHS providers. Professor Farooqi re-joined the meeting.

At month 10 Mrs Iliffe informed that the underlying position has deteriorated to £30.1m. She highlighted that the underlying position shows that recurrent items are being funded from non-recurrent resources, which indicates the level of financial pressure that the CCGs will take into the 2020/21 financial year. Mr Williams set the context stating that it is acknowledged that the financial position as a system is problematic however additional processes are being added to strengthen the governance and overall system-wide process. The financial position was noted by the Governing Body members at month 10. It was RESOLVED to:

• NOTE the financial performance at Month 10 • NOTE the adverse financial forecast position of £20.6m • NOTE the underlying pressure of £30.1m on the 2020/21plan

B/20/28 Corporate Performance Report (Paper H) Ms Trevithick informed that the new Performance Finance and Activity Committee (PFAC) have now met twice in January and February 2020. Ms Trevithick informed that this committee will have a strategic focus on seeking assurances in respect of the mandated standards and the national framework that CCGs are required to be compliant against. She informed that a development session was held in February 2020 to review the Performance Improvement and Performance Management and what it means to the CCGs as the Commissioners. The session focused on the following key areas:

• What is the role of a strategic commissioner to seek assurance and support improvement opportunities;

• What key indicators do we as the performance sub group for the governing bodies need to monitor;

• What key metrics (in addition to the national reporting measures) support the higher level indicators to identify opportunities for improvement;

• How do we use the data we review to identify key lines of inquiry to undertake ‘deep dives’ on areas of concern;

In response to Dr Glover’s query with regards to Cancer performance, Ms Trevithick explained that at the development session, it was proposed that appropriate colleagues from the Cancer Board will be invited to PFAC to understand how they are maintaining the focus on cancer triage. Dr Trotter commented that looking at the information provided it highlights that there seems to be some discrepancies in how each of the CCGs are receiving data from UHL and suggested that it may be an areas to explore. Ms Trevithick explained the differences between the data for County CCGs and City CCGs by

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stating that performance is reviewed at population health management level and referral rate level however the challenges lie in the differences as the County CCGs also refer patients to their neighbouring providers. Professor Lakhani left the meeting. Mr Wood commented on the format of the report stating that previous reports used to include a traffic light system which assisted in understanding the performances better. He suggested that perhaps the traffic light system should be re-introduced. Ms Trevithick stated that she would take the comment on board and look at the corporate performance reports going forward. There was some further discussion around cancer performance and meeting the required targets. Mr Gibara explained that the cancer pathway is reviewed as whole and there are improvements that can be noticed however as they are happening in individual specialities the impact of the overall improvement is not seen across the whole of the pathway. As stated earlier Mr Gibara informed that work is underway and pathways are being reviewed to understand the blockers and implement the changes. Ms Trevithick reiterated on the discussions from the development session and actions to be taken forward. Professor Lakhani re-joined the meeting. Dr Montgomery thanked Ms Trevithick for presenting the report and requested to take on the comments on board, highlighting that the committee will evolve as going forward. It was RESOLVED to: • RECEIVE the current performance and actions being taken for

areas where performance does not meet the required standard. • DISCUSS additional actions being taken to consider whether

further action is required to improve performance. B/20/26 Leicestershire County Council Adults and Communities Strategy

Consultation (Paper F) Mr Sandy McMillan joined the meeting Mrs Sidyot left the meeting. Dr Montgomery welcomed Mr McMillan to the meeting. Mr McMillan presented the report outlining that the County Council has developed a strategy which brings together the functions of adult social care with those of Community and Wellbeing services and Adult Learning services. He informed that the strategy is set within the context of the Leicestershire County Council Strategic Plan which will contribute to its identified strategic outcomes. Mr McMillan elaborated on the Council’s overarching strategic aims stating that:

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• Work is underway to enhance the wellbeing of individuals and communities whilst providing opportunities for people to live fulfilling lives;

• Keep people safe whilst supporting people to live independently with as much control of their own lives as possible;

• Contribute to the development of flourishing communities which support people’s wellbeing and happiness;

• Help to develop accommodation and housing which supports people to remain safe and well in their own homes;

• Recognise the impact that a great economy can have on the wellbeing of the population, and support individuals to enhance their own economic prosperity through learning, employment and wellbeing.

Mr McMillan explained that the Council is undertaking a consultation on its draft strategy document ‘Delivering Wellbeing and Opportunity in Leicestershire’. The strategy is highly relevant to the work of the CCGs in respect of the role that social care and community services play in supporting people to live healthy, productive and independent lives and, through improving wellbeing, reducing the extent of ill health within our communities.

Mr McMillan stated that the CCGs have a shared responsibility with the local authority to promote wellbeing and support the development of flourishing communities which strengthen resilience and reduce reliance on statutory services. He informed that the CCGs work with Leicestershire Council through the Health and Wellbeing Board and Integration Executive to ensure the planning and delivery of services that support health and wellbeing for local people. He stated that the draft strategy is an important part of the Council’s plans to develop services within the County that contribute to the development of integrated services at ‘place’. Mr McMillan highlighted that the strategy consultation provides opportunity for the CCGs to contribute to the development of services supporting our population over the period to 2024 as it is a 4 year high level strategy. Mr Carter commented that the strategy appended to the report did not indicate any funding that would be available in bringing some of these services together. Mr McMillan explained that this is a 4 year high level strategy and not a planning document and therefore the funding element would be part of their commissioning intentions and would be highlighted in that document. Mrs Sidyot re-joined the meeting. Ms Trevithick left the meeting. Professor Knight commented on page 4 of the strategy under the technology section where it stated that ‘we could make better use of Technology Enabled Care (TEC) to meet service user outcomes’. He asked if there were any examples of models where this has improved to be effective and if the CCGs and the Council could adopt the most cost effective model. Dr Pulman also commented on the IT areas and the fact that a number of communities, Councils and CCGs working together is a

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right step in terms of direction of travel and stated that it would be useful to see evidence of some effective models. Mr McMillian reiterated on the work that is underway which will be developed as next steps. Ms Hooton stated that she welcomed the strategy and support in developing the scope to a more partnership working with the council colleagues and to have a true health integration partnership. She added that the partnership working is reflected in the strategy which is a positive step forward. Mr Potter highlighted that where the strategy talks about building a plan for workforce which is flexible, welcomed the opportunity to provide feedback around work force planning. Furthermore he stated that he would also welcome discussions around building communications and engagement with regards to work force planning. Professor Farooqi and Mr Morris left the meeting. Ms Barber commented on delivering wellbeing and opportunities in Leicestershire, especially for older people and asked what work is being taken forward which could influence and what lessons learnt around health and wellbeing agenda are available. Mr McMillan informed that they will be addressing all areas and looking at streamlining the process and make it more accessible as they continue to develop the strategy. Professor Farooqi re-joined the meeting. Dr Montgomery concluded the discussion and stated that Mr Potter will be collating the appropriate comments and stated that the report recommends delegation of responsibility to Ms Hooton and Mr Gibara to draft a response to the consultation questions on behalf of the CCGs. Ms Trevithick re-joined the meeting. Dr Montgomery asked if the Board members were in consensus in terms of granting delegated responsibility to Ms Hooton and Mr Gibara to respond on behalf of the CCGs. The Governing Body members were in consensus in terms of delegating the responsibility to Ms Hooton and Mr Gibara to respond on behalf of the CCGs. It was RESOLVED to:

• RECEIVE the report. • DELEGATE responsibility to the Director of Service Redesign and

Integration (WLCCG) and the Chief Commissioning Officer (ELRCCG) to draft a response to the consultation questions on behalf of the CCGs.

Mr McMillan left the meeting. B/20/30 Summary report from the Audit Committee meetings in common

(January 2020) (Paper J) Professor Knight highlighted some of the areas from the report. Under 360 Assurance Internal Audit Progress Reports, he informed that the Audit Committee members were provided progress against the

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individual CCG internal audit plans for 2019/20 including any new reports issued, follow-up reports detailing progress against suggested recommendations, contract performance (KPI’s) and work completed/underway. The meeting was followed by an initial discussion on the 2020/21 Internal Audit Plans.

Under the External Audit Progress Reports, Professor Knight informed that three individual reports were presented which focussed mainly on preparation for year-end. There was also a discussion on the Mental Health Investment Standard (MHIS) work that they have undertaken on behalf of the three CCGs.

Professor Knight stated that the most up to date Board Assurance Frameworks were presented to the Audit Committee for information. Members were advised that work is underway to align these with a standard template produced. In addition, the governance leads advised that the Risk Management Policy is one of the first to be prioritised across LLR and it is anticipated that a draft version will be brought to the Audit Committee at its meeting in March 2020. It was RESOLVED to:

• RECEIVE the Summary report from the Audit Committee meetings in common (January 2020)

Mr Morris re-joined the meeting. B/20/29 LLR CCGs’ Conflict of Interest Policy (Paper I)

Mr Richard Morris presented the paper stating that the purpose of the report is to ask the Governing Bodies members to approve the proposed single LLR CCGs’ Conflicts of Interest, Gifts and Hospitality and Sponsorship Policy and processes.

He informed that the governance leads, are working on aligning a number of key corporate and risk management policies and processes across LLR CCGs and one of the priority areas is to ensure there is consistency in following processes for the management of conflicts.

Mr Morris explained that during the review of the governance arrangements, a review of the three existing conflicts of interest policies was carried out and noted that each of the CCGs across LLR have robust arrangements in place to manage conflicts of interests. During the review Mr Morris informed that it became apparent that there were some differences in the way each CCG had adopted and implemented the national guidance. He stated that since the establishment of the new governance arrangements, processes have been aligned to ensure consistency with managing conflicts within committee meetings and in screening of committee reports prior to the meetings. Mr Morris informed that the proposed single policy was presented at the LLR CCGs’ Audit Committee meetings held in common in January 2020, and they supported the proposal and the content of the policy noting that the Policy document enables the CCGs to continue to comply with the checklist provided within NHS England’s guidance.

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Mr Morris highlighted that once the policy is approved by the Governing Bodies members, the policy will be disseminated to staff and Governing Body members across all three CCGs. Furthermore he stated that key points and forms from the policy will be included in a governance handbook. Following presentation of the report, Dr Montgomery asked the Governing Bodies members if there were any comments or questions for Mr Morris in relation to the appended policy and if there was a general consensus to approve the policy. It was noted that the members did not have any comments or questions on the policy and all three Governing Bodies approved the policy. It was RESOLVED to: • APPROVE the LLR CCGs’ Conflicts of Interest, Gifts and

Hospitality and Sponsorship Policy.

B/20/31 Summary report from the Primary Care Commissioning Committee meetings in common (4 February 2020) (Paper K) Ms Barber took this paper as read and no questions or comments were noted. It was RESOLVED to: • RECEIVE the Summary report from the Primary Care

Commissioning Committee (February 2020)

B/20/32 Summary report from the Clinical Reference Group meetings

(Paper L) Professor Lakhani took this paper as read and no questions or comments were noted. It was RESOLVED to: • RECEIVE the summary report from the Clinical Reference Group

meetings

B/20/33 Summary report from the Collaborative Commissioning Committee meeting (January and February 2020) (Paper M) Dr Montgomery took this paper as read and no questions or comments were noted. It was RESOLVED to: • RECEIVE the report from Commissioning Collaborative

Committee

B/20/34t Summary report from the Integrated Governance and Quality Committee (January and February 2020) (Paper N) Mr Kendrick informed that at the Integrated Governance and Quality Committee (IGQC) in February 2020, the members received a

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Quarterly Safeguarding report which highlighted some critical messages and emerging safeguarding themes. Mr Kendrick added that the report also detailed CCG safeguarding compliance as required by NHS England and the Care Quality Commission (CQC). The report alluded that the designated capacity for both Children and Adult Safeguarding remains below the recommended requirements of both the Children and Adult intercollegiate documents. Furthermore under the Provider Assurance section, Mr Kendrick informed that on 5th February 2020 the CQC published their final report detailing the findings of their inspection visits that took place at the University Hospitals of Leicester (UHL) which indicated improvements that have been made within the Trust, with an overall CQC rating of “Good”. Under the Leicestershire Partnership Trust (LPT), it was noted that the CCG, NHS England and NHS Improvement and CQC continue to meet through the System Improvement Assurance Meeting (SIAM) to oversee progress against the Trust’s action plan. Under the Safeguarding report, Dr Montgomery asked Ms Trevithick if she would like to explain how the risk is being managed in terms of designated capacity issue. Ms Trevithick explained that this risk has been on all three CCGs risk register for some time as organisations are not fully compliant against the designated professional element. Ms Trevithick assured the Governing Bodies that the risk has been and is being managed by continuing to manage delegation of designated nurse responsibilities to team members. Furthermore in light of the change in team structures across the three CCGs she noted that there are opportunities within the Quality and Nursing teams to utilise skills and knowledge across the teams which will support in mitigating some of the risks. It was RESOLVED to: • RECEIVE the report from the Integrated Governance and Quality

Committee (January and February 2020) B/20/35 Summary report from the Performance Finance and Activity

Committee (January and February 2020) (Paper O) Ms Kerr presented the report outlining that the first PFAC meeting held in January 2020 was well received by the committee members with a strategic focus in terms of receiving assurances on the mandated standards and the national framework that the CCGs are required to be compliant against. In February 2020, a development session was held to review the performance improvement and performance management and focus on developing key metrics in addition to the national reporting measures. Furthermore the session also looked at bringing some alignment with the Cancer Board and the A&E Delivery Board (AEDB) in adopting a more collaborative approach in reporting. Ms Kerr informed that the comment made earlier during the

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presentation of the Corporate Performance report where it is suggested at looking at the reporting format to include a traffic light template will be taken forward for future reporting. Professor Knight commented on the PMO and QIPP section on page 3 of the report where a large amount of unidentified QIPP schemes have resulted in under-delivery of those QIPP schemes. He stated that we need to ensure as organisations that there are not many unidentified QIPP schemes for next year. Ms Kerr acknowledged that there is a large amount of unidentified QIPP schemes highlighted for this year however also stated that colleagues need to recognise that a Financial Recovery Plan (FRP) have been put in place to achieve the financial targets and mitigate some of these risks. Mr Williams added that there are challenges in terms of unidentified QIPP schemes however work is underway to understand those challenges and are having discussions with NHS England and NHS Improvement colleagues in terms of LLR CCGs position as a whole. He stated that the work that is underway is towards developing a meaningful plan however assured the Board members that regular updates will be provided. It was RESOLVED to: • RECEIVE the report from the Performance Finance and Activity

Committee (January and February 2020) B/20/36 Items of Any other business

Dr Montgomery noted that there were no items of business to discuss under AOB.

Date of next meeting The next meeting of the LLR CCGs’ Governing Body meetings in common will be take place on Tuesday 14 April 2020, venue to be confirmed. The meeting concluded at 10:52am

Page 16 of 16

Paper A2 LLR CCGs’ Governing Body Meetings in common

12 May 2020

LEICESTER CITY CLINICAL COMMISSIONING GROUP

Minutes of the eighty seventh meeting of the Leicester City Clinical Commissioning Group Governing Body meeting

held on Tuesday 14 April 2020 at 2.00pm, via Webex PRESENT: Professor Azhar Farooqi Clinical Chair (Chair) Dr Tony Bentley North & East HNN Chair Dr Gopi Boora North and West HNN Chair Mrs Donna Briggs Interim Executive Director of Finance, Contracting and Corporate Governance Mr Nick Carter Independent Lay Member/Vice Chair Mr Zuffar Haq Independent Lay Member Professor Jeffrey Knight Independent Lay Member Mr Richard Morris Director of Operations and Corporate Affairs Dr Sulaxni Nainani South HNN Chai Dr Avi Prasad Assistant Clinical Chair Ms Sarah Prema Executive Director of Strategy and Planning Dr Raj Than Left Shift/Integration Lead Ms Chris West Director of Nursing and Quality Mr Andy Williams Accountable Officer, LLR CCGs IN ATTENDANCE: Mrs Claire Middlebrook Corporate Affairs Support Officer (minutes)


LCCCG/ 20/14

Welcome and Introductions Professor Azhar Farooqi, Clinical Chair welcomed members to the Leicester City Clinical Commissioning Group Governing Body meeting.

LCCCG/ 20/15

Apologies for Absence and Quorum Apologies for absence were received from: • Mr Ivan Browne, Local Authority Representative • Dr Matthew Trotter, Secondary Care Clinician • Mrs Michelle Iliffe, Director of Finance • Ms Caroline Trevithick, Executive Director Nursing and Quality. The meeting was confirmed as quorate.

LCCCG/ 20/16

Declarations of Interest on Agenda Topics The Chair reminded governing body members of their obligation to declare any interest they may have on issues arising at this meeting

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which might conflict with the business of Leicester City CCG. Declarations of interest by members of the Leicester City CCG Governing Body are listed on the CCG’s Register of Interests. The Register is available either via the Board Support Officer or the CCG website at the following link: https://www.leicestercityccg.nhs.uk/about-us/meetings/2019-governing-body-meetings/november-2019-governing-body-meeting/ There were no specific conflicts of interest identified for this meeting.

LCCCG/ 20/17

Minutes of the Leicester City CCG Governing Body meeting held on 11 February 2020 (Paper A) The minutes of the Leicester City CCG Governing Body meeting held on 11 February 2020 were accepted as an accurate record. It was RESOLVED

- To approve the minutes of the meeting held on 11 February 2020

LCCCG/ 20/18

Matters Arising of the Leicester City CCG Governing Body meeting (Paper B) The matters arising of the Leicester City CCG Governing Body meeting held on 11 February 2020 were received and the following update noted: LCCCG/20/009, Accountable Officers Report, AF pulse readings by Home Visiting Service - Dr Tony Bentley reported that this action had been passed to Ms Priya Pandya, who had in turn passed this to West Leicestershire CCG (WL CCG) as they lead on this contract. No update was available at this time. Dr Sulaxni Nainani confirmed she would follow up this action outside of the meeting. Action ongoing. It was RESOLVED

- To received and note the updates on the matters arising following the meeting held on 11 February 2020

LCCCG/ 20/19

To receive written questions from the Public in relation to items on the Agenda It was confirmed that no written questions had been received.

LCCCG/ 20/20

Chair’s Report (Paper C) Professor Azhar Farooqi, Clinical Chair, presented the Chair’s Report (Paper C). In addition to the detail in the paper, Prof Farooqi highlighted the following;

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https://www.leicestercityccg.nhs.uk/about-us/meetings/2019-governing-body-meetings/november-2019-governing-body-meeting/

https://www.leicestercityccg.nhs.uk/about-us/meetings/2019-governing-body-meetings/november-2019-governing-body-meeting/


12 May 2020

On 31 December 2019 the government of China issued a notice that they had seen an increase in the number of Pneumonia cases in Wuhan province as a result of a new novel corona virus. Following this the World Health Organisation (WHO) issued a notice of internal concern on 23 January 2020 and on 31 January 2020 the first cases of Corona virus were identified in Italy and in York, in the United Kingdom. On 11 March 2020 the WHO declared a pandemic, as a result of the novel corona virus, due to its infectious nature, spread by droplets and no known treatment being available. The virus has a high mortality rate and to date, has 2m cases worldwide with 120,000 deaths, a death rate of 6%. In the UK there have been 88,621 cases, with 11,329 deaths, a death rate of 13%. A lot of patients have not yet been tested so the death rate could rise further; although 13% is significant. At the present time within University Hospitals of Leicester NHS Trust (UHL) there has been 109 deaths, with 199 current cases, of these 50 patients are on ventilators. The peak is expected next weekend in this area and the virus is thought to be more serious for elderly and men. There are two main actions that are taking place;

1) Prevention of transmission; following public guidance for shielding patients by keeping 2m apart and remaining in isolation where needed

2) Supporting treatment of the worst cases of the virus Nearly everyone is working differently, following the national and local strategy. All meetings are taking place remotely and Prof Farooqi thanked clinicians and managers for their wider support and hard work. On a personal note Prof Farooqi reported that himself and the other CCG Chairs had been working more hours for the CCG in recent weeks and were holding daily check-ins. Weekly catch ups with Mr Dale Bywater, from NHS England to discuss national and local guidance have been held, in conjunction with Public Health England. The diabetes strategy has been discussed and programme guidelines agreed, along with the research agenda for Arch and CRM. Covid trials are taking place to look at the epidemiology and how it affects people. Twice a week there are strategic telephone calls taking place and weekly calls with Clinical Directors. A weekly telephone meeting takes place with GPs and Primary Care Network (PCN) Clinical Directors (CDs) and the Clinical Reference Group is still meeting weekly. The primary care cell is meeting regularly with four clinical / GP leads, with Dr Sulaxni Nainani leading for LC CCG.

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The key work that has taken place to date includes setting up two hot hubs, with one more to follow. Clinical pathways have been reviewed to ensure that cancer and covid-19 patients can be treated appropriately, following shielding rules. The problems with PPE have been testing and a daily situation report has been provided by all practices through the primary care team. Practices have been RAG rating themselves daily and improvement has been seen in this area. Prof Farooqi paid tribute to the primary care team, who are doing a fantastic job, with practices triaging patients via telephone calls, whilst still maintaining a service to patients. PCNs have been supporting teams; UHL have mobilised their bed base and currently the number of HDU and ITU beds is meeting the need of the population. LPT and East Midlands Ambulance Service have also been working hard during this period. There are likely to be local heroes identified in the future and these will be acknowledged when appropriate. Mr Zuffar Haq noted the problems with the supply of scrubs for GPs and that he has a contact that may be able to assist with supplying these items. Prof Farooqi suggested that members email him with their requests and he will resolve this outside of this meeting. Mr Nick Carter noted the UHL figures and asked if this included patients in care home. Prof Farooqi confirmed that there is currently no data available from the community, as this is still being collated. Mr Carter stated that care homes are struggling to obtain correct PPE. Ms Sarah Prema noted that there is a wider mortality data available; however, there is a lag with this data being included in national figures; due to the time being taken to register care home deaths. There is a process in place for care homes to obtain PPE, through local authorities and a situation report is due in a few days time. Mr Andy Williams confirmed that there are specific workstreams for care homes as part of the local resilience arrangements; as a subset of primary care. The difficulty with obtaining PPE has been noted; although thought to be getting better. Dr Raj Than noted, that following a meeting held this morning, there is no data available for access to testing. Mr Williams confirmed that testing is improving and the focus is to support UHL and wider health services, including care home staff. This has been problematic, however, is starting to improve, through the LRS and there is a process in place to take this forward to test more staff and patients. Prof Farooqi suggested that the likelihood is that the number of death locally will increase in care homes. Mr Carter asked how these will be reported; as they are not the GPs responsibility in most cases. Public Health colleagues feel that there may be up to 15,000 deaths reported to

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date, if deaths in care homes were included. Dr Than noted that care home patients will only get tested if they are admitted to hospital; Dr Than also mentioned the availability of testing, as the figures do not appear to be an accurate reflection at present. Prof Farooqi acknowledged the comments made and noted that GPs can record Covid-19 as the cause of death. Prof Farooqi noted the governance arrangements highlighted in the paper; including the changes to the single management team process and the changes required to the constitution and scheme of delegation. Governing Body and other committee meetings are likely to be held remotely for the foreseeable future and this may mean that the public are unable to join in. Mr Richard Morris confirmed that unless we make the Webex link available on line the public cannot join these meetings at present. Other technology is being looked at to see if this can be utilised in future. Prof Farooqi confirmed that members of the public will be invited to submit written questions in advance of a meeting, through the website and approved minutes will continue to be uploaded onto the CCGs website for information. The frequency of meetings may need to change; however, any changes will be communicated in advance. It may be necessary in some circumstances to have written decisions made. Mr Haq expressed some concern that Healthwatch is not represented at this meeting and asked if the meeting can be recorded and the link made available to these colleagues following the meeting. Mr Morris confirmed that Healthwatch were invited to the meeting, however, did not respond to the invite. Mr Carter noted that the Council live stream there meetings; Mr Morris will look at this possibility later this week. Prof Farooqi noted that section of the paper relating to quoracy and the exceptional circumstances identified. It was RESOLVED

- To receive and note the contents of the Chair’s Report. - Agree and approve proposed constitutional changes as set out in

the report.

LCCCG/20/21

Accountable Officer’s Report (Paper D) Mr Andy Williams presented this paper, noting that a lot of the content shows the CCGs response to covid-19. Mr Williams echoed Prof Farooqi’s thanks to all for their work in recent weeks, their energy and enthusiasm; along with the collaborative working and professionalism

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shown. A more detailed local model is needed to support the tactical decision making and recovery process. Mr Nick Carter will be involved in the discussions regarding recovery, along with other Lay Members; this group will look at clinical recovery, working practices and new technology etc. Remote ways of working have delivered some efficiencies. There will be a wider social and economic impact on the human element of this pandemic and we need to ensure that there is suitable help and support available to help staff to readjust. The recovery phase is likely to last a long time, possibly into 2021/22 and at this time it is unclear how we move out of lockdown and therefore it is difficult to predict how we can move forward. There have been national problems with PPE and testing; although a good response from local volunteers and local government. Prof Farooqi formally thanked Mr Williams for his report and continued leadership during the recent weeks. Prof Jeff Knight asked about the situation with PPE in care homes. Mr Williams acknowledged that this has received a lot of press in recent days and this is part of a work stream. There have been general supply issues, which are getting better and there is a national process to get supplies into care homes. The local resilience forum is aware of the problem and will continue to monitor the situation. Dr Avi Prasad stated that the teams have to be prepared to operate at a community level for some time to come, to ensure that patients who are shielding are appropriately cared for in the long term. The CCGs may also need to look at equipment for patients to use in their own homes. The way we operate at a patient level will have to change. Mr Williams noted the number of opportunities and challenges we have experienced and that the recovery phase may take up to 18 months. There is likely to be a national and global change to government spending priorities, although Mr Williams is optimistic that we can do things differently in the future. Prof Farooqi noted his disappointment that only two hot hubs have been set up to date; Mr Williams responded that there is concern about the delays which have been noted. Dr Nainani confirmed that she had received an email confirming that the third site is due to open on Wednesday. Dr Prasad noted his potential conflict with this discussion as one of the hot hubs is being provided from his practice. Mr Haq noted that the Loughborough site was set up quite quickly and that the lack of a third site in the city has had an impact on the black and ethnic minority (BEM) community and therefore this should have been set up earlier.

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Dr Nainani confirmed that the original plan was to have all three sites opened at the same time, however, the city site had to be changed at the last minute and therefore the opening was delayed. It was RESOLVED

- To receive and note the contents of the Accountable Officer’s Report.

LC/CCG/20/22

Quality Briefing Covid-19 (Paper E) Ms Chris West presented this paper and noted that it is the quality and safety response to covid-19. Ms Caroline Trevithick and Ms Sarah Prema sit on the tactical group and the nursing and quality cell; which includes GPs. A lot of work has taken place on discharge planning and maintaining committees to ensure appropriate decisions can be made. Some sub-cells have been set up to look at escalating problems through the local system and then the strategic group if required. No permanent changes have been made to pathways and the team are still following due process. The Nursing and Quality team are in regular contact with care providers and routine data is still being collected. A quality and safety log has been set up, to log incidents or safety concerns; issues can then be escalated via the cells if necessary. All concerns are being formally logged. Nursing within care homes is a key area and care homes are being contacted about their PPE supplies. The team are no longer visiting homes, however, are offering support along with the local authority and additional information is being added to the website. A safeguarding sub-cell has been set up; with the membership including experts; this has been aligned with the children’s and primary care cells. A summary of work that is taking place for cancer patients is included in the paper; noting some gaps in the service. Dr Prasad asked where Mental Health (MH) sits within the diagram of cells, as the current situation will increase patients anxiety. Ms West noted that smaller cells have been set up and are not necessarily included on the diagram, as this would be too large to read and understand. There is not a separate MH cell as this is mainly the responsibility of LPT; although it is aligned to other cells. Dr Prasad queried the UHL bed base and asked if there was suitable capacity; Ms West confirmed that she is not sited on the UHL bed base; although work need to take place to ensure that the CCGs and UHL are meeting the needs of patients. All MH patients already known about have

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access to the Bradgate unit, through the front door. It was noted that MH is a big issue and the CCGs need to look at different ways of using the Improving Access to Psychological Therapies (IAPT) service, via the use of webinars etc. There is a lot of anxiety amongst patients and therefore a wide scale response is required. The CCGs need to ensure that staff are appropriately trained to give the right message to patients. This issue has been picked up by the national media and therefore we need to ensure that the CCGs are doing the right thing for this cohort of patients. A recent online programme attracted over 3000 listeners. Prof Farooqi noted that the cancer pathway has been looked at; Ms West stated that we need to understand what information is available and where this is being shared. Mr Morris confirmed that he had a conversation with UHL last week and all cancer patients are due to be contacted regarding their care pathway and therefore members were asked to inform Mr Morris if they were made aware of this not happening. There are also 17 community radio stations, which are being used to communicate messages in different languages. Prof Farooqi noted that clinicians are involved with cells to ensure that care is transferred safely. Dr Nainani noted that pathways are included on PRISM and although there have been some delays with referrals, GPs should still refer as per normal practice. Dr Gopi Boora noted the LLR Covid-19 email address and suggested that this was a good resource to use. Mr Morris noted that pathway changes are being collated through the Patient and Public Involvement group, in order that patient experiences of the pathways can be noted and to provide support to enable recovery. Ms West noted the comments made and that work is being linked together to provide learning for the future. Mr Carter asked if Ms West is assured that the treatment of patients with LD is appropriate in care homes. Ms West confirmed that patients with LD or Autism are being risk assessed and care and treatment reviews are still taking place. LPT have been supportive with MH patients; although the CCGs are less sited on these patients and there is an understanding that the situation may get worse. Following a query from Prof Farooqi, Ms West confirmed that there is no MH work stream specifically, as this cohort of patients are within the adult social and community cell and the children’s cell. Mr Williams sated that recovery work is being discussed, and a conversation was held with Ms Angela Hilary to look at the focus of the recovery of MH services.

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It was RESOLVED

- To receive the Quality Briefing Covid-19

LCCCG/ 20/23

Finance Report: month 11 Update (Paper F) Mrs Donna Briggs noted that the paper shows the month 11 figures, however, the finances teams are in the process of closing the year-end accounts. At month nine the forecast showed a £1.4m surplus for LC CCG, with ELR and WL CCGs having a combined deficit of £20.6m. Confirm and challenge is taking place and the aim is that the LLR CCGs will be able to achieve the revised position. One of the main risks is the plan to revisit the Epact prescribing data, which may have an adverse affect on the plan. Another risk is the covid-19 costs of £1.7m which are due to be reimbursed on Thursday. Mr Williams held a detailed review of the costs, prior to submission to the regulator. The final risk is that the final accounts are not submitted on 27 April due to ongoing IT issues for finance staff. A review of the CCGs position has been planned with Mrs Michelle Iliffe, Mr Carter, Prof Knight and Mr Williams to look a the assumptions and risks. Prof Farooqi asked about the report that primary care payments are behind schedule; Ms Briggs confirmed that she has chased a response from Mr Cal Deane, last week, however, has not yet received a reply. Mr Haq noted the comment made on the national news regarding writing off NHS debt; Mrs Briggs confirmed that whilst the announcement was interesting, this will have no impact for the LLR CCGs or UHL. It was RESOLVED

- To receive the finance report, Month 11 update

LCCCG/20/24

Suspension of Delegated Authority for Continuing Healthcare (Paper G) Mr Williams noted this paper is to advise the members that exceptional rules are being put in place for Continuing Health Care patients, in order that they can be discharged quickly. The plan is already in place and therefore this paper is brought for ratification by members. Going forward the CCGs will be looking at how we review cases, once the current pandemic has resolved; in order to continue to free up bed capacity. It was RESOLVED

- Note the requirements detailed in the COVID-19 Hospital

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Discharge Service Requirements guidance included as appendix B.

- Note the transfer of responsibility for funding care from local assessment and approval processes to the central government COVID-19 response budget.

- Support the proposal for the suspension of the Delegated

Authority Process for approval of health funds in response to the COVID-19 Emergency.

LCCCG/ 20/25

Any Other Business There were no other items of business. The meeting closed at 3.20pm

Date of Next Meeting The next meeting of the LC CCG Governing Body will be held in common with ELR CCG and WL CCG, which will take place on Tuesday 12 May 2020, venue to be confirmed. The next meeting of the LC CCG Governing Body will be held on Tuesday 9 June 2020, venue to be confirmed.

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Paper A3 LLR CCGs’ Governing Body meetings in common

12 May 2020 WEST LEICESTERSHIRE CLINICAL COMMISSIONING GROUP

Minutes of the Public Board Meeting Tuesday 14th April 2020, 11.30 – 12.40

WebEx

Present: Dr Umar Abdulmajid Locality Lead, South Charnwood Ms Gillian Adams Independent Lay Member Mrs Donna Briggs Interim Executive Director of Finance, Contracting and

Corporate Governance, LLR CCGs Mr Ket Chudasama Director of Performance and Corporate Affairs Mr Steve Churton Independent Lay Member Professor Mayur Lakhani Chair (Chair) Dr Geoff Hanlon Locality Lead, North Charnwood Ms Tamsin Hooton Director of Service Redesign and Integration Mrs Wendy Kerr Independent Lay Member Dr Ash Kothari Locality Lead, Hinckley and Bosworth Dr Reema Parwaiz Locality Lead, Hinckley and Bosworth Mr Ian Potter Director of Primary Care Ms Sarah Prema Executive Director of Strategy and Planning, LLR CCGs Dr Nick Pulman Clinical Vice Chair Dr N Sanganee Locality Lead, North West Leicestershire Dr Rowan Sil Locality Lead, North West Leicestershire Ms Caroline Trevithick Executive Director of Nursing, Quality and Performance,

LLR CCGs Mr Andy Williams Accountable Officer

In Attendance: Mr Stuart Fletcher Head of Corporate Governance

Mrs Michele Morton Senior Committee Clerk (Minutes)

Action WL/20/014 Welcome and Apologies for Absence

Professor Lakhani welcomed all to the meeting of WLCCG Board and reported that the meeting was quorate with twelve voting members. Apologies for absence were received from Professor Fahad Rizvi, Mr Spencer Gay, Mr Mike McHugh, and Mrs Yasmin Sidyot Board members noted the impracticality of inviting members of the public to the WebEx based meeting. Meetings had been advertised on the WLCCG Website and public questions had been invited. The minutes from the meeting would also be available.

WL/20/015 Report from Conflicts of Interest Screening Panel held 13th April 2020 Mr Churton reported that the following conflicts of interest had been identified: • WL/20/023 Better Care Fund

Declaration only for Mike McHugh who was employed by LCC. Declaration only for Board GPs

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• WL/20/024 Finance Report Month 11 Declaration only for GPs who were impacted by the CCG’s financial position.

It was RESOLVED to: • RECEIVE the above update

WL/20/016 To receive questions from the public in relation to items on the agenda No questions from the public had been received.

WL/20/017 Minutes of the Governing Body meeting The minutes of the meeting held on Tuesday 11th February were approved and accepted as a correct record. It was RESOLVED to: • APPROVE the minutes of the meeting held on Tuesday 11th February 2020.

WL/20/018 Matters Arising Paper B, the action log was received and would be appended to the minutes. It was RESOLVED to: • RECEIVE paper B, the action log.

WL/20/019 Chairman’s Announcements

Professor Lakhani presented paper C that provided an overview and update of some of the key constitutional and strategic updates that affected the Governing Body and provided an overview of meetings attended. Further key points of note:

• Minor changes to the WLCCG Constitution had been submitted to NHS England/Improvement and approvals to those changes was awaited. In the meantime the CCG would be operating by the original rules in terms of Board quoracy.

• With regard to COVID-19 a hot hub had been established in Loughborough and an End of Life Programme was up and running in LLR.

It was RESOLVED to: • RECEIVE the Chairman’s Report.

WL/20/020 Accountable Officer’s Corporate Report

Mr Williams presented paper D that informed the Governing Body of key activities with which himself and the Executive Leadership Team had been involved in since the last meeting of the Governing Bodies. The report included updates on items not covered elsewhere in the Governing Body papers, as well as details of achievements and other pieces of useful information. Further key messages included: • A huge thank you was extended to staff, together with an acknowledgement of

how effectively clinical executives and non executive colleagues had worked together in order to respond to COVID-19. Collaboration had produced higher

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12 May 2020 levels of partnership working that had resulted in realistic problem solving.

• A blue/red team function had been adopted as part of the Emergency Preparedness, Resilience and Response (EPPR) which had given an opportunity for people to work on business as usual as well as responding to COVID-19.

• Governance processes were currently being tightened to ensure a good record of decisions was made during COVID-19, and to also provide evidence on the relationships between the cells.

• A data cell was currently being established that would enable some local modelling. Dr Sil said he would be very interested in joining that group.

• A group had been formed to consider clinical recovery post COVID-19 and financial recovery would feed into that group. Professor Lakhani added that UHL and LPT had established recovery groups and Mr Williams explained that each organisation would have an opportunity to feed into the health and care systemwide process which would include issues such as economic recovery and care homes. He added that recovery would be a huge challenge and the economic impact of COVID-19 would dominate the health agenda for up to the next eighteen months.

Dr Pulman asked if any links had been made between top teams and the Scientific Advisory Group of Experts (an epidemic, national group), notably in terms of what might happen next. He added it had been useful to receive information around modelling, especially with the development of a number of pathways whilst adapting to the situation. Further information would also help to plan an approach for shielded patients and to also look at UHL waiting lists from the perspective of recovery. Mr Williams replied the main focus at present was around management of the actual crisis and the possibility of a second or third wave of the pandemic. He added that speculation was that the process of exiting current arrangements would be carried out slowly, over a long period of time and communication would be from within the command and control environment. Mr Williams said it would be necessary to wait for direction whilst ensuring good clinical engagement existed, with a focus on relevant aspects of healthcare processes. At the present time it was hard to understand how NHS future plan would change as a consequence of COVID-19, where the economic impact both nationally and internationally would be huge. Mr Williams said there was a possibility of a fundamental re-evaluation of the NHS Long Term Plan, particularly around investment priorities and future planning would be important, even with the current uncertainties. Within that context Dr Pulman said it would be helpful to develop a number of scenarios on how recovery might work, which would assist with pathway redesign. Mr Williams supported that idea and invited Dr Pulman to be a part of a group looking at future options. Dr Sanganee felt it would be important to have a process to capture the learning on the different and improved ways of working, as well as the innumerable barriers that had been overcome on a day to day basis. Mr Williams agreed and said a number of positive outcomes needed to be captured, especially around the unblocking of bureaucratic processes around discharge by the use of technology. Professor Lakhani said the level of collaborative working had been amazing amongst all organisations, both individually and collectively and people had adapted well to new ways of working, particularly in the acute sector. It was RESOLVED to:

AW/RS

AW/NP

AW

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12 May 2020 • RECEIVE the Accountable Officer’s Corporate Report

WL/20/021 Quality Briefing: COVID-19

Ms Trevithick presented paper E that provided details of the monitoring processes being undertaken for quality and safety during the COVID pandemic, including the governance arrangements for decision making and the way the CCGs were working with providers to ensure that quality and safety was paramount. Of particular note: • In line with EPPR a strategic and tactical infrastructure had been established

to manage the current situation. The two groups were led by the CCGs and had multi-agency representation from health and social care.

• A list of clinical leads across each of the cells was under construction and that would be received at the LLR Clinical Reference Group meeting on the 21st April 2020.

• Governance processes were being strengthened and work had been carried out by Ms Prema to ensure work across the cells was not being duplicated or missed.

• Agreed quality and safety metrics were in place for each commissioned provider; outlined in an agreed quality schedule. Due to COVID-19 face to face meetings had been put on hold to allow providers to concentrate on the delivery of their COVID-19 work.

• A quality and patient safety concerns log had been established that would ensure effective tracking and oversight of any identified quality or patient safety concerns.

• Safeguarding teams were working across health and social care to ensure good communication with all aspects of safeguarding (the risk of on-line abuse and domestic violence was greater at the current time). Information would be shared to practices on what pertinent questions to ask, particularly during telephone triaging.

• The Cancer Board had met to ensure that there was regular communication across the system to ensure that the risk associated with reducing services was fully understood.

• UHL had partially reopened the transferring care safely reporting process, specifically for referral issues to help with implementation and further modifications.

• A data cell was being established, supported by Mrs Davenport, Director of Strategy at Leicestershire County Council and public health colleagues. One aim of that group would be to monitor COVID and non-COVID-19 morbidity and mortality data to determine risks for the whole population.

Dr Pulman reported there was insufficient capacity to fully re-introduce the transferring care safely programme, however a number of reporting channels were open that related to referrals and other areas of significant concern. He added that work continued with UHL on the development of a website to provide COVID-19 information and on-line resources. Information would be included on which referrals were open or closed and PRISM had been updated to reflect any changes. Two week wait pathways were still open and available. Dr Sanganee reported that he was working with local authority colleagues on the shielded patient group and one of the key priorities at present was to provide clarification on the information governance arrangements so that information could be safely and appropriately shared.

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12 May 2020 In conclusion Professor Lakhani said it was important to be sited on the key issues and priorities and he made the following points: • Work was going well around protecting vulnerable patients and practice list

cleansing to ensure they were as accurate as possible. • Clarification was still required for some GPs on the COVID-19 treatment service

when patients were not sick enough to go into hospital but still needed monitoring and treatment (and the responsibilities around follow-ups).

• The Loughborough hot hub had been established. • Leadership contribution to LLR was going well. • Post COVID-19 discussions had commenced. • CCG Chairs were working on whether to commission an enhanced home

visiting service and looking at how to support frail patients in care homes (under consideration by the care homes group).

Following a full discussion it was RESOLVED to:

• RECEIVE the paper to ensure board members were assured by the processes in place to monitor quality and safety during the COVID-19 period.

WL/20/022 Leicestershire Better Care Fund Plan for 2020/21

Board GPs declared an interest in WL/20/22

Mrs Davenport presented paper F the purpose of which was to seek approval for the interim Leicestershire Better Care Fund (BCF) expenditure plan for 2020/21. Further key highlights included:

• A similar report had been submitted to the Health and Wellbeing Board where papers were circulated in lieu of an April 2020 meeting.

• At the time of writing the report, the national BCF policy framework and technical guidance for 2020/21 was still awaited. The timetable for submission would be confirmed when the guidance was published.

• Ahead of the national documentation being released, work commenced in January 2020 to refresh the BCF expenditure plan, in line with the annual financial planning arrangements for the CCGs and Leicestershire County Council. The refreshed plan included an uplift for WLCCG of 5.7% that amounted to £1.7 million.

• The report set out the changes made to the BCF expenditure plan compared to 2019/20. The review of the expenditure plan took into account any imminent changes to models of care affecting elements of the BCF streams in 2020/21, pressures on existing service lines, application of growth and inflation across the plan in line with CCG and local authority assumptions, and specific confirmation of the CCG’s position with respect to the social care investment lines.

• It was anticipated that later in 2020/21, NHS England would request a formal submission of the BCF plan, which along with the expenditure plan would include a supportive narrative, the BCF metrics and a submission against the high impact model for the transfers of care.

• A major national review of the BCF policy is underway with an aim of producing recommendations so that a new policy framework can be introduced from April 2021. Leicestershire have participated in the review via the survey and a deep dive telephone interview with the national review team.

5


12 May 2020 Mrs Davenport drew the attention of the Board to the areas outlined in pink on Appendix A of the expenditure plan that highlighted the IBCF grant which was given for specific purposes in social care. That grant had been due to end on the 31st March 2020 but had been rolled over for a further year. All elements were being treated as non-recurrent in terms of adult social care, pending future decision on the funding settlement.

Mrs Kerr sought clarification on the reductions in the TCP co-ordinator roles even though the national trajectories were not being met. She asked if that was being offset elsewhere. Mrs Davenport replied that one of the 3 additional areas of expenditure identified for the adult social care allocation was intended for TCP. If approved, there would be investment across the three adult social care schemes, noted in para 22. TCP remained a high priority for social care and implementation was anticipated within the current year.

In terms of the approval of the BCF plan Mrs Briggs stated, as confirmed also at the earlier ELRCCCG Board meeting, that financial and business planning for CCGs for 2020/21 had been paused nationally, and due to that it would only be possible in governance terms to support the plan in principle, rather than formally approve it, at the current stage. However she assured the Board that did not lessen its significance and the strong support from the CCGs for the 2020/21 BCF Plan. Mrs Davenport explained the plan was written on the basis that formal submissions would go ahead later in 2020/21. It was also noted that some national COVID-19 related financial allocations were entering the LLR system and County CCGs and the Local Authority had met to discuss that last week. The BCF plan presented today gave assurance of having an opening plan with the acknowledgement that further adjustments and approvals could take place in year as required through the usual governance routes.

Subject to the above discussion it was RESOLVED to:

• Support in Principle the Leicestershire Better Care Fund Plan for 2020/21.

6


12 May 2020 WL/20/023 Finance Report: Month 11 Update

Mrs Briggs presented paper G, the finance report for Month 11. Key highlights included:

• The 19/20 financial Plan required delivery of an “in year” £1.42 million surplus across LLR CCGs. The plan was considered challenging and included the anticipated delivery of identified gross savings of £68.4 million (net £54.5 million) and a further £11.2 million unidentified savings.

• As part of the month 11 reporting to NHS England/Improvement LLR CCGs reported a variance of £20.6 million against the original plan. LC CCG was continuing to forecast delivery of the planned surplus of £1.42 million that gave an in year forecast position for LLR CCGs of £19.175 million overspend.

• The LLR QIPP programme was currently (as at Month 11) delivering £19.675 million less than originally planned. That included £9.9 million non delivery of unidentified QIPP.

• That variance was forecast to increase to £21.76 million by the year end against an original budget of £65.7 million, representing delivery of 67% of the originally identified QIPP.

• The gap was more than mitigated by delivery of £29.25 million from the financial recovery plan (FRP).

• A year-end financial agreement had been reached with UHL to the value of £562 million. That was a positive step for the system as it meant that there was certainty for commissioners and providers of the final value of the contract. It enabled the system to focus on preparing for the 2020/21 contract year

• For the last 8 months the CCGs had been discussing the risks around delivery of the planned position with Governing Bodies and NHS England/Improvement. A likely adverse variance of £20.6 million had been recognised as part of FRP and had been shown in the reports and declared in submissions to NHS England/Improvement.

• At month 11, the underlying position was £27.2 million. The underlying position showed that recurrent items were being funded from non-recurrent resources, that indicated the level of financial pressure that the CCGs would take into the 2020/21 financial year.

Mrs Briggs reported that one further risk was the submission of additional COVID-19 costs from LLR CCGs of £1.7 million and it would be known shortly whether that would be reimbursed. She added that the final accounts were due for submission on the 27th April, IT permitting. Mr Gay would be making contact with Mrs Kerr and Mr Churton to discuss accrual estimate methodology used for the final accounts.

Mrs Kerr informed the Board that the Finance, Performance and Activity Committee did not meet in March 2020 but finance month 11 and QIPP papers had been circulated to members for review by email, feedback was provided. She added the feedback from those emails perhaps should be collated for audit trail purposes. It was RESOLVED to: • RECEIVE the Finance Report: Month 11 Update

SF

WL/20/024 Suspension of Delegated Authority for Continuing Healthcare

7


12 May 2020 Ms Trevithick presented paper H that set out the proposals for the suspension of the delegated authority process for approval of health funds in response to the COVID-19 Emergency. She added that it was in line with: • The Hospital Discharge Service Requirements for all NHS trusts, community

interest companies and private care providers of acute, community beds and community health services and social care staff in England, who had been required to adhere to the requirements from Thursday 19th March 2020.

• The Government agreement that NHS CHC assessments for individuals on the acute hospital discharge pathway and in community settings would not be required until the end of the COVID-19 emergency period.

• The Government agreement that the NHS would fully fund the cost of new or extended out- of-hospital health and social care support packages, referred to in the guidance. That applied for people being discharged from hospital or would otherwise be admitted into it, for a limited time, to enable quick and safe discharge and more generally reduce pressure on acute services.

• The introduction of a single discharge to assess model across England. • The requirements detailed in the COVID-19 Hospital Discharge Service

Requirements guidance were included as appendix B

It was RESOLVED to:

• NOTE the requirements detailed in the COVID-19 Hospital Discharge Service Requirements guidance included as appendix B

• NOTE the transfer of responsibility for funding care from local assessment and approval processes to the central government COVID-19 response budget.

• APPROVE the proposal for the suspension of the Delegated Authority Process for approval of health funds in response to the COVID-19 Emergency

WL/20/025

Any Other Business There was no other business.

WL/20/026 Date of Next Meeting

The next meeting of the WLCCG Governing Body would be held in common with LCCCG and ELRCCG, would take place on 12th May, venue to be confirmed.

The next WLCCG Governing Body Board meeting would be Tuesday 9th June, venue to be confirmed.

8


12 May 2020

EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP Minutes of the Governing Body Meeting held on

Tuesday 14 April 2020 at 9.30am, via Webex

Present: Dr Ursula Montgomery Clinical Chair (Chair) Ms Fiona Barber Deputy Chair and Independent Lay Member Mr Andy Williams LLR CCGs’ Chief Executive Mr Warwick Kendrick Independent Lay Member Mr Clive Wood Independent Lay Member Mrs Donna Briggs Interim Executive Director of Finance, Contracting and Corporate Governance Ms Caroline Trevithick Executive Director of Nursing, Quality and Performance Ms Sarah Prema Executive Director of Strategy and Planning Mr Tim Sacks Chief Operating Officer Dr Andrew Ahyow Member Practice Representative Dr Nick Glover Member Practice Representative Dr Nikhil Mahatma Member Practice Representative Dr Girish Purohit Member Practice Representative Dr Vivek Varakantam Member Practice Representative In Attendance: Dr Katherine Packham Public Health Consultant Mrs Daljit K. Bains Head of Corporate Governance and Legal Affairs Mrs Claire Middlebrook Corporate Affairs Support Officer (minutes) Members of the public: There were no members of the public on the call.


B/20/1 Welcome and Introductions Dr Ursula Montgomery welcomed members of the Governing Body, noting that as the meeting was being held via Webex there were no members of public at the meeting. All members were asked to email any questions they wished to raise to the Chair or indicate on the system that they have a question or comment, to make it easier to run the meeting. Dr Montgomery noted that Dr Janet Underwood, Healthwatch Rutland, was unable to join the meeting on this occasion due to recent CCG IT issues that the CCG had been experiencing, however it is anticipated that this will be resolved for the next meeting. Dr Montgomery welcomed Dr Nikhil Mahatma to his first meeting of the ELR Governing Body and noted that Dr Mahatma will be meeting colleagues remotely over the next few weeks as part of his induction programme.

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12 May 2020


B/20/2 Apologies for Absences Apologies for absence were received from: • Mr Paul Gibara, Chief Commissioning and Performance Officer • Dr Janet Underwood, Chair, Healthwatch Rutland

B/20/3 Declarations of Interest on Agenda Topics All GP members declared an interest in items relating to primary care where a potential conflict may arise and also where there are any items concerning the Leicester, Leicestershire and Rutland Provider Arm where GP members’ are minor shareholders. The conflict was noted and will be managed during the discussions as required, it was also noted that the Register of Interests is published on the CCG website detailing declarations made by Governing Body members. No specific declarations on agenda items were recorded. It was RESOLVED to: • RECEIVE the declarations of interest and NOTE the actions being

taken.

B/20/3 Minutes of the meeting held in December 2019 (verbal) The minutes of the meeting held in December 2019 were approved at the LLR CCGs Governing Body meetings in common.

B/20/4 Matters Arising: Update on actions following the meetings held in common in March 2020 (Paper A) The action log was received and the following updates were provided: • B/19/54 Summary report from the Provider Performance

Assurance Group meeting, review of home visiting service – it was noted that an update has been provided in the paper and this action is now closed.

• B/19/86 Appointment of Secondary Care Clinician – it was noted that the decision to appoint a secondary care clinician had been deferred until discussions in relation to the future form of the CCGs have been determined. Action closed.

It was RESOLVED to: • RECEIVE the update.

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12 May 2020


B/20/5 To receive written questions from the Public in relation to items on the agenda only Dr Montgomery confirmed that written questions has been invited from members of the public on this occasion, and no questions had been received from members of the public relating to items on the agenda. It was RESOLVED to: • NOTE that no questions were raised on agenda items from the

public.

B/20/6 Chair’s Report (Paper B) Dr Ursula Montgomery took this report as read and reiterated the welcome to Dr Mahatma. The report shows the CCGs response to the current covid-19 pandemic and changes that have taken place over the past few weeks. Paragraph 12 onwards shows important governance arrangements that are in place and Dr Montgomery highlighted paragraph 15, which shows the actions Governing Body need to take to ensure members continue to provide oversight and support as required; including changes to the CCG’s Constitution and Scheme of Delegation and Reservation. Paragraph 15, section 2 highlights the sub-groups that have been set up and will be held virtually, noting that at this time members of the public will be unable to join the meetings. Different options are being explored on how to ensure the public can still be involved, going forward. At this time there may be delays with papers being circulated or reports being ready and therefore members are asked for their cooperation during this time. As the majority of meetings are being held virtually at present members are asked to regularly check their emails in case of additional ‘special’ or ‘extraordinary’ meetings being called. Although appropriate notice will be given as per the Standing Orders (within the CCG constitution). It may also be necessary to consider written resolutions during this period, to allow for swifter decision making to take place. It may be necessary to consider changing the quoracy requirements;

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12 May 2020


at present 50% of the membership would be considered a quorate meeting and further details as stipulated within the report. National guidance has been issued and was attached as appendix A; along with a letter from Ms Amanda Pritchard, Chief Operating Officer for NHS England / Improvement, which provided further guidance to support CCGs to free-up management capacity and resources during the current emergency situation. The Governing Body members are asked to agree the constitutional changes as listed in the paper. Mr Clive Wood asked that Lay Members are involved as much as possible as required during the current emergency situation. This was noted. Dr Girish Purohit raised two questions; 1) how will the CCG continue to engage with the membership and 2) if meetings are cancelled or postponed, how will the organisation let members know about emergency meetings being called. Dr Montgomery suggested that Dr Purohit may be able to suggest an answer to question one. Dr Purohit stated that prior to COVID-19 the Governing Body agreed a monthly engagement forum with the members / practices, where questions could be raised, however, this has not yet been arranged. It would be a positive move to ensure that this still takes place. Since the start of the pandemic the primary care team have been doing a great job with daily situation updates and regular communications to deal with urgent questions. Dr Montgomery suggested that the monthly engagement forums via teleconference or other means should be arranged and asked Mr Sacks to action. Mr Tim Sacks agreed that these calls should go ahead and apologised that they had not yet been arranged, the primary care team will aim to get these arranged by the end of this week. Mr Andy Williams commented that the CCG constitution allows for meetings to be called, as long as appropriate notice is given. It is for the Chair and others to decide if an additional meeting is required, as long as the meeting is quorate. The public can be notified through the website; although it is not always practical to share the Webex details via the websites. It is important that we are transparent by advising that a meeting is taking place and ensuring that copies of the approved minutes are made available on all three CCGs’ websites. Written questions can be submitted and this is acceptable for the present time as it is reasonable and therefore the CCGs should not be challenged on their actions.

Tim Sacks

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12 May 2020


Ms Fiona Barber stated that whilst the CCG was being sensible with its approach to meetings; it is important to ensure Healthwatch colleagues continue to be involved and the CCGs should continue to use these contacts. Subject to the IT issues, the Governing Body hope that Dr Underwood would be able to join in with virtual meetings in future. The recommendations were highlighted and the members agreed with the recommendations. It was RESOLVED to: • RECEIVE the contents of the report.

• AGREE and APPROVE proposed constitutional changes as set

out in the report.

B/20/7 Accountable Officer’s Corporate Report (Paper C) Mr Andy Williams highlighted that the majority of the content of the report is the CCGs response to the current pandemic. Mr Williams offered his thanks to colleagues at the CCGs and partner organisations for their response to Covid-19 and the different working circumstances. This has helped to bring people together to find practical solutions to problems; and the blue / red team working arrangements are working at present. It is still very important that any key decisions are documented; the only current identified gap is to have a local sophisticated model in place. Dr Montgomery noted the importance of documenting decisions, to ensure that the CCG is compliant with governance arrangements and that all actions are appropriately captured. Ms Barber commented that she was impressed by the way everyone had pulled together at this time and this was appreciated. Ms Barber asked what systems have been put in place in LLR for Care Homes to address problems which have been highlighted this week and what assurance can be given that appropriate processes are in place. Mr Williams confirmed that Care Homes is a strand of work; which is being looked at in association with local government. There have been issues highlighted this week in relation to the supply of PPE equipment which are being worked through as part of the overall system wide plan. The wider Local Resilience Forum (LRF) does not treat Care Homes any differently to any other healthcare setting. Mr Williams asked Ms Caroline Trevithick to comment on the processes

Page 5 of 12


12 May 2020


for care homes; including project structures and management. Ms Trevithick noted that there is a care home cell, as part of the primary care cell and Dr Andrew Ahyow is the clinical lead for this cell. Testing in care homes is due to be rolled out shortly and it has been acknowledged that the CCGs were slightly slow on sorting out care homes, so we are playing catch up to some extent. The interface with the three Local Authorities is good. Ms Barber confirmed that she is reassured by the information given. Dr Kath Packham noted that there has been an issue with Infection Prevention and Control (IPC) in care homes. Dr Mike McHugh is coordinating the staffing issues in the community and primary care; and providing support from Public Health with regards to supporting and advising GPs and care home staff. Discussions on how information relating to outbreaks in care homes are communicated to GPs are ongoing. Dr Vivek Varakantam acknowledged the massive changes that have taken place and that colleagues are working well together; not just within ELR, but with the main provider organisations as well. The strengthening of some cells has meant rapid changes taking place. The issue of PPE is being worked on by CCGs, in conjunction with the University Hospitals of Leicester NHS Trust (UHL), this issue is very important for primary care and care home staff. Mr Sacks confirmed that Ms Sarah Prema hosted a conversation yesterday, to ensure greater delivery of supplies, which will be arranged by the logistics cell and from this week onwards there should be a clearer process in place. Mr Sacks thanked everyone involved for their hard work in this area. It was RESOLVED to: • RECEIVE for information the Accountable Officer’s report.

B/20/8 Quality Briefing; COVID-19 (Paper D) Ms Caroline Trevithick noted that this paper should be read in conjunction with other papers presented today and highlights the CCGs response to the pandemic from a governance and quality perspective. The letter attached to paper B provides guidance on how NHS England / Improvement are going to help reduce the burden of covid-19; without over-burdening trusts, whilst maintaining statutory duties. A lesson that has been learnt is not to over-work teams, when they may be short staffed as members are supporting clinically elsewhere.

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12 May 2020


A quality and patient concerns log has been set up and regular conversations are taking place. There is a requirement for CCGs to support care homes from a quality perspective. The health and social care system is aware that safeguarding concerns may increase during this period of social distancing. Section 4 of the report provides an update on cancer and what is taking place in the system to support patients etc. Information in the report includes data provided as part of the return to NHS England and how services will be maintained. Referrals can still be made by Primary Care Networks (PCNs) and the system will look at transferring care safely in all cases. Information sharing is important to ensure that the health and social care system can make appropriate arrangements to support patients who are shielding. Ms Trevithick is the CCGs Caldicott guardian. Information governance issues should not be a barrier to supporting patients appropriately. Ms Prema is in the process of setting up a data cell to look at the model and areas of concern, such as the non-covid impact on patients; the population and; mortality and morbidity. A daily situation update will be provided to Governing Body members in conjunction with Accountable Officers and Chairs. Systems are in place to monitor quality and safety. Dr Nick Glover noted the information provided regarding quality monitoring and that the team will also be looking at non-covid issues. Dr Glover raised concern over safeguarding and the potential for an increase in domestic violence / abuse and suggested that the team link in with Ms Jan Harrison to provide an update in the daily situation report. A list of trigger questions would also be helpful and provide examples of good practice. Dr Purohit thanked Ms Trevithick for the paper and the clear governance structure. He suggested that a strengthening of the clinical leadership is required and that a named clinical lead for each cell, would visually strengthen the information. Ms Trevithick noted the comments and confirmed that this is an outstanding action with is currently being worked through with UHL and Leicestershire Partnership NHS Trust (LPT) and once confirmed will be shard with members. Dr Montgomery suggested that this should be further discussed at the Clinical Reference Group next week to review; in line with emerging capacity of GPs. Mr Wood added his thanks to colleagues for their response to the current challenge; their assurance and support. Mr Wood noted that

Claire Middlebrook

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12 May 2020


a telephone call is taking place tomorrow with all Lay Members to discuss time and capacity and how they may be able to assist cells. Dr Andrew Ahyow thanked everyone for the information provided to date, which provides assurance. It is important to remember that it is not just medical issues care homes are experiencing, there is also the issue of access for relatives and the perception that care homes are doing all they can to overcome the current access difficulties. Ms Trevithick acknowledged the comment made and will ensure this is looked into. Ms Barber noted Mr Woods’ comments about Lay Members being involved and suggested that they could be used to highlight ‘community engagement’ and welcomed any suggestions which could be put to the telephone meeting tomorrow. Dr Varakantam suggested that the tactical cell have a closer understanding of work that is taking place elsewhere to avoid duplication of work, we need to make sure that work is done well the first time. Dr Varakantam suggested that cells make use of NHS volunteers, where possible, such as for delivering medicines. Ms Trevithick noted that the community cell are looking at the use of volunteers, however, there are strict rules regarding the collection / delivery of medicines that have to be followed. Ms Prema recognised the comments made regarding duplication and this has been recognised. All teams are currently looking at their Terms of Reference and key tasks to reduce the amount of duplication; although it is inevitable that there will be some overlap. The tactical group will be taking this forward. Ms Prema confirmed that the Community Pharmacy contract has been amended this week. Mr Sacks confirmed that the Pharmacy contract had been amended for all dispensing and community pharmacies to ensure that they are funded to deliver medicines to all shielding patients. Mr Williams thanked the lay members for their offers of support and suggested that they could become involved in the recovery group that is being set up. This group will initially look at how the CCGs recover clinically, especially for Long Term Conditions; however, will also have a wider agenda, looking at the LRF and recovery of finances as part of the clinical leadership. Non-executives could become actively involved in this group and should email Mr Williams if this is something they would be interested in joining / supporting. The next phase of this group needs to be finalised with Ms Prema. It was RESOLVED to:

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12 May 2020


• RECEIVE the update included in the report.

B/20/9 Leicestershire Better Care Fund Plan for 2020/21 (Paper E) Mrs Briggs took the paper as read, highlighting that the Better Care Fund expenditure will be highlighted in more detail in finance report and that the approval may change following the update provided. It was RESOLVED to: • APPROVE in principle the interim BCF expenditure plan for

2020/21 for inclusion in Leicestershire County Council, WLCCG and ELRCCG financial plans.

B/20/10 Finance Report: Month 11 update (Paper F) Mrs Briggs presented this report which details the year to date and forecast position as at February 2020 (Month 11); however Mrs Briggs noted that the information is now out of date as the finance team are in the process of closing the accounts for 2019/20. The main item to highlight is at month 11 there was a £24m gap; which is on track at month 12, with £20.6m off plan, which was agreed at month 9; following changes made to the plan. At month 12 the LLR CCGs should be able to deliver the revised plan, with the expected gap of £20.6m. Confirm and challenge is taking place. The main risk to achieving the revised total is an email received noting that Epact data needs to be re-run and this may have an adverse affect. There is also the risk of the covid-19 costs; £1.7m in 2019/20, which have been submitted to NHS England and are due to be reimbursed by the regulator on Thursday. Another key risk is the possible problem of the finance team being able to access the on-line system to access the ledgers and close down the accounts. The draft accounts are due to be submitted on 27 April 2020. A review meeting has been agreed with Mrs Bains, Mr Wood, Mr Warwick Kendrick, Mr Colin Groom and Mrs Briggs in advance of this submission. The overall gap of £27.2m will need to be looked at to see if this can be reduced this year. Following a question from Mr Kendrick; Mrs Briggs confirmed that Mrs Bains will be emailing the members concerned to confirm the timing of the review. It was RESOLVED to:

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12 May 2020


• NOTE the financial performance at Month 11

• NOTE the adverse forecast position of £20.6m

• NOTE the underlying pressure of £27.2m on the 2020/21 plan

B/20/11 Suspension of Delegated Authority for Continuing Healthcare (Paper G) Ms Trevithick confirmed that this paper is being presented today for ratification. The paper outlines the proposals for the suspension of the Delegated Authority Process for approval of health funds in response to the COVID-19 Emergency. Patients should be discharge within two hours if medically fit to be discharged. This process has already been implemented, in order to speed up the discharge process. Mr Wood noted his support of the paper and assurance that this is appropriate; as previously discussed at the High Risk and Children’s panel. Guidance provided shows that organisations should have a light touch on decision making. Ms Trevithick confirmed that patients will still be required to have a three month review and all known patients are already in the system and will have their reviews undertaken by the Commissioning Support Unit. Dr Montgomery commented that all blocks to discharging patients have been removed and lessons learnt should be noted, so that this approach can be applied in the future. It was RESOLVED to: • NOTE the requirements detailed in the COVID-19 Hospital

Discharge Service Requirements guidance included as appendix B • NOTE the transfer of responsibility for funding care from local

assessment and approval processes to the central government COVID-19 response budget.

• SUPPORT the proposal for the suspension of the Delegated

Authority Process for approval of health funds in response to the COVID-19 Emergency.

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B/20/12 Governing Body Board Assurance Framework update 2019/20 (Paper H) Mrs Briggs noted that this paper is presented to show the CCG’s final position against its corporate risks in the Board Assurance Framework as at the end of 2019/20. The risks have been reviewed by the Executives throughout the year and also by the Audit Committee through to the Governing Body at agreed intervals. Mrs Briggs also informed that the end of year position of the Board Assurance Framework provides the starting point for 2020/21 Board Assurance Framework. It was also noted that going forward the three LLR CCGs will be using the ELR CCG format for this corporate risk register so that there is consistency in processes across the organisations. Members of the Governing Body noted the content and approved the Board Assurance Framework. It was RESOLVED to: • APPROVE the Board Assurance Framework as at Appendix 1 for

2019/20 year-end and as the starting point for 2020/21 noting the actions supported by the Audit Committee to ensure alignment of strategic risks and processes across the LLR CCGs.

B/20/13 Register of Interests and Register of Gifts and Hospitality 2019/20 (Paper I) Mrs Briggs noted that this paper is presented for approval by members, however, if any members have any amendments to the Conflicts of Interests Register these should be emailed to Mrs Bains no later than Friday. Appendix 2 is the Register of Gifts and shows that the CCG has followed procedures regarding registering any gifts and hospitality offered, accepted and / or declined. Dr Glover suggested that a slight amendment to the Register of Interests may be required with regards to PCN membership to be stated and ownership of Practice property where this is missing for some GP colleagues. Mrs Bains would update the register accordingly along with any further updates received by Friday. It was RESOLVED to: • RECEIVE and APPROVE the report and the register of interests

as at Appendix 1 and the register of gifts and hospitality at

Daljit Bains

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12 May 2020


Appendix 2 ahead of publishing these versions as at 31 March 2020, subject to any changes being emailed to Mrs Bains by the end of the week.

B/20/14 Items of any other business

Dr Montgomery noted there were no items of any other business.

B/20/15 Date of next meeting The next meeting of the ELR CCG Governing Body will be held in common with LC CCG and WL CCG, which will be take place on Tuesday 12 May 2020, venue to be confirmed. The next meeting of the ELR CCG Governing Body will be held on Tuesday 9 June 2020, venue to be confirmed. The meeting concluded at 10.40am.

Page 12 of 12

Blank Page

Paper B1 LLR CCGs’ Governing Body Meetings in common

12 May 2020

Outstanding On-going Completed

Key LEICESTER, LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUPS

ACTION NOTES

Minute No.

Meeting Item Responsible Officer

Action Required To be completed by

Progress as at May 2020

Status

No outstanding actions

Blank Page

Page 1 of 1

Paper B2 LLR CCGs’ Governing Body Meetings in common

12 May 2020 LEICESTER CITY CLINICAL COMMISSIONING GROUP

PUBLIC GOVERNING BODY ACTION NOTES

Minute No. Meeting Item Responsible Officer

Action Required To be completed

by

Progress as at 12 May 2020

Status

LCCCG/20/009 Feb 2020

Accountable Officer Report

Sarah Prema/Dr Bentley

Follow up AF pulse reading being taken by Home Visiting Service. To be followed up with Primary Care Team and CRG.

Dr Nainani Verbal update to be provided at the meeting.

Amber

No progress

On-Track Completed

Key

1

Paper B3 LLR CCGs’ Governing Body meetings in common

12 May 2020 West Leicestershire Clinical Commissioning Group Board Actions following April 2020 Meeting

Item Date Lead By When

Progress

WL/20/20 14.04.20 Accountable Officer’s Corporate Report • Ensure Dr Sil joined the newly established

data cell

AW/RS

April

Complete

• Invite Dr Pulman to join the group looking to develop a number of scenarios on how recovery might work.

AW/NP

April

Complete

• Develop a system-wide process to capture the learning on the different and improved ways of working, as well as the innumerable barriers that had been overcome on a day to day basis.

AW/

system leaders

April

Restoration and Recovery programme launched.

WL/20/023 14.04.20 Finance Report Month 11 Gather feedback from the FPAC papers circulated in March by email.

SF

April

Complete

Complete On-going Outstanding Not yet due

1

Paper B4 ELR CCG Governing Body meeting

12 May 2020

NHS EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP

ACTION NOTES

Minute No.

Meeting Item Responsible Officer

Action Required To be completed

by

Progress as at May 2020

Status

CB/20/6 14 April 2020

Chairs report Tim Sacks Monthly engagement forums via teleconference or other means should be arranged between CCG and member practices.

May 2020 Verbal update to be provided at the meeting.

AMBER

CB/20/7 14 April 2020

Quality Briefing; COVID-19

Claire Middlebrook

Named clinical leads for cells to be discussed at CRG.

May 2020 Email sent to CRG administrator to include item on next agenda. Action closed.

GREEN

CB/20/13 14 April 2020

Register of Interests and Register of Gifts and Hospitality 2019/20

Daljit Bains To include information in relation to PCN and property ownership by GPs on the Register of Interests for GPs where this is missing.

April 2020 ACTION COMPLETE GREEN

Blank Page

Outstanding On-going Completed

Key

1

Blank Page

Aligned to Strategic Objectives Leicester City CCG West Leicestershire CCG East Leicestershire and

Rutland CCG

Implications a) Conflicts of

interest: None identified

b) Alignment to Board Assurance Framework

Not applicable

c) Resource and financial implications

None identified

d) Quality and patient safety implications

None identified

e) Patient and public involvement

None identified

f) Equality analysis and due regard

Not required

Name of meeting: LLR CCGs’ Governing Body meetings in common

Date: 12 May 2020 Paper: C Public Confidential

Report title:

LLR CCG’s Chairs’ Report

Presented by: Dr Ursula Montgomery, Clinical Chair, ELR CCG Professor Azhar Farooqi, Clinical Chair, LC CCG Professor Mayur Lakhani, Clinical Chair, WL CCG

Report author: Daljit K. Bains, Head of Corporate Governance and Legal Affairs, ELR CCG Jo Grizzell, Head of Corporate Affairs, LC CCG Stuart Fletcher, Head of Corporate Governance, WL CCG

Executive lead: Donna Briggs, Interim LLR CCGs’ Executive Director of Finance, Contracts and Corporate Governance

Action required: Receive for information only: Progress update:

For assurance: For approval / decision:

Executive summary: The purpose of this report is to provide an overview and update of some of the key constitutional and strategic updates that affect the Governing Body and to provide an overview of meetings that attended.

Appendices: • None

Recommendations:

The LLR CCG Governing Bodies are asked to: • RECEIVE the contents of the report.

Report history and prior review:

• Not applicable

LLR CCGs’ Chairs’ Report Introduction 1. The purpose of this report is to provide an overview and update of some of the key

constitutional and strategic updates that affect the LLR CCGs’ Governing Bodies and to provide an overview of meetings that we have attended.

Meetings 2. In line with the national guidance in response to the COVID-19 pandemic we continue to

work remotely to support a system wide response to the current situation.

3. To enable clinical and managerial capacity to support the ongoing arrangements some meetings have been postponed, cancelled or take place virtually. Some meetings such as the LLR CCGs’ Clinical Reference Group and meetings with the Primary Care Network Clinical Directors continue to meet frequently to ensure clinicians continue to support and provide timely clinical input and advice in relation to changes that may be required to clinical pathways to support the response to the emergency situation, and to ensure clinicians are supported during this period.

4. All staff across the CCG are also working incredibly hard to ensure we can continue to

support the system response and also operate business as usual the best we can during these difficult times.

5. We would like to take this opportunity to once again thank all NHS colleagues and local

partners across Leicester, Leicestershire and Rutland (LLR) for their continued contributions, commitment and support in fighting coronavirus and delivering a system wide response in these challenging circumstances.

Meetings over the last month 6. As Clinical Chairs of the three CCGs we continue to work closely in implementing our

strategic approach to managing the response of the CCGs to the pandemic.

7. We continue to hold the following meetings on a weekly basis and will review the frequency as the situation evolves: a) Participate in a telephone conference with Dale Bywater (NHS England Midlands

Regional Director), Nigel Sturrock (Medical Director and Chief Clinical Information Officer), and CCG Chairs to receive a daily update report on the Midlands region.

b) Update from Caroline Trevithick on the strategic cell.

c) Update from primary care leads assigned to the primary care cell.

d) LLR CCGs’ Clinical Reference Group weekly teleconference meetings with the clinicians on the three Governing Bodies across LLR.

e) Webex with Clinical Directors of Primary Care Networks.

f) Andy Williams, Chief Executive update.

g) NHS England / Improvement telephone conferences for primary care as needed. 2

h) Clinical directors call between medical directors of Derbyshire Health United (DHU),

University Hospitals of Leicester NHS Trust (UHL), Leicestershire Partnership NHS Trust (LPT), East Midlands Ambulance Service (EMAS) and clinical chairs of LLR CCGs.

i) Professor Farooqi represents the clinical chairs at the twice weekly Health Economy Strategic Coordinating Group meetings.

8. We will continue to review these meetings and our involvement regularly to ensure that

we are focused on supporting the CCGs and managing the governance.

We have also maintained communication with our member practices by supporting the primary care team messages sent in the daily situation update report (SITREP). The team have also developed a website page for practices where all the information is easily accessed from previous SITREPs.

9. Other meetings attended include the following:

• On 16 April 2020 the Collaborative Commissioning Committee meeting; • 24 April 2020 - Recovery Cell to consider steps to take to support local system

recovery from the current situation; • Clinical Leadership Group – Webex on generating a clinical vision and principles

for LLR Restore and Recovery. We have had positive engagement in this from all partners across the system.

CCG specific meetings attended 10. In addition, to the above:

a) CCG specific update from Dr Ursula Montgomery:

As you will be aware, I have announced my intention to step down from my role as chair of ELR CCG at the end of July as I will be relocating to Cambridgeshire with my family I have been privileged to be chair of ELR CCG since October 2018. I arrived with a clear mandate to drive collaboration with partners across health and social care in Leicester, Leicestershire and Rutland and to work jointly towards improving services for the changing needs of our population. I believe we have taken great strides together towards delivering those ambitions. I look back on my time here with a sense of achievement, particularly noting the many changes we have made to deliver improvements for our patients. I would like to thank my governing body members, staff, member practices and our system partners for all of their support. I also want to take this opportunity to reflect on the current challenges facing everyone in the NHS due to the coronavirus pandemic. The impact has been enormous on so many of our citizens. However, I will be leaving the organisation at a real turning point. We are seeing out-dated working models that have all too often failed patients and staff being transformed for the better. It has also given us new

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perspectives on those things we already do well. I look forward to continuing to play my part in learning from and embedding the best of these new practices, in partnership with patients and clinicians, over the next three months to further improve the care we provide to our citizens.

b) Professor Azhar Farooqi attended the following meetings:

• Along with the other two chairs, and as outlined above, much of our work over the last weeks has been focused on the COVID-19 emergency.

• It has been great to see the degree of clinical engagement and collaboration that has taken place. We should all be proud of our response to this unique and challenging set of circumstances, but should always be looking to learn lessons, and improve further in meeting the needs of our population.

• I have been involved in a number of local and regional radio and TV events promoting messages to the general public on COVID-19.

• In my role as CCG diabetes lead, I have worked with the National Advisory Group, the regional Diabetes Clinical Network, and locally with the LLR Diabetes Delivery Group to develop guidance, and explore new ways of working, including learning from the COVID-19 emergency in how recovery and reset should look.

• I have taken part in an ongoing national piece of work looking to ensure wider recruitment into COVID-19 clinical research studies is undertaken in the NHS, including working with a number of regional research leads from across England.

• I have been involved with regular communication with LC CCG practices and PCNs, and in supporting members of the Governing Body, in particular the GP members.

• I have continued the discussion/dialogue with our GP practices on the proposed CCG re-configuration strategy.

c) CCG specific update from Professor Mayur Lakhani: • I have continued with the WL CCG clinical coordination meetings; • Participated in regional frailty seminar; • Authored document on CPR guidance in light of the risk of cross infection; • I am currently working on a risk assessment framework for primary care staff

including ethnicity considerations; • Finally, I have enrolled on the national COVID-19 Clinical Assessment Service

NHS 111 (CCAS) to provide clinical support. The shifts I have undertaken reveal the extent and severity of COVID-19 in the community and the impact this is having.

Recommendations The Leicester, Leicestershire and Rutland CCGs Governing Bodies are asked to:

• RECEIVE the contents of this report.

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Leicester City Clinical Commissioning Group West Leicestershire Clinical Commissioning Group

East Leicestershire and Rutland Clinical Commissioning Group


Rutland CCG


interest: No conflicts of interest have been identified.


Not applicable.


Date: 12 May 2020 Paper: D Public Confidential

Report title:

Accountable Officer’s Corporate Report

Presented by: Andy Williams, Chief Executive

Report author: Jo Grizzell, Head of Corporate Affairs Daljit K. Bains, Head of Governance and Legal Affairs Stuart Fletcher, Head of Corporate Governance


Action required: Receive for information only: Progress update: For assurance: For approval / decision:

Executive summary: The purpose of this report is to inform the Governing Bodies of key activities with which the Executive Membership Team and Chief Executive have been involved in since the last meeting of the Governing Bodies. The report includes updates on items not covered elsewhere in the Governing body papers, as well as details of achievements and other pieces of useful information.

Appendices: None

Recommendations:

The LLR CCGs’ Governing Bodies are asked to: • RECEIVE for information the Accountable Officer’s report.


Not applicable


There are no financial implications.


None identified.


Not applicable.


Not applicable.

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ACCOUNTABLE OFFICER’s REPORT INTRODUCTION 1. This report sets out to the Governing Bodies some of the key activities with which the

Executive Leadership Team (ELT) and I have been involved in across Leicester, Leicestershire and Rutland (LLR) since our last meeting of the Governing Bodies. It includes updates on items not covered elsewhere in the Governing Body papers, as well as details of achievements and other pieces of useful information.

COVID-19 Update 2. Throughout April the Leicester, Leicestershire and Rutland (LLR) NHS has continued to

work well with our partners within the Leicester, Leicestershire and Rutland Local Resilience Forum (LRF) and through the Strategic Co-ordination Group in response to the Covid-19 outbreak.

3. There are many examples of excellent work across LLR; one such example is through

the Strategy and Implementation Team who have been working closely with primary care throughout April. The team has been involved in the delivery of IT and personal protective equipment (PPE) supplies to general practice, and the sourcing of PPE supplies for LLR on a more sustainable basis. This has resulted in over 90% of practices reporting themselves as Green for PPE supplies across LLR.

4. On 29 April, it was reported that the 7 day rolling average for daily cases of coronavirus

cases across LLR was 34.9, which is the lowest 7 day rolling average since 4 April.

5. A more detailed report is on the agenda later today for the Governing Body members to receive.

Covid-19 Communications 6. The communications teams in University Hospitals Leicester NHS Trust and

Leicestershire Partnership NHS Trust are continuing to take a system – wide approach to communications. This is supporting consistency and coordination of activity. Current focus of work has been supporting the national campaign on the NHS is open, encouraging the public to use services when they need them for non-covid related health problems. The communications have emphasised the measures put in place to keep patients safe and highlighted how patients are accessing services and care differently through online consultations, for example. We have also taken the opportunity to thank all key workers in the media.

7. Regular Stakeholder Bulletins are being issued – nine so far and an MPs briefing was held on 30 April between the three NHS LLR Chief Executives and all Leicestershire MPs.

8. NHS communications teams are also forging strong links with other agencies through the

Local Resilience Forum. This is helping us to establish ongoing access to extended channels for communications, disseminating our messages through local authority newsletters.

9. Through the partnership of the LRF, a new website,

OnePrepared, https://www.llrprepared.org.uk/one-prepared/ has been created. This

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https://www.llrprepared.org.uk/one-prepared/

provides a portal for local information and support for Covid-19 for local residents in LLR. We are also continuing with our community radio initiative – a series of short messages delivered by senior managers and clinicians – through radio stations serving particular communities.

10. Work has now started on the Communications and Engagement Recovery Plan. Key

themes I the plan are re-building confidence in services and continuation of public health messaging and advice to the public.

LLR Maternity Voices Partnership (MVP)

11. Maternity Voices Partnership (MVP) is a NHS working group comprised of a team of women and their families, commissioners and providers (midwives and doctors) working together to review and contribute to the development of local maternity care.

12. In light of Covid-19 outbreak there have been some adaptations to local maternity

services in line with national guidance. This is to ensure that maternity services remain safe, effective and continue to meet the needs of local service users during these challenging times.

13. The LLR MVP have co-produced a short video to signpost women and families locally to:

• the Leicester maternity services website; • providing an insight into the adaptations to local services and what to expect

during the antenatal, intrapartum and postnatal period during the coronavirus situation;

• highlighting key information such as contact telephone numbers through to the importance of attending scheduled antenatal care, what to expect when they meet clinical staff (staff wearing PPE) and what to do if they have any concerns.

14. Further information will be provided alongside UHL as to how the video is shared with service users.

Children and Young People’s (C&YP) Emotional Mental Health and Wellbeing Services 15. The CCG has continued to work collaboratively in partnership with providers of C&YP

services across the system to ensure that we are continuing to meet the needs of C&YP during this national pandemic.

16. It is noted that there has been a change in the pattern of referrals into the different

services across the pathways, such as:

• A reduction in C&YP referred in to CAMHS • A reduction in C&YP attending A&E (urgent care central hub) with no physical

need. • A reduction in C&YP referred into the crisis resolution and home treatment

service (CRHTx) • An increase in C&YP accessing Early Intervention Service

Launch of the Children and Young People’s Triage and Navigation Service

17. The C&YP Emotional, Mental Health and Wellbeing Triage and Navigation Service went live on Monday 4 May 2020.

4

18. The service will be delivered by Derbyshire Health United. It is a central point of contact

for referrals, self-referrals and professionals working with CYP.

19. The referrals into the service will undergo a triage and then referred into the most appropriate service across the pathway to ensure they receive access to the right care in order to meet their needs.

New Central Access Point for all age Mental Health 20. Based in the Bradgate Mental Health Unit, the new hub will operate a 24

hour telephone helpline and a face-to-face service, providing telephone triage and face-to-face mental health assessments and care for people with urgent mental health needs, with specialist CAMHS practitioners to conduct mental health assessments for C&YP.

21. C&YP attending the hub for face-to-face assessment will be C&YP who have previously

been seen by the mental health triage team based at Emergency Department at the Leicester Royal Infirmary, or C&YP referred from the police, NHS111, the crisis team, other LPT services and GPs.

22. Commissioners will continue to monitor the service, regarding demand, efficiency,

effectiveness, impact, and service user satisfaction as part of the recovery and restoration work, to inform the continued transformation of C&YP services across LLR.

Covid-19 Funding Allocated to the Early Intervention Service 23. The CCG has allocated additional funding to the Early Intervention Service to support the

service over the next 6 moths to meet the increasing demand as a result of the Covid-19 outbreak and the closure of schools.

24. The funding will enable the service to increase their staffing numbers to address the rise

in demand, and adapt their services including the introduction of digital interventions, whilst at the same time continuing to deliver a safe, efficient and effective service.

Conclusion 25. The response of the NHS in LLR to the Covid-19 outbreak continues to demonstrate the

NHS at its best. Working across boundaries the focus has entirely been on doing what is best for our patients and ultimately to save lives.

26. We have achieved this through effective partnership working both within the NHS and

with other public, private and voluntary organisations and sheer determination and hard work.

Recommendation: The Leicester, Leicestershire and Rutland CCG Governing Bodies are asked to:

• RECEIVE for information the Accountable Officer’s report

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Rutland CCG


interest: None – for information


EPRR


N/A


Quality/clinical input through the management of incident and cell structure


N/A


N/A

`Name of meeting: LLR CCGs’ Governing Body meetings in common

Date: May 2020 Paper: E Public Confidential

Report title:

LLR Health response to COVID 19

Presented by: Andy Williams, Chief Executive

Report author: Dan Webster, Acting Deputy Director of UEC, and Head of Operational resilience and EPRR

Executive lead: Andy Williams, Chief Executive


Executive summary: The below report provides an overview to the current arrangements for the response to COVID 19 within the LLR health system.

Appendices: Command and control structure

Recommendations:

The LLR CCGs’ Governing Bodies are asked to: Receive the below information provided as an overview of the protracted incident management of Covid-19.


LLR Health response to COVID 19

History:

1. On 31 December 2019, WHO was informed of a cluster of cases of pneumonia of unknown cause detected in Wuhan, Hubei Province, China.

2. A novel coronavirus (SARS coronavirus-2 (SARS-CoV-2)) was subsequently identified from patient samples (PHE 2020). This is now known as COVID-19.

3. Organisations across LLR met at the end of January 2020 began preparing

services. This led to a Health Economy Tactical Coordination group being established to coordinate the health response to COVID-19 for LLR.

Current status: Risk level 4. Currently working at NHS level 4 incident management with LRF Major Incident

declaration in place

LLR Preparedness:

5. Thanks to a great collective and collaborative efforts between health partners LLR has been able to put in place plans of which are in line with national guidance.

6. Health and social care along with the support from the Local Resilience partnership have a comprehensive command and control structure in place of which has distributed workload to achieve swift action and turnaround.

7. The Health TCG works alongside the LRF TCG supported by the strategic levels of

Health Strategic coordination group and the Local resilience Strategic group to ensure strong governance around decision making.

8. Working to an incident management style these types of structures are well tested and

provide the response required achieving positive outcomes.

9. By working collaboratively as identified above we have been able to protect capacity for the below as required for our initial health actions set by NHSEI.

10. Initial Key actions for health Protect primary care Protect the Ambulance service Protect the Acute site

11. It needs to be understood that currently there is no vaccine or heard immunity therefore

a potential resurgence needs to be planned for in preparedness for continued COVID 19 Impacts.

Command and Control: 12. LLR CCG’S implemented command and control procedures under the agreed Pandemic

plan; this enables the coordination of efforts as a health system to ensure protection of our patients, staff and core services.

2

13. The LLR CCG executive chair system wide Health tactical coordination group meetings

(HTCG). In the initial co-ordination phase these were held daily and now meet 3 times per week as work is coordinated and planned. The HETCG receives updates from each sub cell along with Public Health England (PHE) to ensure we have the latest up to date information to plan our response.

14. Each health organisation along with the CCG’s has an incident management team in

place 7 days per week 8am until 20:00.

15. LLR CCG’s initially chaired the LRF TCG as requested by the LRF due to this being a health incident, as the incident evolved and placed more pressure on services outside of health the LRF TCG and SCG are then handed over to the Police due to an LRF major incident declaration of which allows exploration of additional powers.

16. NHSEI have a regional incident response cell in order to monitor the situation and

provide timely flow of information to assist local health systems’ response to COVID 19.

17. Via NHSEI we are briefed with a weekly webinar chaired by Professor Keith Willet. With key aides this forum provides a national overview to planning arrangements; each region/Locality then adapts this information to tailor an approach for their respective areas.

Protection plans: 18. As the incident evolved and new scientific advice came on line from central government

our society in LLR was asked to follow social distancing rules commonly known as “Lockdown”.

19. With thanks to our Public adherence to the guidelines has ensured that we have been able to protect the NHS and save lives.

20. Future Testing – The CCG have established a testing cell for LLR. In collaboration with

the CCG, local councils, MOD and the LRF we now have a testing centre in place at Birstall providing testing for Key workers. We then have a mobile testing centre mobilised by the MOD of which will visit Leicester, Leicestershire and Rutland sites providing testing for priority groups such as Care home staff. https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested

21. Through our recovery cell working with EPRR functions we will review the incident and

changes in working practice to build in resilience for future protection.

22. With any incident a debrief will take place to highlight areas of learning for the future, we prepare for this now however a formal structured debrief will take place once the incident is stood down.

Response: 23. During the response to this incident LLR has responded to all National and regional

requests.

24. We now await further government advice regarding relaxation of social distancing measures to understand the impacts into the next phase of response.

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https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested

25. As with any incident there are always challenges to overcome, LLR from a health

perspective has been extremely proactive in resolution and escalation. Below are examples of the challenges we have faced:

PPE: The national supply chain was initially overwhelmed with requests for PPE,

during the response we have ensured that any potential shortage has been notified to the HETCG Incident management team for resolution. The CCG also requested for a PPE cell to be established within the LRF, this cell is chaired by the MOD who coordinate the logistics and act on emergency shortages.

Staffing: Within a Pandemic it is expected to see organisations may escalate to a 20% abstraction rate. All organisations have provided abstraction rates to the workforce cell to report to HETCG for action. With this in mind the government implemented the return to practice scheme. Testing of suspected staff cases has also been provided to return staff to duty safely. We have also seen mutual aid arrangements such as the Fire service providing staff to work on Ambulances if required.

Care Homes: We are working in partnership through our social care cell to support

from the NHS perspective into care homes. CCG in partnership with local authority public health / environmental health teams will provide a named contact to help ‘train the trainers’ in care homes about PHE’s recommended approach to infection prevention and control. Particular support will be offered to those care homes that lack the infrastructure of the bigger regional and national chains. The CCG is taking immediate action to mobilise that offer and identify as many trainers as possible. This important work must be undertaken at the direction of local authorities and LRFs as they have the oversight and relationships with all care homes in their area. The NHS is providing mutual aid support to LRFs, and to support registered care home managers with their responsibilities. Any training provided will build on the good practice and relationships already in place in each local area. Staff testing in care homes is also underway with the Mobile testing units.

Recovery: 26. Although we are still very much in the managing the emergency stage there are signs

that the situation is levelling off and as such we now need to consider planning for the recovery phase of the emergency.

27. To support the recovery phase the LLR Health Economy Strategic Coordinating Group has agreed to establish a Recovery Cell to co-ordinate the health response to recovery and to work alongside the LRF in this phase of the emergency.

28. The Recovery Cell will manage the actions required to bring the LLR health

organisations out of managing the COVID-19 emergency to business as usual. It will be a strategic group with links into both the individual organisations and the Local Resilience Forum Recovery Cells.

29. There has been an opportunity to do things differently due to COVID the recovery cell

will now reflect on these changes moving forward to a new normal.

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30. The approach to recovery is being set out in three phases; all phases will also include an

element of continued management of COVID-19: 1. Restoration: from May 2020 to July 2020 with the focus on restoring critical urgent

care services and some routine elective care 2. Recovery: from July 2020 to March 2021 with the focus on recovering services to a

new norm, tackling backlog in services and recovering to agreed standards. 3. Reset: from April 2021 resuming longer term planning and delivery.

31. New normal – During our response to COVID -19 pandemic we have worked differently

across health services. For example we have increased and implemented the use of Video/Telephone triage/consultation, changed discharged processes and suspended some functions such as assessments, establishment of co-horting and managing patients which has meant that we have used our services in different ways. Through the recovery cell we will review the changes we have made to understand how we restore certain functions that require that and how we utilise the learning and innovation to inform how we are likely to establish or maintain new ways of working. This would then ensure future resilience and benefit BAU.

32. We also need to review our response including lessons learned in order to commence the work to plan for winter which will include possible further surges that may occur of COVID-19 in addition to dealing with Influenza and Norovirus outbreaks.

33. To support our approach to recovery the LLR Clinical Leadership Group is reviewing the

lessons learnt from the COVID-19 emergency and developing a new clinical model based on that experience and how we would want to see services develop in the future.

34. This new model will then be used by each of the work stream/cells to develop a plan that

will deliver on this new model. The model will be underpinned by a set of system principles and a review of the system vision, mission and values.

Summary: 35. The proactive collaborative approach by LLR Health partners in conjunction with the

amazing effort of compliance from our great LLR public we have been able to provide the capacity required to currently manage covid-19 in LLR.

36. We now need to ensure that we are prepared for a potential second wave of activity once social distancing measures are relaxed and build in timeframes of normal activity escalation such as winter pressures and seasonal flu.

37. We must pay tribute to our amazing staff who have without question, flexed in their work

approach and ethic and have used their skills across the system to enable a structured approach to managing this incident.

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Strategic Co-ordinating Group (SCG) Chair: Rob Nixon Membership: Chief Execs or Senior Managers from all LRF partners Support: LLR Prepared Office

Tactical Co-ordinating Group (TCG)

Chair: Martyn Ball Membership: Tactical Managers and Resilience Practitioners from all LRF partners Support: LLR Prepared Office

Media & Comms Cell

Chair: Katie Pegg (LCC) and Dave Rowson (CCG) Membership: Comms representatives from all LRF partners Support: Resilience Partnership Team

Health Economy Tactical Co-ordinating Group (HETCG)

Chair: Caroline Trevithick Membership: Tactical Managers and Resilience Practitioners from Health Partners Support: LLR CCG UEC Team

Local Authority Sub-Group

Chair: Elaine Bird (HDC) Membership: Senior / Tactical Managers for all LLR Local Authorities Support: Resilience Partnership Remit: Coordination of LA issues

Mortality Cell

Chair: Tom Purnell (LCC) / Professor Mason HM Coroner Membership: As per Excess Deaths Plan – local authorities, Coronial Services, UHL, Coronial Services and Funeral Directors Support: Resilience Partnership Remit: Planning for and management of excess deaths

Community, Voluntary and faith engagement Cell

Chair: Leicestershire County Council Membership: Tactical/Operational Managers from local authorities, community, voluntary and faith groups Support: Resilience Partnership Remit: Planning for support to vulnerable self-isolated people NOT requiring specialist health/social care support

Health Economy Strategic Co-ordinating Group (HESCG)

Chair: Andy Williams Membership: Chief Execs or Senior Managers from all health partners Support: LLR CCG UEC Team

Faith Engagement

Food Support

Volunteer &Community engagement

Support for Self-Isolation

Sub Group

Equipment and PPE Prioritisation Cell

Chair Sam Phillips – Mahon Remit: To support the coordination and distribution of critical supplies of equipment and PPE.

Business Cell LEPP

Chair: Fiona Baker

Multi Agency COVID Response

Blue Light Cell

Chair: Fire Carl Fire

Police Ambulance

LRF Recovery Cell

HETCG Sub cell structure

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Health Economy Tactical Co-ordinating Group (HETCG)

Chair: Caroline Trevithick Membership: Tactical Managers and Resilience Practitioners from Health Partners Support: LLR CCG UEC Team

Workforce Cell

Hazel Wyton Louise Young

UEC Cell AEDB

Yasmin Sidyot

UHL Tactical Cell

Fiona Lennon

LPT Cell Anne Scott

Independent sector

capacity Cell Rachel

Bilsborough

Medicines Cell

Claire Ellwood

Primary Care Cell

Tim Sacks

Discharge Cell

Rachna Vyas Tamsin Hooton

Social Care Cell

Martin Samuels

Care homes (sub-cell)

Chair: Sarah L Smith

Children’s (sub-cell) Chair: Melanie Thwaites Deputy: James Hickman

Terms and Conditions

Staff Accommodatio

n

Health and wellbeing

workforce sharing agreement & redeployment

Equality, Diversity and

Inclusion

Business Continuity

Clinical Pathways

Health Media and

Comms Dave Rowson

Testing Cell Ket

Chudasama Cathy Lea

IM&T

Recovery Cell

Sarah Prema

Both Cells have internal command structures

Data Cell Simon Pizzey

Digital Adhvait Sheth

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Date: 10 April 2020 Paper: F

Public Confidential Report title:

Paper to consider a number of changes to S117 processes in response to COVID –19 Emergency.

Presented by: Caroline Trevithick - Executive Director of Nursing, Quality and Performance

Report author: Julie Croysdale PHB Service Delivery Manager Nick Hey Senior Contract Manager

Executive lead: Caroline Trevithick - Executive Director of Nursing, Quality and Performance


Executive summary: This report sets out the proposals for the suspension of S117 Panels, move to 50:50 split care packages and the suspension of the Delegated Authority approval process during the COVID-19 emergency period. This proposal is designed to support the LLR Health and Social Care response to theCOVID-19 emergency and mirrors the ambition to expedite discharge from inpatient beds and in addition will remove some of the burden on staff dealing with new priorities as a result of COVID 19.

• The Hospital Discharge Service Requirements for all NHS trusts, community interest companies and private care providers of acute, community beds and community health services and social care staff in England, who must adhere to the requirements from Thursday 19th March 2020; although this does not specifically refer to Mental Health patients in a Mental Health setting there are synergies which we should draw upon

• Staff being redeployed to help on acute wards and working on COVID 19

priorities

• The requirements detailed in the COVID-19 Hospital Discharge Service Requirements guidance included as appendix B

Appendices: Appendix A - Mental Health Act Section 117 after-care – funding joint packages of care Appendix B - COVID-19 Hospital Discharge Service Requirements

Recommendations:

The Board is being asked to • Review and accept the financial risk to the CCGs and the proposed

mitigation actions • Support the costs being reimbursed under the COVID-19 scheme • Support and approve the recommendation to allow S117 packages to be

funded at 50:50 split between Health and Local Authority • Support the proposal for the suspension of the Delegated Authority

Process for approval of health funds in response to the COVID-19 Emergency

• Support the implementation of an emergency discharge process from mental health units for S117 eligible patients.


N/A

1


Rutland CCG


interest: None


None


Yes


No


Yes


Yes

Purpose of the Report

2

The purpose of this report is to inform the Board of the proposals to consider a number of interim changes to standard S117 and AHP processes and emergency discharge processes from mental health units in response to COVID –19 Emergency.

Specifically:

For standard S117 and AHP referrals

• To stop funding negotiation panels between Health and Local Authority colleagues; • Move to 50:50 splits between Health and Local Authority; • Stop cases going to Delegated Authority for approval.

For emergency discharge processes from mental health units for S117 eligible patients:

• Implementation of a short term measure in which the local authority will organise temporary supported residential accommodation for patients requiring emergency discharge from Mental Health units with an agreed 50:50 funding split between health and local authority, with the health element funded through COVID19 funding.

Background

Standard S117 and AHP referrals

Under section 117 of the Mental Health Act 1983 (‘section 117’), CCGs and local authorities have a joint duty to provide after-care services to individuals who have been detained under certain provisions of the Mental Health Act 1983. The duty applies when those individuals cease to be detained and are discharged from hospital (including on Section 17 leave, or under a Community Treatment Order under section 17a) until such time as the CCG and local authority are satisfied that the person is no longer in need of such services. Section 117 is a freestanding duty to provide after-care services to the individual for needs arising from, or related to, their mental disorder. CCGs and local authorities should have in place local policies detailing their respective responsibilities, including funding arrangements.

The health element of the Section 117 team are based within the CCG and work collaboratively with the local authorities to ensure people are cared for, following discharge from Section 3, 37, 45A, 47 or 48 of the Mental Health Act 1983.

The current process for the provision of after-care services for S117 eligible patients is as follows:

• Person discharged and eligible for s117 • The majority of Section 117 aftercare is provided by core health and social care services and

does not require additional funding arrangements. CCGs and Local Authorities do however commission services beyond core provision which are referred to as ‘bespoke’ packages. Where this is the case a timely and robust approach in deciding who leads on commissioning and who funds the ‘bespoke’ package is required.

• Local Authority Social Workers and CCG Case Managers review patient, discuss necessary package of care and agree funding split. This can be in any increment of percentages.

• The package of care is then submitted to the Nursing and Quality team for approval. • Any cases costing more than £50,000 cannot be agreed by the Delegated Authority function

within the Nursing and Quality team and are submitted to the bimonthly High Risk and Complex Care Panel for discussion and approval.

• Once funding has been approved the Local Authority will lead on the brokerage and commissioning of packages of care to support patients.

• The CCGs and LA will then complete and agree separate IPA’s under their respective contracts for their elements of the care commissioned.

3

Across the rest of health and as part of the NHS emergency response to the COVID-19 crisis the Government has agreed that the NHS will fully fund the cost of new or extended out-of-hospital health and social care support packages, referred to in the COVID-19 hospital discharge service requirements guidance. This has enabled other funding streams to amend their current processes to enable a more streamlined discharge and care commissioning process. However this funding agreement does not extend to support those people in Mental Health hospitals who are being discharged.

We do however see some synergies in the processes being followed and would like to propose some temporary changes to ensure the flow of discharge is as unhindered as possible. These amendments would support LPT to reduce current DTOCs in MH beds and expedite discharge which is turn should hopefully free up capacity within LPT’s MH beds which could then be used as part of the COVID response.

For emergency discharge processes from mental health units

Concerns have been escalated by LPT, Local Authorities and CCG commissioners around the delays being experienced in the discharge process for patients from Mental Health Units. These concerns have been ongoing for some time and are routinely discussed through numerous forums and are, in part, due to the governance processes within both the CCGs and LA for agreement of funding for aftercare from discharge. The other major factor being the sourcing and procuring of appropriate mid-long term placements which will meet the needs of patients.

In line with the COVID-19 hospital discharge service requirements guidance discussed above within the proposed amendments to the S117 process, there is also the potential to provide supported discharge to patients for emergency placements. This proposal will allow patients to be discharged into the community, freeing up beds, without being delayed due to funding and responsibility decisions. To enable this emergency discharge pathway the proposal suggests an automatic 50:50 funding split agreement between the LA and CCGs, with the LA responsibility for brokering and contract management of the placement. Financially this type of agreement and placement would meet with the COVID funding criteria and the health element would be allocated to the COVID reimbursement. The placement being sourced would be in the short term whilst a more appropriate mid to long term package was procured, mirroring the processes implemented for discharges from acute beds.

Proposal for approval

As part of these temporary discharge measures, in relation to NHS Continuing Healthcare, NHSE have informed CCGs of the need to suspend any new assessments of eligibility for NHS CHC funding to help expedite patients out of acute and community hospitals beds in the most time efficient method possible. Nationally this does not extend to S117 aftercare patients, however locally we would like to implement some temporary changes to ensure we are freeing capacity and removing blockers from our processes. This includes, for those patients requiring an emergency discharge and placement, the use of COVID funds to support the initial placement whilst a mid to long term placement or care package can be sourced which appropriately meets the patient’s needs.

We are therefore requesting that when a person is ready for discharge following being sectioned under Section 3, 37,45a, 47 and 48 that Health and Local Authority agree to fund their package on a 50:50 basis. This will negate the need for a discussion between the two organisations to make this decision; secondly, if we are agreeing to this split, and in line with other delegated authority tasks being removed, the package would not have to be ratified by the Nursing and Quality Team. Dependant on whether the patient already has an appropriate care setting sourced will determine whether the patient can be discharged under normal S117 processes (with the amendment to the

4

https://www.england.nhs.uk/coronavirus/publication/covid-19-hospital-discharge-service-requirements/

https://www.england.nhs.uk/coronavirus/publication/covid-19-hospital-discharge-service-requirements/

funding splits and governance) or, if they require a short term interim placement, they are discharged under the emergency discharge process (with COVID supported funding).

The current local LLR CCG approval process for health funding of packages, although as efficient as it can be, does implement additional steps in the commissioning of care which do cause delay. The new process being implemented during the emergency period will require care decisions to be made and commissioned without an approval process for the spend of NHS funds.

The Mental Health team have previously conducted a review of the cost of care packages agreed through s117 and established that the predominant outcome of cases is an agreement of a 50:50 funding split between Health and Social Care

Although it could be seen as a risk that some cases could be funded more generously than previously, on average the cases should average out based on previous analysis. Further details of this can be found in Appendix A.

Mitigation

To mitigate against the potential financial risk to the CCGs in the suspension of approval and governance processes the follow actions are proposed:

• Regular review of the spend on S117 packages and comparison with historical agreements and spend.

• Monthly review of the amended processes and outcomes to identify any unintended consequences

• Continued approval process for packages of care costing more than £50,000 through the High Risk and Complex Care Panel.

• Reimplementation of approval and governance processes once the emergency period has ended, with the option to review current practices and recommend the introduction of any positive outcomes from the interim, process.

• If the proposal for amendments to the Standard S117 funding process are not supported, the current S117 funding agreement process could be implemented to support the transition from emergency discharge placement to mid-long term S117 placement and funding.

Conclusions

0

5

10

15

20

25

30

Mai

nstr

eam

10/9

0

20/8

0

25/7

5

30/7

0

40/6

0

50/5

0

60/4

0

70/3

0

75/2

5

80/2

0

90/1

0

100

CHC

Please read % split as Health/ASC

No. of cases

Section 117 Panel outcomes by CCG - February 2017-April 2018

ELR

WL

City

Rutland

5

• The proposals within this paper support the LLR and national requirements to expedite discharge by removing the funding split panel discussions and support patients into the community whilst longer term placements can be procured.

• Previous analysis support the assumption that packages funded on a 50:50 basis may cost more in some cases than those negotiated but on the whole should average out based on previous analysis.

• As an additional benefit the proposals will bring a level of consistency not always implemented

within current processes and remove pressure on Nursing and Quality teams from approving packages through Delegated Authority.

Recommendation

The Board is asked to:

• Review and accept the financial risk to the CCGs and the proposed mitigation actions • Support the costs being reimbursed under the COVID-19 scheme • Support and approves the recommendation to allow S117 packages to be funded at 50:50

split between Health and Local Authority • Support the proposal for the suspension of the Delegated Authority Process for approval of

health funds in response to the COVID-19 Emergency • Support the implementation of an emergency discharge process from mental health units for

S117 eligible patients.

List of Appendices

Appendix A – Mental Health Act Section 117 after-care – funding joint packages of care Appendix B - COVID-19 Hospital Discharge Service Requirements.

Appendix A

MHA Section 117 funding joint package

Appendix B

200318 - COVID-19 Discharge Guidance (H

6

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East Leicestershire and Rutland Clinical Commissioning Group Name of meeting: LLR CCGs’ Governing

Body meetings in common Date: 12th May 2020 Paper: G

Public Confidential Report title:

Finance Report Month 12

Presented by: Donna Briggs, Interim LLR Executive Director of Finance, Contracting and Corporate Governance

Report author: Gill Killbery, Deputy CFO, Helen Ellis, Deputy Director of Finance.

Executive lead: Michelle Iliffe, Director of Finance; Donna Briggs, Chief Finance Officer; Spencer Gay, Chief Finance Officer.


Executive summary: Context: The 19/20 financial Plan requires delivery of an “in year” £1.42m surplus across LLR CCGs. This plan was considered challenging and included the anticipated delivery of savings of £65.9m of which £11.2m were unidentified. As part of the month 12 reporting to NHS E/I LLR CCGs reported a variance of 20.6m against the original plan. LC CCG has delivered its planned surplus of £1.42m giving an in year final position for LLR CCGs of £19.1m overspend. The LLR QIPP programme has delivered £20.5m less than originally planned, £11.2m of which was initially unidentified. This represents a 69% delivery of the original QIPP (65.9m). This gap is more than mitigated by delivery of £29.25m from the financial recovery plan (FRP). A year-end financial agreement has been reached with UHL to the value of £562m. This is a positive step for the system as it means that there is certainty for commissioners and providers of the final value of this contract. For the last 9 months the CCGs have been discussing the risks around delivery of the planned position with Governing Bodies and NHS E/I. A likely adverse variance of £20.6m was recognised as part of FRP and has been shown in these reports and declared in submissions to NHS E/I since December 2019. At month 12, the underlying position is £28.6m. The underlying position shows that recurrent items are being funded from non-recurrent resources, which indicates the level of financial pressure that the CCGs will take into the 2020/21 financial year.

Appendices: • Appendix 1 – Actual Position at Month 12 • Appendix 2 - Balance sheet • Appendix 3 - BPPC


Rutland CCG


interest: Not applicable



As at month 12, LLR CCGs reported an adverse £20.513m variance against plan across LLR.


Not applicable


Not applicable


Not applicable

Recommendations:

The LLR CCGs’ Governing Bodies are asked to:

• NOTE the adverse performance for the year of £20.513m which reflects the revised forecast outturn submitted at month 9.



Reported to the LLR Performance, Finance and Activity Committee on 30th April 2020. Discussed with Audit Chairs 23rd / 24th April 2020

2

Finance Report Month 12

Context:

The 19/20 financial Plan requires delivery of an “in year” £1.42m surplus across LLR CCGs. This plan was considered challenging and included the anticipated savings delivery of £65.9m inclusive of £11.2m unidentified savings.

Questions:

1 What is the financial performance for the year ending 31st March 2020 (Month 12)?

LLR CCG’s have ended the year £20.513m away from target with a combined overspend of £19.1m

The main areas of overspend are:

• Acute services: The majority of this is UHL (including the Alliance UHL Pillar) over-performance of £18.9m; the pressure is being seen across all areas. The remaining pressure is attributable to QIPP non delivery and the out of county providers (mainly Derby and Burton Hospital and University Hospital Nottingham.) Non NHS services have an overspend of £4m, predominantly due to Independent sector over activity.

• Prescribing (£7.8m). This is the result of a combination of slipped QIPP delivery and national changes to drug prices.

• Mental Health (£2.9m). Mainly due to increases in S117 costs (£1.7m).

This is countered slightly by favourable variances against Continuing care (£6.6m), contingencies (£6.8m) and Better Care Performance Fund (£1.8m).

A yearend financial agreement has been reached with UHL to the value of £562m. This is a positive step for the system as it gave certainty for commissioners and providers of the final value of this year’s contract.

At month 12, the underlying position is £28.6m. The underlying position shows that recurrent items are being funded from non-recurrent resources, which indicates the level of financial pressure that the CCGs will take into the 2020/21 financial year.

2 What is the performance against the LLR QIPP programme?

The LLR QIPP programme has delivered £20.5m less than originally planned. This includes £11.2m non delivery of unidentified QIPP.

69% of the original budget has been delivered.

This gap is more than mitigated by delivery of £29.249m from the Finance Recovery Plan (FRP)

3 What are the key risks?

3

At the point at which year end accounts are produced some costs are still unknown. Assumptions are made with regard to these, the basis for the calculations form part of the external audit work carried out post year end. Variances between the estimate and actual costs, (when they are received), will impact on 20/21. The biggest areas affected by these calculations are estimates made in prescribing (£4.3m), contract challenges (£2.1m), CHC and Sec 117 costs (£12.2m).

Non recurrent allocations which remained unspent at the year end due to scheme slippage will, where appropriate, be made available to complete the required programme of work in 20/21. Any increase in these over and above the planned values will be a pressure in future years’ accounts.

4 Are we delivering the Better Payment Practice Code?

All three CCGs have delivered on the Better Payment Practice Code (BPPC) across all four metrics. (Minimum 95% payment within 30 days both in month and cumulatively for NHS and Non NHS providers).

6 Is Cash remaining at month end within national tolerances?

Each CCG is expected to hold minimal cash balances at the end of each month, (maximum 1.25% of cash drawn down in the month); all CCGs have met this expectation.

7 Is Capital spending within allocation limits?

A small in year capital allocation has been received by ELR and WL CCGs and spent on corporate IT equipment. Assets held on behalf of alliance have now been transferred (with effect from 31st December 2019) on a ‘no impact’ basis to UHL.

8 Are the CCGs operating within the Running costs allocation?

The CCGs received running cost allocations totalling £23.541m. The financial plan anticipated an underspend against this allocation of £1.7m, thereby releasing funds to spend on health care. Actual spend was £21.5m.

The CCGs are therefore showing a small underspend against plan of £0.34m and an underspend against running cost allocation of £2m.

Summary:


• NOTE the adverse performance for the year of £20.513m which reflects the revised forecast outturn submitted at month 9.


4

SUMMARY FINANCIAL POSITION 2019/20 - MONTH 12 Appendix 1

East City West LLR East City West LLR East City West LLR£000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's

Acute - NHS 209,347 235,865 240,898 686,110 216,672 243,524 251,816 712,012 7,325 7,658 10,918 25,901 Acute - Non-NHS 8,291 8,415 8,346 25,051 10,135 9,802 8,784 28,721 1,844 1,387 439 3,669 Acute - Urgent Care 958 674 3,118 4,749 1,011 680 3,438 5,129 53 6 321 380 Total Acute 218,596 244,954 252,361 715,911 227,818 254,006 264,039 745,862 9,222 9,052 11,677 29,951

Mental Health - NHS 32,151 58,722 38,143 129,015 32,211 59,485 38,268 129,963 60 763 126 948 Mental Health - Non-NHS 5,820 11,394 7,272 24,486 6,857 10,979 8,563 26,399 1,036 (415) 1,291 1,913 Total Mental Health 37,971 70,115 45,414 153,501 39,067 70,463 46,831 156,362 1,096 348 1,417 2,861

Community Health - NHS 32,123 35,911 37,259 105,293 32,501 36,273 37,211 105,984 377 362 (48) 691 Community Health - Non-NHS 1,857 3,236 248 5,341 1,407 2,532 227 4,166 (450) (703) (21) (1,175) Total Community Health 33,980 39,147 37,507 110,634 33,907 38,805 37,438 110,150 (73) (342) (69) (484)

Total Continuing Care 27,622 31,292 32,297 91,211 25,495 29,609 29,473 84,577 (2,127) (1,683) (2,824) (6,634)

Primary Care Services 14,656 13,405 14,013 42,073 12,398 11,908 12,134 36,441 (2,258) (1,496) (1,878) (5,632) Prescribing 48,300 52,233 55,957 156,490 51,685 54,419 58,158 164,262 3,385 2,186 2,202 7,772 Total Primary Care 62,956 65,638 69,969 198,564 64,083 66,328 70,293 200,703 1,127 689 323 2,140

Total Primary Care Co-Commissioning 43,077 54,441 48,598 146,116 43,228 53,378 50,008 146,614 151 (1,063) 1,410 498

Total Corporate 6,683 7,759 7,379 21,821 6,567 7,538 7,362 21,467 (117) (221) (17) (355)

Reserves 2,414 3,102 3,418 8,934 3,831 (832) 3,066 6,065 1,417 (3,934) (352) (2,870) Other - Acute 3,175 4,035 3,809 11,019 2,971 4,439 4,121 11,531 (204) 403 312 511 Other - Non Acute 14,588 21,470 16,971 53,030 14,039 18,850 16,007 48,896 (550) (2,620) (964) (4,134) Programme Infrastructure 961 5,042 564 6,567 669 4,364 562 5,595 (292) (678) (2) (972) Total Other 21,138 33,650 24,762 79,550 21,509 26,820 23,757 72,086 371 (6,830) (1,005) (7,464)

Total CCG Expenditure 452,025 546,996 518,288 1,517,309 461,674 546,947 529,200 1,537,821 9,650 (49) 10,912 20,513

Surplus

Full Year Position

Budget Spend Variance

BALANCE SHEET (STATEMENT OF FINANCIAL POSITION) Appendix 3

19/20 - MONTH 12

Mar-19 Feb-20 Mar-20 In Month Movement

Movement since opening

positionMar-19 Feb-20 Mar-20 In Month

Movement


positionMar-19 Feb-20 Mar-20 In Month

Movement


position

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000Non Current Assets:Property Plant and Equipment 1,100 181 194 13 (906) 77 60 58 (2) (20) 1,045 82 106 24 (939)TOTAL Non Current Assets 1,100 181 194 13 (906) 77 60 58 (2) (20) 1,045 82 106 24 (939)Current Assets: 0 0 0 0 0 0Trade & Other Receivables 6,189 4,326 4,902 576 (1,287) 3,665 3,576 5,289 1,712 1,624 7,630 3,771 9,475 5,704 1,845Cash and Cash Equivalents 40 60 28 (32) (12) 49 62 18 (44) (31) 150 34 12 (22) (138)TOTAL Current Assets 6,229 4,386 4,929 543 (1,300) 3,714 3,638 5,307 1,668 1,593 7,780 3,805 9,487 5,682 1,707

0 0 0 0 0 0TOTAL ASSETS 7,329 4,567 5,124 557 (2,205) 3,791 3,698 5,364 1,666 1,573 8,825 3,887 9,592 5,705 767

0 0 0 0 0 0Current Liabilities: 0 0 0 0 0 0Trade & Other Payables (20,751) (24,837) (25,853) (1,016) (5,102) (35,915) (35,035) (29,680) 5,355 6,235 (24,969) (20,722) (27,147) (6,425) (2,178)Provisions (94) (212) (216) (4) (122) (224) (109) (154) (45) 70 (56) (96) (211) (115) (155)Total Current Liabilities (20,845) (25,049) (26,069) (1,020) (5,224) (36,139) (35,144) (29,834) 5,310 6,305 (25,025) (20,818) (27,358) (6,540) (2,333)

Non Current Liabilities:Provisions 0 0 0 0 0 (375) (533) (533) 0 (158) 0 0 0 0 0TOTAL Non Current Liabilities 0 0 0 0 (375) (533) (533) 0 (158) 0 0 0 0 0

0 0 0 0 0 0TOTAL LIABILITIES (20,845) (25,049) (26,069) (1,020) (5,224) (36,514) (35,677) (30,367) 5,310 6,147 (25,025) (20,818) (27,358) (6,540) (2,333)

0 0 0 0 0 0ASSETS LESS LIABILITIES (Total Assets Employed) (13,516) (20,482) (20,946) (464) (7,430) (32,723) (31,979) (25,003) 6,976 7,720 (16,200) (16,931) (17,766) (835) (1,566)

0 0 0 0 0 0TAXPAYERS EQUITY 0 0 0 0 0 0General Fund (Opening Balance, Fixed) (9,089) (13,473) (13,473) 0 (4,384) (31,731) (32,723) (32,723) 0 (992) (17,445) (16,200) (16,200) 0 1,245Income & Expenditure (year to date) (434,020) (421,614) (461,674) (40,060) (27,654) (518,793) (502,157) (546,947) (44,790) (28,154) (497,413) (483,695) (529,200) (45,505) (31,787)Parliamentary Funding (year to date) 429,637 414,605 454,201 39,596 24,564 517,801 502,900 554,667 51,767 36,866 498,658 482,964 527,634 44,670 28,976Total (13,473) (20,482) (20,946) (464) (7,473) (32,723) (31,979) (25,003) 6,976 7,720 (16,200) (16,931) (17,766) (835) (1,566)

East Leicestershire & Rutland CCG Leicester City CCG West Leicestershire CCG

Statement of Financial Position

BETTER PAYMENT PRACTICE CODE Appendix 4

19/20 - MONTH 12

A B C D E F G A B C D E F G

No of Bills Paid Within

Period


Target

% of Bills Paid Within

Target

Value of Bills Paid Within

Period


Target

% Value of Bills Paid Within

Target

Cumulative Value of Bills paid within

Target


Period


Target


Target


Period


Target


Target


TargetMonth No. No. % £'000 £'000 % % No. No. % £'000 £'000 % %

Apr 219 216 98.63 22,383 22,330 99.77 99.77 478 473 98.95 3,067 2,993 97.58 97.58May 205 205 100.00 18,001 18,001 100.00 99.87 616 615 99.84 3,482 3,474 99.77 98.75Jun 343 341 99.42 22,986 22,962 99.90 99.88 602 598 99.34 4,250 4,233 99.60 99.08Jul 323 321 99.38 24,701 24,620 99.67 99.82 569 561 98.59 4,245 4,208 99.13 99.10Aug 193 193 100.00 22,465 22,465 100.00 99.86 638 635 99.53 3,500 3,494 99.83 99.23Sep 300 298 99.33 23,066 23,059 99.97 99.88 649 648 99.85 3,435 3,433 99.95 99.35Oct 279 273 97.85 23,407 23,178 99.02 99.75 594 584 98.32 3,971 3,857 97.13 99.01Nov 266 266 100.00 24,078 24,078 100.00 99.78 577 569 98.61 2,951 2,942 99.70 99.08Dec 300 295 98.33 23,411 23,374 99.84 99.79 603 603 100.00 4,173 4,173 100.00 99.19Jan 182 181 99.45 29,819 29,818 100.00 99.82 560 559 99.82 4,524 4,523 99.97 99.29Feb 344 344 100.00 24,037 24,037 100.00 99.83 621 619 99.68 3,731 3,729 99.95 99.35

March 395 393 99.49 24,529 24,527 99.99 99.85 542 540 99.63 5,169 5,146 99.56 99.37Total 3,349 3,326 99.31 282,884 282,449 99.85 99.83 7,049 7,004 99.36 46,497 46,204 99.37 99.35



Period


Target


Target


Period


Target


Target


Target


Period


Target


Target


Period


Target


Target



Apr 256 255 99.61 21,157 21,157 100.00 100.00 556 547 98.38 5,061 4,983 98.47 98.47May 369 368 99.73 23,308 23,304 99.98 99.99 715 711 99.44 4,004 3,827 95.59 97.20Jun 190 189 99.47 27,123 27,121 99.99 99.99 608 604 99.34 6,013 6,009 99.93 98.29Jul 292 291 99.66 30,816 30,816 100.00 99.99 591 588 99.49 5,448 5,317 97.60 98.11Aug 323 320 99.07 25,303 25,302 100.00 99.99 581 578 99.48 3,945 3,939 99.85 98.39Sep 297 292 98.32 28,538 28,343 99.32 99.87 488 488 100.00 4,530 4,530 100.00 98.64Oct 314 313 99.68 28,257 28,257 100.00 99.89 683 676 98.98 4,763 4,659 97.82 98.52Nov 305 304 99.67 29,326 29,325 100.00 99.91 850 846 99.53 4,706 4,686 99.59 98.65Dec 353 348 98.58 28,550 28,522 99.90 99.90 526 526 100.00 8,588 8,588 100.00 98.90Jan 252 250 99.21 36,378 36,377 100.00 99.92 548 537 97.99 4,118 4,062 98.63 98.88Feb 281 280 99.64 28,148 28,131 99.94 99.92 855 853 99.77 6,059 6,058 99.99 99.00

March 448 448 100.00 31,942 31,942 100.00 99.93 736 733 99.59 10,499 10,477 99.79 99.12Total 3,680 3,658 99.40 338,846 338,598 99.93 99.92 7,737 7,687 99.35 67,734 67,137 99.12 99.00



Period


Target


Target


Period


Target


Target


Target


Period


Target


Target


Period


Target


Target



Apr 192 187 97.40 19,945 19,943 99.99 99.99 524 522 99.62 3,173 3,161 99.61 99.61May 319 318 99.69 20,129 20,126 99.99 99.99 1,926 1,926 100.00 9,593 9,593 100.00 99.90Jun 290 289 99.66 26,312 26,288 99.91 99.96 707 705 99.72 10,272 10,272 100.00 99.94Jul 297 295 99.33 28,246 28,243 99.99 99.97 695 690 99.28 7,912 7,845 99.15 99.74Aug 326 324 99.39 28,543 28,539 99.99 99.97 1,911 1,911 100.00 8,903 8,903 100.00 99.80Sep 255 255 100.00 28,347 28,347 100.00 99.98 1,784 1,784 100.00 9,048 9,048 100.00 99.84Oct 365 364 99.73 29,530 29,428 99.65 99.92 2,198 2,196 99.91 12,128 11,890 98.04 99.48Nov 338 336 99.41 27,655 27,647 99.97 99.93 1,912 1,912 100.00 10,527 10,527 100.00 99.56Dec 364 363 99.73 27,406 27,406 100.00 99.94 1,739 1,738 99.94 10,751 10,726 99.77 99.58Jan 223 216 96.86 33,341 33,288 99.84 99.93 2,244 2,236 99.64 11,378 11,216 98.58 99.46Feb 305 304 99.67 27,267 27,265 100.00 99.93 1,846 1,846 100.00 6,581 6,581 100.00 99.50

March 433 433 100.00 28,791 28,791 100.00 99.94 2,334 2,334 100.00 12,235 12,235 100.00 99.55Total 3,707 3,684 99.38 325,511 325,310 99.94 99.94 19,820 19,800 99.90 112,501 111,997 99.55 99.55

West Leicestershire CCGNHS CREDITORS NON-NHS CREDITORS

East Leicestershire & Rutland CCGNHS CREDITORS NON-NHS CREDITORS

Leicester City CCGNHS CREDITORS NON-NHS CREDITORS

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Date: Tuesday 12th May 2020

Paper: H Public Confidential

Report title:

CCG Performance Assurance Report

Presented by: Caroline Trevithick - Chief Nurse, LLR CCGs Executive Director of Nursing, Quality and Performance

Report author: Amita Patel – Performance Manager (M&LCSU) Kate Allardyce – Senior Performance Manager (M&LCSU) David Baxter – LC Contracting (LC CCG)

Executive lead: Caroline Trevithick - Chief Nurse, LLR CCGs Executive Director of Nursing, Quality and Performance Leicester, Leicestershire and Rutland CCGs


Executive summary: 1. The paper outlines the various elements that form the COVID-19 Management Report, which is presented to the Health Economy Strategic Coordinating Group on a twice-weekly basis.

2. It includes a high level overview of the number of COVID-19 cases & deaths across LLR. The 7day rolling average for daily cases in LLR is 34.9 (at 29-Apr), this is the lowest 7day rolling average since 4-Apr.

3. Using publicly available ONS weekly data to 17-Apr, there have been 296 deaths in LLR, across all settings (hospital, care homes, hospices, own home).

4. Work is being progressed by the LCCCG Contracting Team to analyse activity levels during COVID-19, compared to the same period last year.

5. The Board is to receive the Performance, Finance & Activity Committee’s (PFAC) summary report and an overview of monthly performance for the Leicestershire CCGs. It must be notes this relates to performance prior to COVID-19 due to the timing of national data releases.

6. The key constitutional standards and targets currently at risk of non-achievement include: • IAPT Access • Cancer waiting times • A&E 4 hour wait • Ambulance handovers and response times • Referral to Treatment times and Waiting List size

7. The requirement of NHS England/Improvement is to routinely report numbers of >62day & >104day cancer waits, outcomes, learning themes & harm reviews. This has been provided to PFAC in April 20 (Paper F).

8. NHSE/I have delayed the planning timetable for the financial year 2020/21 and is expected to re-commence from September 2020.

Appendices: N/A


Rutland CCG


interest: N/A


N/A


N/A


N/A


N/A


N/A

Recommendations:

The LLR CCGs’ Governing Bodies are asked to: • RECEIVE the current performance and actions being taken for areas

where performance does not meet the required standard. • DISCUSS additional actions being taken to consider whether further

action is required to improve performance.


• This format of the performance assurance report was first reported to January’s PFAC meeting and for Information to February & March PFAC meeting.

2

CCG Performance Assurance Report

1. Introduction This report brings 3 performance elements together;

• Outline of the COVID-19 Management Report provided to the Health Economy Strategic Coordinating Group on a twice-weekly basis

• High level analysis on activity levels during COVID-19, compared to the same period last year.

• The key performance risks for Leicestershire CCGs and specific actions being undertaken to improve performance in IAPT, cancer, urgent care and RTT. In most cases this to the end of February only, and therefore the impact of Covid-19 on performance cannot yet be seen.

2. COVID Reporting April 2020

During April 2020, the tactical group commissioned an LLR COVID Management Report which covered several items relating to the management of the COVID outbreak in LLR. This is reported to the Health Economy Strategic Coordinating Group. Various organisations were involved in its creation and content covering providers, CCGs and Local Authorities. It was co-ordinated by the CSU and continues to report twice weekly. The report covers the following sections: • COVID Tracker – trends on testing, cases and deaths across LLR • Predictive Model – providing a daily overview of admissions into UHL and predictive bed

capacity available • Workforce – a daily overview staff absences across all providers • Provider Summary – a daily overview of cases, patient flow, bed capacity, deaths and

personal protective equipment at UHL and LPT • Primary Care – a daily overview of GP practice status relating to their ability to meet the

needs of patients and provision of personal protection equipment • Care Homes – number of patients and employees and suspected cases. • Public Contact – number of patients who have contacted NHS111 & EMAS and

disposition/conveyance of patients to various services as a result, the community infections reported, shielded patients and volunteers.

3

3. As part of the COVID Tracker, the following graphs show COVID Cases and Deaths across LLR

Cases in LLR – Rolling 7-day Average

This graph reports the 7day rolling average for daily cases in LLR and is currently 34.9, which is the lowest 7day rolling average since 4-Apr. Deaths Per Week - LLR residents, by place of death

This graph reports the number of deaths reported in LLR as at 17-Apr, using weekly ONS data. There have been a total of 296 deaths across LLR, 220 of these were within a hospital (74.3%), 58 within a care home (19.6%) and 18 within another setting (6.1% - home, hospice, Other communal establishment or ‘elsewhere’). There have been 43 deaths within care homes over the previous 2 weeks. This compares with 13 deaths in the previous 2 weeks. 4. Work is being progressed by the LCCCG Contracting Team to analyse activity levels

during COVID-19, compared to the same period last year. For Planned care, the impact of COVID-19 has resulted in 62% lower activity. Similarly, non-elective during has shown discharges at 63% lower than pre-COVID.

5. Constitutional Performance Risks

It must be noted that national data shown within this section does not generally capture any impact of COVID-19 on performance levels. Updates to the data primarily relate to February 20 performance, therefore before any impact relating to COVID-19. The Actions in Place sections do refer, in most cases, to the impact of COVID-19.

010203040506070

27-M

ar28

-Mar

29-M

ar30

-Mar

31-M

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-Apr

02-A

pr03

-Apr

04-A

pr05

-Apr

06-A

pr07

-Apr

08-A

pr09

-Apr

10-A

pr11

-Apr

12-A

pr13

-Apr

14-A

pr15

-Apr

16-A

pr17

-Apr

18-A

pr19

-Apr

20-A

pr21

-Apr

22-A

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0 4 19

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0 2

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0 0

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w/e 13th Mar w/e 20th Mar w/e 27th Mar w/e 3rd Apr w/e 10th Apr w/e 17th AprCovid-19 LLR LA deaths - Hospital Covid-19 LLR deaths - Care Homes Covid-19 LLR LA deaths - All other settings

4

The CCGs key performance risks and associated recovery actions are presented in the following table;

Indicator Leicestershire Actions in Place IAPT Access - Proportion of people that enter treatment against the level of need in the general population National data (YTD January 20) 19.8% target in 19/20 ELR CCG - 15.7% LC CCG - 13.9% WL CCG - 16.0% LLR – 15.1% IAPT Recovery Rate - Percentage of people who are assessed as ‘moving to recovery’ National data (January 20) 50% national target in 19/20 ELR CCG - 54% LC CCG - 47% WL CCG - 50% LLR – 50%

Referrals have decreased and will have an impact on future performance and the service are focusing on contacting patients on the waiting lists to reduce these in preparation for expected increase in referrals later in the year. Additionally, there is significant promotion work on social media and websites to try and increase referrals, whilst reducing social isolation and supporting the wider public. Access rates have been recently affected by increased levels of Did Not Attend (DNA) and reduction in referrals. The service has recently experienced some Psychological Wellbeing Practitioner (PWP) staff leaving to apply for High Intensity training with other providers – most notably in LC CCG. Recruitment is ongoing however this may result in under performance, in addition to a lack of referrals.

Cancer 62 day waits - Patients receiving first definitive treatment for cancer within 62 days of an urgent GP referral for suspected cancer (Feb 20) National target of 85% ELR CCG - 77% LC CCG - 77% WL CCG - 67% LLR - 73% Cancer 62 day waits - Patients receiving treatment for cancer within 62 days of an NHS Cancer Screening Service (Feb 20) National target of 90% ELR CCG - 87% LC CCG - 100% WL CCG - 83% LLR - 90% Cancer 31 Day Wait - % of patients receiving subsequent treatment for cancer within 31 days where that treatment is radiotherapy (Feb 20)

The COVID-19 pandemic has meant that UHL has made some changes to the cancer pathways. These changes are in line with the National recommendations to ensure that patients are safe and receive the time critical cancer treatments they require. There are governance systems in place to:

1) Oversee the service changes that are being implemented with dialogue to understand the decision-making processes undertaken

2) Review patients daily to ensure the patients with the highest clinical need are operated on the following day.

The Trust recovery plan for radiotherapy was to send patients for part of their treatment to NGH, however due to the COVID-19 restrictions the clinical team have decided this is no longer appropriate. There has however been a change to radiotherapy treatment which will provide additional capacity and recovery (staff availability dependent).

Any patient who is more at risk of coming into hospital due to COVID-19 versus the risk of delaying their cancer treatment has had their pathway paused.

5

Indicator Leicestershire Actions in Place National target of 94% ELR CCG 80% LC CCG 86% WL CCG 80% LLR - 82% Cancer 31 Day Wait - % of patients receiving subsequent treatment for cancer within 31 days where that treatment is surgery (Feb 20) National target of 94% ELR CCG - 93% LC CCG - 86% WL CCG - 83% LLR - 87%

These patients are under constant review by the clinical teams.

The following actions have been identified in response to the >104 wait breach themes:

1. UHL are in communication with the tertiary Trusts (KGH, NGH and Lincolnshire) to improve processes and limit the late referrals. A minimum dataset has been agreed between the Trusts and patients are to be worked up and ready for surgery before referring onto UHL. This has resulted in a reduction in late tertiary referrals.

2. Improved ‘Next steps’ processes being targeted within tumour sites which is expected to help with some patients pathway

3. Options to maximise Robot theatre utilisation is being implemented and additional robotic capacity being created for urology specifically.

To date the Trusts 104-day Harm reviews in line with the NHSE/NHSI Backstop policy have not highlighted any patient harm as a result of the long waits.

UHL A&E & UCC 4 Hour Wait Data source; UHL’s ED daily report as at 28/4/20. April 20 – 89.4% - This includes UCC’s activity. ED only – 85.3% UCC only – 100% March 20 – 81.6% against local target of 87.4%. This includes UCC’s activity. ED only – 72.1% UCC only – 99.8%

At the end of March, the Strategic Health Executive approved a number of temporary changes to UEC services in order to manage and reduce unnecessary patient flow into the Acute. It also helped to consolidate the clinical workforce to divert to the services with the most demand. The approved temporary changes and/or moves include temporary closures of five peripheral Urgent Care sites in ELR CCG, two GP extended access sites in WL CCG and two of the Healthcare Hubs in LC CCG.

A report was presented to the April Collaborative Commissioning Committee to summarise the LLR service changes arising out of the response to COVID-19 within Acute, Urgent & Emergency Care. It should be noted that this is an evolving picture with Providers managing the implications of COVID in conjunction with system partners.

Handover Time between EMAS ambulances & UHL A&E 30-60 mins

22% against zero tolerance (Feb 20)

Handover Time between ambulances & A&E over 60 mins

14% against zero tolerance (Feb 20)

During February, EMAS as a region achieved only one of the six national standards (C1 90th centile). At a county level Leicestershire achieved only one of the national performance standards (C1 90th centile). However, performance has improved for all six standards for a second consecutive month and this was EMAS’ best performance since September 2019. The improvements could be attributed to EMAS resourcing over planned staffing hours. Ambulance Handover times continue to be a key

6

Indicator Leicestershire Actions in Place Ambulance Waits (Feb 20)

Cat 1; Only LC achieved the average wait time national target. EMAS, LC and WL achieved the 90th centile national target.

Cat 2; not achieving national targets for EMAS nor LLR CCGs

Cat 3; not achieving national targets for EMAS nor LLR CCGs

Cat 4; Only LC achieved the national, target. EMAS, WL and ELR not achieving national target.

priority and has shown a reduction in handover times in February, although this remains below National Standards. On the 17

th March 2020 guidance was received setting

out the steps on the NHS response to COVID-19. The guidance set out that the operational planning process for 2020/21 would be suspended and commissioners should agree block contracts with providers to cover the period 1

st April 2020 to the 31

st July 2020.

Referral to Treatment time (RTT) (Feb 20) National target >92%

ELR - 80% LC – 80% WL – 81% LLR – 81% Total patients waiting at end of Feb 20;

ELR – 21,604 against a target of <20,651

LC – 23,694 against a target of <24,110

WL – 25,412 against a target of <23,379

LLR – 70,710 against target of <68,140

RTT waiting list size at UHL has increased as a result of the winter pressures, and this trend has also been observed at other acute providers. The system agreement to close an orthopaedic ward and convert the nursing workforce to support medical admissions over January-March 2020 affected the waiting list size.

In addition to the orthopaedic capacity reduction, UHL have also reduced the volumes of booked surgery in ENT, General Surgery, Maxillo-facial, Paediatric Surgery and Paediatric ENT Surgery due to ongoing bed pressures.

UHL had successfully avoided 52 week RTT breaches for over a year, however with the winter pressures, reduced elective capacity and impact of COVID-19, the risk of reportable breaches had increased. CCG and UHL teams are working jointly to estimate the likely impact of COVID-19 and the cancellation of all elective operations on RTT waiting list size and 52-week breach numbers.

The UHL teams are stratifying patients by clinical need to ensure that emergency and cancer treatments are prioritised during this time.

6. Operational Performance Planning 2020/21 Update

On 17th March 2020, a joint letter was issued from the NHSE/I Chief Executive & Chief Operating Office regarding the service response to COVID-19. It confirmed that Operational Planning for 2020/21 has currently been suspended and would be revisited when appropriate. This is expected to be in September 20. Recommendations The LLR CCGs’ Governing Bodies are asked to:

7

• NOTE the current performance and actions being taken for areas where performance does not meet the required standard.

• DISCUSS additional actions being taken to consider whether further action is required to improve performance.

8

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Leicester City Clinical Commissioning Group

West Leicestershire Clinical Commissioning Group


Aligned to Strategic Objectives

Leicester City CCG West Leicestershire CCG East Leicestershire and Rutland CCG

Implications

a) Conflicts of interest:

Declarations of interest were declared and managed within the Audit Committees meetings in common. There are no specific conflicts to raise in respect of this report as it is to receive for information.


Not applicable in relation to this report, however the three LLR CCGs Governing Body Assurance Frameworks were an agenda item at the meeting.

c) Resource and None identified.


Date: 12 May 2020 Paper: I Public Confidential

Report title:

Summary report from the Audit Committee meetings in common (March 2020)

Presented by: Professor Jeff Knight, Leicester City CCG, Audit Committee Chair

Report author: Daljit K. Bains, Head of Corporate Governance and Legal Affairs, ELR CCG


Action required: Receive for information only:

Progress update:


Executive summary: This report provides a summary of the key areas of discussion and outcomes from the first LLR CCGs Audit Committees meeting in common held on 24 March 2020. The report also covers any items for escalation and consideration by the Governing Bodies ensuring that they are alerted to emerging risks or issues.

Appendices: None

Recommendations:


RECEIVE for information the Audit Committee summary report.


Not applicable

2

financial implications


None identified.


Not applicable.


Not applicable in relation to this report.

3

SUMMARY REPORT FROM THE AUDIT COMMITTEE MEETINGS IN COMMON (March 2020)

INTRODUCTION

1. This report provides a summary of the key areas of discussion and outcomes from the first LLR CCGs’ Audit Committee meetings held in common on 24 March 2020. The report also covers any items for escalation and consideration by the Governing Bodies ensuring that they are alerted to emerging risks or issues. The following provides a short summary of the key areas of discussion.

2. 360 Assurance Internal Audit Progress Reports – these provided Audit Committee members with progress against the individual CCG internal audit plans for 2019/20 including any new reports issued, follow-up reports detailing progress against suggested recommendations, contract performance (KPIs) and work completed/underway. The Audit Committees also received an initial overview of the Head of Internal Audit Opinion audit review which will inform the Interim and Final versions of the Head of Internal Audit Opinion for year end processes. The draft Internal Audit Plan 2020/21 was reviewed.

3. Grant Thornton External Audit Progress Reports – the external auditors presented the individual updates against each of the CCGs. The Committees noted that interim audit work has commenced across all three CCGs and all three have been identified as “well placed” which is positive. It was also noted that the current COVID-19 emergency situation may have an impact on audit processes and timescales, although at present the auditors continue to work with all three CCGs and anticipate meeting the requirement end of year timelines.

4. External Audit Contract Extension – the Committee noted that the External Auditor contract across the three CCGs was coming to end of its initial term of three years at 31 March 2020. The contract had been awarded by the Governing Bodies with an initial term of 3 years plus up to 2 year extension. The Audit Committee therefore supported the extension of the contract for a further year until 31 March 2020.

5. Transfer of clinical equipment – a legacy item which dates back to the establishment of CCGs which is specific to West Leicestershire CCG and East Leicestershire and Rutland CCG. Members were advised that this matter has now been resolved.

6. Losses and special payments – the three Chief Finance Officers outlined details of any losses and special payments (where applicable).

7. Detailed financial policies waiver register 2019/20 - the three Chief Finance Officers outlined details of any financial policy waivers (where applicable).

Recommendation: The Leicester, Leicestershire and Rutland CCGs Governing Bodies are asked to:

RECEIVE for information the summary report

.

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Rutland CCG

Name of meeting: LLR CCGs’ Joint Governing Body

Date: 12th May 2020 Paper: J Public Confidential

Report title:

LLR Clinical Reference Group Highlight Report

Presented by: Prof Mayur Lakhani, Chair WL CCG Prof Azhar Farooqi, Chair LC CCG Dr Ursula Montgomery, Chair ELR CCG

Report author: Louise Young / Michele Morton

Executive lead: Mayur Lakhani, Azhar Farooqi, Ursula Montgomery


Executive summary: The Clinical Reference Group (“CRG”) has been established as a joint advisory group of LLR CCGs and provides support and clinical commissioning advice to the Governing Bodies of the CCGs and the committees of the CCGs. The CCG receives and discusses updates on strategic, operational and LLR CCG issues. This report covers the period from 17th March until the 30th April 2020. For the month of April meetings moved from monthly to weekly in response to the Covid-19 pandemic to ensure that clinical leads were able to update and be updated on arrangements nationally, regionally and within LLR.

Appendices: N/A Recommendations:

The LLR CCGs’ Governing Bodies are asked to: • RECEIVE the LLR Clinical Reference Group Highlight Report.


-


interest: GPs are conflicted in all primary care matters.


Yes


None



None


N/A

2

LLR Clinical Reference Group Highlight Report

1. Introduction

The CRG has been established as a joint advisory group of LLR CCGs and provides support and clinical commissioning advice to the Governing Bodies of the CCGs and the committees of the CCGs.

The CCG receives and discusses updates on strategic, operational and LLR CCG issues.

This report covers the period from 17th March until the 30th April 2020. For the month of April CRG meetings moved from monthly to weekly as a response to the Covid-19 pandemic, to ensure that clinical leads were able to update and be updated on arrangements nationally, regionally and within LLR.

2. Strategic Overview

Chairs provided strategic updates on the current Covid-19 situation, notably: • Taking part in regular national and regional teleconferences and dissemination of

important information and guidance. • The establishment of a primary care cell plan, setting out structure and appropriate

communication updates and networks to deal with Covid-19. • Strategic provider updates, including care homes. • Weekly teleconferences with provider Medical Directors in order to be able to respond

in a timely manner to any changes or issues. • Weekly calls with Primary Care Network Clinical Directors in order to be able to respond

in a timely manner to any changes or issues. • Receipt and dissemination of Cas Alerts.

3. Primary Care Covid-19 operational updates

The primary care team provided operational updates as follows: 3a Business Continuity Planning Constant liaison was taking place on how best to work with and support PCNs and practices that included: • How practices were managing the Covid-19 situation. • Ensuring contingency plans were established. • How practices planned to move towards a restoration and recovery phase. • Regular reports on PPE supplies, identifying shortages and ensuring the correct

standards and routes for deliveries to practices. • Clinical leadership to the establishment of PCN hot hubs and the production of a

Standard Operating Procedure. • Buddying arrangements to help PCNs work more efficiently in the different zone areas

within GP practices. • Acknowledging the importance of maintaining essential services, particularly for

vulnerable patient groups. • Workforce demand and capacity, in conjunction with system workforce cell

3

3b IM&T – significant progress had been made, with the support of LHIS in a number of areas that had resulted in advanced technological solutions to support the interface between partner organisations and also patient appointments, for example: • Establishment of VPN within LLR. • GP connect and linking SystmOne to EMIS. • Covid-19 testing and the management of test results in clinical systems. • On-line consultations and an overall objective for developing a transformation to a ‘total

triage flow’. 3c System Response and communications across the interface A planned care cell had been established to look at how the system could be made as efficient as possible by pathway revision, updates to PRISM, the production of a specific website and the re-opening up of the Transferring Care Safely programme. Work on shared care agreements was ongoing with LPT and UHL to ensure patients did not visit outpatient departments unnecessarily. 3d Pathway changes and adaptations CRG members had been involved in: • Slight changes to pathways in response to Covid-19, how the appropriateness of

referrals was being managed and how some resources had been taken from other acute areas to support the Covid-19 response.

• The tracking and responsibility for referrals and the development of a waiting list system within primary care.

• Temporary closure of sleep and pain pathways. • The importance of the continuation of services such as infant checks and immunisation

& vaccination programmes. • The development of a pathway for Covid-19 patients who required a home visit. • Streamlining the process around NHS 111 calls, the use of the bed bureaux at UHL and

999 calls. • Circulation of information on agreed changes to the breast cancer pathways and where

key decisions were made. • Clarification on midwifery services during Covid-19.

3e Consideration of End of Life Care and high risk groups Discussions were held on the importance of ensuring: • Care plans were updated and accurate. • Remote desk top reviews were held. • Enhanced summary care records and consent issues were up to date. • Additional workforce capacity in this area developed

The Chairs joined shielded patient discussions on the appropriate management of people remaining at home for a period of twelve weeks. CRG members agreed on the requirement for a unified strategy for care homes, being developed in conjunction with the care homes support group.

4

3f Mental Health Services Discussions had been held over people with mental health issues and liaison continued with LPT to ensure the mental health facilitators were involved in making contact with that vulnerable group of people. Included in that group were people who might have symptoms of illness but were reluctant to visit their GP because of Covid-19 or were afraid of taking up the time of the GP. 3g Additional Primary Care Support A number of volunteers had been recruited through a national process (9 GPs, 4 practice nurses, 3 clinical pharmacists) to provide support to primary care. A primary Care workforce sub-cell of the LLR workforce cell, proposed a coordinated approach and process to managing additional capacity and demand into primary care, overseen by the LLR training hub.

4. LLR Clinical Commissioning Group Business Clinical leads had been identified and established to drive forward progress in all the clinical areas. It had been acknowledged that the landscape would be a moving and evolving situation to reflect changes in progress and advancements of primary and secondary care service provision. Clinical leads had been identified for each of the cell groups dealing with Covid-19 where leadership and advice was provided in key areas.

5. The Future In conclusion the focus has shifted to restoration and recovery and the objective of maintaining the huge changes that had been implemented in a very short space of time during the Covid-19 pandemic, to define a ‘new normal’, including a revised clinical model and set of principles. There was clear clinical vision and innovation that included: • Re-imaging health and care in LLR recovery post Covid-19. • Development of what the new normal might look like by capturing those areas the system

wishes to ‘lock in’ and build the momentum. • Preparation to manage future waves of Covid-19. • Managing backlog of care, resurgent demand for urgent and emergency care, including

diagnostics. • Routine preventative care. • Preparation for a vulnerable political situation. • Consideration of equality; racial, ethnic and economic disparities. • Principles on which to build the new model.

6. Recommendation The LLR CCGs’ Governing Bodies are asked to: • RECEIVE the LLR Clinical Reference Group Highlight Report.

5

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Rutland CCG

Implications a) Conflicts of interest: These are managed during the meetings and appropriate steps are

taken. b) Alignment to Board

Assurance Framework

Individual reports to the Collaborative Commissioning Committee are aligned to risks within respective CCG Board Assurance Frameworks.


None


None


None


Not undertaken in respect of this report, however would be undertaken in relation to the reports presented to the Committee.


Date: 12 May 2020 Paper: K Public Confidential

Report title:

Summary Report from the Collaborative Commissioning Committee (joint committee) held 16 April 2020

Presented by: Professor Mayur Lakhani, Chair, West Leicestershire CCG

Report author: Jayshree Raval, Commissioning Collaborative Support Officer

Executive lead: Andy Williams, Chief Executive, Leicester, Leicestershire and Rutland CCGs


Executive summary: This report is from the Collaborative Commissioning Committee (CCC), which is a joint committee of NHS East Leicestershire and Rutland CCG, NHS West Leicestershire CCG and NHS Leicester City CCG. The CCC supports joint decision making and undertakes collective strategic decisions on those areas where authority has been delegated by the respective CCG Governing Bodies.

Appendices: • N/A Recommendations:

The LLR CCGs’ Governing Bodies are asked to: • NOTE there was no Collaborative Commissioning Committee meeting

held in March 2020. • RECEIVE the Summary Report from the Collaborative Commissioning

Committee held on 16 April 2020. Report history and prior review:

• N/a

Highlight Report from the Public Collaborative Commissioning Committee (CCC) held

16 April 2020

Introduction 1. The purpose of this report is for Collaborative Commissioning Committee (CCC) to

provide the Governing Body with an update on decisions made and escalate risks and issues identified.

2. CCC is a joint committee of NHS East Leicestershire and Rutland CCG, NHS West

Leicestershire CCG and NHS Leicester City CCG. CCC’s role is to:

• Support CCGs to create a financially sustainable health system in LLR, working beyond organisational boundaries to make best use of the public purse;

• Provide a forum where commissioners can agree and align priorities and identify opportunities for further collaboration and consistency.

3. The CCC meeting held on 16 April 2020 considered the minutes from the 20 February

2020 meeting for approval and that there were no other items on the public agenda to approve, receive or to consider.

RECOMMENDATIONS

Leicester Leicestershire and Rutland CCGs’ Governing Bodies are requested to:

• RECEIVE the report from the Collaborative Commissioning Committee.

2

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Leicester City Clinical Commissioning Group

West Leicestershire Clinical Commissioning Group


Aligned to Strategic Objectives

Leicester City CCG West Leicestershire CCG East Leicestershire and Rutland CCG

Implications

a) Conflicts of interest:

None identified for the purposes of the assurance report. Any conflicts arising in respect of IGQC items were manged as per LLR COI Policy.


At present each CCG has its own Board Assurance Framework; however, going forwards any risk that impacts on LLR Strategic Objectives will be reported and aligned to the Board Assurance Framework where appropriate

c) Resource and financial

None identified.

Name of meeting: LLR CCGs’ Joint Governing Body

Date: 12 May 2020 Paper: L Public Confidential

Report title: Integrated Governance and Quality Committee (IGQC) Highlight Report

Presented by: Caroline Trevithick, Chief Nurse and Quality Lead

Report author: Stuart Fletcher, Head of Corporate Governance, WLCCG

Executive lead: Caroline Trevithick, Chief Nurse and Quality Lead

Action required: Receive for information only:

Progress update:


Executive summary: This highlight report provides a summary the key issues discussed by the Integrated Governance and Quality Committee (IGQC) when it met on 3rd March, 7th April and 5th May. The IGQC has delegated authority to monitor quality and performance within provider organisations and to provide assurance to the Governing Body that appropriate systems for ensuring patient safety and clinical quality are robust. Further to this the report will provide assurance that when risks or challenges have been identified within provider organisations that the CCG has taken appropriate actions to confirm effective oversight and to ensure that patients are protected from harm.

Appendices: None

Recommendations:


RECEIVE this report and be ASSURED of the actions of the Integrated Governance and Quality Committee in respect to monitoring quality and performance and providing assurance to the Governing Body that appropriate systems for ensuring patient safety and clinical quality are robust across the LLR.


Not applicable

2

implications


The report provides the Governing Body with a summary of the actions of the Integrated Governance and Quality Committee (IGQC), a subcommittee of the Governing Board with delegated authority to monitor quality and performance within provider organisations and to provide assurance to the Governing Body that appropriate systems for ensuring patient safety and clinical quality are robust. Further to this the report will provide assurance that when risks or challenges have been identified within provider organisations that the CCG has taken appropriate actions to confirm effective oversight and to ensure that patients are protected from harm.


None identified


None identified

3

LEICESTER CITY, WEST LEICESTERSHIRE AND EAST LEICESTERSHIRE AND

RUTLAND CLINICAL COMMISSIONING GROUPS

Integrated Governance and Quality Committee – Highlight report

12 May 2020

1. Introduction

This highlight report provides a summary the key issues discussed by the Integrated Governance and Quality Committee (IGQC), a subcommittee of the Governing Board with delegated authority to monitor quality and performance within provider organisations and to provide assurance to the Governing Body that appropriate systems for ensuring patient safety and clinical quality are robust. Further to this the report will provide assurance that when risks or challenges have been identified within provider organisations that the CCG has taken appropriate actions to confirm effective oversight and to ensure that patients are protected from harm.

2. Scope

This highlight report covers key issues that were discussed at the IGQC when it met on 3rd March 2020, 7th April and 5th May 2020. In light of the Covid-19 situation, the April and May IGQC meetings were held by teleconference and, or videoconference and was convened to consider and discuss essential business items.

3. Summary of key discussions and actions from Integrated Governance and Quality

Committee meeting held on 3rd March 2020

Data Security and Protection Toolkit (DSPT) Update

A progress update and an overview of the work undertaken during 2019/20 were provided to ensure respective CCG compliance with information governance and information security requirements, and specifically the DSPT.

The report provided assurance of compliance across the three LLR CCGs in preparation for the year-end submission of the DSPT by 31 March 20201

A table detailing policies was appended seeking approval to extend review dates so that policies can be updated to LLR versions and presented over a phased basis.

The LLR CCGs’ Integrated Governance and Quality Committee:

RECEIVED the report. SUPPORTED the inclusion of a corporate risk in respect of cyber security on the LLR CCGs’ Board Assurance Framework. APPROVED the extension to policy and procedure review dates as requested in Table 2 within the report, to enable policies and procedures to be reviewed in 2020/21 to form collaborative policies across the three CCGs.

1 Post meeting note: in light of events NHSX has taken the decision to push back the final deadline for DSPT

submissions to 30 September 2020

4

Infection Prevention and Control Report – Quarter 3

A summary was presented of LLR Infection Prevention and Control Teams (IPC)

activity for Q3 2019/2020. The report also provided a brief summary on the

preparedness and work activity to date in response to COVID-19

The following key points were noted in respect of COVID-19:

o Information and advice had been placed on CCG public websites. o A large amount of information was available through a number of other NHS

websites. o People were being encouraged to wash their hands more frequently and for

longer, using soap and water. o Senior nurses met regularly to consider next steps on the daily changing

picture.


RECEIVED the contents of the report.

Transforming Care Exception Report

A paper was presented that outlined the position with the LLR Transforming Care Programme (TCP) which was not currently meeting the required in-patient trajectory.

The following key points were noted:

o NHS England had set an inpatient trajectory for the number of individuals with learning disability and or autism in a mental health bed by the end of March 2020. The local footprint for LLR should only have 34 individuals in an inpatient bed.

o A number of people were ready for discharge from hospital but had no accommodation to move into.

o There had been no admissions within the last few months. o A number of governance processes had been refreshed since January 2020

with the introduction of a PMO approach. o A risk escalation policy and risk log had been developed as part of a

governance and oversight approach.

A further update report to return to the June IGQC meeting. The LLR CCGs’ Integrated Governance and Quality Committee: RECEIVED the report NOTED that TCP were not meeting the NHSE trajectory; however, control plans were in place NOTED the risks and mitigations highlighted by the TCP work streams to the Executive Board

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Provider Quality Assurance Report

A monthly update was provided on quality across the system provider contracts and offered assurance in relation to the oversight, ongoing monitoring and quality improvements.

Key points to note included:

o Discussion on the EMAS rating of ‘outstanding’ in respect of the known delays in handovers resulted in no harm to patients.

o A governance quality assurance visit with the contracting teams was planned with TASL, to determine whether the data submitted was poor or whether there were genuine issues such as problems with cash flow.

o Discussion was held on the merits of involving and, or linking care home staff into the workforce work stream.

o Discussion was held on the importance of maintaining the confidence of staff in care homes in the management of patients, whilst ensuring that good quality standards were maintained

o IGQC informed that DHU had been asked to provide the CCGs with ongoing information of examples of positive contact in respect of DHU home visiting service to refer to adult social care.

The LLR CCGs’ Integrated Governance and Quality Committee RECEIVED the report and were assured of processes within LLR for oversight and ongoing monitoring with providers to support risk reduction and ongoing quality improvements Medicine Optimisation Report

The report provided IGQC with a comprehensive overview of the main activities of Leicestershire Medicines Strategy Group (LMSG), the Medicines Optimisation Programme Board (MOPB) and the LLR Primary Care Medicines Optimisation Committee.

Key points to note included:

o A review of the CBS for “Near patient testing” was underway o A task and finish group had been convened between the Medicines

Optimisation Team and DHU to resolve some current issues such as the quality schedule audits; prescription payments for items supplied on PGD; prescribing codes and antimicrobial stewardship and review of the Patient Group Direction Policy (PGD). The first meeting scheduled for March 13th 2020.

o A service specification and business case for pain management in patients on high dose opioids was being worked through.

The LLR CCGs’ Integrated Governance and Quality Committee RECEIVED the highlight report.

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Request for approval of LLR primary care rebate: AproDerm Emollient Range

GP representatives declared an interest in this item, with low materiality. However this did not affect the quoracy required to approve the item under the terms of reference. The LLR CCGs’ Integrated Governance and Quality Committee AGREED the rebate for the AproDerm emollient range.

4. Summary of key discussions and actions from Integrated Governance and Quality Committee meeting held on 7th April 2020.

LeDeR Report

The IGQC was provided with a position statement on the Learning From Deaths Reviews and a forecast for completion of outstanding reviews by the end of June 2020.

A high level thematic analysis of learning from reviews was also provided with recommendations for improvement in the following areas:

o End of Life Care / Advanced Care Planning o Communication between agencies o The consistent application of Mental Capacity Act / Best Interest decision making o A reduction in variation in practice for people with learning disabilities o Improved links between community and secondary care

An annual report would be submitted to the Transferring Care Safely Executive that would highlight learning and demonstrate progress made from reviews.

Further key points included: o The second part of the report highlighted issues on learning for the system and detail

would also be fed into a partnership approach with local authorities and LPT. o All information would be consolidated into an annual report that would be shared with

LLR governing bodies. o A summary of the learning from the last twelve months would be presented at the

May 2020 meeting of the LD and Autism Executive which would identify any gaps in service provision.

The LLR CCGs’ Integrated Governance and Quality Committee RECEIVED the LeDeR update. Provider Quality Assurance Report

A verbal update was provided outlining that robust processes had been established with

commissioned providers for monitoring quality and safety, particularly through Covid-19.

Further key points included:

o The serious incident reporting system through StEIS remained in place which ensured that commissioners were effectively sighted on patient safety issues occurring within services.

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o Ongoing contact was being maintained with providers around tracking of concerns and an LLR Quality and Patient Safety Log had been established for tracking concerns.

It was noted that the NHS England guidance “Host Commissioner Guidance: Quality

oversight of CCG-commissioned inpatient care for people with a learning disability and autistic people” (published in February 2020) focused on ensuring strong governance oversight for individuals being cared for out of area, and identified the role of hosted CCGs.

Assurance provided on SNP Medical who provided specialist private ambulance and medical transport services

Care Homes: in order to maintain effective oversight of issues within care homes during the COVID-19 crisis the CCG Care Homes Team had been calling all nursing homes and residential care homes with nursing to ascertain how those homes were coping and to identify if they required additional support, information or resources.

Further discussion was held on care homes adhering to Public Health England guidance in respect of the of End of Life care.

Discussions held on the statutory responsibilities of CCGs towards quality and performance of all providers in light of the Covid situation. It was highlighted that NHS England had issued some guidance on the changes such as releasing capacity and acknowledging that some things would not continue to be carried out in the standard way. It was noted that some aspects of care were still being monitored such as the national performance measures and some local outcomes were being monitored for patients.


RECEIVED a verbal update on the Provider Quality Assurance Report. Patient Group Direction (PGD) for Clarithromycin and Amoxicillin

A paper was presented in respect of two PGDs that had undergone the pre-approval process:

o Supply of Clarithromycin for sore throat in penicillin allergic patients o Amoxicillin for otitis media

It was confirmed that any PGDs likely to expire during the Covid situation could be given a three month extension and reviews to commence in November 2020.


APPROVED the PGDs for local adoption within the primary care provider services

commissioned for DHU in LLR.

5. Summary of key discussions and actions from Integrated Governance and Quality

Committee meeting held on 5th May 2020. Quality Report for Commissioned Services

The committee was provided with a summary of provider quality across the provider contracts. The key point noted by the committee included:

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o The overall CQC rating of DHU 111 is outstanding. o Some concerns with TASL and further action required on improvements. it had

not been possible to conduct quality visits during the Covid-19 pandemic but those would be rescheduled as soon as restrictions were lifted.

o UHL Opthalmology and concerns following a serious incident in respect of administration processes and capacity.

o Continued work was ongoing with regard to reviews to identify potential or actual harm to cancer patients whilst waiting for investigation or treatment.

Discussions were held on the impact of Covid-19 on Children and Young People and potential harm reviews for cancer patients waiting over 52 weeks.

The committee sought assurances on what measures were in place in care homes to monitor care quality and non-adherence to infection prevention and control (IPC) measures and how any issues might be escalated. It noted that responsibility for IPC sat with individual care homes, however any escalation would be routed through the care homes cell and ultimately through the CQC. The aim for the CCGs was to build up relationships that existed and offer support in the best way possible. That included working with local authority safeguarding teams to help with specific issues.


RECEIVED and ACCEPTED the report and were assured of processes within the LLR for oversight and ongoing monitoring with providers to support risk reduction and ongoing quality improvements. Nursing and Quality Risk Register

An update was provided on the development of an LLR Nursing, Quality & Performance Risk Register. The work informed part of the wider governance agenda in aligning statutory policies and risk management approaches as part of closer working arrangements.

Work continued to align the individual risk registers across the three CCGs that would fall within the portfolio of the LLR Chief Nurse. .

The plan was for a more comprehensive risk register to be submitted to the joint IGQC meeting.

There were currently 43 risks grouped in themes and an opportunity existed for them to be updated on an LLR wide basis.


RECEIVED the report and PROGRESS UPDATE to develop a single LLR Nursing, Quality & Performance Risk Register AGREED to RECEIVE the draft LLR Nursing, Quality & Performance Risk Register at the June meeting. Looked After Children’s (LAC) Report

This item outlined the CCG’s responsibilities in relation to LAC, who originated from LLR that included those subsequently placed outside LLR, and LAC from out of area placed into LLR.

The paper described the current services and the monitoring and assurance reported to the CCG’s that included gaps in those services and consequent risks to the CCG’s.

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It was highlighted that recommendations from two recent Care Quality Commission (CQC) inspections of Safeguarding and Looked after Children in Leicestershire in November 2018 and Rutland in July 2019 were relevant to all three CCG’s and were discussed in the paper.

There were at least 1,300 children registered as being in care and the attention of the IGQC was drawn to the amount of assurance work currently being carried out.

Discussion held on a potential capacity gap (due to a number of factors) and that the highest priority areas were the tracking and audit of children out of area, and those living in unregistered or unregulated placements.


RECEIVED the Looked After Children’s Report.

Patient Safety Report – Quarter 4 of 2019/20 (January to March 2020)

The committee received a report on the Serious Incidents and GP Concerns reported to NHS LLR CCGs during Quarter 4. The reporting period was January 2020 to March 2020. The key points included:

o A total of 57 Serious Incidents were reported: − 15 for ELR CCG − 20 for LCCCG − 21 for WLCCG. − 1 related to a non-Leicestershire CCG area.

The report also summarised themes and actions taken by Providers and Commissioners during the financial year 2019/20.

The Transferring Care Safely Group had reviewed the Consultant to Consultant Referral Policy to reduce the ambiguity and the policy had been circulated.

Some changes had been made to the GP concerns process to reduce the potential for breaches of information.

Learning from Serious Incidents and GP concerns was being shared across the wider system.

In addition to the Quarterly information, there were brief annual summaries in relation to the Providers.


RECEIVED and NOTED the contents of the report.

CHC – Supporting Patients

A verbal report was provided on the support mechanisms in place that supported CHC funded patients, notably through the Covid-19 pandemic. Key points included:

o Patients were supported in a number of ways, many of which were under the

shielded patient category. Those were being monitored through primary care and other agencies such as the local authorities and LPT.

o 3 and 12 month standard checks were still being carried out where needed and the CHC team were currently working on those.

Recommendation: The LLR CCGs’ Integrated Governance and Quality Committee:

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RECEIVED an update on CHC supporting patients.

FINAL Version Controlled Drugs delivery by Leicestershire Fire and Rescue Service (LFRS)

A framework for the LFRS was presented for information. This is to support Community Pharmacists with the delivery of controlled drugs to vulnerable patients to support timely administration of palliative care medicines during the Covid-19 pandemic.


RECEIVED and NOTED the paper.

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Rutland CCG


interest: These would be managed during the meeting and appropriate actions would be taken to mitigate conflicts should there be conflicts at any point during the meeting.


Individual reports to the Performance, Finance and Activity Committee are aligned to risks within respective CCG Board Assurance Frameworks.


Date: 12 May 2020 Paper: M Public Confidential

Report title:

Summary Report from the Performance Finance and Activity Committee (PFAC) meeting held on 30 April 2020

Presented by: Wendy Kerr, Chair, West Leicestershire CCG

Report author: Jayshree Raval, Commissioning Collaborative Support Officer

Executive lead: Caroline Trevithick, Executive Director of Nursing, Quality and Performance, Leicester, Leicestershire and Rutland CCGs


Executive summary: This report is from the Performance, Finance and Activity Committee (PFAC) that has been established as a joint committee of NHS Leicester City Clinical Commissioning Group, NHS East Leicestershire and Rutland Clinical Commissioning Group, and NHS West Leicestershire Clinical Commissioning Group, collectively referred to as the Leicester, Leicestershire and Rutland Clinical Commissioning Groups (“LLR CCGs”). The PFAC will support joint decision making on those matters delegated to it where the Governing Bodies of the CCGs have agreed to undertake collective strategic decision making.

Appendices: • N/A

Recommendations:

The LLR CCGs’ Governing Bodies are asked to: • NOTE the Performance, Finance and Activity Committee meeting did not

take place in March 2020. • RECEIVE the Summary Report from the Performance, Finance and

Activity Committee held on 30 April 2020. Report history and prior review:

•


None


None


None


Not undertaken in respect of this report, however would be undertaken in relation to the reports presented to the group.

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LEICESTER LEICESTERSHIRE AND RUTLAND GOVERNING BODIES MEETING 12 May 2020

Highlight Report from the Performance Finance and Activity Committee (PFAC)

30 April 2020

Introduction 1. The purpose of this report is for Performance Finance and Activity Committee (PFAC) to

provide assurances to the Governing Bodies on the delivery of the annual commissioning programme.

2. The Committee has oversight and seek assurance in respect of provider contract management, provider performance including performance of primary care providers through assurance reports and dashboards. Seek assurance in relation to the delivery of services provided to the CCGs through the contractual performance.

3. The Committee will have a strategic focus on seeking assurance in respect of the

mandated standards and the national framework that CCGs are required to be compliant against (e.g. NHS England and Improvement Outcomes Framework). In addition, the Committee will also be responsible for ensuring delivery against the financial plans and transformational delivery plans, and where activity is not on track assurance is sought and advice offered in respect of remedial actions required.

4. The key areas of discussion and outcomes from the PFAC meeting held on 30 April

2020 are summarised below. 5. 2019/20 Financial Position at Month 12: It was reported that the LLR CCGs have

ended the year at £20.6m away from the target with a combined overspend of £19m.The main areas of overspend highlighted are the Acute at £29.95m of which £19.6m is UHL’s overspend. Furthermore Mental Health overspend is by £2.86m and Prescribing at £7.8m. In terms of QIPP delivery, the LLR CCGs have delivered QIPP schemes of £45.5m, with a shortfall of £20.5m against the plan. It was highlighted that this shortfall has been covered by the Financial Recovery Plan.

6. It was highlighted that the CCGs have met their Better Payments Practice Code (BPPC)

and cash targets in 2019/20. In addition ELR and WL CCGs have received a capital allocation of £25k which has been fully spent in-year.

7. The committee noted that the LLR CCGs’ declared a total of £1.7m COVID-19 costs

incurred, which have been included within the year-end accounts for 2019/20. A total allocation adjustment of £0.8m was received. It was highlighted that the value of risk share agreed between the LLR CCGs’ during 2019/20 was adjusted at the year-end to ensure there was coverage of Primary Care COVID-19 expenditure that was not reimbursed by NHS England and NHS Improvement and the plans reflect full repayment of risk share in 2020/21. The final adjustments were enacted via accruals rather than allocation adjustments.

8. PFAC members were informed that the underlying position has worsened over the year

as pressures within Acute, Mental Health Services, Primary Care and Prescribing have been largely covered via the non-recurrent underspends, generating a movement in the underlying position of £28.6m into 2020/21. The final outturn is slightly below that anticipated when producing the 2020/21 operational plan.

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9. LLR Programme Management Office (PMO) and Finance QIPP Report: It was

reported that against the 2019/20 annual QIPP target of £65.963m, the LLR CCGs are forecasting an under-delivery of £20.229m. Due to the level of QIPP under delivery, work has been undertaken to identify further efficiency opportunities which have been incorporated into the system Financial Recovery Plan (FRP) with the aim to achieve the financial targets. PFAC members were informed that as at Month 12 £27.848m of FRP schemes have been delivered.

10. The committee noted that against the overall QIPP target of £65.963m, the CCGs have delivered savings of £73m, which is made up of £45.733m QIPP schemes and £27.848m of FRP savings. This level of savings is likely to only partly offset the overall system risk. Furthermore it was highlighted that due to the recent COVID-19 crisis, the efficiency schemes; planned for the financial year 2020/21 have been reviewed to determine which opportunities still remain and which schemes in accordance with NHS England and NHS Improvement guidance required pausing. It was noted that all documentation in relation to 2020/21 QIPP schemes have been collated and saved for now. It has been agreed that the provision of any new or refreshed information in relation to 2020/21 schemes needs to create minimum disruption to colleagues focusing on the COVID-19 response. Therefore, refreshed documentation can be based on action plans previously produced by work streams and a new minimal PID is being produced to keep PMO asks to a minimum.

11. Once it has been determined which schemes can progress, the appropriate paperwork

will be requested and support will be provided as required. The PMO will then review and determine appropriate arrangements and governance structures for reporting throughout the financial year. In addition the PMO will also review schemes to determine whether COVID-19 reimbursement is applicable due to additional costs incurred or lost opportunities due to the outbreak.

12. In terms of next steps, it was highlighted that work has been undertaken to identify

further opportunities which has been incorporated into a system FRP to ensure achievement of financial targets. In particular opportunities of new ways of working highlighted during COVID-19 which could be incorporated into the system FRP.

13. LLR CCGs’ Performance Assurance Report: The report provided the committee with

information against the levels of current performance across a number of nationally defined metrics. It was reported that the data highlighted in the report did not capture any impact of COVID-19 on performance levels as the updates primarily related to February and March 2020 performances which are prior to COVID-19 crisis.

14. The committee were informed that there was a significant improvement seen in the A&E

4hr waits performance. Furthermore improvements were noted in terms of Out of Area Placements which had declined. In addition ELR and WL CCGs have achieved the national recovery target for IAPT. The performance for Cancer 2week wait had also improved. It was reported that NHS England and NHS Improvement have delayed the planning timetable for the 2020/21 financial year due to the COVID-19 situation and it is expected to recommence from September 2020. It is not yet clear how much the planning process will change to reflect the impact of Covid-19 on national performance standards in 2020/21.

15. LLR CCGs Contract Activity Report: It was reported that providers across LLR are in

the process of implementing a number of service changes in response to COVID-19 planning. This will start to have a significant performance impact across some providers

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from April onwards. The committee noted that the changed arrangements will initially apply until 31 July 2020. Furthermore the providers have reviewed their service portfolios in line with NHS England and NHS Improvement guidance and local circumstances. As a result some services are now temporarily suspended, whilst others are being partially delivered, and/ or delivered in an alternative way. Essential and urgent cancer services continue to be delivered.

16. It was highlighted that the impact of COVID-19 has caused large number of beaches

for 52 week wait and it is anticipated that there will be further increase by the end of April 2020. The committee were assured that the CCGs and UHL teams are working jointly to estimate the likely impact of COVID-19 and the cancellation of all elective operations on Referral To Treatment (RTT) waiting list size and 52 week breach numbers. The UHL teams are stratifying patients by clinical need to ensure that emergency and cancer treatments are prioritised during this time. The committee however expressed concerns in terms of the potential delays in diagnosing cancer and commencing treatments due to the temporary changes made to the services as a result of COVID-19 crisis.

17. The report outlined key activity flows for all the main contracts, as well as areas of

material activity variance to plan, alongside actions being taken to analyse and address these. Other key performance and contract issues are also highlighted.

18. COVID-19 Expenditure Update for 2019/20 and 2020/21: The key points highlighted in

the presentation was: • The national guidance is continuing to be developed at this point in time and will be

published by the regulators; • The finance guidance to date includes NHS and Non NHS Contracts Arrangements,

pre-payment mechanisms, paying off of invoices and hospice funding; • In terms of finance governance, CCGs to continue to maintain a firm grip on

finances; • Processes to be in place to record approvals and expenditure incurred; • National requirement for the Chief Executive Officer to sign off CCGs COVID-19

finance submissions; • Funding received for schemes supported by NHS England and NHS Improvement; • • Continuation of monthly submissions for COVID-19 cost reimbursement is underway; • There are continued discussions taking place to secure national reimbursement of

primary care expenditure in 2020/21.

19. Budget Setting Methodology for 2020/21: The presentation highlighted key points to the approach taken to set 2020/21 budget. The areas covered were: • National escalation with NHS England and NHS Improvement following submission

of the plan; • Operational Financial plan indicated there is commitment to hold to the strategic plan

that was submitted to the regulators; • Work is underway to create a system PMO whilst reviewing areas for further

opportunities for savings; • Operational planning process has paused in light of COVID-19 and a pragmatic

approach is required to maintain grip and control over the CCGs finances in 2020/21; • LLR CCGs to prepare the budgets centrally based on expected costs using the

submitted plan as the start point for setting budgets; • Any COVID-19 related costs in excess of the budget to be recorded and funded for

providers;

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• Budgets will be set for a period of 12 months considering the impact of the COVIS-19 financial regime;

• No efficiencies are expected to be delivered; A review will continue to take place to ensure the finance regime has not changed significantly post July 2020;

• Furthermore these budgets will be added to the ledgers going forward which will form the basis on which financial reports will be presented to committees, the Governing Bodies and to NHS England and NHS Improvement;

• Budgets will also be amended to reflect any significant changes in terms of impact of final outturn for 2019/20, any non NHS contract agreements, impact of updated allocations, guidance in relation to primary care co-commissioning and indication of any other cost pressures;

• Infrastructure budgets will be set based on staff in post and reasonable estimates of non-pay, the remaining budget available will be set aside to create a pay reserve;

• The infrastructure budget will be set to live within the allocations received and with the intentions to deliver the QIPP schemes of £1m set out in the financial plan;

• Infrastructure costs will be shared between the LLR CCGs on a proportionate basis recognising the joint working between the CCGs.

20. The committee welcomed the new approach taken in setting the budget for 2020/21. RECOMMENDATIONS

LLR CCGs’ Governing Bodies are requested to:

• RECEIVE the report from the Performance Finance and Activity Committee

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meeting llr ccgs’ governing body meetings date tuesday, 12...

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