newham ccg board part i meeting · jane milligan/ selina douglas 2. patient and public engagement...
TRANSCRIPT
Newham CCG Board part I meeting
2-4pm Thursday 28 February 2019
Committee Rooms, Newham CCG
4th Floor Unex Tower, 5 Station Street, London E15 1DA
ACRONYM MEANING
A&E Accident & Emergency
ACS Accountable Care System
APMS Alternative Provider Medical Services (a type of Primary care contract)
AQP Any qualified provider
BAF Board Assurance Framework
Bart's / BHT Barts Health NHS Trust
BAU Business as usual
BCP Business continuity plan
BHRUT Barking, Havering and Redbridge University Hospitals NHS Trust
BMA British Medical Association
CAS Clinical Assessment Service
CCG Clinical Commissioning Group
CCG IAF Clinical Commissioning Group Improvement and Assessment Framework
CCU Critical Care Unit
CEG Clinical Effectiveness group
CEPN Community Education Provider Network
CHN Community Health Newham Directorate
CHP Community Health Partners
CHS Community Health Systems
CIL Construction Industry Levy
CPD Continuing Professional Development
CQC Care Quality Commission
CQRM Clinical Quality Review Meeting
CQUINs Commissioning for Quality and Innovation (Payment Framework)
CSU Commissioning Support Unit
CYP Children and Young People
DASL Drug and Alcohol Service in London
DES Direct Enhanced Service
DoH/ DH Department of Health
DoPM Department of Psychological Medicine
DRSS Diabetes Retinopathy Screening Service
DToC Delayed Transfers of Care
ED Emergency Department
ELFT East London Foundation Trust
ELHCP East London Health and Care Partnership
EMIS web Egton Medical Information Systems (System that records patient consults)
EPCS Extended Primary Care Service
EPCT Extended Primary Care Team
EPR Electronic Patient Record
ETTF Estates and Technology Transformation Fund
FOI Freedom of Information
GB Governing Body
GIA Gross internal area
GLA Greater London Authority
GMC General Medical Council
GMS General Medical Services (a type of Primary care contract)
GP General Practitioner
HBPoS Health Based Places of Safety
HEE Health Education England
HLP Healthy London Partnership
HMT Her Majesty's Treasury
HoT Heads of Terms (Contract Summary)
HUH The Homerton University Hospital NHS Foundation Trust
IAPT Increasing Access to Psychological Therapy
ICC Integrated Care Committee
ICP Integrated care partnership
ICS Integrated Care System
IG Information Governance
IMCA Independent Mental Capacity Advocate
IMT Information Management and Technology
INEL Inner North East London
IPS Individual placement and support schemes
ITT Invitation to Tender
ITU Intensive Therapy Unit
IUC Integrated urgent care
JCC Joint Commissioning Committee
JSNA Joint Strategic Needs Assessment
KGH King George Hospital
KPI Key Performance Indicator
LAP Local Area Partnership
LAS London Ambulance Service
LAs Local Authorities
LBN London Borough of Newham
LBWF London Borough of Waltham Forest
LCFS Local Counter Fraud Specialist
LD Learning Disability
LD SAF Learning Disability Self-Assessment Framework
LEB London Estates Board
LEDU London Estates Development Unit
LES Local enhanced service
LMC Local Medical Committee
MHCC Mental Health Commissioning Committee
MM Medicines management
MoLCV Medicines of limited clinical value
MOU Memorandum of understanding
MPIG Minimum Practice Income Guarantee
MSK Musculoskeletal
NAFO Newham Alternative Funding Option
NCCG Newham Clinical Commissioning Group
NDPP National diabetes prevention programme
NEL North East London
NELCA North East London Commissioning Alliance
NELCSU North East London Commissioning Support Unit
NELFT North East London Foundation Trust
NHC Newham Health Collaborative
NHS PS NHS Property Services
NHSE NHS England
NHSI NHS Improvement
NICE National Institute of Health and Care Excellence
NUH Newham University Hospital
NWP Newham Wellbeing Partnership
OOH Out of hours
OPD Outpatient department
OPE One Public Estate
PALS Patient Advice and Liaison Service
PCCC Primary Care Commissioning Committee
PCH Primary Care Home
PCT Primary Care Trusts
PHE Public Health England
PMS Personal Medical Services (a type of Primary care contract)
PPE Patient and Public Engagement
PPG Patient and Public Group
PREM Patient Reported Experience Measure
PROM Patient Reported Outcome Measures
QIPP Quality, Innovation, Productivity and Prevention
QOF Quality Outcome Framework (Assessor Validation Reports)
R&D Research & Development
RAG Red, Amber, Green
RICS Royal Institute of Chartered Surveyors
RLH Royal London Hospital
ROI Return on Investment
RTT Referral to treatment
SEP Strategic Estates Plan
SMI Severe mental illness
SPA Single Point of Access
SPR Service Program Review
STP Sustainability and Transformation Plan or Partnership
THCCG Tower Hamlets Clinical Commissioning Group
TOR Terms of reference
TSCL Transforming Services Changing Lives
TST Transforming Services Together
UCC Urgent Care Centre
UCLP UCLPartners/ University College London Partners
UCWG Urgent Care Working Group
UEC Urgent and Emergency Care
UTC Urgent Treatment Centre
WELC Waltham Forest, East London and City (Integrated Care Programme)
WFCCG Waltham Forest Clinical Commissioning Group
Whipps X / WX Whipps Cross Hospital
WTE Whole Time Equivalent
2018-19 Newham CCG Board meetings attendance log
Dr Prakash Chandra Yes
Ashwin Shah Yes
Dr Ambady Gopinathan Yes
Wayne Farah Yes Apols Yes Yes Apols
Lei Wei Yes Apols Yes Yes Yes
Apr-18 Jun-18 Sep-18 Oct-18 Dec-18 Feb-19
Members
Henry Black Yes
Dr Clare Davison Yes Apols Yes Apols Yes
Ellie Robinson
Dr Nadeem Faruq Yes Apols Yes Yes
Dr Catherine Gaynor Yes Yes Yes Yes Yes
Dr Nasim Joarder Yes Apols Yes Yes Apols
Ajith Lekshmanan Yes Yes Yes Yes Yes
Andrea Lippett Apols Yes Yes Yes Yes
Jane Milligan Yes Yes Yes Apols Yes
Dr Muhammad Naqvi Yes Yes Yes Apols Yes
Dr Arpana Patel Yes Yes Yes Yes
Selina Rodrigues Apols Yes Yes Yes Apols
Livia Royle Yes Yes Yes Yes Yes
Dr Bapu Sathyajith Yes Yes Yes Yes Yes
Grainne Siggins Apols Apols Yes Yes Apols
Fiona Smith Apols Yes Yes Yes Yes
Hazel Trotter Apols Yes Yes Yes Yes
Dr Rima Vaid Yes Yes Yes Yes Yes
Attendees
Selina Douglas Yes Yes Yes Yes Yes
Steve Collins
Satbinder Sanghera Yes Yes Yes Yes Apols
Chetan Vyas Yes Yes Yes Yes Yes
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NCCG Board Part I 2-4pm Thursday 28 February 2019
Committee Rooms, Unex Tower, 5 Station Street, Stratford, E15 1DA
Agenda
No Item Page Action Required Owner
1. Welcome
1.1 Welcome, introductions, apologies
Declarations of interestVerbal Chair
1.2 Minutes of the meeting held 19 December 2018 and
matters arising:
Action log
7
12
Approve
Discussion Chair
1.3 Chair’s report Verbal Note Chair
1.4 Accountable Officer and Managing Director’s Report
NHS Long Term Plan summary13 Note
Jane Milligan/
Selina Douglas
2. Patient and public engagement
2.1 Questions from the public Verbal Discussion Chair
3. Strategic and discussion items
3.1 Finance and QIPP report 31 Note Steve Collins/
Henry Black
3.2 Integrated quality and performance report 43 Note Fiona Smith
3.3 Board Assurance Framework 57 Approve Ajith Lekshmanan
3.4 Safeguarding Child Death Review arrangements update 63 Approve Rima Vaid
3.5 Healthy London Partnership update 67 Approve Jane Milligan/
Henry Black
4. Any other business
5. Items for information
5.1 2019-20 Board meeting planner 79 Note Chair
6. Date of next meetings: 2-4pm, Committee Rooms, Unex Tower
25 April 2019
27 June 2019
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NHS Newham CCG Board Part I 2-4pm Wednesday 19 December 2018
Committee Rooms, 4th Floor, Unex Tower, 5 Station Street, E15 1DA
Minutes
Present:
Elected Members
Dr Clare Davison Elected GP Representative, Newham CCG
Dr Nadeem Faruq Elected GP Representative, Newham CCG
Dr Catherine Gaynor Elected GP Representative, Newham CCG
Dr Muhammad Naqvi (Chair) Chair and Elected GP Representative, Newham CCG
Dr Arpana Patel Elected GP Representative, Newham CCG
Dr Bapu Sathyajith Elected GP Representative, Newham CCG
Dr Rima Vaid Deputy Chair and Elected GP Representative, Newham CCG
Appointed Members – voting
Henry Black Chief Finance Officer, Newham CCG
Ajith Lekshmanan Lay Member for Audit and Governance, Newham CCG
Jane Milligan Accountable Officer, Newham CCG
Fiona Smith Registered Nurse, Newham CCG
Appointed Members – non-voting
Andrea Lippett Lay Member Remuneration, Newham CCG
Livia Royle Director of Public Health (interim), LBN
Hazel Trotter Practice Manager Representative, Newham CCG
In attendance
Selina Douglas Managing Director, Newham CCG
Kate McFadden-Lewis (minutes) Board Secretary, Newham CCG
Chetan Vyas Director of Quality and Development, Newham CCG
Lei Wei Interim Chief Finance Officer, Newham CCG
Reagender Kang (item 3.4) Designated Nurse for Safeguarding Children, Newham CCG
Mohammed Shofiuzzaman (item 3.4) Designated Nurse for Safeguarding Adults, Newham CCG
Julie van Bussel (item 3.1) Associate Director, Acute Transformation, Newham CCG
Apologies:
Selina Rodrigues Healthwatch Newham
Satbinder Sanghera Director of Partnerships and Governance, Newham CCG
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1. Welcome, introduction, apologies for absence and declarations of interest
1.1 Muhammad Naqvi welcomed Members to the meeting. Apologies were noted as above, there were no declarations of interest.
1.2 Minutes of the last meeting
The minutes of the meeting held 25 October 2018 were accepted as an accurate record.
It was agreed to close CCG actions: 169, 173, 174, 179 and 181.
1.3 Chair’s report
Muhammad Naqvi updated the Board on the work of the Chair since the last meeting.
WEL Board to Board
We have all reflected on this to have been a success. We had positive discussion, and a great
opportunity to share some examples of work we are currently doing collectively, as well as allowing
us to identify services and functions we could collaborate across in the future. It was great to see the
enthusiasm in the room to work together. Next session is planned for 30 January 2019.
Winter Planning
Clare and the Urgent Care Working Group, Newham health and social care system, have agreed a
set of “triggers” and a communication system whereby if any key provider is experiencing significant
surge, a set of text messages and escalation phone calls and resulting processes will be put in place
to give mutual aid and assistance. We have commissioned extra capacity over the holiday period for
primary care appointments; these are available on Christmas Day, Boxing and New Year’s Day. In
addition to this, extra capacity for nursing home beds have been purchased by LBN. The CHC and
the discharge to assess pathways are working well at Newham University Hospital (NUH) and this
capacity will promote more discharges. We are sending out various ‘how to stay well at winter’
messages to residents, and related communications to our Practices. We are also writing to Barts
Health and NUH.
MSK
Julie van Bussel and her team have been undertaking a review of the MSK service in conjunction with
our providers, we agreed to review this service after its first year as part of the original contract. A
clinical meeting was held in December, where three GP clinical board members attended and were
able to input to the “mid review” findings. The commissioning team are finalising the review and have
been asked to ensure analysis of the three MSK models across WEL is included. The outcome of the
review will be available for Board consideration in early 2019. My main issue with our Newham
pathway is that is currently not an end to end pathway as elective care was taken out of the contract
earlier this year. For true ICS pathways we need to work towards end to end pathways.
NHC Federation
Jenny Mazarelo and I have had positive meetings with Saidur and Steve Gilvin, who has been
appointed as the interim CEO. From an update perspective they are doing a fair amount of work on
QI, which I think we should all be looking to do more collaboratively and I would look to the QIA for
that. There has been better utilisation of appointments for the seven day access, but there is still
some work to be done with the GP Co-Op to deliver the benchmark number of appointments, and
also some work to be done around 111 and practices being able to book directly into various
services.
Primary Care
Jennny Mazarelo and her team have done some robust work around access. Where we had 33 out of
51 practices not delivering core hours, the team have worked with practices over the last six months
to improve access. We are now we are down to 21 practices, I believe, out of 50 which we need to
do some more work with. There seems to be conflicting advice from the LMC and BMA around
contractual requirements, and we are looking into this with the practices. We haven't taken the hard
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line approach some CCGs have taken by issuing CQNs. We have had great success with accurX
with 45 out of 50 practices signed up, feedback is that each practice is saving hours a day in doctor
and administration time since installing, there is easier communication with patients, and for me, most
importantly resilience is improving among staff. Online triage is another success with great work from
Bhupi, we went it alone using the Emis version. From the 15 practices using this, we have generated
more forms in a month than other CCGs generate in a year, again, better resilience and
administration time saved. Interestingly, I interviewed some millennial salaried GPs and GP Partner
candidates, and the questions we were no longer about QOF and about contracts and the like;
questions were more about the use of technology and QI, and using AI in collaborative structures to
review data. This was really mind boggling and refreshing.
I can't go without mentioning the HSJ award. Well done to all involved; this was a great collaborative
piece of work in Newham, and great for residents and public health.
Radology t-quest has now been rolled out and practices are using.
Director of Public health
Selina and I were on the panel interviewing for the Director of Public Health, and were positive about
the appointment. We will soon be able to announce the appointment.
Lei Wei
Lei is moving on to a more senior role in NW London. Lei has left our financial position in good order,
with resilient and robust plans going forward. She leaves in January and Vincent and Ingrid will
continue the good work.
I must say when we interviewed Lei four years ago she stood head and shoulders above others and
has continued to deliver in a very difficult time for NHS finance. Lei we owe a great debt to you.
1.4 Accountable Officer and Managing Director’s Report
Jane Milligan and Selina Douglas presented the AO and MD’s report, updating the Board on work
undertaken by the CCG and NEL teams since the last Board meeting. Key additional points included:
i. the appointment of the new Regional Director for London has been announced, David
Sloman, who starts on 4 February 2019
ii. once the NHS England Long Term Plan is published the NEL strategic and operating plans
will be finalised.
2. Patient and public engagement
2.1 Questions from the public: None.
3. Strategic items
3.1 Demand Management Programme - Approach for Newham
Julie van Bussel presented on the Demand Management Programme, highlighting the three key
areas: Emergency Department and Urgent Care Centre, outpatient services and un-planned
emergency admissions to a hospital bed. Discussion points included:
i. the positive impact of NHS111 on A&E attendance, and the importance of analysing where
the activity is moving to
ii. the need to test the new Referral Pathway Scheme with clinical leaders before it is rolled out
iii. the need to clarify what sits at a NEL, WEL and CCG level
iv. that effective triage is key
v. confirmation that the minor ailments scheme will cease in April 209, and the CCG is exploring
options to mitigate the impact on demand management
vi. the importance of ensuring GP awareness of schemes in place such as emailing the SPA for
advice and that advice and guidance is in place
vii. importance of engaging with the cluster leads as well as clear communication with patients
and the public around the referral process.
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It was agreed that the Demand Management Communications and Engagement plan would be
circulated to the Board for information. (ACTION: SS/ JvB)
3.2 Proposed changes to primary care governance
Nadeem Faruq presented on the proposed changes to primary care governance, which includes the
establishment of a GP Transformation Sub-Group and a time-limited GP federation oversight.
The Board discussed the remit, role and proposed timescale for the GP federation oversight group. It
was agreed that further detail around the governance, as well as an action plan with specific
milestones on the phase out of CCG funding, was required.
The Board approved the proposed changes to be ratified at Practice Council, with the provision that
the timeline and detailed action plan for the work of the GP federation oversight group is approved at
the next Board meeting. (ACTION: SS/ JM)
3.3 Board Assurance Framework report: deep dives outcome report
Ajith Lekshmanan presented the BAF report to the Board, reporting that there are no changes to the
risk ratings from the last report and highlighting the recommendation from the Primary Care
Commissioning Committee to delegate BAF.07 to the Commissioning Committee. In discussion the
Board noted:
i. that, following discussion at the last Audit Committee as well as QPFC, suggested changes to
the BAF include to:
a) specify a time limit for risks rated 16 and above (‘high’)
b) identify risks as internal (CCG can mitigate) or external (CCG is unable, or has limited
capacity, to influence)
c) include an indication of how risk ratings have changed over time
ii. the importance of accurately describing the BAF risks
iii. the potential for joint risk registers for the Newham Wellbeing Partnership, as well as across
the WEL and/ or NEL footprints.
It was agreed to dedicate a Board development session to review the BAF risk descriptions, ratings
and committee responsible for their assurance. This will be held following the session in January to
discuss, with providers, the strategic priorities as a borough, as this will help to inform the review of
the BAF risks. (ACTION: CV/ SS)
The Board agreed the BAF and recommendation to delegate BAF.07 to the Commissioning
Committee.
3.4 Safeguarding annual reports
Rima Vaid presented the 2017-18 Adults and Children’s Safeguarding annual reports to the Board,
outlining key progress and giving assurance on the process through the CCGs Quality, Performance
and Finance Committee. Discussion points included:
i. that it is the responsibility of primary care to identify staff who require a safeguarding learning
process
ii. assurance that Newham CCG is on track to implement the updated statutory guidance for
Children’s safeguarding
iii. the need to incorporate the learning from patient stories, and continually review the critical
safeguarding processes that are in place
iv. that robust and appropriate information sharing is key.
The Board approved the reports.
4. AOB
Jane Milligan shared the NEL Brexit “no-deal” Business Continuity Planning & Contingency
Arrangements with the Board for information.
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Ajith Lekshmanan informed the Board that he will be joining the National NHS CCG Strategy group.
5. Items to note
5.1
5.2
5.3
Integrated Quality and Performance report: Fiona Smith presented the Integrated Quality and
Performance report
Finance and QIPP report
2018-19 Board meeting planner
6. Date of next meeting:
2-4pm Thursday 28 February 2019
Committee Rooms, 4th Floor Unex Tower, 5 Station Street, Stratford, E15 1DA
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Action reference
Meeting date
Minute reference Action Owner Target completion
date Update
CCG 167 28/06/2018 3.1CEPN: Carry out a feasibility study and develop a business case for establishing the Improvement Academy as a social enterprise.
C Gaynor Apr-19 Update at April Board meeting.
CCG 170 28/06/2018 4 Selina Douglas will share CCGs draft priorities for public health with LBN. S Douglas Feb-19
27/9: S Douglas to update on ensuring that the CCG and local authority priorities are aligned for public health, at a future meeting.
CCG 177 27/09/2018 3.3 Share a summary of patient engagement with Healthwatch S Sanghera Dec-18
CCG 178 27/09/2018 3.3Discuss the performance and provision of children’s services, as well as joint working with the local authority on this at a future meeting.
Secretariat Feb-19 To be scheduled
CCG 180 27/09/2018 3.5 Develop a talent management process across NEL J Milligan Apr-19
CCG 182 25/10/2018 3.4CCG draft performance framework: Test the proposed governance structure with some example KPIs.
S Sanghera/ A Lippett Feb-19
CCG 183 19/12/2018 3.1 Demand Management Communications and engagement plan to be circulated to the Board for information.
S Sanghera/ J van Bussel Apr-19
CCG 184 19/12/2018 3.2Develop a timeline and detailed action plan for the work of the GP federation oversight group to be approved by the Board before ratification at Practice Council.
S Sanghera/ J Mazarelo Feb-19
CCG 185 19/12/2018 3.3
Board Assurance Framework: Dedicate a Board development session to review the BAF risk descriptions, ratings and committee responsible for their assurance - following the session in January to discuss the strategic priorities as a borough.
S Sanghera/ C Vyas Mar-19
Newham CCG Board part I action log - 28/02/2019
Highlighted items represent a recommendation to remove from register
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Newham CCG Board meeting 28 February 2019
Committee rooms, Unex Tower
Title Single Accountable Officer / Managing Director Report
Agenda item 1.4
Author Selina Douglas, Managing Director/ Jane Milligan, Accountable Officer
Presented by Selina Douglas, Managing Director/ Jane Milligan, Accountable Officer
Contact for further information
Selina Douglas, Managing Director
This paper is for ☐ Decision ☐ Monitor ☐ Discussion ☒ For Information
Action required To note.
Executive summary This report provides an update on the work of Newham CCGs Accountable Officer and Managing Director since the last Board meeting, as well as information about future activities.
Supporting papers Appendix 1 - NHS Long Term Plan – a summary
Next Steps/ Onward Reporting
None.
Where has the paper been already presented?
No previous presentation to any previous meetings/forums.
How does this fit with NHS Newham CCG strategic priorities?
Strategic Priorities:
To commission a Newham-based integrated health and care system whichdelivers high quality services for the residents of Newham, in accordancewith statutory requirements
To commission and develop GP services that are modern, accessible and fitfor the future in caring for our residents.
Enabling Priorities:
Securing financial stability
Making sure our governance is fit for purpose
Valuing and enabling our staff, Board and Clinical Leaders to learn and
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develop thereby enabling them to deliver against the CCG Priorities
Ensuring we maintain our performance across the key business areas.
Risk The programmes of work relate to all of the risks as described in the BAF.
Equality impact Equality Impact Assessments will be carried out on programmes of work as required.
Stakeholder engagement
No previous presentation to any previous meetings/forums
Financial Implications
Newham CCG faces a significant financial challenge in 2018/19 and is undertaking
a range of measures to ensure sustainability including the 18/19 QIPP program.
This paper presents issues that may have financial consequences. These are yet
to be fully determined but if not already embedded in budgets or reserve provision,
a further Board decision would be required to release any additional expenditure
commitment.
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Newham CCG Accountable Officer’s update - February 2019
Long Term Plan
The Long Term Plan was published on Monday 7 January. This sets out how we will future proof the
NHS and we have produced a summary of the document, attached as an appendix to this report.
We welcome the plan which outlines many areas we are already making significant progress in such as
the integrated Urgent and Emergency Care NHS 111 Clinical Assessment Service which we launched
across north east London in 2018. Other areas to note are the increased focus on community based
health services, development of primary care networks bringing GP practices and community teams
together as well as the creation of fully integrated care systems by 2021.
I was pleased to see the a digital case study from north east London featured in the plan, outlining how
Tower Hamlets CCG, working with City and Hackney and Newham CCGs, established e-Clinics to
improve management of Chronic Kidney Disease and reduce End Stage Renal Disease. Since the e-
Clinic began in December 2015, 50% of referrals are managed without the need for a hospital
appointment. The average waiting time for a renal clinic appointment has fallen to five days, from 64
days in 2015.
We will now spend the coming weeks working looking through each ask in detail. We have already met
with Chief Executive’s and leaders from our system and started working with the senior management
team on a draft delivery plan, which will cement our plans for integrated care systems in north east
London, aligned with local health and wellbeing plans and strategies. Engagement with local people is
also a key area for consideration and we will be working with patient involvement leads to ensure we
have a robust plan in place.
We will continue to provide regular updates on this through team meetings and via Managing Directors.
CCG allocations
The CCG allocations for 2019-24 were published on 10 January. We are still working through much of
the detail, but the headline figures show a relatively generous settlement for NEL which we are
cautiously pleased about. The average 19/20 uplift for NEL is 6.31% compared to the national average
uplift of 5.65%. However, with the high population growth expected, this translates to 4.86% per head,
compared to the national average of 4.99%. For the sector as a whole, this would equate to £4m if we
received average growth per head of population across core and primary care allocations of £3bn.
This means that while we receive what looks like a generous settlement on the face of it, we will
continue to need to work smarter to get more from our investments to make sure the money goes
further. This will be crucial if we are to deliver all of the challenges and commitments set out in the ten
year plan.
The 19/20 planning guidance has made it clear that the intention is to use the new money to bring
providers back into balance, with the changes to the tariff supporting this. While the support for the
provider sector is welcomed, we need to understand as CCGs that this will affect out flexibility to make
investments in out of hospital care and means we need to focus all the more on our integrated care
approaches.
Joint Commissioning Committee (JCC)
I am pleased to announce that we have successfully recruited to the post of Secondary Care Consultant
for the Joint Commissioning Committee. Dr Charlotte Harrison will be joining us as of the 21 January
2019. Charlotte has been a consultant psychiatrist at South West London and St Georges Mental Health
NHS Trust since 2003 and was appointed as the Deputy Medical Director in April 2017.
The most recent meeting of the JCC took place on Wednesday 9 January. Items on the agenda
included maternity planning (outlining the progress made on the National Maternity Transformation
Agenda for East London in 2018/19, the plans for 2019/20, the strategic commissioning priorities for
maternity services and system capacity of maternity services in East London), outpatients and the
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relocation of Moorfields Hospital. Members of the public were in attendance but no questions were
asked. The next meeting will take place on 13 March. Full papers and details can be found on CCG
websites.
Work is continuing on a business case for an early diagnostic centre and the committee will be
discussing this in due course.
Public Accounts Committee
In January I was invited to Parliament to give evidence to the Public Accounts Committee Inquiry in to
CCGs alongside Dr Mark Rickets, Chair of City and Hackney CCG, Julie Wood, Chief Executive of NHS
Clinical Commissioners and Dr Paul Chair of South Devon and Torbay CCG.
The Committee asked a range of questions on the challenges faced by CCGs, the barriers to working
across multiple organisations, working with local authorities, financial challenges, leadership and patient
involvement.
Following our session the Committee questioned a range of national officials including Simon Stevens,
Chief Executive, NHS England and Sir Chris Wormald, Permanent Secretary, Department of Health and
Social Care, David Williams, Director General, Finance and Group Operations, DHSC and Matthew
Swindells, National Director: Operations and Information, NHS England
The full session can watched back here and a transcript can be found here.
Emergency Preparedness Resilience and Response (EPRR)
The 2018-19 annual EPRR assurance process is used in order to be assured that NHS Organisations in
London are prepared to respond to an emergency, and have the resilience in place to continue to
provide safe patient care during a major incident or business continuity event. The process this year is
broadly similar to that followed in 2017-18; however, where possible it incorporates learning from
feedback received through the post assurance debrief process.
All NEL CCGs were required to carry out a RAG rated self-assessment against the NHS Core Standards
for EPRR which would provide the framework for the assurance review meetings furthermore the review
meetings would also have a broader oversight and ensure that plans and arrangements were being
updated with relevant learning and guidance.
At the review meeting on the 30th November 2018 the Sustainability and Transformation Partnership
(STP) single Accountable Emergency Officer (AEO) for EPRR (Archna Mathur) was present with each
CCG Emergency Planning Officer and the progress that the North East London (NEL) CCGs are making
in regards to working collaboratively on EPRR was recognised.
In accordance with the requirements laid out in the EPRR 2018-19 Assurance Process Letter (1st
August 2018), the overall level of compliance is based on the total percentage of amber and red ratings.
In respect of the NELCA CCGs, for Core Standards 1 – 69, the following RAG ratings and degree of
compliance were agreed at the review meeting:
CCG Red Ratings Amber Ratings Overall Level of
Compliance
Tower Hamlets 0 2 Substantial
BHR 0 0 Full
C&H 0 2 Substantial
Newham 0 1 Substantial
WFCCG 0 1 Substantial
Overall the substantial level compliance demonstrates the NEL CCGs commitment to EPRR, evident
in the CCG’s assurance submissions. All CCGs are aware of the areas where further improvement is
required. In addition, the CCG highlighted how they would consider the collaborative working approach
in delivering EPRR improvements in the future. These considerations and discussions were noted by the
NEL STP AEO and assurance statements to each CCG Governing Body signed off as such.
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Flu Vaccination Uptake – London
North East London are currently best performing across London in terms of uptake on flu vaccinations
for adults across London. We are at 68.47% (the target is 75%). The NELCA Primary Care team are
leading the work to drive uptake and working closely with CCGs to support practices undertaking a
range of methods including use of a flu dashboard, GP communications and patient facing
communications in a range of languages.
Meeting with Healthwatch
I met with local Healthwatch leads from across North East London to update them on the Long Term
Plan and the process for engaging the public. Healthwatch Waltham Forest have been selected as the
lead Healthwatch for the area by NHS England. They will have a role in coordinating activity with their
NEL colleagues.
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WEL Managing Director’s Update - February 2019
Five Year Framework for GP Contract Reform for 2019-2023
On 31 January 2019, NHS England published new GP Contract arrangements covering the next
five years. Various elements will be introduced throughout the five years with the most
substantial changes commencing from April 2019. The changes should provide much needed
support and resources for general practice, expanding the workforce, reducing workload,
increasing funding, retaining GP and partnership autonomy and ensuring GPs have a leadership
role at the centre of primary care.
Watch the animation https://www.youtube.com/watch?v=Lh1QJabX7uI&feature=youtu.be
A summary of the publication is available at this link
https://www.england.nhs.uk/gp/gpfv/investment/gp-contract/
Mental Health Employment Service delivering positive outcomes for Newham patient
Early this year the CCG was successful in bidding for NHSE expansion funding for Individual
Placement Support Services (specialist mental health employment support).
TG was a “difficult to engage” patient open to the ELFT Community Recovery Team. Following
intensive and persistent work with him by the IPS service he received several job offers. TG has
now decided train as a nurse associate with the intention to become qualified mental health nurse in
the future.
TG’s mental health recovery journey is going well and will be “stepped down” to outpatient services
or to his GP soon.
Success in transforming care for a Newham patient with Learning disabilities
After three years in hospital, a Newham patient has now been discharged and is living a more
independent life in a residential setting. This comes after a long history of challenging behaviour,
and multiple placement breakdowns.
The CCG led a Care and Treatment Review, bringing together professionals and those involved in
his care, to introduce new innovative ways of working with him which are having positive outcomes.
The patient is now happy in his new home, engaging with staff, getting involved in activities and has
recently been on holiday for the first time in 20 years.
Integrated Urgent Care (111)
As is expected through the winter months there have been some surges in activity with regard to
patients accessing our IUC service. We are now working across the 7 CCG’s to review current activity
and ensure patients are being directed to the most appropriate service. In addition to this, we are now
implementing direct booking arrangements from the service to appropriately set appointments in our
UCC and practices.
LAS review on conveyances to NUH
The UCWG has received the outcome of a study looking at the reasons for conveyances in
Newham. For the cohort studied (257) 70% were discharged from ED, i.e. did not need an emergency
admission. Additionally, the cohort revealed that there is a higher number of younger people being
conveyed than in other areas (18 to 34 age range).
Minor Eye Condition Service
The pathway and contracting arrangements have now been signed off, and service implementation with
a communication plan will commence in March. Benefits of this service for our patients, is service
closer to home and a quicker appointment offers for minor eye condition.
MSK
We are now entering the final stages for the MSK year-end review, and it is proposed that we hold a
Board development session to receive the findings and discuss options going forward. 18
Building Healthier Communities
First Checkpoint with the provider collaborative was undertaken on 14 January 2019. Providers
outlined their strategic vision and approach to the programme, and there were some concerns
over the rate of progress. Meetings with provider collaborative scheduled between checkpoints
to assure progress. The CCG has also offered CCG officer’s time to support finance, project
management and redesign elements of the programme
Discussions on baseline approach and detail on Service Redesign Process undertaken
A joint CCG/ Provider Collaborative project plan has been produced
The CCG’s Finance lead has undertaken meetings with Newham Health Collaborative and Barts
Health colleagues to support the baseline review
Two Provider Collaborative workstreams commenced on 23 January 2019, focussing on
MDT/Care Coordination and Specialist Expertise.
Mildmay Clinical Audit Progress
A clinical audit is underway to review the care and interventions for patients receiving treatment at
Mildmay Hospital:
Audit questions were shared with Mildmay, (Geoff Coleman, CEO and Simon Rastrick, Medical
Director) and comments were incorporated into the audit specification in Dec 2018.
The audit started on 23 January with completion expected on 6 February 2019.
Findings analysis and a summary report are to be completed by late February.
Following discussions with associate CCG commissioners and other stakeholders, a series of
recommendations around potential changes to the pathways will be proposed by early March.
Recommendations to be discussed with Mildmay in late March for implementation in the 2019-20
contract.
Diabetes IAF rating
Newham is one of two CCGs in NEL to have their diabetes care rated as outstanding in the CCG IAF.
The ratings reflect performance in relation to diabetes clinical outcomes and uptake of patient
education.
Newham Wellbeing Partnership
The Newham Wellbeing Partnership (the borough based integrated care system) is in the process of
finalising its service model for the next 3 years which will focus on the development and delivery of a
Neighbourhood based service model, in line with the recently published NHS Long Term Plan (focussing
on primary care networks, neighbourhoods and integration), GP Contract (focus on primary care
networks) and local development of neighbourhoods by London Borough of Newham. The development
of this model in Newham will see local partners identify what the neighbourhood model in Newham will
deliver in each neighbourhood, what services make sense to be delivered at borough level (specialist
services) and what this will look like in practice. Two partner development workshops have been
arranged to support this, the first taking place on 14 February, which will review and adopt the
neighbourhood approach; the second session will take place in March to look at Governance to enable
delivery of the neighbourhood model. All partners will be in attendance, including clinicians, CCG Board
Members and LBN Cabinet Member for Health and Adult Social Care. Wider engagement on the detail
of the model will take place once the outline is agreed by the Newham system leaders. All partners
have agreed that the final Neighbourhood service model and delivery plan will be adopted through their
Boards and Cabinet.
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In addition the NWP will work with LBN and the Health and Wellbeing Board to examine the
development of a Health Charter between the public in Newham and the organisations that deliver
health and care services in Newham.
The key work streams under the NWP continue to be delivered; Building Healthier Communities
continues to develop new service models (and is reflecting the new neighbourhood focus), Primary Care
Home pilots are continuing and being assessed with lessons learnt influencing the design of the new
neighbourhood model, and the development of Integrated Commissioning continues with the
appointment of an Interim Director for Joint Commissioning to oversee the development of integrated
commissioning in Newham.
Improvement and Assessment Framework (IAF)
NHS England has a statutory duty to conduct an annual performance assessment of every CCG. The
annual assessment will be a judgement, reached by taking into account the CCG’s performance in each
of the indicator areas over the full year and balanced against the financial management and qualitative
assessment of the leadership of the CCG.
Newham CCG was rated Good overall for 2017/18, however since the overall rating which was
published in July 2018, further ratings which are components of the overall ratings have been published:
Cancer (published August 2018) – Requires Improvement
Maternity (published August 2018) - Requires Improvement
Mental Health (published January 2019) – Requires Improvement
Learning Disability (published January 2019) – Requires Improvement
Dementia (published January 2019) – Outstanding
Diabetes (published January 2019) – Outstanding
Further information can be found here https://www.nhs.uk/service-search/performance-
indicators/organisations/ccg-year-end-2015-assurance-assessment?ResultsViewId=1176
Planning Guidance
The NHS Operational Planning and Contract Guidance for 2019/20 was published on 10 January 2019.
The guidance describes a single operational planning process for commissioners and providers, with
clear accountabilities and roles at national, regional, system and organisational level.
This guidance describes system leadership and system working, financial framework for CCGs and
requirements in relation to NHS standard contracts. The guidance also includes operating plan
requirements on the following areas; Emergency Care, Referral to Treatment Times (RTT), Cancer
Treatment, Mental Health, Learning Disabilities and Autism, Primary Care and Community Health
Services, Personal Health Budgets and Longer-term deliverables. CCGs are required to submit
operating plans as a result of this guidance by April 2019.
Further information can be found here https://www.england.nhs.uk/publication/preparing-for-2019-20-
operational-planning-and-contracting/
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Key points to note from the NHS Long Term Plan – a summary
Overarching headlines Dissolve the divide between primary care and community based health services
Increase “floor” investment in primary medical and community health services as a share ofthe total national NHS revenue spend across the five years from 2019/20 to 2023/24. Thismeans spending on these services will be at least £4.5 billion higher in five year’s time
This is the first time in the history of the NHS that real terms funding for primary andcommunity health services is guaranteed to grow faster than the rising NHS budget overall.
Chapter one: A new service model More patient options and better support as well as properly joined up care at the right time
and in the right setting.
Primary Care
Every patient will have a right to online GP consultations, this will be aided through therollout of the NHS App
Primary care networks of local GP practices and community teams GP practices covering30-50k patients will be funded to work together to deal with pressures in Primary Care andextend the range of local services, creating integrated teams of GPs, community health andsocial care staff. Community health teams will provide fast support to people in their ownhomes as an alternative to hospitalisation. These will be fully integrated and supported bymulti-disciplinary teams in primary and community hubs
Changes to the QOF – new QI element with least effective indicators to be retired. A revisedQOF to support personalised care. Also includes a review of GP vac and imms standards. Alsoa shared savings scheme among primary care networks to reduce avoidable A&Eattendances, admissions and delayed discharges
Carers – improve identification of unpaid carers and strengthen support – introduce bestpractice quality markers for primary care that highlight best practice in carer identificationand support
Investment – in primary and medical and community services will grow faster than theoverall NHS budget – ring-fenced local fund worth at least an extra £4.5bn a year in realterms by 2023/24 will fund expanded community multi-disciplinary teams aligned with newprimary care networks based on neighbouring GP Practices.
Urgent and Emergency Care
Emergency Care System – Same Day Emergency Care (SDEC) model to be rolled out acrossall acute hospitals, increasing the proportion of acute admissions typically discharged on dayof attendance from a fifth to a third. SDEC to be embedded in every hospital in both medicaland surgical specialities during 2019/20
DTOC – goal over next two years is to achieve and maintain an average DTOC figure of 4000or fewer delays and over next five years reduce further
Care-homes – roll out the Enhanced Health in Care Homes scheme (EHCH) to ensurestronger links between primary care and networks and local care homes with all care homessupported by a consistent team of healthcare professionals including named generalpractice support. Also give care home staff access to NHS Mail to make it easier to shareinformation.
Item 1.4 - Appendix 1
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Pre-hospital urgent care – embed a single multidisciplinary Clinical Assessment Servicewithin an integrated NHS111, ambulance dispatch and GP OOO services from 2019/20.Additionally UTC model to be fully implemented by 2020 so that all localities have aconsistent offer for OOH urgent care with the option of appointments booked through a callto NHS111
Ambulance services – work with commissioners to put in place timely responses so patientscare be treated by skilled paramedics at home or in a more appropriate setting. – NHSE willset out a new national framework to overcome the fragmentation that ambulance serviceshave experienced in how they are locally commissioned.
Personalised care
Within 5 years over 2.5m more people will benefit from social prescribing, a PHB and newsupport for managing their own health. The NHS Comprehensive Model of PersonalisedCare is being implemented across a third of England. The next step is to roll out the modelacross the country reaching 2.5m people by 2023/24 and aiming to double that within adecade. In terms of social prescribing this will involve over 1000 trained link workers in placeby the end of 2020/21 rising further by 2023/24. The aim is over 900,000 referred to SPscheme. For PHBs the aim is up to 200,000 people benefiting from a PHB by 2023/24.
Move to ICS’s
Create Integrated Care Systems by April 2021ICS will need streamlined commissioningarrangements to enable a single set of commissioning decisions at a system level. This willtypically involve a single CCG for each ICS area. CCGs will become leaner, more strategicorganisations that support providers to partner with local government and othercommissioning organisations on population health, service redesign and LTPimplementation
o A partnership board, drawn from and representing commissioners, trusts,primary care networks with participation from local authorities, the voluntaryand community sector and other partners
o A non-exec chair (locally appointed but subject to approval by NHSE/I)o Sufficient clinical and management capacityo Full engagement from Primary Care including a named accountable clinical
director of each primary care networko Clinical leadership aligned around ICSs to create clear accountability to the ICSo Coterminous cancer alliances with one or more ICS
Other points to note:
Blended budgets – support local approached to this where council and CCGs agree thismakes sense
Social Care – Green Paper to follow later this year
Better Care Fund (BCF) - a review of the Better Care Fund will conclude in early 2019 andwill include requirements to continue to reduce DTOCs and improve care packages.
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Chapter two: Focuses on prevention and health inequalities Five key priorities - The NHS prevention programme is based on the Global Burden of
Disease top five risk factors: smoking, poor diet, high blood pressure, obesity, alcohol anddrug use
Funding - LTP funds specific new evidence based NHS prevention programmes, including tocut smoking, to reduce obesity, partly by doubling enrolment in the successful type two NHSDiabetes Prevention Programme to limit alcohol related A&E admissions
Funding conditions - As a condition of LTP funding all major national programmes and everylocal area across England will be required to set out specific measurable goals andmechanisms by which they will contribute to narrowing health inequalities over the next 5-10 years
Specific actions include cutting smoking in pregnancy and long term mental healthconditions, ensuing people with learning disability/autism get better support, provideoutreach services to people experiencing homelessness and improving uptake of screeningand early cancer diagnosis
Primary Care Network Contract – neighbouring GP practices to work with local NHS, socialcare and voluntary services funded by LTP investment guarantee
Inequalities – NHSE will continue to target a higher share of funding towards geographieswith high health inequalities. This funding is estimated to be worth over £1bn by 2023/24.For the five year CCG allocations that underpin the LTP, NHSE will introduce from Apr 2019more accurate assessments of community health and mental health services. All localsystems will be expected to set out during 2019 how they will specifically reduce healthinequalities by 2023/24 and 2028/29. These plans will set out clearly how CCGs are targetingfunding to improve equity of access and outcomes.
Next steps
Refreshed STP prevention workstream is key and plan for how we will tackle thefive key areas above
Note health inequalities detail and ensure a robust plan is in place to set out howwe will work to reduce this and use additional funding.
Next steps
Outline next steps for Primary Care
Note focus on personalised care and have a plan in place
Key points to note about QOF, blended budgets and BCF review
Ensure rollout of EHCH and SDEC is in hand
Move to ICS’s – a series of actions to note here eg clinical leadership, chairs andstructure and need to be clear on messaging
From a comms point of view we can talk about what we are already doing with CASsince it launched in June. We also have positive things we can say about socialprescribing.
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Chapter three: Focus on care quality and outcomes improvement
Maternity
halving maternity related deaths by 2025
specialist smoking cessation for women who smoke during pregnancy
specialist pre-term birth clinics across England
National Maternal and Neonatal Health Safety Collaborative
Continuity of care during pregnancy
Maternity digital care records being offered to 20,000 eligible women in 20 accelerator sitesacross England, rising to 100,000 by the end of 19/20.
Children
Create a Children and Young People’s Transformation Programme which will in conjunctionwith the Maternity Transformation Programme oversee the delivery of commitments in thisplan
2019/20 clinical networks to be rolled out to ensure we improve the quality of care forchildren with long term conditions such as asthma, epilepsy and diabetes
Move to a 0-25 years service.Cancer
By 2028 LTP commits to dramatically improving cancer survival, partly by increasingproportion of cancers diagnosed early from half to three quarters
New faster diagnosis standard from 2020 to ensure most patients receive a definitivediagnosis or ruling out of cancer within 28 days referral from a GP or from screening
o Bowel cancer screening programme to detect more cancers earliero Implement HPV primary screening for cervical cancer across England by 2020o By 2022 extend the lung health checks that have already produced strong results in
Liverpool and Manchester
From 2019, start the roll out of the new Rapid Diagnostic Centres (RDC’s) across the country
Recruit an additional 1,500 new clinical and diagnostic staff across seven specialismsbetween 2018 and 2021
Complete the £130m upgrade of radiotherapy machines
Children’s cancer – offer all children with cancer whole genome sequencing. Introduce CAR-T cancer therapies
NHS England will increase its contribution by match-funding CCGs who commit to increasetheir investment in local children’s palliative and end of life care services including children’shospices. This should be more than double the NHS support from £11 million up to acombined total of £25 million a year by 2023/24
By 2021 every person diagnosed with cancer will have access to personalised care
By 2023, stratified, follow-up pathways for people who are worried their cancer may haverecurred
Sir Mike Richards is leading a review of the current cancer screening programmes anddiagnostic capacity.
Mental health
ring fenced local investment fund worth at least £2.3bn a year by 2023/24
Perinatalo Increasing access to evidence-based care for women with moderate to severe
perinatal mental health difficulties and a personality disorder diagnosis, to benefitan additional 24,000 women per year by 2023/24, in addition to the extra 30,000women getting specialist help by 2020/21. Care provided by specialist perinatal
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mental health services will be available from preconception to 24 months after birth (care is currently provided from preconception to 12 months after birth), in line with the cross-government ambition for women and children focusing on the first 1,001 critical days of a child’s life.
CAMHS – funding will grow faster than both overall NHS funding and total mental healthspending
o extend current service models to create a comprehensive offer for 0-25 year olds.The new model will deliver an integrated approach across health, social care,education and the voluntary sector, such as the evidenced-based ‘iThrive’ operatingmodel
o with those units with a long length of stay and look to bring the typical length of stayin these units to the national average of 32 days. This will contribute to ending acuteout of area placements by 2021
o Over the next three years, autism diagnosis will be included alongside work withchildren and young people’s mental health services to test and implement the mosteffective ways to reduce waiting times for specialist services
o seven-day specialist intensive, crisis and forensic community based multidisciplinarycare. We will continue to work with partners to develop specialist community teamsfor children and young people
Suicide prevention – New Mental Health Safety Improvement Programme, which will have afocus on suicide prevention and reduction for mental health inpatients
IAPT - By 2023/24 an additional 380,000 people per year will be able to accessNICE-approved IAPT services
Capital – investment from the forthcoming Spending Review will be needed to upgrade thephysical environment for inpatient psychiatric care.
Learning disability
Improve uptake of the existing annual health check in primary care for people aged over 14years with a learning disability, so that at least 75% of those eligible have a health checkeach year
By 2023/24, a ‘digital flag’ in the patient record will ensure staff know a patient has alearning disability or autism
By 2023/24, all care commissioned by the NHS will need to meet the Learning DisabilityImprovement Standards
By 2023/24 children and young people with a learning disability, autism or both, withthe most complex needs, will have a designated keyworker. Initially, keyworker.
Cardiovascular
Deliver existing Right Care Programme
Improve Community First Response and build defibrillator networks to improve survivalfrom out of hospital cardiac arrest.
Stroke
By 2020 begin improved post-hospital stroke rehabilitation models, with full roll-out overthe period of this Long Term Plan
By 2022 we will deliver a ten-fold increase in the proportion of patients who receive athrombectomy after a stroke.
Lung
Build on existing Right Care programme to reduce variation in the quality of spirometrytesting across the country
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Primary Care Networks to support the diagnosis of respiratory conditions. More staff inPrimary Care will be trained and accredited to provide the specialist input required tointerpret results.
Diabetes
Patients with type 1 benefit from flash glucose monitors from April 2019 – ending variationacross the country
By 2020/21 offer pregnant women with type 1 continuous glucose monitoring
Drive down variation between CCGs through continued investment.
System architecture - all of the above will be backed by actions on workforce, technology, innovation and efficiency and an overarching “system architecture”
Chapter four: workforce A workforce implementation plan will be published later in 2019. NHS Improvement, HEE
and NHS England will establish a national workforce group to ensure that such workforceactions agreed are delivered quickly
Wider reforms will be finalised in 2019 when workforce, education, training budget for HEEis set
Highlights:o an extra £1 million a year to extend WRES to 2025o Clinical placements for an extra 5,000 places will be funded from 2019/20, a 25%
increase. From 2020/21, we will provide funding for clinical placements for as manyplaces as universities fill, up to a 50% increase. And every nurse or midwifegraduating will also be offered a five-year NHS job guarantee within the regionwhere they qualify
o new online nursing degree could be launched from 2020o in community pharmacy, we will work with government to make greater use of
community pharmacists’ skills and opportunities to engage patients, while alsoexploring further efficiencies through reform of reimbursement and wider supplyarrangements
o growing medical school places from 6,000 to 7,500 per yearo the way doctors are trained and the way they work will be a key component of the
workforce implementation plan. We want to accelerate the shift from a dominanceof highly specialised roles to a better balance with more generalist ones
o a net increase of 5,000 GPs as soon as possibleo newly qualified doctors and nurses entering general practice will be offered a two-
year fellowshipo new state-backed GP indemnity scheme from April 2019o enable trainees to switch specialties without re-starting trainingo accelerate the development of credentialing
What this means for us/ next steps
Note actions on cancer, mental health, long term conditions, LD and autism andensure robust updated plans in place
Note we are already doing much of this and eg we are already making progress withEarly Diagnosis through the ED centre so can talk about this in comms messaging.
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o development of incentives to ensure that the specialty choices of trainees meet theneeds of patients by matching specialty and geographical needs, especially inprimary care, community care and mental health services
o new national arrangements to support NHS organisations in recruiting overseas. Wewill explore the potential to expand the Medical Training Initiative so that moremedical trainees from both developed and developing countries can spend timelearning and working in the NHS
o NHS Improvement’s Retention Collaborative has already delivered substantialmeasurable improvements through targeted support for trusts with high turnover.We will extend this support to all NHS employers, and NHS Improvement iscommitted to improving staff retention by at least 2% by 2025
o Following agreement of the HEE training budget in this year’s Government SpendingReview, we will expect to increase investment in CPD over the next five years
o expanded Practitioner Health Programme will help all NHS doctors access specialistmental health support, providing a safe, confidential non-stigmatising service to turnto when they are struggling and need help. This means the NHS will have the mostcomprehensive national mental health support offer to doctors of any health systemin the world
o targeted support to trusts to access fast track occupational health services and a linemanagement development programme
International recruitment will be significantly expanded over the next three years
New Primary Care Networks will provide flexible options for GPs and wider Primary Careteams
Funding for the new primary care networks will be used to substantially expand the numberof clinical pharmacists.
Chapter five: Technology and Digital Chapter Five sets out a wide-ranging and funded programme to upgrade technology and
digitally enabled care across the NHS. These investments enable many of the wider servicechanges set out in this Long Term Plan. Over the next ten years they will result in an NHS wheredigital access to services is widespread. Where patients and their carers can better manage theirhealth and condition. Where clinicians can access and interact with patient records and careplans wherever they are, with ready access to decision support and AI, and without theadministrative hassle of today. Where predictive techniques support local Integrated CareSystems to plan and optimise care for their populations. And where secure linked clinical,genomic and other data support new medical breakthroughs and consistent quality of care.Chapter Five identifies costed building blocks and milestones for these developments.
Rollout of the NHS App
Digital Maternity records
Work with the wider NHS, the voluntary sector, developers, and individuals in creating arange of apps to support particular conditions
interoperability of data, mobile monitoring devices and the use of connected hometechnologies over the next few years
What this means for us/next steps
Await refreshed workforce plan in 2019
Need to consider the above in light of impact of Brexit on workforce and also need toawait more detailed workforce plan.
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Patients’ Personal Health Records will hold a care plan that incorporates information addedby the patient themselves, or their authorised carer
Supporting health and care staff - enable staff to capture all health and care informationdigitally at the point of care, and optimise clinical processes to reduce administrativeburden
All providers, across acute, community and mental health settings, will be expected toadvance to a core level of digitisation by 2024
Supporting clinical careo By 2024, secondary care providers in England, including acute, community and
mental health care settings, will be fully digitised, including clinical and operationalprocesses across all settings, locations and departments. Data will be captured,stored and transmitted electronically, supported by robust IT infrastructure andcyber security, and LHCRs will cover the whole country
o A new wave of Global Digital Exemplars will enable more trusts to use worldclassdigital technology and information to deliver better care, more efficiently
o A secure NHS login will provide access and a seamless digital journey. The NHS Appand its browser-based equivalent will enable people to follow a simple triage onlineto help them manage their own health needs or direct them to the appropriateservice. If needed they will be able to be connected with their local services; get anappointment with an urgent treatment centre, out of hours services or GP, or beprescribed medicine to be collected from their nearest pharmacy
o full roll-out of the health and justice digital patient record information system acrossall adult prisons, immigration removal centres and secure training centres forchildren and young people. This will include the digital transfer of patient recordsbefore custody, in custody and on release
o By 2023/24, a ‘digital flag’ in the patient record will ensure staff know a patient has alearning disability or autism.
Improving Clinical efficiencyo By 2022/23 An integrated child protection system will replace dozens of legacy
systems and we will deliver a screening and vaccination solution that is worthy ofthe NHS' world leading services
o By 2021, pathology networks will mean quicker test turnaround times, improvedaccess to more complex tests and better career opportunities for healthcarescientists at less overall cost. Mandated open standards in procurement will ensurethat these networks are ready to exploit the opportunities afforded by AI, such asimage triage, which will help clinical staff to prioritise their work more effectively, oridentify opportunities for process improvement
o By 2023, diagnostic imaging networks will enable the rapid transfer of clinical imagesfrom care settings close to the patient to the relevant specialist clinician to interpret.
Population health management - During 2019 deploy population health managementsolutions to support ICSs to understand the areas of greatest health need and match NHSservices to meet them.
What this means for us/next steps
Already making progress in digital across NEL but there are some areas to nore hereparticularly around online GP consultations and the rollout of the NHS App
Update digital workstream and plan.
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Chapter six: 3.4% NHS Funding settlement details
Aim to have financial balance by 2023/24
Reforms to payment system moving funding away from activity based payments topopulation based funding.
Blended payment model starting with urgent and emergency care with a single set offinancial incentives aligned to the commitments in the LTP
Reforms to CQUIN
2019/20 will be a transitional year with one-year rebased control totals and greaterflexibility for all STPs and ICSs to agree financially neutral charges to control totals
NHSI accelerated turnaround process for 30 worst financially performing Trusts
Beyond 2019/20 there will be further financial reforms that will support ICSs to deliverintegrated care
Financial recovery fund to support systems and organisations efforts to make NHS servicessustainable
Getting it right first time (GIRFT) – will combine with other clinically led programmes such asNHS Right Care and an increased investment in Quality Improvement (QI) to accelerate workand end unjustified clinical practice variation
There are ten priority areas as part of a strengthened efficiency and productivityprogramme
1. Availability and deployment of clinical workforce2. Procurement savings by aggregation of volumes and standardising specs through the
Supply Chain Coordination Limited3. Diagnostic Tests – deliver pathology imaging networks to improve the accuracy and
turnaround times on tests and scans will make best use of workforce and reducecosts
4. Improve efficiency in community health services, mental health and primary careincluding access to mobile devices and digital services, better access to records forambulance services
5. Delivering value from £16bn we spend on medicines over next 5 years all providerswill be expected to implement e-prescribing to reduce errors by 30%. Pharmacists towork with GPs to relieve pressure on GPs and support care homes
6. Savings to NHS admin costs across commissioner and providers £290m fromCommissioners and £400m from providers
7. Estates – reduce non-clinical space by 5%8. Ensuring least effective interventions are not routinely performed9. Improve patient safety – new ten year national strategy to be published in 201910. Counter fraud
Chapter seven: Next steps Five year indicative financial allocations for local health systems for 2019/20 - 2023/24
Mutual aid will be an integral part of the role of leaders “duty to collaborate”
What this means for us/next steps
Funding allocations to follow
Finance team to work up next steps based on the above.
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NHS Assembly to be established in early 2019 – will bring together a range of organisationsand individuals at regular intervals to advise the boards of NHSE/NHSI. Members will bedrawn from the voluntary sector, ALB’s and frontline leaders from ICSs, STPs, Trusts, CCGsand LA’s
2019/20 will be a transitional year as the local NHS and partners have the opportunity toshape local implementation for their populations
Clinical standards review and national implementation framework to be published in thespring
Local ICS’s to be created by April 2021
Legislation changes – plan makes some suggestions to Parliament to accelerate the progressof integration, admin efficiency and public accountability
o Give CCGs and NHS Providers shared new duties to promote the ‘triple aim’ ofbetter health for everyone, better care for all patients and sustainability both fortheir local NHS system and wider NHS
o Remove specific impediments to place-based NHS Commissioningo Support effective running of ICS’so Support creation of NHS Integrated Care Trustso Remove counter-productive effect that general competition rules and powers can
have on integrationo Cut delays and costs of NHS having to automatically go through procurement
processo Increase flex in NHS pricing regimeo Make it easier for NHSE and NHSI to work together (eg through a joint committee)
A full version of the Long Term Plan can be found here: https://www.longtermplan.nhs.uk/
What this means for us/next steps
Extended SMT session to scope out gaps and next steps
LTP to be discussed with Chairs and Governing Bodies
Next steps for LTP to include refreshed STP workstreams, clear plan for patientengagement, clear plan for finances
Need to develop an outline of all the key milestones – into one timeline eg when wecan expect key publications, when key elements of the LTP need to be fullyimplemented
Clear narrative for staff, GPs, stakeholders about what happens next and what it meansfor NEL.
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Newham CCG Board meeting Thursday 28 February 2019
Committee rooms, 4th floor Unex Tower, Stratford
Title Finance Report M10
Agenda item 3.1
Author Steve Collins, Interim WEL Director of Finance
Presented by Steve Collins, Interim WEL Director of Finance
Contact for further
information
Steve Collins, Interim WEL Dir of Finance
[email protected], 07770 843385
This paper is for ☐ Decision ☐ Monitor ☐ Discussion ☒ For Information
Action required Note CCG’s financial position as at 2018/19 Month 10 including QIPP.
Executive summary This Month 10 report outlines the financial position of the CCG as at 31 January
2019:
Overall, the CCG is reporting breakeven year to date and is currently projecting a
surplus of £0.5m at year end after the utilisation of all of our available reserves.
The favourable reported position is to manage at an STP level a deterioration at
WFCCG, through subsequent improvements in the positions reported by City and
Hackney, Newham and Tower Hamlets from the release of the planned risk
reserve. This report will go on to identify key variances to plan and the key
assumptions underpinning the projected year end position.
The overall acute position year to date is reported as £2.0m above plan with a
forecast year end overspend of £1.0m which is partially mitigated by application of
our acute reserve totalling £6.3m. Overall the only material change in our year
end projection across the acute portfolio compared with M9 is a £0.5m
improvement on the Barts contract as a result of the year end deal being
concluded for the core acute contract. For Mental Health, Community and
primary care overall we are projecting to remain on plan (this includes the
delegated Primary Care Co-Commissioning budget). Other non-acute including
reserves is projecting an underspend of £1.5m.
In summary, at M10 we are forecasting that the CCG will deliver a small surplus in
18/19, however this assumes that there are no further deteriorations within other
commissioning budgets. We have applied our contingency and contracts reserve
in full in order to offset the continuing cost pressures.
31
Supporting papers Not applicable.
Next Steps/ Onward
Reporting
None.
Where has the paper
been already
presented?
The Month 10 financial position has been reviewed at the CCG’s Senior
Management Team meeting.
How does this fit with
NHS Newham CCG
strategic priorities?
Enabling priority: Securing financial stability.
Outcome: We will spend the Newham pound wisely, ensuring value for money
and maintaining financial balance.
Risk The Financial Plan and effective Financial monitoring, reporting and control
(including the QIPP programme) as identified in the Finance and Activity Plan is
an essential component in identifying and managing financial risk and ensuring
the CCG delivers its statutory financial requirements.
The risk of failure to deliver this is identified specifically in BAF.02
Equality impact Effective delivery of the financial plan will support the CCG in achieving its duty to
reduce inequality of health provision and outcomes for the residents of Newham.
Stakeholder
engagement
This report has been subject to no specific prior consultation but reflects any
comments from NHSE scrutiny and assurance processes and any comments,
queries or suggestions raised by CCG members, the Board or Newham residents
in relation to earlier reports.
Financial Implications The report provides a high level view of the CCG’s financial performance and any
recommended remedial actions for 2018/19.
32
Finance Report
NCCG Finance Report – Month 10 Jan 2019
Document revision history Date Version Revision Comment Author/Editor
08/02/2019 1.1 Initial Draft of Narrative None Vincent Heneghan
Document approval Date Version Revision Role of approver Approver
CFO Steve Collins
33
Contents 1. Introduction........................................................................................................................ 3
2. Executive Summary ............................................................................................................. 3
3. Detailed Report .................................................................................................................. 3
4. Key Risks & Opportunities/Mitigation to Forecast at Month 10 ........................................... 5
5. Key Variances – Forecast vs Plan ......................................................................................... 6
6. Total QIPP Position ............................................................................................................. 9
7. Key Performance Indicators (KPI’s M10) ............................................................................. 10
34
nth 9 Finance & QIPP Report – 2017/18
1. Introduction
The purpose of this report is to update the Newham CCG Board on the financial position as at the end of January (Month 10) and provide projections of income and expenditure to year end. The report goes on to describe any key variances to the commissioning budget and identifies potential further financial risks and mitigating actions where appropriate.
2. Executive Summary
This Month 10 report outlines the financial position of the CCG as at 31st January 2019. Overall, the CCG is reporting breakeven year to date and is currently projecting a surplus of £0.5m at year end after the utilisation of all of our available reserves. The favourable reported position is to manage at an STP level a deterioration at WFCCG, through subsequent improvements in the positions reported by City and Hackney, Newham and Tower Hamlets from the release of the planned risk reserve. This report will go on to identify key variances to plan and the key assumptions underpinning the projected year end position. The overall acute position year to date is reported as £2.0m above plan with a forecast year end overspend of £1.0m which is partially mitigated by application of our acute reserve totaling £6.3m. Overall the only material change in our year end projection across the acute portfolio compared with M9 is a £0.5m improvement on the Barts contract as a result of the year end deal being concluded for the core acute contract. For Mental Health, Community and primary care overall we are projecting to remain on plan (this includes the delegated Primary Care Co-Commissioning budget). Other non-acute including reserves is projecting an underspend of £1.5m
In summary, at M10 we are forecasting that the CCG will deliver a small surplus in 18/19, however this assumes that there are no further deteriorations within other commissioning budgets. We have applied our contingency and contracts reserve in full in order to offset the continuing cost pressures.
3. Detailed Report
Revenue Resource Limit (Income) - The CCG’s total resource limit at Month 10 is £516.5m which represents a decrease of £1.0m during the month associated with Perinatal and Transformation funding being distributed to STP partners. The total resource limit is comprised of our opening baseline allocation and subsequent recurrent and non-recurrent adjustments as detailed within the table below:
35
Reserves & Contingencies
The CCG held full year central reserves totaling £7.9m, including acute reserves, primary care development funding, and ICS development funding. At M10 the central reserves are fully committed.
Running Cost Allowance - The CCG’s running cost allowance for 2018/19 is £7.6m and the CCG has set a plan that is within this expenditure cap. At Month 10, the CCG’s is on plan to maintain spend within its Running Cost Allocation. The table below shows the breakdown of the CCG’s total corporate position at M10.
Sum of Revenue Resource £000 Column LabelsRow Labels Non-recurRecurrent Grand TotalBaseline 394 442,675 443,069 Primary Care Co Commissioning 52,985 52,985 2017/18 Brought Forward Surplus/Deficit 8,227 8,227 Running Cost Allocation 3 7,619 7,622 Extended Access Funding 2,270 2,270 CEOV 2,095 2,095 GPFV -Tranche 2 funds 1,107 1,107 Perinatal Comm Services Development Fund 1st alloc 510 510 Practice resiliance funds 360 360 CHP Voids and subsidies 304 304 Diabetes Transformation: DTCL02 TT 270 270 Q71 GENERAL PRACTICE FORWARD VIEW 243 243 Quality Premium 181 181 LTBI Qtr 1 allocation 163 163 LTBI Qtr 2 allocations 163 163 LTBI Quarter 3 allocation 162 162 Diabetes Transformation Fund: TT DTCL02 135 135 Perinatal MH Wave 2 Funding 132 132 Liaison and Diversion/CYP Co-commissioning 86 86 IPS Wave 1 62 62 Other 72 48 120 Lambeth Levies 148- 148- HLP Contribution 18/19 258- 258- PH Section 7a Flu and pneumococcal vaccine funding 1819 278- 278- Practice Resilience Fund 290- 290- Cancer Cardiac 18/19 500- 500- Tranche 1 Transformation Funding 979- 979- Mth10 1,200- 76- 1,276- Grand Total 13,260 503,277 516,537
36
4. Key Risks & Opportunities/Mitigation to Forecast at Month 10
Risks – At Month 10, the CCG recognizes the following potential risks, which are not included within the projected position outlined above;
• The potential for run rates on associate acute contracts to outstrip the forecastassumptions and values projected.
• Any unanticipated high expenditure in Mental Health, Continuing Care andPrescribing.
These risks would need to be mitigated by delaying planned investments, through the delivery of additional QIPP savings and by disinvestment in existing services.
Row LabelsSum of YTD Budget
Sum of YTD Actual
Sum of YTD Variance
Sum of Annual Budget
Sum of Forecast
Sum of Forecast Variance
Income 35 80 45 42 42 - Non Pay 1,957 1,663 294- 2,347 2,347 - Pay 4,372 4,613 241 5,245 5,245 - Grand Total 6,364 6,355 9- 7,634 7,634 -
Newham CCG - 2018/19 Corporate Financial Position at M10
37
Summary - Revenue Financial Position
The CCG’s summary revenue financial position is summarised below.
5. Key Variances – Forecast vs Plan
Acute Pressures
The total acute budget is £262.0m, at Month 10, the CCG is projecting a £1.0m full year over-performance. We have had to apply our contract reserve to mitigate this projected overperfomance within our M10 projections which of course restricts the CCG’s ability to accommodate any further deterioration during this year.
Community Health & Other Non-Acute budgets combined (inclusive of reserves) equal c. £0.1m. The CCG is projecting a £2.1m full year under performance across these budget portfolios largely as a result of the application of reserves. Contrastingly Primary Care with a budget of £103.0m, is projecting a £0.6m full year over performance primarily driven by prescribing & EPCS.
Month 9 flex data for Barts Health shows continuing over-performance mainly on non-elective admissions and further details and analysis of this has been provided below. (This does not represent a financial risk because of the year end deal with Barts but highlights the trend in relation to activity)
Barts Health Performance Analysis
Barts Health performance at M9 (flex) is summarised within the following tables:
Newham CCG - Summary of Finance Performance - M10 2018/19
Area 2017/18 Final Outturn
2018/19Annual Budget
2018/19Forecast Outturn
Variance against Budget
Variance against 2017/18
£'000 £'000 £'000 £'000 £'000Acute Services 252,175 262,317 263,363 1,046 11,188 Mental Health 47,862 48,276 48,276 - 414 Community Health 39,938 37,865 37,784 81- 2,154- Other Non-Acute 43,889 46,911 44,866 2,045- 977 Primary Care 101,747 103,345 103,925 580 2,178 Running Cost 7,532 7,634 7,634 - 102 Total Spend 493,143 506,348 505,848 -500 12,706
Total Allocation 501,371- 513,575- 513,575- - -12,204
(Surplus)/Deficit 8,228- 7,227- 7,727- 500- 501
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Newham CCG Barts Health – Summary of Activity
Activity by PODPlan Dec
2018Actual Dec
2018Variance to
plan%
Plan YTD 2018
Actual YTD 2018
Variance to plan
%Variance Year on
Year Dec%
Variance Year on
Year YTD Dec
%Variance
YTD to prior year avge
%
Unplanned Care
Critical Care 487 458 -29 -6% 4,323 3,989 -334 -8% -94 -17% -446 -10% -573 -13%
Non Elective 1,476 1,512 36 2% 13,111 13,589 478 4% 30 2% 396 3% 301 2%Non Elective same day 191 293 102 53% 1,695 2,677 982 58% 115 65% 1,012 61% 961 56%Non Elective short stay 271 289 18 7% 2,403 2,699 296 12% 37 15% 430 19% 352 15%Total Non Elective 1,938 2,094 156 8% 17,209 18,965 1,756 10% 182 10% 1,838 11% 1,614 9%
Non Elective Non Emergency 519 432 -87 -17% 4,603 4,149 -454 -10% -33 -7% -446 -10% -392 -9%
Ward attenders 13 46 33 254% 117 384 267 228% 29 171% 239 165% 184 92%
A&E 7,496 8,430 934 12% 67,842 72,091 4,249 6% 642 8% 2,409 3% 1,631 2%
Planned CareOutpatient First 4,033 3,520 -513 -13% 40,325 37,821 -2,504 -6% -92 -3% -4,398 -10% -3,458 -8%Outpatient Follow Up 7,366 7,561 195 3% 73,769 79,349 5,580 8% 752 11% 384 0% 1,428 2%Outpatient Procedures 3,483 3,832 349 10% 34,830 39,670 4,840 14% 148 4% 6,664 20% 5,206 15%Total Outpatients 14,882 14,913 31 0% 148,924 156,840 7,916 5% 808 6% 2,649 2% 3,176 2%
Day Case 1,348 1,338 -10 -1% 13,481 13,299 -182 -1% 229 21% 1,095 9% 1,287 11%Elective 240 208 -32 -13% 2,401 2,232 -169 -7% -14 -6% 12 1% 2 0%Total Elective 1,588 1,546 -42 -3% 15,882 15,531 -351 -2% 215 16% 1,106 8% 1,289 9%
Diagnostic Imaging 1,496 1,722 226 15% 14,959 16,592 1,633 11% 181 12% 15 0% 241 1%Direct Access 120,377 116,004 -4,373 -4% 1,264,782 1,390,324 125,542 10% 6,260 6% -15,908 -1% -3,544 -0%Regular day attenders 471 530 59 13% 4,713 5,809 1,096 23% 51 11% 1,089 23% 1,035 22%
MaternityBirths 451 399 -52 -12% 4,034 3,662 -372 -9% -21 -5% -341 -9% -321 -8%MatPath 823 821 -2 -0% 7,303 8,385 1,082 15% -14 -2% -35 -0% 5 0%
Variances to prior periods are adjusted to eliminate the impact of the difference in calender and working days
39
Newham CCG Barts Health – Activity Trends Unplanned Care
Barts Health A&E Activity – Newham CCG (Source: SLAM)
Barts Health Emergency Admissions – Newham CCG (Source: SLAM)
POD ActualA&E Attendances 2,409 3%
2017/18 - 2018/19 Movement - M9 YTD
Percentage
POD ActualNon Elective 396 3%Non Elective Same Day 1,012 61%Non Elective Short Stay 430 19%Total 1,838 11%
2017/18 - 2018/19 Movement - M9 YTD
Percentage
40
6. Total QIPP Position
• The CCG’s 2018/19 plan includes a total QIPP expectation of £12.7m.• M10 savings reported of £9.2m vs year to date target £9.5m (97%)• Forecast year end QIPP delivery of £12.6m (99%)• Table below includes a rag rating around YTD delivery
Programme
Full year plan
(£000's)
FOT at Mth 10 (£'000s)
FOT Varaince (£000's)
YTD Plan (£000's)
YTD Actual (£000's)
YTD Variance (£000's) RAG
Overseas patients 1.040 1.040 0.000 0.867 0.821 (0.046)BH Productivity 0.900 0.900 0.000 0.750 0.724 (0.026)BCF Negotiations 0.500 0.500 0.000 0.417 0.417 -TST & STP PMO 0.500 0.500 0.000 0.417 0.417 -Pathology Direct Access 0.830 0.830 0.000 0.692 0.680 (0.011)Referral Management System 0.900 0.900 0.000 0.750 0.745 (0.005)TST: Diagnostics & OP 0.500 0.500 0.000 0.417 0.417 -MH Contracts 1.258 1.258 0.000 1.048 1.048 -CH Contracts 0.766 0.766 0.000 0.638 0.638 0.000Prescribing 2.910 2.910 0.000 2.425 2.351 (0.074)Optimising the Use of Medicines 0.054 0.054 0.000 0.045 0.042 (0.003)Commissioning System Admin - Estates 0.148 0.148 0.000 0.123 0.123 -Commissioning System Admin -Deminis Projects 0.396 0.396 0.000 0.330 0.330 -Discharge Programme 0.090 0.090 0.000 0.075 0.070 (0.005)Elective Care - Discharge to Assess 0.310 0.310 0.000 0.258 0.258 -Elective Care -MSK 0.160 0.160 0.000 0.133 0.133 -Mental Health 0.247 0.247 0.000 0.206 0.206 -Community Healthcare 0.081 0.081 0.000 0.068 0.068 -Primary Care 0.082 0.082 0.000 0.068 0.063 (0.005)Elective Care - DOT Service 0.190 0.190 0.000 0.158 0.158 -Elective Care - Anti Coagulation 0.020 0.020 0.000 0.017 0.016 (0.001)Emergency Care - Alcohol Related Admissions 0.040 0.040 0.000 0.033 0.031 (0.002)Emergency Care - UTC Procurement 0.260 0.260 0.000 0.217 0.217 -Optimising the Use of Medicines - Prescribing (Biosimilars) 0.190 0.190 0.000 0.158 0.147 (0.012)Emergency Care - Ambulatory Care 0.140 0.107 -0.033 0.117 0.087 (0.030)Emergency Care - Ambulatory Care 0.140 0.107 -0.033 0.117 0.087 (0.030)Grand Total 12.652 12.585 (0.067) 10.543 10.293 (0.250)
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7. Key Performance Indicators (KPI’s Month 10)
Appendices:
Appendix A: Statement of Financial Position - - Available on request. Appendix B: Cash Position and Forecast - Available on request. Appendix C: BPPC detail - - Available on request.
Plan £'m Act £'m Var £'m Plan £'m Act £'m Var £'mSurplus/Deficit - 0.0 0.0 - - - Non RCA 367.1 367.1 - 503.0 502.5 0.5- RCA 6.4 6.3 0.1- 7.6 7.6 - Total 373.5 373.4 0.1- 510.6 510.1 0.5- QIPP Delivery 10.5 10.3 0.3- 12.7 12.6 0.1- Indicator YTD CumulativeBPPC NHS - Inv No's 95% 99% 4% 95% 96% 1%BPPC NHS - Inv Value 95% 100% 5% 95% 95% 0%BPPC Non NHS - Inv No's 95% 96% 1% 95% 95% 0%BPPC Non NHS - Inv Value 95% 99% 4% 95% 98% 3%
Month 10 Cumulative
YTD Rating
Forecast Rating
Key Performance Indicators - Month 10
IndicatorYear To Date Full Year Plan
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Newham CCG Board Meeting Thursday 28 February 2019
Unex Tower, 4th Floor
Title Integrated Quality and Performance Report
Agenda item 3.2
Author Saem Ahmed, Newham CCG, Head of Quality and Development Justin Roper, Newham CCG, Associate Director of Quality Lisa Clarkson, Newham CCG, Head of Quality Jeanette Weismann, Newham CCG, Head of Quality Marie Trueman-Abel, Head of Commissioning & Transformation – Maternity & Children
Presented by Fiona Smith, Newham CCG, Chair of Quality, Performance and Finance Committee
Contact for further information
Justin Roper, Associate Director of Quality NHS Newham CCG - [email protected]
Saem Ahmed, Head of Performance and Planning NHS Newham CCG – [email protected]
This paper is for ☐ Decision ☐ Monitor ☒ Discussion ☒ For Information
Action required The Board is asked to Discuss the content of the report.
There are no issues identified with regard to this report from the Quality, Performance and Finance Committee that require escalation to the Board.
Executive summary
The report asks the Board to:
- Note the key quality and performance exceptions of Barts Health.
- Note the key quality and performance exception of East London Foundation Trust
(Mental Health).
- Note the key quality and performance exceptions of East London Foundation Trust
(Community Health).
- Note the other quality matters.
Supporting papers Appendix A: Integrated Quality and Performance Board Report
Next Steps/ Onward Reporting
No further steps.
Where has the paper been already presented?
The report was presented to the January 2019 Quality Performance and Finance Committee.
43
How does this fit with NHS Newham CCG strategic priorities?
This paper fits with the following priorities and outcomes:
Strategic priorities:
• To commission a Newham-based integrated health and care system whichdelivers high quality services for the residents of Newham, in accordancewith statutory requirements
• To commission and develop GP services that are modern, accessible and fitfor the future in caring for our residents.
Enabling priorities:
• Making sure our governance is fit for purpose
• Ensuring we maintain our performance across the key business areas.
Outcomes:
• We will spend the Newham pound wisely, ensuring value for money andmaintaining financial balance
• We will have a borough-based Integrated Care System that is utilised,understood and valued by our residents
• We will ensure we plan, design, and commission accessible high qualityservices for our residents with our residents
• We will improve access to, and the quality of, Primary Care
• We will clearly be able to demonstrate how we have improved outcomes forour residents
• We will promote equality as a commissioner of health services and as anemployer.
How does this fit with NHS Newham Values and Behaviours
We put residents at the heart of everything we do
We value people
We are transparent
We are ambitious and innovative
Risk BAF.05 Failure to effectively monitor the quality of commissioned services,with a focus on ensuring the delivery of better clinical outcomes.
BAF.06 Failure to effectively monitor the performance and activity ofcommissioned services, with a focus on ensuring the delivery of betterclinical outcomes.
Equality impact This document relates to all Newham residents in the 9 protected characteristics that are covered by the Equality Act 2010 and our Equality Duties.
Stakeholder engagement
No consultation has taken place nor is this required for this report.
Financial Implications
This paper outlines to the committee an update of quality and performance indicators against various services commissioned by the CCG. There are no financial implications to the CCG as indicated by the paper.
44
1. Introduction and background
1.1
1.1.1
1.1.2
Month 9 Integrated Quality and Performance Report The November 2018 Integrated Quality and Performance Report provides an update against the reported quality and performance indicators for the providers from which Newham CCG commissions health services in addition to providing an update on other quality and performance related matters.
The report covers the following providers:
Barts Health
East London Foundation Trust (Mental Health)
East London Foundation Trust (Community Health).
This paper was presented at the Quality Performance and Finance Committee in January 2019 and there are no issues identified with regard to this report that require escalation to the Board.
2. Report
2.1
2.1.1
2.1.2
Barts Health / Newham University Hospital Trust The key headlines in relation to Barts Health are:
• 2 Week Cancer Wait Performance exceeded the 93% target for the three most recentmonths (September, October and November 2018)
• A&E Performance continues below trajectory, however, Newham site continues to performbetter than Trust overall
• To support Barts Health around their RTT performance, a capacity alert has been issued toNewham GP practices to consider alternative providers with shorter waiting times
• Following the September and October 2018 CQC inspections of Barts Health NewhamHospital, it is expected that the CQC report will be published in February 2019.
East London Foundation Trust – Adult Mental Health The key exceptions in relation to Mental Health are:
• % of CMHT patients assessed within 28 days has returned to target performance compared to previous months
• Proportion of patients seen within 4 hours of referral to DoPM has seen continued good performance
• Adult re-admissions within 28 days - Newham continues to face a very high rate of admissions, with a similarly high discharge rate (up to 50% higher than neighbouring ELFT directorates)
• Older adult re-admissions within 28 days - 33.3% re-admission rate relates to 1 of 3 patients admitted in the month.
East London Foundation Trust – Adult Community Health
The key exceptions in relation to Community Health are:
• Foot Health % of urgent referrals seen within 2 working days - This relates to two serviceusers
• Diabetes % of referrals seen within 6 weeks in line with service specification/clinical practice- While the Diabetes is reporting below the target, it is in line with the performance trajectorypreviously agreed
• Community Neuro – please note that these KPIs have been redesigned. It is proposed thatthe KPIs reported to QPFC are reviewed in the new financial year once the new KPIs havebeen agreed.
Details of ELFT Community Health Service issues are included in the report.
45
2.1.3
2.1.4
ELFT CAMHS and Children’s Services:
• The CCG is working with LBN and ELFT to review the pathway and processes for healthassessments for LAC children
• The CCG is developing a peer review quality assurance visit process to co-inside withCHQRMs
• Children’s Services OT Performance exception report on slide 11 outlines reasons forunderperformance and actions taken by ELFT and CCG to address the issues with timelines.
London Ambulance Service (LAS)
Quarterly update not yet due
46
Integrated Quality and
Performance Report
January 2019Saem Ahmed
Lisa Clarkson
Jeanette Weismann
Marie Trueman-Abel
Justin Roper
47
Barts Health and Newham Site
Significant changes from previous reporting position:
• No further significant changes from previously reported position.
CQC Domains Outcome Site/Service KPI Indicator Target Apr May Jun July Aug Sep Oct Nov
Barts Health/Newham University Hospital Trust
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Barts Health 18 Weeks RTT Incomplete Pathways 92% 84.2% 84.7% 85.1% 85.4% 85.3% 83.9% 84.3%
Barts Health Incomplete over 52 week waits 0.0 36 37 63 60 50 71 46
Barts Health Diagnostics over 6 weeks 1% 0.5% 0.3% 0.3% 0.5% 0.9% 1.0% 1.0%
Barts Health 2 Week Cancer Wait 93% 98.0% 95.2% 95.8% 95.3% 91.9% 94.0% 95.3% 96.0%
Barts Health 2 Week Cancer Wait: Breast Symptoms 93% 94.4% 93.2% 93.2% 99.4% 95.4% 96.8% 99.4% 99.6%
Barts Health 31 day Cancer Wait: 1st definitive treatment 96% 99.3% 99.4% 98.9% 98.6% 99.3% 98.7% 99.6% 99.3%
Barts Health 31 Day Cancer Wait: Subsequent treatment (Surgery) 94% 97.3% 97.7% 99.0% 97.4% 98.4% 100.0% 100.0% 79.0%
Barts Health 31 Day Cancer Wait: Subsequent treatment (Chemotherapy) 98% 100.0% 100.0% 99.5% 100.0% 100.0% 99.1% 100.0%100.0%
Barts Health 31 Day Cancer Wait: Subsequent treatment (Radiotherapy) 94% 97.6% 98.5% 100.0% 99.3% 98.5% 96.9% 99.3% 98.5%
Barts Health 62 Day Cancer Wait: GP Referral 85% 87.4% 87.9% 86.1% 85.7% 86.7% 86.2% 86.7% 88.4%
Barts Health 62 Day Cancer Wait: Screening service 90% 94.3% 90.0% 100.0% 93.8% 100.0% 90.0% 100.0% 92.9%
Barts Health A&E All Types Performance 95% 86.2% 87.6% 87.6% 87.4% 87.4% 87.1% 86.5% 85.9%
Newham University Hospital A&E All Types Performance 95% 90.4% 93.1% 91.6% 88.0% 91.0% 89.3% 90.6% 89.1%
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Site/Service Quality Indicator Target Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov
Barts Health C. Difficile <82 2 0 0 10 4 0 5 1 4 8 3
Barts Health MRSA 0 0 1 1 0 0 0 0 0 0 0 1
Newham University Hospital Never Events reported 0 1 0 0 0 0 0 0 0 0 0 0
Barts HealthReported Amber Alerts (by
Newham GPs)- 27 18 22 19 5 12 19 25 20 16 8
Newham University Hospital Serious Incidents reported - 5 4 6 4 3 2 5 7 2 12 17
Barts HealthMixed Sex Accommodation
(MSA) breaches0 17 17 15 17 27 16 23* 33 25 20 28*
Newham University HospitalMixed Sex Accommodation
(MSA) breaches
06 7 5 9 0 6 4 8 12 9 13*
Newham University Hospital VTE Risk Assessment 95% 95.7% 95.1% 95.4% 96.7% 96.8% 95.5% 91.9% 95.3% 94.6% 96.1% 95.4%
Significant changes:
• None of the 3 cases of C. Difficile reported by the Barts Health was reported by NUH, all 3 were at WXH
• MRSA – the 1 case of MRSA reported was at RLH.
• Amber Alerts reported in month: discharge summaries not received or incomplete, referral not actioned, rejected radiology requests, inappropriate transfer of
workload, in keeping with longer-term trends
• Serious Incidents – 4 of the 17 SIs reported in November were at NUH: Pressure Ulcer, Sub-optimal care, HCAI Infection and Diagnostic Incident.
• MSA – there is a discrepancy between the number of breaches reported for November 2018 on NHSE MSA data collection and Trust Board papers – the figures
above are taken from the NHSE data collection, however, the Trust Board papers show a total of 27 breaches Trust-wide, with 9 for NUH. The Associate Director of
Nursing for the area in which the majority of breaches occur (ITU) has developed a framework and process for improving step down from ITU to wards. The site
continues gradual refurbishment of wards, which has an impact on the number of beds available, as does winter pressures.
Barts Health and Newham Site
49
Site Visits: due to CQC attendance no visits have taken place recently with NUH
Barts Health and Newham Site Quality Assurance Activity
Other:
CQC report from the inspections of September / October 2018 is awaited in February 2019.
Contractual meetings:
December NUH CQRM – Patient and staff experience, including junior doctors and student nurses and midwives, were the main agenda topics. Cancer patient
experience survey was released in September. Progress has been made in the recruitment of Clinical Nurse Specialists (CNS) since the previous CQRM where this
was reviewed, which has an impact on patient experience. GMC junior doctors’ survey showed positive results for the Trust and site compared to national results, with
more positive outliers than negative
Barts Health KPI / CQUIN meeting December 2018 included deep dive into maternity services, presented by Director of Maternity, discharge summaries. Stoke /
swallowing screening deep dive was deferred to January. Members of the Barts Health Sepsis team attended to review CQUIN audit requirements in terms of number
of notes per month per site. No issues were escalated to CRG.
December 2018 Newham site / CCG Maternity Quality Meeting – third meeting of the group, membership expanded to include Director of Midwifery for Barts Health.
DoM noted the challenge of changing the culture of the service and the long-term focus and staff engagement that is required, updated on the progress made with data
accuracy issues, as well as challenges of increasing take up of the Barking Birth Centre.
December 2018 Urgent Care Centre – following discussion of low patient safety incident reporting at the previous meeting, it was positively noted that this had
increased. No Serious Incidents had been reported, but one incident was currently under review for SI criteria. The unit continues to struggle with FFT response rates,
which is a Trust-wide issue related to a change to a new provider. GP feedback about inaccurate discharge summaries was shared with the UCC with a request that
this be addressed to improve safety.
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ELFT - Adult Mental HealthCQC Domains Outcome Site/Service KPI Indicator Target Apr May Jun July Aug Sept Oct Nov
East London Foundation Trust - Mental Health
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it Inpatient Services Adult Delayed Transfer of Care 2.5% 0.0% 0.5% 1.7% 1.3% 1.5% 1.4% 0.0% 0.3%
Inpatient Services Older Adult Delayed Transfer of Care 2.50% 0.0% 0.0% 0.6% 0.6% 0.0% 0.0% 0.0% 0.0%
Crisis Resolution and Home TreatmentReferral to assessment within 24 hours (Face to face or
Telephone)80% 89.7% 88.0% 83.3% 90.0% 88.6% 88.3% 87.2% 85.9%
Early Intervention (EI)
% of People with a first episode of psychosis seen and
allocated to EIS with a NICE-recommended package of
care within 2 weeks of referral
50% 100.0% 77.8% 91.7% 80.0% 72.7% 83.3% 50.0% 72.7%
Community Mental Health Team (CMHT) % of CMHT patients assessed within 28 days 95% 83.5% 98.0% 97.0% 84.5% 66.3% 70.4% 76.2% 96.2%
Older Adult Community Services % of new older adult patients assessed within 28 days 95% 93.3% 100.0%100.0%100.0% 93.8% 100.0% 90.0% 93.3%
Psychological Therapy Service Percentage of PTS patients starting treatment within 18
weeks (referral to commencement of treatment)95% 66.1% 70.6% 79.4%
Community Mental health ServiceProportion of discharges from hospital followed up within
7 days (%)95% 88.8% 92.5% 92.4% 91.7% 90.0% 91.1% 89.1% 87.6%
Emergency MH Liaison ServicesProportion of patients seen within 4 hours of referral
to DoPM 95% 100.0%100.0%100.0%100.0% 89.0% 94.0% 100.0%100.0%
Cari
ng
/Resp
on
siv
e/ W
ell
Led
Serv
ice u
ser
exp
eri
en
ce is
po
sit
ive
wh
en
th
ey
access t
he
serv
ice Inpatient Services Adult re-admissions within 28 days 7.5% 5.3% 7.4% 10.1% 8.2% 7.0% 4.8% 8.6% 9.3%
Inpatient Services Older Adult re-admissions within 28 days 7.5% 14.3% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 33.3%
Safe
/ W
ell L
ed
Serv
ices u
ser
is s
afe
wh
en
th
ey a
ccess t
he
serv
ice
Adult Inpatient ServicesDischarge notification sent to GP within 48 working hours
of patient's discharge (95%)95% 96.9% 98.2% 97.5% 99.3% 98.5% 98.0% 98.1% 98.3%
Community Mental health Service
% of patients whose CPA review letter/Care plan/
electronic discharge summary is sent to GP within 2
weeks of CPA review
90% 100.0%100.0% 87.5% 99.7% 99.8% 99.6% 99.8% 99.8%
Adult Inpatient Services
Reduction of medication errors through medicines
reconciliation on admission to hospital- 95% Medicine
reconciliation within care plans within 72hours of
admission
95% 97.1% 98.4% 98.9% 94.2% 95.6% 96.1% 97.5% 95.7%
Significant changes:• % of PTS patients starting treatment within 18 week – The Trust continues to make improvements with the development of the new care model. There were 6 breaches noted in November and
following local validation of the data, these were due to: one was an error with the referral paperwork which has been resolved and a contact provided, two seen on 30 November did not have
their RiO record captured in time for this report; and three were client delays, meaning that the Service Users had been contacted and offered appointments but they had not attended.
• Proportion of discharges from hospital followed up within 7 days (%) - 10 breaches of the total 107 discharges due to: multiple attempts to phone, but no answer. Staff are being asked to
confirm all patients’ details prior to discharge and update RIO accordingly to ensure current phone numbers are recorded. The Trust are also exploring ways of removing “withheld number”
status from their landline calls as some service users do not pick up withheld numbers and therefore we are not able to engage with users.
• Adult re-admissions within 28 days - Newham continues to face a very high rate of admissions, with a similarly high discharge rate (up to 50% higher than neighbouring ELFT directorates). One
patient was re-admitted 4 times. She has a diagnosis of personality disorder and is under the care of another Trust. She requires a multi-trust, multi-agency management plan that has recently
been updated with a view to reducing her admission rate. Excluding this patient as an exception would mean the underlying readmission rate is 6%.
• Older adult re-admissions within 28 days - 33.3% re-admission rate relates to 1 of 3 patients admitted in the month. This was a 91 year old patient presenting with psychotic symptoms. She was
admitted informally at Mile End hospital after presentation at A&E. it was considered that this was not a suitable setting for this patient so was discharged home with support. The family
reported being unable to cope and she was readmitted and is undergoing a dementia assessment.
51
Contractual meetings:
• November SPR – update on PTS (Psychological Therapies Service) progress Newham is still seeing an improvement in wait times. Themed report provided in relation
to Enhanced Primary Care Services.
• November CQRM – the meeting covered the following: visit to Newham Centre for Mental Health in October, deep dive into serious incidents and medication incidents,
medicines management audit, adult readmissions and frequent attenders group.
ELFT - Adult Mental Health
Site/Service Quality Indicator Target Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov
Mental Health (Corporate) Reported Amber Alerts - 0 0 0 0 0 0 0 0 0 0 0
All (Corporate)Reported Serious Incidents
(Newham)- 1 1 1 1 1 1 3 4 2 0 1
52
ELFT - Adult Community Health
Significant changes:
• Foot Health % of urgent referrals seen within 2 working days - This relates to two service users. One service user declined the appointment offered within 2 days and was seen on
the fourth day. The second service user was advised to go to Hospital due to the severity of their condition.
• Diabetes % of referrals seen within 6 weeks in line with service specification/clinical practice - While the Diabetes is reporting below the target, it is in line with the performance
trajectory previously agreed.
• Community Neuro – please note that these KPIs have been redesigned. It is proposed that the KPIs report to QPFC are reviewed in the new financial year once the new KPIs have
been agreed.
CQC Domain Outcome Site/Service KPI Indicator Target Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov
East London Foundation Trust – Adult Community Health Indicators
Eff
ec
tive
/We
ll L
ed
Se
rvic
e u
se
r is
ab
le t
o a
cc
es
s s
erv
ice
s w
hen
th
ey n
ee
d
it
Foot Health Service% of urgent referrals seen within 2 working
days90% 66.0%
100.0
%
100.0
%
100.0
%
100.0
%
100.0
%
100.0
%
100.0
%
100.0
%
100.0
%67.0%
Foot Health ServiceOver 18 weeks of patients with waiting times
between referral & first appointment (%)0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%
EPCT% of urgent referrals (within 24 hours)
responded to within 24 hours90%
100.0
%
100.0
%
100.0
%
100.0
%
100.0
%
100.0
%
100.0
%
100.0
%
100.0
%
100.0
%
100.0
%
EPCT% of routine referrals (within 72 hours)
responded to within 72 hours90%
100.0
%
100.0
%
100.0
%
100.0
%
100.0
%
100.0
%
100.0
%
100.0
%
100.0
%
100.0
%
100.0
%
Community Neuro % of stroke patients seen within 24
hours/NWD100%
100.0
%85.7%
100.0
%
100.0
%
100.0
%
100.0
%
Community Neuro % of patients receiving treatment within 2
weeks of referral90% 84.6% 72.4%
100.0
%
100.0
%95.0% 95.7%
Diabetes% of referrals seen within 6 weeks in line with
service specification/clinical practice.90% 82.0% 68.8% 32.1% 32.8% 35.6% 38.4% 57.0% 63.6% 53.0% 88.0% 78.0%
Diabetes% of urgent referrals seen within 2 working
days100% 92.0% 97.0%
100.0
%64.7% 92.9%
100.0
%
100.0
%
100.0
%
100.0
%
100.0
%
100.0
%
53
ELFT– Adult Community Health
Contractual meetings:
• November SPR – the KPIs, server migration and ELFT’s data quality audit were discussed. The winter resilience plans were also discussed including use of the East Ham Care
Centre and Flu vaccinations.
• November CQRM – recommendations arising from visits to diabetes services discussed and actions agreed. Deep dives presented in relation to serious incidents. Joint action
plan with the Local Authority and medication management audit also reviewed.
Site Visits:
Community Stroke and Neuro Rehab service quality assurance visit took place in November this was discussed at Decembers CQRM. Recommendations include:
• Service to report on SSNAP data.
• Service to be invited to partake in annual stroke peer review visit.
Site/Service Quality Indicator Target Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov
Community Health (Corporate) Reported Amber Alerts - 0 3 2 1 0 0 2 1 1 2 2
Incidents reported by month
under ELFT Care - Adults
Services
Pressure Ulcers Grade 3 and 4 - 5 8 8 2 2 2 3 17 12 6
All (Corporate) Reported Serious Incidents - 0 0 1 1 2 0 0 2 0 1 0
54
CQC
DomainOutcome Site/Service KPI Indicator
Targ
et Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov
East London Foundation Trust – CAMHS and Children’s Services
Eff
ecti
ve/W
ell L
ed
Serv
ice u
ser
is a
ble
to
access s
erv
ices
wh
en
th
ey n
eed
it
CAMHS Patients seen within 9 weeks (%) 95% 89.7%86.7%93.8%85.5% 88.2%85.1
%95.5%93.6%93.4%93.9%97.0%
Child Development Centre% of patients seen within 4 weeks between
referral and first appointment <5% 2.7% 5.7% 7.0% 3.3% 2.2% 5.9% 1.5% 8.5% 7.0% 6.9% 4.7%
Child Development Centre% of patients seen within 18 weeks
between referral and first appointment
100
%98.3% 84.4% 89.4% 85.1% 98.6% 97.7% 96.6% 98.8%
Children’s Occupational Therapy % of patients seen within 6 weeks between
referral and first appointment 40% 33.3% 21.7% 32.4% 24% 28% 28% 25% 58.3% 28.6% 25.0% 16.0%
Children’s Occupational Therapy % of patients seen within 18 weeks
between referral and first appointment
100
%95% 100% 89.2% 53.6% 25.5% 38.0% 45.0% 40.0%
Cari
ng
/
Res
po
ns
i
ve
/ W
ell
Le
d
Se
rvic
e
us
er
ex
pe
rie
nc
e is
po
sit
ive
wh
en
the
y
ac
ce
ss
the
se
rvic
e
Children’s Occupational Therapy
% of children who have shown
improvement on agreed Therapy Outcome
Measures following direct intervention
80%100.0
%
100.0
%
100.0
%89% 100% 100% 86% 81.8% 100% 86.0% 100%
ELFT - CAMHS and Children’s Services
Significant Changes: Reasons provided by ELFT for underperformance
Children’s Occupational Therapy - The number of referrals into the OT service has increased by 8% from 14/15 to 17/18 and the number of face to face
contacts increased in the same period by nearly 9%. There have been issues with vacancies (maternity leave and vacancies), there have also been
issues with recruitment to band 6 posts which is a London wide problem. To address the issues ELFT have reduced session times from 60 minutes to
45 minutes to allow for more appointment slots, developed joint pathways with other therapy teams to reduce the number of appointments that families
have to attend, increased the use of telephone reviews and parental workshops, and developed a resource pack for schools. The trust are reviewing
the skill mix and looking at recruiting band 5 rather than band 6 staff with appropriate development support and oversight being put in place. The CCG
has reviewed the KPI’s for ELFT Children's OT for 18/19, this has included a requirement for children’s services to report on caseload numbers rather
than just referral numbers in order to understand capacity issues and enable benchmarking.
55
Contractual meetings:
• November SPR – the KPIs were discussed. There was also a discussion regarding the ongoing demand and capacity work which has been described above.
• November CHQRM – Focus on the SEND work being undertaken within the CCG, across provider services and by the Local Authority.
ELFT CAMHS and Children’s Services
Other:
• The CCG is working with LBN and ELFT to review the pathway and processes for health assessments for LAC children.
• The CCG is developing a peer review quality assurance visit process to co-inside with CHQRMs.
56
Newham CCG Board Thursday 28 February 2019
Committee Rooms, 4th Floor, Unex Tower
Title Board Assurance Framework
Agenda item 3.3
Author Jason Clarke, Risk and Information Governance Manager, NHS Newham CCG
Presented by Ajith Lekshmanan, Lay Member Governance & Audit Committee Chair, NHS Newham CCG
Contact for further information
Satbinder Sanghera, Director of Partnerships and Governance, NHS Newham CCG
This paper is for ☒ Decision ☐ Monitor ☐ Discussion ☐ For Information
Action required Make a decision: The current BAF risk ratings, as noted in 2.1.2.
Note for Information: The next steps listed in section 3.
Executive summary
The report asks the Board to agree the current position of the CCG’s Board Assurance Framework. Since the last report to the Board in December 2018, there has been a reduction in two BAF risks, as highlighted in section 2.2 of this paper.
Supporting papers No supporting papers.
Next Steps/ Onward Reporting
NCCG Board for approval – April 2019.
Where has the paper been already presented?
No previous presentation to any previous meetings/forums.
How does this fit with NHS Newham CCG strategic priorities?
Strategic priority:
To commission a Newham-based integrated health and care system whichdelivers high quality services for the residents of Newham, in accordance withstatutory requirements.
Enabling priority:
Making sure our governance is fit for purpose.
57
Risk
Inadequate governance arrangements, and/or failure to operate a robust risk management system would expose the organisation to the risk that the CCG would be unable to manage and mitigate identified risks or barriers to achieving its stated priorities. An ineffective risk management approach is likely to have a detrimental impact on our head of internal audit opinion and also our Accountable Officer’s annual review of the effectiveness of governance, risk management and internal controls.
Equality impact The CCG has a strong and unequivocal commitment to promoting equality for all our
communities. We believe that Newham CCG should be an exemplar of good practice and able to demonstrate consistently that we are innovative and at the forefront of pushing boundaries for greater equality. We think that our approach to patient and public engagement provides a blueprint for our work because our PPE work has now began to be mainstreamed across all commissioning activity. We consider equalities to be integrally linked to quality and our PPE approach and over the next year we will be looking at how we can mainstream within quality and PPE, our equalities objectives. The CCG expects that the next stage of our PPE work will focus on a more flexible approach intrinsically linked to commissioning activities and the equalities will be central to that, likewise the work on quality processes and indicators and improvement will encompass equalities considerations. The CCG has reviewed the EDS2 (Equality Delivery System) that sets out the CCG’s Equality Objectives, undertaken an equalities analysis of policies and services and set out the work that we will be undertaking with patient, stakeholders and providers. The Board has agreed a revised Equalities Strategy that commits the CCG to SMART actions underlined with the approach identified above that will aim to ensure that equalities is embedded within the organisation. A key action will be to communicate to all commissioning committees their responsibility in relation to equalities impact assessments and targets and to monitor their compliance.
Stakeholder engagement
No previous stakeholder engagement has taken place.
Financial Implications
The CCG faces reputational and financial risk if the risks identified in this paper are not sufficiently mitigated. Plans outlined in this paper address these issues, however inherent financial risk remains.
58
1. Introduction and background
1.1
1.1.1
Introduction
The Board Assurance Framework (BAF) is the primary mechanism by which the Board of NHS
Newham CCG is appraised and updated on material risks which may affect the CCG’s ability to
deliver its strategic objectives as set out in the Operating Plan.
2. Board assurance framework
2.1
2.1.1
2.1.2
NHS Newham CCG Board assurance framework
The Board received a paper at the June 2018 meeting outline the revised approach to the
management and presentation of the BAF to the Board. This included revising the risk target dates
and the addition of BAF.10 relating to the North East London Commissioning Alliance (NELCA)
governance arrangements. Each BAF report presented to the Board notes the link between the BAF
risks, the CCG’s strategic objectives and the supporting key enablers, as noted in the table in 2.1.3.
BAF heatmap
The current BAF heat map is as follows:
Current Board Assurance Framework risk ratings
BAF risk Lead
committee
Strategic
priority
Enabler Dependencies Current
Risk
Target Risk
BAF.01 – Failure
to meet NHS
Constitutional
standards.
Quality,
Performance
and Finance
Committee
1 4 BAF.02
BAF.06
BAF.08
BAF.10
16 12
(31/03/19)
BAF.02 – Failure
to effectively meet
the CCG’s
financial targets
and savings plans
in 2018/19
Executive
Committee
1, 2 2 BAF.01,
BAF.04
BAF.07
BAF.09
BAF.10
10 10
(31/03/19)
59
BAF.03 Failure to
implement the key
programmes
within the
Sustainability and
Transformation
Plan and
therefore failure to
achieve the
system control
total
Executive
Committee
1,2 4 BAF.01
BAF.07
BAF.08
16 8
(31/03/19)
BAF.04 – Failure
to effectively
integrate health
and social care by
progressing
Building Healthy
Communities
programme and
the development
of an Integrated
Care System
(ICS)
Commissioning
Committee
1, 2 4 BAF.02
BAF.07
BAF.08
BAF.10
16 8
(31/10/2019)
BAF.05– Failure
to effectively
monitor the
quality,
performance and
activity of
commissioned
services, with a
focus on ensuring
the delivery of
better clinical
outcomes.
Quality,
Performance
and Finance
Committee
1,2 4 BAF.01
BAF.06
4 4
(30/06/2019)
BAF.06 – Failure
to effectively
monitor the
performance and
activity of
commissioned
services for all
health care
providers, with a
focus on ensuring
the delivery of
better clinical
outcomes.
Quality,
Performance
and Finance
Committee
1,2 4 BAF.01
BAF.05
4 4
(30/06/2019)
60
BAF.07– Failure
to effectively
develop a primary
care strategy that
is adequately
resourced to
serve Newham
residents and
secure a
sustainable and
viable GP
Federation.
Primary Care
Commissioning
Committee
2 1,3,4 BAF.02
BAF.04
BAF.06
BAF.09
BAF.10
16 8
(30/11/19)
BAF.08 – Failure
to effectively
develop and
implement the re-
designed urgent
care pathway and
understand the
interdependencies
with the NHS 111
procurement
Failure to
effectively
develop and
implement the re-
designed urgent
care pathway and
understand the
interdependencies
with the NHS 111
procurement
Commissioning
Committee
2 1,3,4 BAF.01
BAF.02
BAF.07
BAF.10
16 8
(30/06/19
09 – Failure to
equip staff, the
Board and clinical
leaders with the
skills, knowledge
and expertise to
enable the
delivery of the
CCG’s priorities
and
commissioning
agenda.
Executive
Committee
1, 2 3 BAF.03
BAF.04
8 4
(31/07/19)
BAF.10 – Failure
to implement the
proposed NEL
commissioning
arrangements in
the interests of
Newham.
Executive
Committee
1,2 1,2,3,4 BAF.01
BAF.03
BAF.04
BAF.07
BAF.08
8 8
(30/09/19)
61
2.2
2.2.1
2.2.2
Changes since the last board report
Since the Board report in December 2018, there has been a reduction in two BAF risks. These are as
follows:
BAF.02 – Failure to effectively meet the CCG’s financial targets and savings plans in 2018/19.
Management response: The Month 10 report outlines the financial position of the CCG as at 31
January 2019. Overall, the CCG is reporting breakeven year to date and is currently projecting a
surplus of £0.5m at year end after the utilisation of all of our available reserves.
Successful implementation of our QIPP and savings programmes, combined with effective
management of agreed budgets, is the key to deliver our financial target and maintain
sustainability. The Finance Team is working closely with our budget holders and staff to ensure we
can deliver our financial commitments and support the wider health economy.
BAF.06 – Failure to effectively monitor the performance and activity of commissioned services
for all health care providers, with a focus on ensuring the delivery of better clinical outcomes
Management response: The terms of reference for the suite of meetings to manage the
performance of the CHS contract have been updated following a number of concerns around the
reporting and escalation of performance concerns.
Additionally, the remit of the technical sub group has now been narrowed, and is primarily focused on
data quality and technical matters such as EMIS and coding.
The KPI schedule and discussions around performance all take place at the SPR. This facilitates a
more comprehensive discussion around service performance as more senior staff from both
organisations attend.
3. Next steps
3.1
3.2
Board assurance framework audit
The CCG’s board assurance framework is currently underway. Through the audit, the CCG will be
seeking to gain assurance from the auditors that our risk management approach remains fit for
purpose. The outcome of this audit will support the head of internal audit opinion in our 2018/19
annual report and our 2018/19 assurance process with NHS England. The outcome of the audit will
also allow us to shape our risk management work plan for 2019/20 and support our committees in
managing their associated risks in a more cohesive manner.
NHS Newham CCG 2019/20 strategic objectives
At the CCG board development sessions in December 2018 and January 2019, the Board began to
facilitate the conversation regarding the proposed 2019/20 strategic objectives. The January 2019
session included colleagues from Newham Healthcare Collaborative (NHC) and East London
Foundation Trust (ELFT) with a view to ensuring that there is joined up thinking regarding the
management and approach to key risks which affect the local health economy.
The governance team will be working with the lay members to ensure that our BAF effectively
addresses the risks to the delivery of our strategic objectives and ensures that the focus of the
conversation at committee and board meetings remains effective and fit for purpose.
62
Newham CCG Board meeting Thursday 28 February 2019
Committee rooms, 4th floor Unex Tower
Title Children’s Safeguarding – Statutory requirements for Child Death Reviews
Agenda item 3.4
Author Chetan Vyas, Director of Quality and Development, NHS Newham CCG
Presented by Chetan Vyas, Director of Quality and Development, NHS Newham CCG
Contact for further information
Chetan Vyas, Director of Quality and Development, NHS Newham CCG
This paper is for ☒ Decision ☐ Monitor ☐ Discussion ☒ For Information
Action required The Board are asked to:
NOTE the direction of travel outlined in this report
AGREE to delegating the formal approval of any partnership to the Quality,Performance and Finance Committee who will provide appropriateassurances to the NCCG Board.
Executive summary
The Children and Social Work Act (2017), Working Together: transitional guidance (2018) and the subsequent Child Death Review Statutory and Operational Guidance (updated January 2019) set out how Local Authorities and Clinical Commissioning Group are required to come together as Child Death Review Partners.
This will result in a change to the way the current Child Death Overview Panel are required to function and each Partner is required to agree and publish their new arrangements by 29 June 2019. Under the old guidance the process was under the remit of the London Borough of Newham.
Discussions have commenced and continue across the Waltham Forest and East London (WELC) footprint to explore the possibility of developing a WELC Child Death Review Panel.
Supporting papers N/A
Next Steps/ Onward Reporting
Quality, Performance and Finance Committee for support – February 2019
Quality, Performance and Finance Committee for approval - March 2019
NCCG Board – for approval – April 2019
Publish new ways of work by June 2019.
63
Where has the paper been already presented?
No previous presentation to any previous meetings although content and direction of travel has been discussed at the:
Joint Health Safeguarding Sub-Group – 20 November 2018
Joint Health Safeguarding Sub-Group – 5 February 2019
A WELC Child Death Review meeting proposing the direction of travel – 24January 2019.
How does this fit with NHS Newham CCG strategic priorities?
Strategic Priorities:
• To commission a Newham-based integrated health and care system whichdelivers high quality services for the residents of Newham, in accordancewith statutory requirements.
Enabling Priorities:
• Securing financial stability
• Ensuring we maintain our performance across the key business areas.
Outcomes:
• We will have a borough based Integrated Care System that is utilised,understood and valued by our residents
• We will ensure we plan, design, and commission accessible high qualityservices for our residents with our residents.
How does this fit with NHS Newham Values and Behaviours
We put residents at the heart of everything we do
We value people
We are transparent
We are ambitious and innovative
Risk BAF.05 Failure to effectively monitor the quality of commissioned services,with a focus on ensuring the delivery of better clinical outcomes.
BAF.06 Failure to effectively monitor the performance and activity ofcommissioned services, with a focus on ensuring the delivery of betterclinical outcomes.
Equality impact This document relates to all Newham residents in the 9 protected characteristics that are covered by the Equality Act 2010 and our Equality Duties
Stakeholder engagement
Joint Health Safeguarding Sub-Group – 20 November 2018
Joint Health Safeguarding Sub-Group – 5 February 2019
A WELC Child Death Review meeting proposing the direction of travel – 24January 2019.
Financial Implications
Newham CCG faces a significant financial challenge in 2018/19 and is undertaking a range of measures to ensure sustainability. This paper presents issues that may have financial consequences. These are yet to be fully determined but if not already embedded in budgets or reserve provision, a further Board decision would be required to release any additional expenditure commitment.
64
1. Purpose
1.1 The purpose of this report is to:
Inform the Board with regards to the new Children’s Safeguarding multi-agency arrangements
Inform the Board how the new multi-agency arrangements will have an impact upon the CCG
Update the Board on progress made to date with regards to the new Child Death Review
arrangements.
2. Context
2.1
2.1.1
2.1.2
2.2
2.2.1
The purpose of setting out key features of a robust child death review process is to enable the
standardisation of outputs from Child Death Reviews as much as possible.
This in turn should enable effective thematic learning from reviews, i.e. a local review may be able to
identify specific learning but trends analysis at a national level may identify modifiable factors that
could be altered to prevent future deaths.
Indeed, the aim of the published Child Death Review; Statutory and Operational Guidance (England)
(Updated January 2019) is to do this by setting out standardised approaches to:
Immediate decision making and notifications
Investigating and information gathering
The child death review meeting
The Child Death Overview Panel
Family engagement and bereavement support.
Legislative Context
The Children and Social Work Act (2017), Working Together: transitional guidance (2018) and the
subsequent Child Death Review Statutory and Operational Guidance (updated January 2019) set
out how Local Authority areas must begin their transition from Local Safeguarding Children’s Boards
to a new system of multi-agency arrangements and local and national child safeguarding reviews.
At the latest the new safeguarding and child death review arrangements must be in place by 29
September 2019
3. Impact to NHS Newham Clinical Commissioning Group
3.1
3.1.1
3.1.2
3.1.3
This new way or working, while not new to the CCG, will formally mean the CCG becomes a
statutory partner in the new multi-agency way of working.
This does not materially differ to existing working arrangements and the CCG are already a statutory
partner to the Local Safeguarding Children’s Board and a key contributor through the multi-agency
Safeguarding Executive Group (with the Local Authority and the Metropolitan Police)
Child Death Review; Statutory and Operational Guidance (England) (Updated January 2019) states
that the child death review footprint, while locally agreed, should typically cover 60 child deaths per
year, thereby enabling appropriate thematic learning to take place. This means that any future Panel
needs to be across a wide geographical footprint than just Newham.
At the time of writing this paper the author is lead to believe that the Barking and Dagenham,
Havering and Redbridge (BHR) geographical footprint are working together to explore the possibility
in creating a BHR Child Death Review Panel. This has led to various health and social care leads
having exploratory discussions about the development of a WELC Child Death Review panel, which
provides the bechmarkable number suggested in the Guidance.
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4.0 Progress update
4.1
4.1.1
4.1.2
4.1.3
The Director of Public Health presented a paper at the Newham Joint Health Safeguarding Sub-
Group in November 2018 outlining a suggested approach from a Public Health perspective.
This paper enabled the Director of Quality and Development to convene a meeting of CCG and
Local Authority representatives across the WELC geographical footprint to seek views on how we
should progress to develop new Child Death Review arrangements.
While the group have no decision-making authority, they did agree in principle to seek a formal view
from their respective organisations on an approach that was agreed in principle ie development of a
WELC panel, considering the BHR footprint have agreed to explore the development of a BHR
panel.
The group agreed to the development of ‘one’ paper that outlined any agreed approach that would
need to be taken to each CCG Board and LSCB during March/ April to enable each partner to
publish their arrangements by the required deadline.
5.0 Recommendations
5.1 The Board are requested to:
NOTE the direction of travel outlined in this report
AGREE to delegating the formal approval of any partnership to the Quality, Performance and
Finance Committee who will provide appropriate assurances to the NCCG Board.
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Newham CCG Board meeting 28 February 2019
Committee rooms, 4th floor Unex Tower
Title Healthy London Partnership update
Agenda item 3.5
Author Henry Black, NELCA, Chief Finance Officer
Presented by Henry Black, NELCA, Chief Finance Officer
Contact for further information
Henry Black, NELCA, CFO, [email protected], 020 3816 3158
This paper is for ☒ Decision ☐ Monitor ☐ Discussion ☐ For Information
Action required CCG Governing Bodies are asked to:
Note phase 1 of the review has taken place; this has included a review ofHLP budget to establish the HLP funding envelope for 2019/20
Approve the recommended 2019/20 HLP CCG contribution which forNewham CCG is £258,440 - a saving of £30,048 on 18/19 contributions.
Executive summary
This paper sets out the CCGs 19/20 funding requirement for the Healthy London Partnership, noting a reduction against 18/19 costs. It also defines the planned work programmes for 19/20 and the review process to be undertaken by the London STP network as part of the review of the London improvement and transformation architecture.
Supporting papers None.
Next Steps/ Onward Reporting
None.
Where has the paper been already presented?
No previous presentation to any previous meetings/forums.
How does this fit with NHS Newham CCG strategic priorities?
Strategic Priorities:
To commission a Newham-based integrated health and care system whichdelivers high quality services for the residents of Newham, in accordance withstatutory requirements
To commission and develop GP services that are modern, accessible and fitfor the future in caring for our residents
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Enabling Priorities
Securing financial stability
Ensuring we maintain our performance across the key business areas
Outcomes:
We will spend the Newham pound wisely, ensuring value for money andmaintaining financial balance
We will have a borough based Integrated Care System that is utilised,understood and valued by our residents
We will ensure we plan, design, and commission accessible high qualityservices for our residents with our residents
We will improve access to, and, the quality of, Primary Care
We will clearly be able to demonstrate how we have improved outcomes forour residents
We will support our entire CCG workforce to deliver what we need to for ourresidents
We will promote equality as a commissioner of health services and as anemployer.
Risk BAF.03 Failure to implement the key programmes within the Sustainability and Transformation Plan and therefore failure to achieve the system control total.
BAF.10 – Failure to implement the proposed NEL commissioning arrangements in the interests of Newham.
Equality impact This document relates to all Newham residents in the 9 protected characteristics that are covered by the Equality Act 2010 and our Equality Duties.
Stakeholder engagement
No previous presentation to any previous meetings/forums.
Financial Implications
The 19/20 contribution for Newham CCG is £ 258,440 which is a saving of £ 30,048 on 18/19.
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Healthy London PartnershipHealthy London Partnership planning 2019/20Executive SummaryThis is a paper from the CCG Accountable Officers and NHS England (London) Directors and provides anupdate to CCG Governing Bodies and NHS England (London) on the Healthy London Partnership (HLP)2019/20 planning round and, following a robust review, the proposals for 2019/20 which are for agreement.
HLP was formed by London CCGs and NHS England (London) in 2015 with the aim of supporting delivery ofthe ambitions set out in Better Health for London and the NHS Five Year Forward View. The landscape haschanged significantly since then, with the establishment of Sustainability and Transformation Partnerships(STPs) and the signing of the London Health and Care Devolution Agreement, as well as increasing financialchallenges. It is therefore entirely appropriate that we again look to reassess and rebalance our collectiveresources.
HLP has successfully evolved on an annual basis in response to the changing context and demands.Initially, when it was established four years ago, it was a programme solely supporting NHS commissioners,with £17m funding. In 2017/18 significant resource (circa £5m) was released and deployed back locally tosupport the establishment of the emergent STPs. As we went into the third year, HLP was increasingly seenas London's delivery vehicle for transformation across both health and care (as referenced in the DevolutionMemorandum of Understanding), although further rebalancing of funding occurred with an overall CCGcontribution reduced to £7,642k (a reduction of 51% from CCG funding in 15/16).
HLP has successfully attracted broader financial contributions beyond the initial partners. In 2015/16, CCGcontributions as a percentage of the total HLP budget was 92% and NHS England 8%. In 2017/18 thischanged to a CCG contribution of 37% with the remainder contributions from NHS England and widerpartners. In 2018/19, the contributions from CCGs have been less than 50% of our income.
For 2019/20 planning a task and finish group, comprising representation from NHSE(L) and CCGs has beenformed to review London’s improvement architecture. The review includes two phases; Phase 1 involved
working with HLP senior management to undertake a robust but rapid and tactical review of HLP to allow fora budget to be set for 2019/20. Phase 2 includes a longer-term piece of work being initiated as a systemconversation across a broader scope of organisations that support CCGs in regional delivery. This isexpected to report during 2019/20.
Following the Phase 1 review, the HLP 2019/20 programme funding envelope from CCGs and NHS England(London) is proposed at £8,009k plus digital funding of £300k, giving a total of £8,309. This reflects areduced contribution of £800k from CCGs. Although face-paced, the HLP tactical review was robust,however the cost reduction was found with some difficulty in the context of an existing cost pressure at HLP.
CCG Governing Bodies and NHS England (London) are asked to note the 2019/20 planning process andapprove the HLP budget for 2019/20 at £8,309k. This equates to a total CCG contribution of £6,842k(Average - £214k; Range £135 - £291k) and a sustained NHS England (London) contribution of £1,467k.
HLP planning for 2019/201. Purpose of paperThis paper provides an overview of proposed Healthy London Partnership 2019/20 activity and resources forCCG Governing Body and NHS England (London) agreement.
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2. ContextHealthy London Partnership (HLP) has been in existence for almost four years, established by LondonCCGs and NHS England (London) in response to the London Health Commission report – Better Health forLondon - and the NHS Five Year Forward View to bring together the fragmented system that had formed andundertake activity best done Once for London. In 2016 HLP undertook a review of its activity and operatingmodel in light of the emergence of STPs. During engagement in this review there was broadacknowledgement that a pan-London transformation resource was needed and the operating model wasrevised to support the system to move to delivery at pace. In 2017/18, a further review of HLP activity wasundertaken with CCG Accountable Officers and programme SROs and this resulted in a decrease of CCGfunding to HLP. More recently, in September 2018 the third review of HLP started, with the expectation that itwould be completed in November. HLP engaged fully with this review and this has now been scoped in twophases – a rapid, more short term review focussing on the first six months of the 2019/20 financial year anda longer term ‘improvement architecture review’ which considers the wider improvement offer, including the
CSU. This paper has been written in the context of the short term review (phase 1).
3. Achievements of 2018/19HLP’s partnerships, networks and programme management have led to the following achievements across
London throughout 2018/19:
• The Digital Mental Wellbeing Service - Good Thinking - for Londoners experiencing sleep difficulties,anxiety, low mood and stress directing people towards self-care support has been developed withpartners, it’s had over 215,000 visits in the past year and around 25,000 visitors this month (Jan
2019), approximately 1/3 are repeat visitors.• STPs have been supported to implement specialist perinatal MH services across London which
means over 2000 women will now be getting treatment that weren’t able three years ago. This has
included attracting funding for workforce development and building sustainability through perinatalcapability into IAPT services for the 80% not needing specialist care.
• The Thrive LDN city-wide movement led by HLP, launched by the Mayor of London in mid-2017, isimproving the mental health and wellbeing of all Londoners reaching over 15.5 million people; over400 events across London have been held and over 120,000 NHS workers have been engaged.
• Pan-London rollout of the mental health voluntary handover form between A&E staff and the policewas implemented in response to a homicide review. This has led to an 83% reduction in missingpersons compared to the previous year and was awarded the 2018 HSJ Patient Safety award inpartnership with the Metropolitan Police.
• A Paediatric Critical Care in Practice (PCCP) e-learning platform was launched for all acutepaediatric staff in London. Over 500 paediatric staff (doctors, nurses and allied health professionals)from 29 of London’s 31 hospital sites are now registered since its launch in August 2018.
• The E-CDOP (Child Death Overview Panel) has been rolled out enabling collated population baseddata on child deaths for the first time in London to support from child deaths
• Collaboratively redesigned how patients with prostate cancer are safely transferred to their GP andfollowed-up in the community rather than in outpatient clinics leading to a HSJ award nomination.
• Development of the ‘Next Steps to the Strategic Commissioning Framework for General Practice in
London’ in collaboration with London CCGs and the London Local Medical Committee and overseenby London’s Primary Care Clinical Cabinet.
• The 'One London' Local Health and Care Record Exemplar bid, developed by HLP and partners,was one of only three selected for the national programme, attracting £7.5m to London.
• HLP recently co-ordinated the delivery of the NHS e-Referral Service across London deliveredsuccessfully one month ahead of schedule.
• London’s Mental Health Dashboard now has over 1200 users across London (80 active users each
week with a strong focus on MH Crisis and ED). This is now in the public domain supportingimprovement by illuminating unwarranted variation.
• HLP co-ordinated the development of eight London policies for ‘Procedures of Limited Clinical
Effectiveness’, working with clinical expert panels across London to agree the policies.
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• The London Estates Board and delivery unit is taking a wider partnership approach to estates, thishas been instrumental in supporting direct investment into health through the One Public Estateprogramme - to date this investment is almost £1 million in London.
• HSJ finalist for in the ‘Primary Care Innovation’ category for the pan-London suspected cancerreferral form project which standardises the process electronically, making it easier for referrers torefer suspected cancer referrals into primary care.
• Launched direct appointment booking for over 98% of London’s GP Extended Access Hubs (over
100 physical sites) from NHS 111/IUC services – over 25,000 appointments booked to date sinceFeb 2018.
4. Planning round 2019/20The HLP 2018/19 planning round was led by the CCG AOs and a number of potential scenarios for a‘reshaped’ HLP were set out for consideration. AOs agreed HLP should to aspire to Provide a strategic
delivery function and a limited number of Once for London projects. This reflected their considerationthat HLP is part of the fabric of London’s Health and Care system and the planning process was about
making HLP ‘fit for the future’ now that STPs are more developed and we have secured devolution inLondon.
In line with this, the vision for HLP was reaffirmed as a collaborative, agile, and responsive strategictransformation delivery unit that is aligned to local system needs and valued by all health and care partners,focussed on supporting delivery of London’s ambition to be the world’s healthiest global city. To do this its
offer would include:
• Bringing partners together across health and care and across different geographical levels tosupport transformation and improvement.
• Supporting improvement and transformation to happen at the pace required and across our wholepopulation by doing some things once for London where there is clear benefit in doing so,particularly around the devolution commitments and five year forward view priorities; and providebespoke support to STPs where requested.
• Supporting the system to navigate and leverage the wider improvement and transformation supportlandscape and bring alignment and coherence where possible to make best use of our collectiveresources.
In mid- 2018, it was proposed that there would be an ‘HLP review’ which would determine HLP programmes
and budget for 2019/20. Originally due to be completed in November 2018, this review has now beenbroadened to focus on the wider improvement infrastructure architecture in London led by a task and finishgroup comprising of NHSE(L) and CCG representation.
The review includes two phases; Phase 1 has involved working with HLP senior management to undertake arobust rapid and tactical review of HLP as proposed by CCG AOs. This includes continuing with existingprogrammes and structure but ensuring a cost saving, allowing for a budget to be set for 2019/20. CCGChairs have been engaged in this process via Sam Everington and the CCG Chairs meeting in January2019. Phase 2 includes a longer-term piece of work being initiated as a system conversation across abroader scope of organisations that support CCGs in regional delivery. This is expected to report during2019/20.
5. 2019/20 programme resource requirementsA summary output of the core HLP and projects is provided in appendix 1; this includes 2018/19 programmebudgets; proposed envelope for 2019/20 and efficiencies. It should be noted that other funding sourcesbeyond CCGs/NHSE(L) are being discussed but unlikely to be confirmed until April (and potentially as lateas June).
The total 2019/20 HLP portfolio envelope is £8,309k from NHSE(L) and CCGs. This is broken down by HLPprogrammes below, individual CCG and STP contributions are provided in appendix 2.
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Resources Total CoreHLP*
PrimaryCare
MentalHealth
TransformingCancerServices
UEC, 111andCC2H
Digital**
By CCG
£6,842(Average -£214k;Range£135k -£291k)
£3,194k(Average -£100k ;Range -£63k -£136k)
£458k(Average -£14k;Range £9k -£19k)
£562k(Average- £17k;Range£11k -£24k)
£952k(Average -£30k; Range19k - £40k)
£1,376k(Average- £43k;Range£27k -£59k)
£300k(Average- £9k;Range£6k -£13k
NHSE(London £1,467k £1,467k Other programme contributions to be confirmed
Total £8,309k £4,661k
*Core HLP is our non FYFV programmes, e.g. Good Thinking, MH crisis care, Prevention, CYP, ThriveLDN,Partnerships as well as our operations and infrastructure.** Digital is not delivered by HLP and funding is transferred back to CCGs / NHSE(L).
6. Operating modelHLP has developed a flexible operating model, bringing together core policy, strategy and transformationand change management skills together with subject matter expertise. This was presented to AOs in2018/19 and this model will continue to be utilised to ensure that we are as flexible and responsive aspossible, and that risk is managed for STPs and NHSE(L).
7. GovernanceIt is proposed that the programme governance and leadership model continues, until such time as the longerterm improvement architecture review is completed (which includes a review of governance and ownership).
• Programmes are overseen by a CCG AO and NHS England (London) Director as joint programmeSROs (see appendix 3 for agreed SROs). SROs – supported by the programme teams - areresponsible for ensuring robust delivery plans are in place and monitored.
• Programme Transformation and Delivery Boards are responsible for putting in place a programmefinancial plan and on-going monitoring; ensuring robust financial governance and reporting is inplace.
• There is a nominated lead for the programme from each STP footprint ensuring connectionsbetween London and local STP activities are maintained.
HLP and the portfolio of programmes will continue to be overseen by CCG Accountable Officers and NHSE(L) Sustainability and Transformation Executive. London’s Heath and Care Strategic Partnership Board will
continue to direct the partnership work. Monthly reports on deliverables of each programme; financialreports; and summaries of Board meetings are shared with these groups as well as CCG CFOs and STPProgramme Directors.
8. RecommendationCCG Governing Bodies and NHS England (London) are asked to:
• Note Phase 1 of the review has taken place; this has included a review of HLP budget to establishthe HLP funding envelope for 2019/20.
• Approve the recommended 2019/20 HLP portfolio envelope of £8,009k plus £300k for digital (total of£8,309k). This equates to a total CCG contribution of £6,842k (Average - £214k; Range £135k -£291k) including:
- CCG contribution to primary care programme of £458k (Average of £14k; Range £9k - £19k)
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- CCG contribution to transforming cancer services programme of £952k (Average of £30k; Range£19k - £40k)
- CCG contribution to UEC, 111 and CC2H programmes of £1,376k (Average of £43k; Range £27k- £59k)
- CCG contribution to mental health programme of £562k (Average of £17k; Range £11k - £24k)- CCG contribution to digital programme of £300k (Average £9k; Range £6k - £13k)- CCG contribution to non FYFV programmes and overheads - £3,194k (Average of £100k; Range
£63k - £136k) and NHS England (London) contribution to core HLP - £1,467k
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Appendix 1: Draft budget and deliverables
Project18/19 CCG Funding
19/20 CCG Funding proposal
Fundingreduction £ Deliverables
Operations, Leadership,Partnership (workforce,estates, integration,secretariat), analytics andcommunications
£1,153k
£3,194k £150k
Provide secretariat function across the health and care partnership structure including London Health Board & associatedboards e.g. Transformation Funding Oversight Board. Provide external stakeholder communications function and leadershipand operational running of HLP. Continue progressing London vision and supporting STPs on once for London basis.Continuing to progress London Estates Strategy through London Estates Board and support recruitment and retentionacross health and care through London Workforce Board.
Proactive Care £198kWorking in partnership with the London Fire Brigade’ to complete five pilots in London by mid-2019 to demonstrate model of care is effective and expand into other areas e.g. post. Build on social prescribing pilots moving towards every Londonerhaving access to social prescribing referrals and services within their local area, focussing on link workers.
Homeless Health £166k Exploring effective hospital discharge and improving access to specified services
MH Crisis Care £174kPan-London oversight and system support to continue momentum towards all-age s136 model of care implementation by 2020 (inc. multi-agency engagement & HOSCs support, s136 evaluation, commissioning review, new workforceapproaches).
Good Thinking £396kExpanding reach into public sector orgs, universities and top 100 employers in London, targeting 16-17 year old age groupand exploring 13-15 year olds. Reaching out to online communities in London.
Prevention £306k Delivery of the HIV Fast Track cities roadmap with partners to get London to ‘zero’ and further development of London’s
social impact fund to tackle health and wellbeing challenges in London.Hosting: Accommodation, IT,finance and HR £650k Looking at options to improve efficiencies in these areas.
Children and Young People £215kDevelop proposals for London as a CYP friendly city. Embed asthma networks as a delivery vehicle. Complete workaround implementation of new child death reviews. In line with LTP, support work on CYP UEC
Thrive LDN £86kContinue large scale social movement campaign in partnership with London councils and GLA, includes This is Mecampaign, suicide prevention training and multi-agency data hubs, youth MH first aid, ThriveLDN employment network,targeting faith groups.
CYP MH £0Expand work to support CYP MH including MH in schools, physical health checks for young people with learning disability/autism, implementation of crisis care pathways, engage with stakeholders around 0 -25 service.
Total Core (non FYFV) HLP £3,344k £3,194k £150k
Primary Care £488k £458k £30kSupporting general practice working at scale through implementation of ‘Next Steps to the Strategic Commissioning
Framework’. Include focus on workforce, digital and federations. Maintain extended access programme.
Cancer £1,012k £952k £60kSupport cancer waits (including introduction of Faster Diagnosis Standard); diagnostics optimisation; early diagnosis ofcancer, living with and beyond cancer, provision of cancer intelligence and leading on strategy to reduce inequalities incancer.
Adult Mental Health £572k £562k £10kContinue Mental Health in Integrated Care Systems (Previously Return on Investment) and Digital IAPT as 'Once for London' activity and add support STPs in development of LTP MH planning.
Digital £800k £300k £500k Delivery of the digital programme will not fall under HLP
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IUC Mobilisation £307k
£1,376k £50k
Continuation of 18/19 activity supporting STPs to deliver the IUC specification and delivering a portfolio of change initiatives which transform London’s UEC services
Digital IUC £792k
Care Closer to Home £0 Accelerated improvement programme across local UEC systems with a focus on flow in acute and mental health services,DTOC and end of life care.Urgent & Emergency care £327k
Total FYFV HLP £4,298 £3,648 £650k
Total £7,642k £6,842k £800k
*2018/19 reflects the initial budget of £7,777k, prior to the £135k being retained by the CCGs for digital which reduced HLP’s budget to £7,642k
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Appendix 2: Individual CCG and STP contributions to HLP 19/20
CCG 19/20 CCGcontribution* (£)
Reduction from18/19 (£)
19/20 STPcontribution (£)
NCL
NHS Barnet CCG 288,748 27,412
1,155,872
NHS Camden CCG 209,870 27,986
NHS Enfield CCG 240,076 26,629
NHS Haringey CCG 213,032 23,647
NHS Islington CCG 204,147 20,756
NEL
NHS Barking & Dagenham CCG 165,849 15,487 1,508,146
NHS City and Hackney CCG 230,949 23,392
NHS Havering CCG 215,435 21,244
NHS Newham CCG 258,440 30,048
NHS Redbridge CCG 209,104 23,453
NHS Tower Hamlets CCG 220,248 24,672
NHS Waltham Forest CCG 208,122 25,024
NWL
NHS Brent CCG 248,908 29,571
1,643,340
NHS Central London (Westminster)CCG
156,411 23,158
NHS Ealing CCG 287,043 39,125
NHS Hammersmith and Fulham CCG 153,046 21,814
NHS Harrow CCG 173,602 20,686
NHS Hillingdon CCG 214,453 22,814
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NHS Hounslow CCG 203,757 24,090
NHS West London (K&C & QPP) CCG 206,119 31,148
SEL
NHS Bexley CCG 180,101 21,841
1,422,932
NHS Bromley CCG 256,635 32,442
NHS Greenwich CCG 221,189 26,087
NHS Lambeth CCG 274,975 34,708
NHS Lewisham CCG 248,244 30,236
NHS Southwark CCG 241,787 29,039
SWL
NHS Croydon CCG 291,442 30,605
1,111,710
NHS Kingston CCG 135,470 14,662
NHS Merton CCG 148,892 15,370
NHS Richmond CCG 138,962 16,469
NHS Sutton CCG 146,102 16,394
NHS Wandsworth CCG 250,843 29,992
TOTAL £6,842,000 £800,000
* CCG contributions above include contributions to digital programme
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Appendix 3: CCG and NHSE(L) programme leadership
Programme CCG lead (Joint SRO) NHSE lead (Joint SRO)Cancer Andrew Eyres Khadir Meer
Mental Health Jane Milligan Oliver Shanley
Primary Care Andrew Bland David Slegg
Urgent & Emergency Care Sarah Blow Diana Lacey
Digital TBC Dr Jonty Heaversedge
Devolution Andrew Eyres David Sloman
Estates Dr Sam Everington David Slegg
Workforce TBC Oliver Shanley
Children and Young People Martin Wilkinson Dr Vin Diwakar
Prevention Angela Bahn Dr Vin Diwakar
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Item 5.1
NCCG Board – plan 2019-20
Standing items:
Chair’s report
Accountable Officer and Managing Director’s Report
o ELHCP update – every other month (April, Sept, Dec, Feb)
WEL update
Regular reports:
Integrated Quality and Performance Report
Board Assurance Framework report
Finance and QIPP Report
Part I Part II Part III
Th 25 April 2019
Integrated commissioning - full
business proposal and OBC (to go to
board development session first)
CEPN: update
Citizens UK: presentation and
participatory budgeting update
Child Death Review Panel
Arrangements
Unscheduled carepathways: outcomes fromthe pilot and WEL position
Th 27 June 2019
Continuing Healthcare Strategic Plan
W 18 September 2019
Commissioning intentions
BHC – approval of service models
Patient story
Th 24 October 2019
W 18 December 2019
Safeguarding annual reports
Th 27 February 2020
Additional items to schedule:
Primary care home
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